Hypolipidemic and anti-atherosclerogenic effects of aqueous extract of Ipomoea batatas leaves in diet-induced hypercholesterolemic rats

Objective:Ipomoea batatas (L.) Lam.is a food plant used in African traditional medicine to treat cardiovas-cular diseases and related conditions.We assessed the...     

Abortion Incidence and Postabortion Care in Rwanda

Abortion is illegal in Rwanda except when necessary to protect a woman's physical health or to save her life. Many women in Rwanda obtain unsafe abortions, and some experience health complications as a result. To estimate the incidence of induced abortion, we conducted a national sample survey of health facilities that provide postabortion care and a purposive sample survey of key informants knowledgeable about abortion conditions. We found that more than 16,700 women received care for complications resulting from induced abortion in Rwanda in 2009, or 7 per 1,000 women aged 15–44. Approximately 40 percent of abortions are estimated to lead to complications requiring treatment, but about a third of those who experienced a complication did not obtain treatment. Nationally, the estimated induced abortion rate is 25 abortions per 1,000 women aged 15–44, or approximately 60,000 abortions annually. An urgent need exists in Rwanda to address unmet need for contraception, to strengthen family planning services, to broaden access to legal abortion, and to improve postabortion care.     

Clinical and epidemiologic trends in HIV/AIDS patients in a hospital setting of Yaoundé, Cameroon: a 6-year perspective.

OBJECTIVES: In order to appreciate the impact of the HIV/AID pandemic in Yaound , Cameroon, an evaluation of the clinical and epidemiologic trends in HIV/AIDS patients was undertaken in a hospital setting. METHODS: A rapid assessment method was used to collect data. Patient record examination, interviews and direct observation were employed. RESULTS: Of 875 cases studied in the hospital during a 6-year period, 43.7% were males and 56.3% females. A total of 5.4% of all the cases were seen in 1993 compared to 30.5% in 1998. The number of admissions per patient ranged from 0 to 4, with a median duration of admission of 14 days (range 0-343 days). The 25-44-year age group was mostly affected (63.4% cases) and 10.1% were in the 0-14-year age group. About 27% of cases died in hospital, mainly between 1996 and 1997. The predominant clinical manifestations included persistent fever and diarrhea, excessive weight loss, chronic cough and profound asthenia. Opportunistic infections and cancers also formed part of the picture. CONCLUSIONS: The increasing clinical and epidemiologic trends of the HIV/AIDS pandemic within the hospital show the devastation and socio-economic impact, especially on the Cameroonian youth and women. Intense public health measures must be put in place to educate and cater for the vulnerable groups in society.     

Missed Opportunities in Neonatal Deaths in Rwanda: Applying the Three Delays Model in a Cross-Sectional Analysis of Neonatal Death

Objective Administered in a timely manner, current evidence-based interventions could reduce neonatal deaths from infections, intrapartum injuries and complications due to prematurity. The three delays model (delay in seeking care, in arriving at a health facility, and in receiving adequate care), which has been applied to understanding maternal deaths, may be useful for understanding neonatal deaths. We assess the main causes of neonatal deaths in Rwanda and their associated delays. Methods Using a cross-sectional study design, we evaluated data from 2012 from 40 facilities in which babies were delivered. Audit committees in each facility reviewed each neonatal death in the facility and reported finding to the Ministry of Health using structured questionnaires. Information from questionnaires were centralized in an electronic database. At the end of 2012, records from 40 health facilities across Rwanda’s five provinces (mainly district hospitals) were available in the database and were used for this analysis. Results Of the 1324 neonates, the major causes of death were: asphyxia and its complications (36.7%), lower respiratory tract infections (LRTI) (22.5%), and prematurity (22.4%). At least one delay was experienced by nearly three-quarters of neonates: Maternal Delay in Seeking Care 22.1%, Maternal Delay in Arrival to Care 11.2%, Maternal Delay in Adequate Care 14.2%, Neonatal Delay in Seeking Care 8.1%, Neonatal Delay in Arrival to Care 9.3%, and Neonatal Delay in Adequate Care 29.1%. Neonates with each of the main causes of death had statistically significantly increased odds of experiencing Maternal Delay in Seeking Care. Asphyxia deaths had increased odds of experiencing all three Maternal Delays. LRTI deaths had increased odds of all three Neonatal Delays. Conclusion Delays for women in seeking obstetrical care is a critical factor associated with the main causes of neonatal death in Rwanda. Improving obstetrical care quality could reduce neonatal deaths due to asphyxia. Likewise, reducing all three delays could reduce neonatal deaths due to LRTI.     

Influence of orthopedic implant structure on adjacent bone density and on stability

We evaluated the ability of a porous metallic interbody fusion implant made with porous nitinol (PNT) to achieve intervertebral fusion and the capacity of stabilization at the implantation site 3, 6, and 12 months after implantation. Sixteen sheep each received 1 PNT implant and 1 titanium (TiAIV) cage at intervertebral lumbar levels L2-L3 and L4-L5; 3 other sheep were used as untreated controls. The TiAIV cage was used as a control implant. After animal sacrifice, computed tomography was used to study peri-implant bone mineral density (BMD), and histologic slices were used to evaluate implant osseointegration. BMD around PNT implants was close to physiological (control value) BMD, whereas BMD around TiAIV cages was usually higher (sclerosis) than physiological BMD. Histologic analysis showed better osseointegration with PNT implants than with TiAIV cages. Sclerosis might result from bone acting to stabilize implants in their implantation sites. Compared with PNT implants, TiAIV cages seemed to be unstable in their implantation sites. For PNT implants, osseointegration was successful, and surrounding BMD was close to physiologic BMD.     

Health insurance and the bamako initiative in Burundi: Value for money?

Despite its a priori attractiveness, health insurance schemes are rare in developing countries. A recent external review of the Bamako Initiative in Burundi considered the extent to which the ‘Carte d'Assurance Maladie’ (CAM) has the potential to improve the quality of, and access to, health services. Although utilization of the CAM was found to be low overall, most of those visiting the health centres were in possession of a card, leading the team to conclude that health service utilization for curative care is extremely low. Focus group discussion revealed that users perceive the quality of health services to be poor, and that frequent shortages of basic drugs and supplies create uncertainty as to whether the CAM will provide good value for money, the shortage of basic drugs, the lack of community participation in the management of health services, and the fact that very little of the revenue from sales of the CAM is spent on health service provision provide possible explanations for the weak uptake of health insurance. Closing the link between the payment for health services and the financing of those services would contribute to an improvement in the quality and the confidence of the population in government health services.     

Urine testing to monitor the impact of HPV vaccination in Bhutan and Rwanda

Bhutan (2010) and Rwanda (2011) were the first countries in Asia and Africa to introduce national, primarily school‐based, human papillomavirus (HPV) vaccination programmes. These target 12 year‐old girls and initially included catch‐up campaigns (13–18 year‐olds in Bhutan and ninth school grade in Rwanda). In 2013, to obtain the earliest indicators of vaccine effectiveness, we performed two school‐based HPV urine surveys; 973 female students (median age: 19 years, 5th‐95th percentile: 18–22) were recruited in Bhutan and 912 (19 years, 17–20) in Rwanda. Participants self‐collected a first‐void urine sample using a validated protocol. HPV prevalence was obtained using two PCR assays that differ in sensitivity and type spectrum, namely GP5+/GP6+ and E7‐MPG. 92% students in Bhutan and 43% in Rwanda reported to have been vaccinated (median vaccination age = 16, 5th–95th: 14–18). HPV positivity in urine was significantly associated with sexual activity measures. In Rwanda, HPV6/11/16/18 prevalence was lower in vaccinated than in unvaccinated students (prevalence ratio, PR = 0.12, 95% confidence interval, CI: 0.03–0.51 by GP5+/GP6+, and 0.45, CI: 0.23–0.90 by E7‐MPG). For E7‐MPG, cross‐protection against 10 high‐risk types phylogenetically related to HPV16 or 18 was of borderline significance (PR = 0.68; 95% CI: 0.45–1.01). In Bhutan, HPV6/11/16/18 prevalence by GP5+/GP6+ was lower in vaccinated than in unvaccinated students but CIs were broad. In conclusion, our study supports the feasibility of urine surveys to monitor HPV vaccination and quantifies the effectiveness of the quadrivalent vaccine in women vaccinated after pre‐adolescence. Future similar surveys should detect increases in vaccine effectiveness if vaccination of 12 year‐olds continues.     

Achieving high coverage in Rwanda's national human papillomavirus vaccination programme

Problem

Virtually all women who have cervical cancer are infected with the human papillomavirus (HPV). Of the 275 000 women who die from cervical cancer every year, 88% live in developing countries. Two vaccines against the HPV have been approved. However, vaccine implementation in low-income countries tends to lag behind implementation in high-income countries by 15 to 20 years.

Approach

In 2011, Rwanda’s Ministry of Health partnered with Merck to offer the Gardasil HPV vaccine to all girls of appropriate age. The Ministry formed a “public–private community partnership” to ensure effective and equitable delivery.

Local setting

Thanks to a strong national focus on health systems strengthening, more than 90% of all Rwandan infants aged 12–23 months receive all basic immunizations recommended by the World Health Organization.

Relevant changes

In 2011, Rwanda’s HPV vaccination programme achieved 93.23% coverage after the first three-dose course of vaccination among girls in grade six. This was made possible through school-based vaccination and community involvement in identifying girls absent from or not enrolled in school. A nationwide sensitization campaign preceded delivery of the first dose.

Lessons learnt

Through a series of innovative partnerships, Rwanda reduced the historical two-decade gap in vaccine introduction between high- and low-income countries to just five years. High coverage rates were achieved due to a delivery strategy that built on Rwanda’s strong vaccination system and human resources framework. Following the GAVI Alliance’s decision to begin financing HPV vaccination, Rwanda’s example should motivate other countries to explore universal HPV vaccine coverage, although implementation must be tailored to the local context.