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71.
《Injury》2017,48(7):1376-1381
IntroductionInjury is a major cause of premature death and disability in East Africa, and high-quality pre-hospital care is essential for optimal trauma outcomes. The Rwandan pre-hospital emergency care service (SAMU) uses an electronic database to evaluate and optimize pre-hospital care through a continuous quality improvement programme (CQIP), beginning March 2014.Materials and methodsThe SAMU database was used to assess pre-hospital quality metrics including supplementary oxygen for hypoxia (O2), intravenous fluids for hypotension (IVF), cervical collar placement for head injuries (c-collar), and either splinting (splint) or administration of pain medications (pain) for long bone fractures. Targets of >90% were set for each metric and daily team meetings and monthly feedback sessions were implemented to address opportunities for improvement. These five pre-hospital quality metrics were assessed monthly before and after implementation of the CQIP. Met and unmet needs for O2, IVF, and c-collar were combined into a summative monthly SAMU Trauma Quality Scores (STQ score). An interrupted time series linear regression model compared the STQ score during 14 months before the CQIP implementation to the first 14 months after.ResultsDuring the 29-month study period 3,822 patients met study criteria. 1,028 patients needed one or more of the five studied interventions during the study period. All five endpoints had a significant increase between the pre-CQI and post-CQI periods (p < 0.05 for all), and all five achieved a post-CQI average of at least 90% completion. The monthly composite STQ scores ranged from 76.5 to 97.9 pre-CQI, but tightened to 86.1-98.7 during the post-CQI period. Interrupted time series analysis of the STQ score showed that CQI programme led to both an immediate improvement of +6.1% (p = 0.017) and sustained monthly improvements in care delivery—improving at a rate of 0.7% per month (p = 0.028).ConclusionThe SAMU experience demonstrates the utility of a responsive, data-driven quality improvement programme to yield significant immediate and sustained improvements in pre-hospital care for trauma in Rwanda. This programme may be used as an example for additional efforts engaging frontline staff with real-time data feedback in order to rapidly translate data collection efforts into improved care for the injured in a resource-limited setting.  相似文献   
72.
J. B. Gahutu 《Andrologia》2014,46(10):1198-1199
To illustrate the male reproductive hormone profile, a study was conducted among healthy male university students living at Butare, Rwanda (altitude: 1 768 m, barometric pressure: 629 mm Hg). Venous blood was collected in the morning, after overnight fasting. Hormonal assays were performed by classical sandwich ELISA technique. Mean values (±standard deviation SD) were follicle‐stimulating hormone FSH: 3.7 ± 1.6 IU l?1; luteinising hormone LH: 3.6 ± 2.2 IU l?1; and total testosterone: 21.0 ± 7.5 nm . The results compare well with findings of other studies.  相似文献   
73.
ABSTRACT

In Rwanda, disruptions to family and social life as a result of the 1994 genocide, and the economic transformations in its aftermath, have complicated the fabric of elder care across the country. In this article, I focus on how elderly Rwandans are reconfiguring their care networks – many of which were destroyed during the genocide – by acting as caregivers and care receivers for each other on a daily basis. Although emotionally and physically taxing, elderly Rwandans emphasize that the “small things” embedded in the giving and receiving of care are intricately connected to how personal and collective dignity is cultivated.  相似文献   
74.
Around 71 million people are living with chronic hepatitis C virus (HCV) infection, with approximately 14% residing in sub‐Saharan Africa. Direct‐acting antiviral (DAA) therapies offer clear benefits for liver‐related morbidity and mortality, and data from high‐income settings suggest that DAA treatments also provide significant benefits in terms of health‐related quality of life (HRQL). In this study, we assessed the effect of DAA treatment on HRQL for individuals treated for HCV in a clinical trial in Rwanda. We assessed the HRQL of participants using an 83‐question composite survey at Day 0 (‘baseline’) and Week 24 (‘endpoint’). Data were analysed in R. A total of 296 participants were included in this analysis. Their ages ranged from 19 to 90, and 184 (62.2%) were female. There were significant improvements from baseline to endpoint median scores for all physical and mental quality of life sub‐scales. Additionally, a reduction—before and after treatment—in the proportion of those classified as depressed and needing social support was statistically significant (both P < .001). Economic productivity increased after treatment (P < .001), and households classified as food secure increased from baseline to endpoint (P < .001). These results demonstrate that Rwandans with chronic HCV infection experience both clinical and HRQL benefits, including household‐level benefits like substantial gains in workforce stability, economic productivity, and poverty alleviation, from DAA treatment. A stronger demonstration of accurate and broader household‐level benefits achieved through treatment of HCV with DAAs will help financing and investment for HCV in resource‐constrained settings become an urgent priority.  相似文献   
75.
The Global Fund Against AIDS, Tuberculosis and Malaria (GFATM) approved only three 'health systems strengthening' projects ever, one of them in Rwanda. This project intends to enhance financial access to health care by subsidising health insurance for the poor in order to combat the three diseases successfully. It was submitted to a mid-term evaluation in 2007. The findings of this evaluation are presented and triangulated with experience gained through several years of membership in the Rwandan Country Coordinating Mechanism and the multi-stakeholder 'Working Group on Mutuelles ': The GFATM-funded project improved dramatically the financial access of its target group, the very poor – reaching approximately one Rwandan in six. Because of the established rigid regulatory framework, its impact on other population strata was more ambiguous. Improved financial access went hand-in-hand with growing health service utilisation and improvements in the population's health status, including better control of AIDS, tuberculosis and malaria. This success was achieved with limited financial resources. In consequence, interventions that strengthen health systems should always be considered for a prominent – if not a priority role – in GFATM-funded projects.  相似文献   
76.
77.
We have studied the prevalence of hepatitis C virus (HCV) infection in Rwandan patients with histologically proven liver cirrhosis (LC) or primary hepatocellular carcinoma (HCC). Anti-HCV antibodies were determined by using a second-generation test, with a line immunoassay for structural and non-structural antigens as confirmation. Seventy-nine patients with LC, 26 with HCC, and 54 voluntary blood donors as controls were evaluated. Anti-HCV antibodies were more prevalent in LC patients (48%) and in HCC patients (38%) than in the controls (17%; difference, p = 0.0001 and p = 0.03, respectively). Eighty-four per cent of LC patients and 54% of HCC patients were HBsAg-negative. The prevalence of anti-HCV antibodies was significantly higher for LC and HCC patients who had been in contact with HBV but who had no persistent HBV infection (p < 0.05). We conclude that HCV infection is common in Rwanda and is linked to LC and HCC.  相似文献   
78.
The study analyses strengths and weaknesses of the ‘Paying For Performance’ (P4P) approach rolled out in the Rwandan health sector since 2002. It uses three research methods: a cross‐sectoral literature review on P4P, its history and its context; 69 mostly semi‐structured interviews conducted in Rwanda; and an analysis of factors eventually confounding the impact evaluation of the Rwandan P4P approach. It is argued that P4P approaches can be traced backed in written form over four millennia and that considerable negative effects are reported throughout history. All side effects were found again in various forms in the Rwandan health sector. One particular side effect –‘gaming’– seriously threatens to affect the quality of health services. It is argued that P4P implicitly (and unintentionally) promotes a questionable concept of human ‘labour’ and that its focus on improving indicators rather than systemic changes can be regarded as vertical and counter‐productive. Two alternatives to the current P4P system are briefly depicted, and further research on the described challenges is recommended.  相似文献   
79.
Objective To assess factors associated with high output of recently trained medical personnel in Rwanda. Methods Nurses and village health workers (VHW) from all health centres in Rubavu district were included. Data were collected during focus group discussions and through one‐to‐one interviews. Follow‐up interviews were carried out in January 2009. Results There was a wide range from none to all VHW referring people to a health centre. VHW brought more people to the health centre if there was a visiting ophthalmic clinical officer from the Eye Unit offering free screening. VHW output varied; male VHW brought 66.7% of patients identified (regardless of the sex of the health centre nurse), while female VHW brought 5.2 times as many people if the health centre nurse was male compared to if the nurse was female. Conclusion Changes in training curriculum and support and supervision of health workers trained in primary eye care (PEC) are likely to lead to improved outputs. Information efforts should reinforce that male and female nurses have the same training and skills in PEC.  相似文献   
80.
Reducing barriers to use maternal health care is one of the critical components to improving maternal health. Rwanda is among the countries that have made tremendous efforts to reduce maternal mortality. However, the current maternal mortality ratio is still high which calls for further efforts to be considered. This study used a qualitative approach to understand mothers’ perceptions and experiences of using maternal health care in Rwanda. Using in-depth interviews and focus group discussions, data were collected in the Western and Eastern provinces of the country where forty-five women participated in the study from June to August 2014. This paper highlights perceptions of these participants regarding issues that contribute to suboptimal use of maternal health-care services. The geographical, financial, and social–cultural barriers that emerged in this study highlight the need to understand mothers’ experiences and perceptions when using maternal health care as Rwanda and other countries strive to reduce negative maternal health outcomes.  相似文献   
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