Explore the vast range of titles available.

Background Extensive research on infant mortality (IM) exists in developing countries; however, most of the methods applied thus far relied on conventional regression analyses with limited prediction capability. Advanced of Machine Learning (AML) methods provide accurate prediction of IM; however, there is no study conducted using ML methods in Rwanda. This study, therefore, applied Machine Learning Methods for predicting infant mortality in Rwanda.  Methods A cross-sectional study design was conducted using the 2014–15 Rwanda Demographic and Health Survey. Python software version 3.8 was employed to test and apply ML methods through Random Forest (RF), Decision Tree, Support Vector Machine and Logistic regression. STATA version 13 was used for analysing conventional methods. Evaluation metrics methods specifically confusion matrix, accuracy, precision, recall, F1 score, and Area under the Receiver Operating Characteristics (AUROC) were used to evaluate the performance of predictive models. Results Ability of prediction was between 68.6% and 61.5% for AML. We preferred with the RF model (61.5%) presenting the best performance. The RF model was the best predictive model of IM with accuracy (84.3%), recall (91.3%), precision (80.3%), F1 score (85.5%), and AUROC (84.2%); followed by decision tree model with model accuracy (83%), recall (91%), precision (79%), F1 score (84.67%) and AUROC(82.9%), followed by support vector machine with model accuracy (68.6%), recall (74.9%), precision(67%), F1 score (70.73%) and AUROC (68.6%) and last was a logistic regression with the low accuracy of prediction (61.5%), recall (61.1%), precision (62.2%), F1 score (61.6%) and AUROC (61.5%) compared to other predictive models. Our predictive models showed that marital status, children ever born, birth order and wealth index are the 4 top predictors of IM. Conclusions In developing a predictive model, ML methods are used to classify certain hidden information that could not be detected by traditional statistical methods. Random Forest was classified as the best classifier to be used for the predictive models of IM.

Unsafe drinking water and household air pollution (HAP) are major causes of morbidity and mortality among children under 5 in low and middle-income countries. Household water filters and higher-efficiency biomass-burning cookstoves have been widely promoted to improve water quality and reduce fuel use, but there is limited evidence of their health effects when delivered programmatically at scale. In a large-scale program in Western Province, Rwanda, water filters and portable biomass-burning natural draft rocket-style cookstoves were distributed between September and December 2014 and promoted to over 101,000 households in the poorest economic quartile in 72 (of 96) randomly selected sectors in Western Province. To assess the effects of the intervention, between August and December, 2014, we enrolled 1,582 households that included a child under 4 years from 174 randomly selected village-sized clusters, half from intervention sectors and half from nonintervention sectors. At baseline, 76% of households relied primarily on an improved source for drinking water (piped, borehole, protected spring/well, or rainwater) and over 99% cooked primarily on traditional biomass-burning stoves. We conducted follow-up at 3 time-points between February 2015 and March 2016 to assess reported diarrhea and acute respiratory infections (ARIs) among children <5 years in the preceding 7 days (primary outcomes) and patterns of intervention use, drinking water quality, and air quality. The intervention reduced the prevalence of reported child diarrhea by 29% (prevalence ratio [PR] 0.71, 95% confidence interval [CI] 0.59-0.87, p = 0.001) and reported child ARI by 25% (PR 0.75, 95% CI 0.60-0.93, p = 0.009). Overall, more than 62% of households were observed to have water in their filters at follow-up, while 65% reported using the intervention stove every day, and 55% reported using it primarily outdoors. Use of both the intervention filter and intervention stove decreased throughout follow-up, while reported traditional stove use increased. The intervention reduced the prevalence of households with detectable fecal contamination in drinking water samples by 38% (PR 0.62, 95% CI 0.57-0.68, p < 0.0001) but had no significant impact on 48-hour personal exposure to log-transformed fine particulate matter (PM2.5) concentrations among cooks (β = -0.089, p = 0.486) or children (β = -0.228, p = 0.127). The main limitations of this trial include the unblinded nature of the intervention, limited PM2.5 exposure measurement, and a reliance on reported intervention use and reported health outcomes. Our findings indicate that the intervention improved household drinking water quality and reduced caregiver-reported diarrhea among children <5 years. It also reduced caregiver-reported ARI despite no evidence of improved air quality. Further research is necessary to ascertain longer-term intervention use and benefits and to explore the potential synergistic effects between diarrhea and ARI. Clinical Trials.gov NCT02239250.

Background Marburg virus disease (MVD) is a highly fatal hemorrhagic fever with fatality rates between 33 and 88% in sub-Saharan Africa. Rwanda reported its first MVD outbreak on September 27, 2024. This study assessed Rwanda’s response to its first MVD outbreak, focusing on identifying critical success factors and areas for improvement during the initial 10 days after outbreak declaration. Methods This observational study analyzed publicly available data from daily screenings and outbreak reports provided by the Rwanda Ministry of Health and Rwanda Biomedical Center between September 27 and October 7, 2024. The study examined confirmed cases, deaths, testing rates, and recoveries, including healthcare response measures. Data was collected from checkpoints and passenger screening at entry points, with information aggregated into Rwanda’s Health System. Results By October 7, 2024, Rwanda reported 56 confirmed MVD cases, including 12 deaths and 8 recoveries. Daily screening began on October 3rd, and by October 7th, 2387 individuals were tested, with a positivity rate of 2.3%. Healthcare workers accounted for over 70% of confirmed cases. No new deaths were reported from October 4 (day 7) until October 7th (day 10), though the first 2–3 days after outbreak declaration were critical, with 6 deaths occurring during this period. Rwanda’s response included increased testing, early detection, intensive care management, experimental therapeutics (monoclonal antibodies and remdesivir), and comprehensive contact tracing. Conclusions Analysis of the first 10 days of Rwanda’s MVD outbreak provides valuable insights into effective outbreak response, highlighting the importance of early interventions, healthcare worker protection, enhanced testing, and international collaboration. Early detection and intensive management of cases, including advanced critical care and strong laboratory infrastructure, are essential to reduce early mortality. These findings emphasize the need to strengthen healthcare systems by establishing rapid preparedness and response mechanisms before outbreaks occur and fostering international partnerships to enhance outbreak management and control.

During the current outbreak of Marburg virus disease (MVD) in Rwanda, we synthesized evidence from the literature to improve case management. Accordingly, experimental treatment was offered to patients under close follow-up. Remdesivir alone or in combination with monoclonal antibody treatment (MBP091) complemented with supportive care has improved the clinical outcomes of patients. Additionally, we have identified several experimental therapies currently under investigation, including antiviral drugs such as favipiravir, galidesivir, obeldesivir, and remdesivir, along with monoclonal and polyclonal antibodies (e.g., polyclonal IgG, monoclonal antibody MR-78-N; MR82-N; MR191-N; monoclonal antibodies MR186-YTE and MBP091). Furthermore, substantial progress is being made in vaccine development, with promising candidates including adenovirus-vectored vaccines, DNA vaccines, and the recombinant vesicular stomatitis virus (rVSV) vaccine. Moreover, innovative preventive and treatment strategies—such as synthetic hormones like estradiol benzoate, small interfering RNA (siRNA), interferon-β therapy, and phosphorodiamidate morpholino oligomers—are emerging as potential options for MVD management. Further investment is needed to accelerate research and optimize these therapeutics and preventive modalities. Additional epidemiological, preclinical, and clinical studies are warranted to generate the evidence required to inform policymaking, resource mobilization, and the implementation of cost-effective interventions for the prevention, control, and treatment of MVD.

Marburg Virus Disease (MVD) is a severe disease with a fatality rate of up to 90%. Limited studies have suggested hematological and biochemical biomarkers for managing MVD, but data on key markers correlated with MVD development are scarce. This study aimed to investigate the biosignatures that can be used to monitor MVD progression in Marburg virus (MARV)-infected patients. We performed a retrospective analysis of biochemical and hematological data collected from 51 MARV-infected patients in Rwanda. The study subjects were classified according to the day of discharge: early (< 5 days), middle (5–10 days) and late recovery (> 10 days). Our data revealed that Aspartate transaminase (AST), Alanine transaminase (ALT)), and creatinine were significantly lower in MVD-recovered subjects as compared to newly admitted patients ( p  < 0.0001 each). Lymphocytes and platelets were increased in MVD-recovered subjects ( p  < 0.0001 and p  < 0.001, respectively). ALT levels discriminated between middle, late recovered individuals, and MVD patients (AUC: 0.86, 0.90, 0.94, respectively). AST also showed strong discriminatory power for middle, late recovery, and MVD patients  (AUC: 0.81, 0.95, 0.94, respectively). Similarly platelets differentiated the middle, late MVD-recovered groups and MVD patients (AUC: 0.79,0.61, 0.90, respectively). Creatinine and lymphocytes were also suggested as potential biomarkers for MVD development. These findings provide novel insights into biological factors crucial for MVD management. Although all investigated biomarkers can be used to monitor MVD patients, our analyses highlight key biosignatures that can guide clinicians to track MVD progression and enable real-time decisions.

Atypical presentations of diabetes mellitus (DM) have been reported in non-European ethnic populations under various names. It is unclear whether those names are used for the same or different clinical phenotypes. Unclear terminology may lead to inappropriate treatment and an underestimation of the burden caused by atypical diabetes phenotypes overlapping with classic types of diabetes. This review aimed to describe the terms used for atypical forms of diabetes and to investigate whether the terms are used for similar or different phenotypes. PubMed and Scopus were searched for relevant publications in French or English available before 15 September 2015 using the terms: \"Atypical diabetes\", \"Malnutrition Related Diabetes Mellitus (MRDM)\", \"Fibro-calculus pancreatic diabetes (FCPD)\", Protein deficient Pancreatic Diabetes (PDPD)\", \"African diabetes\", \"Ketosis prone-type 2 diabetes\", \"tropical diabetes\", \"Flatbush diabetes\", \"J-type diabetes\". Titles, abstracts screening and quality assessment were performed by two independent authors. Observational studies addressing atypical diabetes in humans aged 14 years and above were included. One author extracted data from selected articles. 22 articles among 350 identified articles were retained for data extraction. Two atypical diabetes phenotypes were identified, each of them with a variety of names but similar definitions. One phenotype occurred in very thin people less than 30 years of age, typically from poor socio-economic backgrounds and requires insulin for life. It differs from type 1 diabetes in the tolerance of high blood glucose without ketosis in the absence of exogenous insulin. The second phenotype resembles type1 diabetes as it presents with ketosis at onset but responds well, as type2 diabetes, to oral hypoglycemic drugs after initial stabilization with insulin. It occurs in individuals who are usually over 30 years of age, with normal or overweight and absence of auto antibodies mainly found in type 1 diabetes. The scarce existing literature used various terms for similar diabetes phenotypes. Agreement on nomenclature for the various forms of diabetes using the above reported characteristics are needed in populations where atypical forms of diabetes exist as well as better characterization of phenotypes and genotypes to inform evidence based treatment.

Background Existing prevention and treatment strategies target the classic types of diabetes yet this approach might not always be appropriate in some settings where atypical phenotypes exist. This study aims to assess the socio-demographic and clinical characteristics of people with diabetes in rural Rwanda compared to those of urban dwellers. Methods A cross-sectional, clinic-based study was conducted in which individuals with diabetes mellitus were consecutively recruited from April 2015 to April 2016. Demographic and clinical data were collected from patient interviews, medical files and physical examinations. Chi-square tests and T-tests were used to compare proportions and means between rural and urban residents. Results A total of 472 participants were recruited (mean age 40.2 ± 19.1 years), including 295 women and 315 rural residents. Compared to urban residents, rural residents had lower levels of education, were more likely to be employed in low-income work and to have limited access to running water and electricity. Diabetes was diagnosed at a younger age in rural residents (mean ± SD 32 ± 18 vs 41 ± 17 years; p  < 0.001). Physical inactivity, family history of diabetes and obesity were significantly less prevalent in rural than in urban individuals (44% vs 66, 14.9% vs 28.7 and 27.6% vs 54.1%, respectively; p  < 0.001). The frequency of fruit and vegetable consumption was lower in rural than in urban participants. High waist circumference was more prevalent in urban than in rural women and men (75.3% vs 45.5 and 30% vs 6%, respectively; p  < 0.001). History of childhood under-nutrition was more frequent in rural than in urban individuals (22.5% vs 6.4%; p  < 0.001). Conclusions Characteristics of people with diabetes in rural Rwanda appear to differ from those of individuals with diabetes in urban settings, suggesting that sub-types of diabetes exist in Rwanda. Generic guidelines for diabetes prevention and management may not be appropriate in different populations.

ObjectivesTo determine the prevalence of proximal deep vein thrombosis (DVT) by ultrasound scanning, as well as associated clinical features and known risk factors, among medical and obstetrics–gynaecology inpatients in two Rwandan tertiary hospitals.DesignCross-sectional study.SettingsRwanda teaching hospitals: Kigali and Butare University Teaching Hospitals.Participants901 adult patients admitted to the Departments of Internal Medicine and Obstetrics–Gynecology (O&G) who were at least 21 years of age and willing to provide a consent.OutcomesPrevalence of proximal DVT, clinical features and known risk factors associated with DVT.MethodsBetween August 2015 and August 2016, participants were screened for DVT by compressive ultrasound of femoral and popliteal veins, conducted as a monthly cross-sectional survey of all consenting eligible inpatients. Patients completed a self-report survey on DVT risk factors. Prevalence of proximal DVT by compression ultrasonography was the primary endpoint, with univariate and multivariate regression analyses performed to assess associated clinical features and risk factors.ResultsProximal DVT was found in 5.5% of the study population, with similar rates in medical and O&G inpatients. The mean age was 41±16 SD (range, 21–91), 70% were female and 7% were pregnant. Univariate analysis showed active malignancy, immobilisation, prolonged recent travel and history of DVT to be significant risk factors for proximal DVT (all p values <0.05); while only active malignancy was an independent risk factor on multivariate regression (OR 5.2; 95% CI 2.0 to 13). Leg pain or tenderness, increased calf circumference, unilateral limb swelling or pitting oedema were predictive clinical features of DVT on both univariate analysis and multivariate regression (all p values <0.05).ConclusionProximal DVT prevalence is high among hospitalised medical and O&G patients in two tertiary hospitals in Rwanda. For reducing morbidity and mortality, research to develop Africa-specific clinical prediction tools for DVT and interventions to increase thromboprophylaxis use in the region are urgently needed.

Background Laparoscopy has proven to be feasible and effective at reducing surgical morbidity and mortality in low resource settings. In Rwanda, the demand for and perceived challenges to laparoscopy use remain unclear. Methods A mixed-methods study was performed at the four Rwandan national referral teaching hospitals. Retrospective logbook reviews (July 2014–June 2015) assessed procedure volume and staff involvement. Web-based surveys and semi-structured interviews investigated barriers to laparoscopy expansion. Results During the study period, 209 laparoscopic procedures were completed: 57 (27.3%) general surgery cases; 152 (72.7%) ob/gyn cases. The majority (58.9%, 125/209) occurred at the private hospital, which performed 82.6% of cholecystectomies laparoscopically (38/46). The three public hospitals, respectively, performed 25% (7/28), 15% (12/80), and 0% (denominator indeterminate) of cholecystectomies laparoscopically. Notably, the two hospitals with the highest laparoscopy volume relied on a single surgeon for more than 85% of cases. The four ob/gyn departments performed between 4 and 87 laparoscopic cases (mostly diagnostic). Survey respondents at all sites listed a dearth of trainers as the most significant barrier to performing laparoscopy (65.7%; 23/35). Other obstacles included limited access to training equipment and courses. Equipment and material costs, equipment functionality, and material supply were perceived as lesser barriers. Twenty-two interviews revealed widespread interest in laparoscopy, insufficient laparoscopy exposure, and a need for trainers. Conclusion While many studies identify cost as the most prohibitive barrier to laparoscopy utilization in low resource settings, logbook review and workforce perception indicate that a paucity of trainers is currently the greatest obstacle in Rwanda.

This is the rst study which shows the prevalence of atopy, asthma and COPD in Rwanda. Asthma and COPD were respectively diagnosed in 8.9% and 4.5% of the participants. COPD was diagnosed in 9.6% of the subjects aged ≥ 45 years and was higher among current smokers (11.2%). Spirometric reference values in our study were nearly similar to those for black Americans by Hankinson. Considering the similarities of the Great Lake regions inhabitants, the reference equations obtained in Rwanda population can be used in neighbouring countries while waiting for further studies in the region.