| 2. Title: Evaluation of transmitted HIV drug resistance among recently-infected antenatal clinic attendees in four Central African countries. Author: Aghokeng AF; Vergne L; Mpoudi-Ngole E; Mbangue M; Deoudje N; Mokondji E; Nambei WS; Peyou-Ndi MM; Moka JJ; Delaporte E; Peeters M Source: Antiviral therapy. 2009;14(3):401-11. Abstract: BACKGROUND: The rapid expansion of antiretroviral treatment in resource-limited settings is raising concerns regarding the emergence and transmission of HIV drug resistance (HIVDR). We evaluated the extent of transmission of drug-resistant HIV strains in four Central African countries: the Republic of Congo, Central African Republic, Chad and Cameroon. METHODS: The World Health Organization (WHO) HIVDR threshold survey was implemented in major treatment areas in each country. Pregnant women who were aged <25 years, who were at first pregnancy and who were HIV type-1-positive were enrolled at each site in 2006-2007 for genotyping. HIVDR prevalence was categorized using the WHO threshold survey binomial sequential sampling method. RESULTS: The prevalence of HIVDR in Brazzaville and Bangui sites could not be classified because the eligible sample number was not reached. HIVDR prevalence was low (<5%) in N'Djamena for all drug classes. In Yaounde, we found one individual with the D67D/N mutation and two with K103N. HIVDR prevalence was categorized as low (<5%) for protease inhibitors (PIs) and nucleoside reverse transcriptase inhibitors (NRTIs), and moderate (> or =5-< or =15%) for non-NRTIs (NNRTIs). HIVDR prevalence in Douala was low for PIs and NNRTIs, and moderate for NRTIs as we identified one individual with M184V plus K101E plus G190A mutations and a second with D67D/N. CONCLUSIONS: The moderate HIVDR prevalence found in Yaounde and Douala indicate that efforts should be made in Cameroon to prevent HIVDR; however, additional surveys are needed to confirm this trend. This study highlighted challenges presented by the WHO methodology, such as additional costs, workload, difficulties in acquiring even small sample numbers and the necessity for better quality assurance of HIV testing and record keeping at antenatal clinics. Language: English Keywords: CAMEROON | CENTRAL AFRICAN REPUBLIC | CHAD | REPUBLIC OF THE CONGO | RESEARCH REPORT | SAMPLING STUDIES | PREGNANT WOMEN | PERSONS LIVING WITH HIV/AIDS | HIV TRANSMISSION | ANTIRETROVIRAL DRUGS | DRUG RESISTANCE | PREVALENCE | ANTENATAL CARE | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Africa, Central | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Measurement | Maternal Health Services | Maternal-Child Health Services | Primary Health Care Document Number: 342346 |
3.  Title: [Newborn babies' health in Rwanda: evolution of factors associated with neonatal mortality trends] La sante des nouveau-nes au Rwanda. Evolution des facteurs associes aux tendances Author: Beck L Source: Sante Publique. 2009 Mar-Apr;21(2):159-72. Abstract: In spite of increasing attention for maternal and child health, neonatal mortality (before the age of one month) represents a significant part of infant mortality in sub-Saharan Africa. Several demographic and health surveys show the lack of any major improvement since the 1980s in Rwanda, and despite some indication of minor improvement, any real progress has been countered by periods of aggravation of the situation. However, a noticeable decrease in neonatal mortality seems to have begun since the year 2000. This study describes the evolution of the determinants of neonatal mortality between 1980 and 2000 and the obstacles that hinder its sustainable decline. Regressive logistical analyses conducted with data on several different generations of newborns showed the persistence of some unfavourable factors and conditions, such as the short period of time between births of babies carried to term and premature births. Nevertheless, although the conditions for pregnancy and delivery are still insufficient, the quality of pre-natal and newborn care seems to be improving. Language: French Keywords: RWANDA | RESEARCH REPORT | DEMOGRAPHIC AND HEALTH SURVEYS | NEONATAL MORTALITY | DEATH RATE | MORTALITY DETERMINANTS | MATERNAL-CHILD HEALTH SERVICES | NEEDS | QUALITY OF HEALTH CARE | Africa, Central | Africa, Sub Saharan | Africa | Developing Countries | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Infant Mortality | Mortality | Primary Health Care | Health Services | Delivery of Health Care | Health | Economic Factors | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration Document Number: 342436 |
| 4. Peer Reviewed Title: A visual dosing aid for first-line pediatric antiretroviral treatment in resource-poor settings. Author: Callens SF; Westreich D; Kitetele F; Lusiama J; Shabani N; Belhorn T; Colebunders R; Behets F; Van Rie A Source: Journal of Tropical Pediatrics. 2009 Apr;55(2):135-7. Abstract: The visual dosing aid (VDA) was developed to facilitate dosing calculations in response to children's; growth and weight during antiretroviral treatment. The theoretical accuracy of the VDA was assessed using anthropometric data from 55 children receiving care in the USA and 324 children in the Democratic Republic of the Congo. The VDA dose was similar to the WHO recommended dose. A potentially significant relative dosing difference of >or=20% occurred in <3% of children for NVP, AZT and d4T, but was observed in 20% for 3TC, overdosing being more frequent. The VDA compared well with generic pediatric fixed dose combination tablets. Results did not differ between sites. The VDA enables accurate dosing of pediatric ART in distinct populations and could facilitate roll-out of pediatric ART in resource-poor settings. Language: English Keywords: DEMOCRATIC REPUBLIC OF THE CONGO | RESEARCH REPORT | CHILDREN | ANTIRETROVIRAL DRUGS | ANTIRETROVIRAL THERAPY | TREATMENT | ADMINISTRATION AND DOSAGE | BODY WEIGHT | Developing Countries | Africa, Central | Africa, Sub Saharan | Africa | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | HIV | HIV Infections | Viral Diseases | Diseases | Drugs | Physiology | Biology Document Number: 331199 |
| 5. Peer Reviewed Title: Dried blood spots are a useful tool for quality assurance of rapid HIV testing in Kigali, Rwanda. Author: Chaillet P; Zachariah R; Harries K; Rusanganwa E; Harries AD Source: Transactions of the Royal Society of Tropical Medicine and Hygiene. 2009 Jun;103(6):634-7. Abstract: A study was conducted in two primary health facilities in Kigali, Rwanda, to determine whether dried blood spots (DBS) used for quality control of HIV testing would give comparable results with serum after being stored for a period of 14 days and 30 days at ambient temperature. DBS and serum specimens were collected from patients undergoing HIV testing. ELISA performed on serum at baseline (gold standard) was compared with DBS results. The study included a total of 491 patients, comprising 92 (19%) males and 399 (81%) females with a median age of 27 years. A total of 148 individuals (30%) were HIV-positive. The average ambient temperature under which DBS specimens were stored at the health facilities was 23 degrees C (range 18-25 degrees C). The kappa statistic at 14 days and 30 days was 0.99 (99.4% agreement) and 0.98 (99.2% agreement), respectively, signifying almost 'perfect agreement (P<0.001)' with the gold standard. In a resource-limited sub-Saharan African country embarking on scaling-up of HIV testing, DBS stored at ambient conditions for up to 1 month were found to be a useful and robust tool to perform quality control of rapid HIV testing at the health centre level. Language: English Keywords: RWANDA | RESEARCH REPORT | LABORATORY PROCEDURES | CLIENTS | HIV TESTING | HIV INFECTIONS | AIDS | QUALITY OF HEALTH CARE | Africa, Central | Africa, Sub Saharan | Africa | Developing Countries | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Program Activities | Programs | Organization and Administration | Viral Diseases | Diseases | Health Services Evaluation | Program Evaluation Document Number: 342745 |
| 6. Peer Reviewed Title: Determinants of nonadherence to a single-dose nevirapine regimen for the prevention of mother-to-child HIV transmission in Rwanda. Author: Delvaux T; Elul B; Ndagije F; Munyana E; Roberfroid D; Asiimwe A Source: JAIDS. Journal of Acquired Immune Deficiency Syndromes. 2009 Feb 1;50(2):223-30. Abstract: OBJECTIVES: To describe experiences, and identify factors associated with nonadherence to a single-dose nevirapine (SD-NVP) regimen for the prevention of mother-to-child transmission (PMTCT) of HIV in Rwanda. METHODS: In April to May 2006, using a case-control design at 12 PMTCT sites, we interviewed HIV-infected women who did not adhere (n = 111) and who adhered (n = 125) to the PMTCT prophylaxis regimen. Nonadherence was defined as mother and/or infant not ingesting SD-NVP at the recommended time or not at all and adherence as mother-infant pairs who ingested it as recommended. RESULTS: Only 61% of nonadherent women had received SD-NVP during pregnancy or delivery. Among nonadherent women who received SD-NVP, 80% ingested it at the recommended time, representing 49% of all nonadherent women. Only 7% of their newborns ingested SD-NVP. Multivariate logistic regression showed that unmarried women, less educated women, women who made 2 or less antenatal care visits, and those offered HIV testing after their first antenatal care visit were more likely to be nonadherent to PMTCT prophylaxis. Not disclosing one's HIV status to someone aside from a partner was also associated with nonadherence in mother-infant pairs. CONCLUSIONS: Sociodemographic factors, health services delivery factors, and a lack of communication and social support contributed to nonadherence to PMTCT prophylaxis in Rwanda. Language: English Keywords: RWANDA | RESEARCH REPORT | KAP SURVEYS | MULTIVARIATE ANALYSIS | PERSONS LIVING WITH HIV/AIDS | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | USER COMPLIANCE | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | HIV PREVENTION | ADMINISTRATION AND DOSAGE | PREVALENCE | EDUCATIONAL STATUS | ANTENATAL CARE | PARTNER COMMUNICATION | Africa, Central | Africa, Sub Saharan | Africa | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Data Analysis | HIV Infections | Viral Diseases | Diseases | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Behavior | Disease Transmission Control | Prevention and Control | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Measurement | Socioeconomic Status | Socioeconomic Factors | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Interpersonal Relations Document Number: 330370 |
| 7. Peer Reviewed Title: Spousal intimate partner violence is associated with HIV and other STIs among married Rwandan women. Author: Dude AM Source: AIDS and Behavior. 2009 Feb 10;:1-11. Abstract: HIV is a health problem in Rwanda, where the adult HIV prevalence is 3.1% (WHO 2008 in Online database of HIV/AIDS epidemiological data, found at: http://www.who.int/globalatlas); the majority of those infected are women (UNAIDS 2008 in http://data.unaids. org/pub/Report/2008/rwanda_2008_country_progress_ report en.pdf). Prior studies indicate that intimate partner violence is frequently associated with increased HIV risk in women, often because men who abuse their wives also exhibit riskier sexual behaviors (Silverman et al. in JAMA 300:703-710 2008. Population-based data from the 2005 Rwanda Demographic and Health Survey indicate that women with few, if any, other sexual risk factors who have experienced sexual, physical, or emotional abuse within their marriages are 1.61-3.46 times as likely to test positive for HIV, and 2.14-4.11 times more likely to report another STI. These findings confirm prior clinical studies that indicate that intimate partner violence is a correlate of HIV/STIs in Rwanda. Further research is needed to determine whether Rwandan men that abuse their wives have higher baseline rates of HIV/STI infection. Language: English Keywords: RWANDA | RESEARCH REPORT | PREVALENCE | WOMEN | PERSONS LIVING WITH HIV/AIDS | MARRIAGE | DOMESTIC VIOLENCE | HIV INFECTIONS | SEXUALLY TRANSMITTED DISEASES | EVALUATION | Africa, Central | Africa, Sub Saharan | Africa | Developing Countries | Measurement | Research Methodology | Demographic Factors | Population | Viral Diseases | Diseases | Nuptiality | Crime | Social Problems | Sociocultural Factors | Reproductive Tract Infections | Infections Document Number: 340206 |
| 8. Title: Knowledge, Use, and Concerns about Contraceptive Methods among Sero-Discordant Couples in Rwanda and Zambia. Author: Grabbe K; Stephenson R; Vwalika B; Ahmed Y; Vwalika C; Chomba E; Karita E; Kayitenkore K; Tichacek A; Allen S Source: Journal of Women's Health. 2009 Aug 26; Abstract: Abstract Objective: The unique needs of sero-discordant couples are largely missing from many current family planning efforts, which focus on the prevention of pregnancies in absence of the reduction of the risk of human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs). Conversely, HIV testing and programs focus exclusively on condom use without discussion of more effective contraceptive methods. In order to provide information to inform the development of family planning services tailored to the unique needs of sero-discordant couples, this study examined the contraceptive knowledge, use, and concerns among sero-discordant couples in urban Rwanda and Zambia. Methods: This article presents a comparison of family planning knowledge, use, and concerns about contraception among two cohorts of HIV sero-discordant study participants in Rwanda and Zambia. Results: The results reveal an interesting profile of contraceptive knowledge and use among sero-discordant couples; in both settings, despite high levels of knowledge of contraception, use of contraceptive methods remains relatively low. There is a clear gender difference in both the reporting of knowledge and use of contraceptive methods, and there is evidence of clandestine contraceptive use by women. Conclusions: Including information on family planning in voluntary counseling and testing (VCT) services in addition to tailoring the delivery of family planning information to meet to needs and concerns of HIV-positive women or those with HIV positive partners is an essential step in the delivery of services and prevention efforts to reduce the transmission of HIV. Family planning and HIV prevention programs should integrate counseling on "dual method use," combining condoms for HIV/STI prevention with a long-acting contraceptive for added protection against unplanned pregnancy. Language: English Keywords: ZAMBIA | RWANDA | RESEARCH REPORT | COHORT ANALYSIS | COUPLES | KNOWLEDGE | CONTRACEPTIVE METHODS | FAMILY PLANNING | REPRODUCTIVE BEHAVIOR | CONTRACEPTIVE METHODS CHOSEN | PROGRAM EVALUATION | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Africa, Central | Research Methodology | Family Characteristics | Family and Household | Sociocultural Factors | Contraception | Fertility | Population Dynamics | Demographic Factors | Population | Contraceptive Usage | Programs | Organization and Administration Document Number: 342591 |
| 9. Peer Reviewed Title: HIV infection among internally displaced women and women residing in river populations along the Congo River, Democratic Repubic of Congo. Author: Kim AA; Malele F; Kaiser R; Mama N; Kinkela T Source: AIDS and Behavior. 2009 Mar 25;:7 p. Abstract: The author's conducted a reproductive health assessment among women aged 15-49 years residing in an internally displaced persons (IDP) camp and surrounding river populations in the Democratic Republic of Congo. After providing informed consent, participants were administered a behavioral questionnaire on demographics, sexual risk, reproductive health behavior, and a history of gender based violence. Participants provided a blood specimen for HIV and syphilis testing and were referred to HIV counseling and testing services established for this study to learn their HIV status. HIV prevalence was significantly higher among women in the IDP population compared to women in the river population. Sexually transmitted infection symptoms in the past 12 months and a history of sexual violence during the conflict were associated with HIV infection the river and IDP population, respectively. Targeted prevention, care, and treatment services are urgently needed for the IDP population and surrounding host communities during displacement and resettlement. Language: English Keywords: DEMOCRATIC REPUBLIC OF THE CONGO | RESEARCH REPORT | PREVALENCE | WOMEN | INTERNALLY DISPLACED PERSONS | WAR | HIV TRANSMISSION | HIV INFECTIONS | SEXUALLY TRANSMITTED DISEASES | Developing Countries | Africa, Central | Africa, Sub Saharan | Africa | Measurement | Research Methodology | Demographic Factors | Population | Settlement and Resettlement | Migration | Population Dynamics | Political Factors | Sociocultural Factors | Viral Diseases | Diseases | Reproductive Tract Infections | Infections Document Number: 341519 |
| 10. Title: Impact of maternal malaria and under-nutrition on intrauterine growth restriction: a prospective ultrasound study in Democratic Republic of Congo. Author: Landis SH; Lokomba V; Ananth CV; Atibu J; Ryder RW; Hartmann KE; Thorp JM; Tshefu A; Meshnick SR Source: Epidemiology and Infection. 2009 Feb;137(2):294-304. Abstract: Maternal malaria and under-nutrition are established risk factors for small-for-gestational-age (SGA) births; however, whether malaria is associated with intrauterine growth restriction (IUGR) is unknown. We investigated IUGR risk among 177 HIV-negative pregnant women enrolled in a longitudinal ultrasound study conducted in Democratic Republic of Congo from May 2005 to May 2006. Malaria infection, maternal anthropometrics, and ultrasound estimated fetal weight were measured monthly. All positive malaria cases were treated and intermittent presumptive therapy (IPTp) provided. Log-binomial regression models for IUGR were fitted using generalized estimating equations to account for statistical clustering of repeat IUGR measurements. Twenty-nine percent of fetuses experienced an episode of IUGR with the majority occurring in the third trimester. The risk of IUGR associated with malaria was greatest after three or more cumulative infections (RR 3.3, 95% CI 1.3-8.2) and was two- to eight-fold higher among women with evidence of under-nutrition. Receiving antimalarial treatment in the previous month (for IPTp or treatment) was significantly protective against IUGR (RR 0.5, 95% CI 0.3-0.7). The interaction observed between malaria and under-nutrition suggests that antenatal programmes in malaria endemic areas should incorporate nutritional screening and supplementation in addition to IPTp. Language: English Keywords: DEMOCRATIC REPUBLIC OF THE CONGO | RESEARCH REPORT | PROSPECTIVE STUDIES | INTRAUTERINE GROWTH RETARDATION | ULTRASONICS | MALARIA | MATERNAL NUTRITION | RISK FACTORS | Africa, Central | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Congenital Abnormalities | Neonatal Diseases and Abnormalities | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Parasitic Diseases | Nutrition | Biology Document Number: 330491 |
| 11. Title: [The Mandoul human African trypanosomiasis focus in Chad: from evaluation to control] Le foyer de trypanosomiase humaine africaine du Mandoul au Tchad : de Author: Louis FJ; Djimadoum NA; Kohagne TL; Simarro PP Source: Medecine Tropicale. 2009 Feb;69(1):7-12. Abstract: The Mandoul focus of human African trypanosomiasis in southern Chad was first described by Gaston Muraz in the 1920s. After 40 years of control measures, case reports became rare and the focus was forgotten. However the number of cases began to increase in 1993 and coordinated control measures were implemented in 2002. The first phase of control consisted of mapping out the focus that was shown to involve 45 villages and camps on both sides of the Mandoul River. The estimated number of inhabitants in the area is 20.000 and the endemic prevalence was 3.78%. Dynamic passive screening and regular active screening undertaken in the framework of the Chadian human African trypanosomiasis control program with the assistance of expert technicians from the subregion reduced the prevalence to 0.77% in 2006. Although this reduction is encouraging, control measures must be maintained and greater involvement of the health care system will be needed to achieve sustainable control of the disease and ultimately to eliminate human African trypanosomiasis as a public health problem. Language: French Keywords: CHAD | RESEARCH REPORT | EVALUATION | PREVALENCE | AFRICAN TRYPANOSOMIASIS | SCREENING | PREVENTION AND CONTROL | Africa, Central | Africa, Sub Saharan | Africa | Developing Countries | Measurement | Research Methodology | Parasitic Diseases | Diseases | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 342502 |
| 12. Peer Reviewed Title: Adult clinical and immunologic outcomes of the national antiretroviral treatment program in Rwanda during 2004-2005. Author: Lowrance DW; Ndamage F; Kayirangwa E; Ndagije F; Lo W; Hoover DR; Hanson J; Elul B; Ayaba A; Ellerbrock T; Rukundo A; Shumbusho F; Nash D; Mugabo J; Assimwe A Source: Journal of Acquired Immune Deficiency Syndromes. 2009 Sep 1;52(1):49-55. Abstract: BACKGROUND: By December 2007, over 48,000 persons had initiated antiretroviral treatment (ART) at 171 clinics in Rwanda. Assessing national ART program outcomes is essential to determine whether programs have the desired impact. METHODS: We conducted a retrospective cohort study to assess key 6- and 12-month outcomes among a nationally representative, stratified, random sample of 3194 adults (> or =15 years) who initiated ART from January 1, 2004, through December 31, 2005. FINDINGS: At ART initiation, the median patient age was 37 years and 65% were female. Overall, the baseline median CD4 cell count was 141 cells per microliter. At 6 and 12 months after ART initiation, 92% and 86% of patients, respectively, remained on ART at their original site. By 6 months, 3.6% were dead and 3.4% were lost to follow-up; by 12 months, 4.6% were dead and 4.9% were lost to follow-up. Among patients with available follow-up CD4 cell count data, median CD4 cell counts increased by 98 cells per microliter and 119 cells per microliter at 6 and 12 months after ART initiation, respectively. CONCLUSIONS: Rwanda's national ART program achieved excellent 6- and 12-month retention and immunologic outcomes during the first 2 years of rapid scale-up. Routine supervision is required to improve compliance with clinical guidelines and data quality. Language: English Keywords: RWANDA | RESEARCH REPORT | DATA QUALITY | IMMUNOLOGIC FACTORS | IMMUNOLOGICAL EFFECTS | PERSONS LIVING WITH HIV/AIDS | CLIENTS | HIV INFECTIONS | TREATMENT | ANTIRETROVIRAL THERAPY | GOVERNMENT PROGRAMS | Africa, Central | Africa, Sub Saharan | Africa | Developing Countries | Data Analysis | Research Methodology | Immunity | Immune System | Physiology | Biology | Viral Diseases | Diseases | Program Activities | Programs | Organization and Administration | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | HIV Document Number: 342884 |
| 13. Peer Reviewed Title: The role of religion in HIV-positive women's disclosure experiences and coping strategies in Kinshasa, Democratic Republic of Congo. Author: Maman S; Cathcart R; Burkhardt G; Omba S; Behets F Source: Social Science and Medicine. 2009 Mar;68(5):965-70. Abstract: Literature from the U.S. has documented the importance of spirituality on the psychological health of people living with HIV/AIDS; however there is little published data on the ways in which people living with HIV/AIDS in Africa turn to religion for support. We conducted 40 in-depth interviews with HIV-positive women who were pregnant or had recently given birth in Kinshasa, Democratic Republic of Congo to inform the development of a comprehensive family-centered HIV treatment and care program. Women described how they relied upon their faith and turned to church leaders when they were diagnosed with HIV and prepared to share their diagnosis with others. The women used prayer to overcome the initial shock, sadness and anger of learning their HIV diagnosis. They turned to their church leaders to help them prepare for disclosing their diagnosis to others, including their partners. Church leaders were also important targets for disclosure by some women. Women's faith played an important role in their long-term coping strategies. Conceptualizing their infection as a path chosen by God, and believing that God has the power to cure their infection comforted women and provided them with hope. In settings like the Democratic Republic of the Congo, where there is a strong foundation of faith, we need to recognize how individuals draw upon their different health belief systems in order to develop and implement coherent and effective prevention, treatment and care strategies. Language: English Keywords: DEMOCRATIC REPUBLIC OF THE CONGO | RESEARCH REPORT | KAP SURVEYS | PERSONS LIVING WITH HIV/AIDS | URBAN POPULATION | PREGNANT WOMEN | INFLUENTIALS | POSTPARTUM WOMEN | WOMEN IN DEVELOPMENT | PARTNER COMMUNICATION | HIV INFECTIONS | PSYCHOLOGICAL FACTORS | RELIGIOUS ASPECTS | LEADERSHIP | Developing Countries | Africa, Central | Africa, Sub Saharan | Africa | Surveys | Sampling Studies | Studies | Research Methodology | Viral Diseases | Diseases | Population Characteristics | Demographic Factors | Population | Knowledge Sources | Communication | Puerperium | Reproduction | Economic Development | Economic Factors | Interpersonal Relations | Behavior | Religion | Sociocultural Factors | Organization and Administration Document Number: 341170 |
| 14. Title: Protecting children with HIV against pneumococcal disease. Author: Meehan A; Mackenzie G; Shingadia D; Booy R Source: Lancet Infectious Diseases. 2009 Jul;9(7):394-5. Abstract: This article reflects on the incidence of pneumococcal disease with people infected with HIV and the continued and considerable risk of the disease throughout their lifetime. It also explains that the PCV-7 vaccination for pneumococcal disease is supplied primarily in high-income countries with low prevalence of HIV infection and is advocating that a worldwide introduction of pneumococcal vaccines are an urgent public health priority. Language: English Keywords: RWANDA | SUMMARY REPORT | INFANT | VACCINES | DISEASE PREVENTION | PREVENTION AND CONTROL | Africa, Central | Africa, Sub Saharan | Africa | Developing Countries | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Diseases Document Number: 342057 |
| 15. Peer Reviewed Title: Local differences in human immunodeficiency virus prevalence: a comparison of social venue patrons, antenatal patients, and sexually transmitted infection patients in eastern kinshasa. Author: Mwandagalirwa K; Jackson EF; McClamroch K; Bollinger R; Ryder RW; Weir SS Source: Sexually Transmitted Diseases. 2009 Jul;36(7):406-12. Abstract: BACKGROUND: This study compares the sexual behavior and HIV prevalence of men and women at social venues where people meet new sexual partners in Eastern Kinshasa with that of sexually transmitted infection (STI) treatment and antenatal clinic (ANC) patients in the same area. METHODS: ANC patients, STI clinic patients, and social venue patrons were interviewed, asked to provide a blood sample on-site, and provided with information about obtaining test results. Every patron at identified social venues in the study area was invited to participate. RESULTS: One thousand one hundred sixteen pregnant women; 66 male and 229 female STI clinic patients; and 952 male and 247 female patrons of social venues were interviewed and tested for HIV. HIV prevalence differed by group: ANC patients (4%); female venue patrons (12%); female STI patients (16%); male venue patrons (2%); and male STI patients (23%). HIV prevalence among sex workers at social venues (29%) was higher than HIV prevalence among other female patrons with new or multiple partnerships in the past four weeks (19%) and higher than HIV prevalence among female patrons denying sex work (6%). However, the absolute number of infected women was higher among women reporting recent new or multiple partnerships than among the smaller group of sex workers (23 vs. 18). Two-thirds of the infected female STI patients (24/36) reported no more than one and no new sexual partner in the past year. CONCLUSION: Improving prevention programs in Kinshasa is essential. Prevention efforts should not neglect women at social venues who do not self-identify as sex workers but who have high rates of new sexual partnership formation. Language: English Keywords: DEMOCRATIC REPUBLIC OF THE CONGO | RESEARCH REPORT | COMPARATIVE STUDIES | CLIENTS | MULTIPLE PARTNERS | HIV INFECTIONS | PREVALENCE | ANTENATAL CARE | SEXUALLY TRANSMITTED DISEASES | CLINICS | VOLUNTARY COUNSELING AND TESTING | INTERVIEWS | CONDOM USE | Developing Countries | Africa, Central | Africa, Sub Saharan | Africa | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Sexual Partners | Sex Behavior | Behavior | Viral Diseases | Diseases | Measurement | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Reproductive Tract Infections | Infections | Health Facilities | HIV Testing | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Data Collection | Risk Reduction Behavior Document Number: 342831 |
| 16. Title: Demand and unmet need for means of family limitation in Rwanda. Author: Ndaruhuye DM; Broekhuis A; Hooimeijer P Source: International Perspectives on Sexual and Reproductive Health. 2009 Sep;35(3):122-130. Abstract: CONTEXT: Rwanda is the most densely populated country in Africa, with substantial annual population growth. The current government seeks new policies for family limitation as a way to facilitate more sustainable development. METHODS: Data from the 2005 Rwanda Demographic and Health Survey were used for a two-step analysis; binary logistic regression was used to identify factors associated with desiring to stop childbearing and having unmet need. RESULTS: Eighty-seven percent of women aged 15-49 approve of family planning, but only 64% believe that their partner approves of it. There is a high level of unmet need for family limitation; 58% of women who want to stop childbearing do not use modern contraceptives. Demand was lower among women who did not approve of family planning, those who did not know their partner's attitude toward family planning and those who had discussed family planning with their partner fewer than three times. Unmet need was higher among women who did not approve of family planning, those who believed their partner did not approve of family planning or who did not know his attitude, and those who had never discussed family planning with their partner or had done so only once or twice. CONCLUSIONS: Negative attitudes toward family planning and failing structures of provision are the dominant constraints on the use of modern contraceptives in Rwanda. Community-based family planning services could greatly expand access, especially in underserved provinces. Spanish Abstract: Contexto: Ruanda es el país más densamente poblado de África, con un sustancial crecimiento anual de la población. El actual gobierno busca establecer nuevas políticas para limitar el tamańo de las familias como medio para facilitar un desarrollo más sostenible. Métodos: Datos de la Encuesta Demografía y Salud de Ruanda de 2005 fueron usados para un análisis de dos pasos; se usó regresión logística binaria para identificar factores asociados con el deseo de no tener más hijos y de tener necesidad insatisfecha de anticoncepción. Resultados: Ochenta y siete por ciento de las mujeres en edades de 15-49 aprueban el uso de la planificación familiar, pero solamente 64% consideran que sus parejas la aprueban. Hay un alto nivel de necesidad insatisfecha para limitar la familia; 58% de las mujeres que desean dejar de tener hijos no usan anticonceptivos modernos. La demanda fue más baja en mujeres que no aprobaban la planificación familiar, en las que no conocían la actitud de su pareja respecto a la planificación familiar y en quienes trataron el tema de la planificación familiar con su pareja menos de tres veces. La necesidad insatisfecha fue más alta en mujeres que no aprobaban la planificación familiar, en las que creían que su pareja no la aprobaba o que desconocían su actitud, y en aquellas que nunca habían tratado el tema de la planificación familiar con su pareja o lo habían hecho sólo una o dos veces. Conclusiones: Las limitaciones dominantes para el uso de anticonceptivos modernos en Ruanda son las actitudes negativas hacia la planificación familiar y las defectuosas estructuras de prestación de servicios. Los servicios de planificación familiar basados en la comunidad podrían expandir el acceso significativamente, especialmente en las provincias insuficientemente atendidas. French Abstract: Contexte: Le Rwanda est le pays d'Afrique qui présente la plus forte densité de population et sa croissance démographique annuelle est considérable. Le gouvernement actuel cherche ŕ définir de nouvelles politiques de limitation des familles au profit d'un développement plus durable. Méthodes: Les données de l'Enquęte démographique et de santé (EDS) 2005 du Rwanda ont servi ŕ la réalisation d'une analyse en deux étapes. Les facteurs associés au désir de ne plus avoir d'enfants et au besoin non satisfait ont été identifiés par régression logistique binaire. Résultats: Quatre-vingt-sept pour cent des femmes de 15 ŕ 49 ans approuvent la planification familiale; 64% seulement croient cependant que leur partenaire y est favorable. Le niveau du besoin non satisfait de limitation des naissances est élevé: 58% des femmes qui ne désirent plus avoir d'enfants ne pratiquent pas la contraception moderne. La demande est moindre parmi les femmes qui n'approuvent pas la planification familiale, qui ignorent la position de leur partenaire ŕ son égard ou qui ont abordé la question avec leur partenaire moins de trois fois. Le besoin non satisfait est supérieur parmi les femmes qui n'approuvent pas la planification familiale, celles qui pensent que leur partenaire ne l'approuve pas ou qui ignorent sa position sur la question et celles qui n'ont jamais abordé la question avec leur partenaire ou qui ne l'ont abordée qu'une ou deux fois. Conclusions: Les attitudes négatives ŕ l'égard de la planification familiale et les faibles structures de prestations sont les principaux obstacles ŕ la pratique de la contraception moderne au Rwanda. Les services de planification familiale ŕ l'échelle de la collectivité pourraient améliorer grandement l'accčs, en particulier dans les provinces sous-desservies. Language: English Keywords: RWANDA | RESEARCH REPORT | DEMOGRAPHIC AND HEALTH SURVEYS | WOMEN | SPOUSAL CONSENT | FAMILY PLANNING | NEEDS | ATTITUDES | CONTRACEPTION | Africa, Central | Africa, Sub Saharan | Africa | Developing Countries | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Spouse | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Economic Factors | Psychological Factors | Behavior Document Number: 343002 |
| 17. Peer Reviewed Title: Post-traumatic stress reactions among Rwandan children and adolescents in the early aftermath of genocide. Author: Neugebauer R; Fisher PW; Turner B; Yamabe S; Sarsfield JA Source: International Journal of Epidemiology. 2009 Feb;:1-13. Abstract: Background Epidemiological investigations of post-traumatic stress reactions in Sub-Saharan Africa, where atrocious violence against civilians is endemic, are rare. This article is the first complete report of the key community-based findings of a 1995 psychiatric epidemiological survey of young survivors of the 1994 Rwandan Genocide. Methods The National Trauma Survey (NTS) of Rwandans aged 8-19 measured traumatic exposures using an inventory of possible war time experiences and post-traumatic stress reactions with a checklist of symptoms of Post-traumatic stress disorder (PTSD). Individuals meeting assessed PTSD diagnostic criteria are classified as cases of 'probable PTSD'. The NTS interviewed youth residing in the community and others institutionalized in unaccompanied children's centres; the former (n = 1547) are the subject of the present report. Instrument change midway into the study divides respondents into two samples. Results Among respondents, over 90% witnessed killings and had their lives threatened; 35% lost immediate family members; 30% witnessed rape or sexual mutilation; 15% hid under corpses. In Sample 1, 95% of respondents reported one or more re-experiencing symptom, 95% reported three or more avoidance/blunting symptoms and 63% reported two or more arousal symptoms; in Sample 2, these figures were 96%, 95% and 56%, respectively. The overall rate of 'probable PTSD' was 62% and 54% in Samples 1 and 2, respectively, and exhibited a dose-response relationship with exposure. Among the most heavily exposed individuals the rate was 100%. Rates of 'probable PTSD' were higher among females than among males. Results for age were inconsistent. Conclusion In industrialized societies, most survivors of traumatizing violence experience symptoms only transiently. In the Rwanda survey, symptom levels and rates of 'probable PTSD' were exceptionally elevated, suggesting that at the limits of catastrophic man-made violence, psychological resilience among youth is all but extinguished. Language: English Keywords: RWANDA | RESEARCH REPORT | SURVEYS | ADOLESCENTS | CHILDREN | GENOCIDE | WAR | VIOLENCE | VIOLENT DEATHS | STRESS | PREVALENCE | SIGNS AND SYMPTOMS | Africa, Central | Africa, Sub Saharan | Africa | Developing Countries | Sampling Studies | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Crime | Social Problems | Sociocultural Factors | Political Factors | Behavior | Mortality | Population Dynamics | Psychological Factors | Measurement | Diseases Document Number: 340215 |
| 18. Peer Reviewed Title: Validation of 2006 WHO prediction scores for true HIV infection in children less than 18 months with a positive serological HIV test. Author: Peltier CA; Omes C; Ndimubanzi PC; Ndayisaba GF; Stulac S; Arendt V; Courteille O; Muganga N; Kayumba K; Van den Ende J Source: PloS One. 2009;4(4):e5312. Abstract: INTRODUCTION: All infants born to HIV-positive mothers have maternal HIV antibodies, sometimes persistent for 18 months. When Polymerase Chain Reaction (PCR) is not available, August 2006 World Health Organization (WHO) recommendations suggest that clinical criteria may be used for starting antiretroviral treatment (ART) in HIV seropositive children <18 months. Predictors are at least two out of sepsis, severe pneumonia and thrush, or any stage 4 defining clinical finding according to the WHO staging system. METHODS AND RESULTS: From January 2005 to October 2006, we conducted a prospective study on 236 hospitalized children <18 months old with a positive HIV serological test at the national reference hospital in Kigali. The following data were collected: PCR, clinical signs and CD4 cell count. Current proposed clinical criteria were present in 148 of 236 children (62.7%) and in 95 of 124 infected children, resulting in 76.6% sensitivity and 52.7% specificity. For 87 children (59.0%), clinical diagnosis was made based on severe unexplained malnutrition (stage 4 clinical WHO classification), of whom only 44 (50.5%) were PCR positive. Low CD4 count had a sensitivity of 55.6% and a specificity of 78.5%. CONCLUSION: As PCR is not yet widely available, clinical diagnosis is often necessary, but these criteria have poor specificity and therefore have limited use for HIV diagnosis. Unexplained malnutrition is not clearly enough defined in WHO recommendations. Extra pulmonary tuberculosis (TB), almost impossible to prove in young children, may often be the cause of malnutrition, especially in HIV-affected families more often exposed to TB. Food supplementation and TB treatment should be initiated before starting ART in children who are staged based only on severe malnutrition. Language: English Keywords: RWANDA | RESEARCH REPORT | CLINICAL RESEARCH | PROSPECTIVE STUDIES | INFANT | HIV INFECTIONS | HIV TESTING | WHO | EXAMINATIONS AND DIAGNOSES | ANTIRETROVIRAL THERAPY | SIGNS AND SYMPTOMS | MALNUTRITION | TUBERCULOSIS | Africa, Central | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Studies | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | Laboratory Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors | HIV | Nutrition Disorders | Infections Document Number: 342347 |
| 19. Peer Reviewed Title: Incontinence and trauma: sexual violence, female genital cutting and proxy measures of gynecological fistula. Author: Peterman A; Johnson K Source: Social Science and Medicine. 2009;68:971-979. Abstract: Obstetric fistula, characterized by urinary or fecal incontinence via the vagina, has begun to receive attention on the international public health agenda, however less attention has been given to traumatic fistula. Field reports indicate that trauma contributes to the burden of vaginal fistula, especially in regions wrought by civil unrest, however evidence is largely anecdotal or facility-based. This paper specifically examines the co-occurrence of incontinence and two potential sources of trauma: sexual violence and female genital cutting using the most recent Demographic and Health Surveys in Malawi, Rwanda, Uganda and Ethiopia. Multivariate selection models are used to control for sampling differences by country. Results indicate that sexual violence is a significant determinant of incontinence in Rwanda and Malawi, however not in Uganda. Simulations predict that elimination of sexual violence would result in from a 7 to a 40% reduction of the total burden of incontinence. In contrast, no evidence is found that female genital cutting contributes to incontinence and this finding is robust for types of cutting and high risk samples. Results point to the importance of reinforcing prevention programs which seek to address prevention of sexual violence and for the integration of services to better serve women experiencing both sexual violence and incontinence. Language: English Keywords: AFRICA, SUB SAHARAN | MALAWI | RWANDA | UGANDA | ETHIOPIA | RESEARCH REPORT | WOMEN | FEMALE GENITAL CUTTING | SEXUAL ABUSE | VESICOVAGINAL FISTULA | Africa | Developing Countries | Africa, Southern | Africa, Central | Africa, Eastern | Demographic Factors | Population | Harmful Traditional Practices | Traditional Health Practices | Culture | Sociocultural Factors | Crime | Social Problems | Urogenital Effects | Urogenital System | Physiology | Biology Document Number: 340216 |
| 20. Peer Reviewed Title: Malaria has no effect on birth weight in Rwanda. Author: Rulisa S; Mens PF; Karema C; Schallig HD; Kaligirwa N; Vyankandondera J; de Vries PJ Source: Malaria Journal. 2009 Aug 10;8(1):194. Abstract: ABSTRACT: BACKGROUND: Malaria has a negative effect on pregnancy outcome, causing low birth weight, premature birth and stillbirths, particularly in areas with high malaria transmission. In Rwanda, malaria transmission intensity ranges from high to nil, probably associated with variable altitudes. Overall, the incidence decreased over the last six years (2002-2007). Therefore, the impact of malaria on birth outcomes is also expected to vary over time and space. METHODS: Obstetric indicators (birth weight and pregnancy outcome) and malaria incidence were compared and analyzed to their association over time (2002-2007) and space. Birth data from 12,526 deliveries were collected from maternity registers of 11 different primary health centers located in different malaria endemic areas. Malaria data for the same communities were collected from the National Malaria Control Programme. Associations were sought with mixed effects models and logistic regression. RESULTS: In all health centres, a significant increase of birth weight over the years was observed (p < 0.001) with a significant seasonal fluctuation. Malaria incidence had no significant effect on birth weight. There was a slight but significant decreasing effect of malaria incidence on the occurrence of premature delivery (p-value 0.045) and still birth (p-value 0.009). Altitude showed a slight but significant negative correlation with birth weight. Overall, a decrease over the years of premature delivery (p = 0.010) and still birth (p=0.036) was observed. CONCLUSION: In Rwanda, birth weight and pregnancy outcome are not directly influenced by malaria, which is in contrast to many other studied areas. Although malaria incidence overall has declined and mean birth weight increased over the studied period, no direct association was found between the two. Socio-economic factors and improved nutrition could be responsible for birth weight changes in recent years. Language: English Keywords: RWANDA | RESEARCH REPORT | INCIDENCE | BIRTH RECORDS | MALARIA | BIRTH WEIGHT | NUTRITION | PROGRAM EVALUATION | Africa, Central | Africa, Sub Saharan | Africa | Developing Countries | Measurement | Research Methodology | Vital Statistics | Population Statistics | Parasitic Diseases | Diseases | Body Weight | Physiology | Biology | Health | Programs | Organization and Administration Document Number: 342541 |
21.  Title: Rwanda: Performance-based financing in the public sector. Author: Rusa L; Schneidman M; Fritsche G; Musango L Source: In: Performance incentives for global health: potential and pitfalls [by] Rena Eichler, Ruth Levine and the Performance-Based Incentives Working Group. Washington, D.C., Center for Global Development, 2009. :189-214. Abstract: Countrywide implementation demonstrates that a national performance-based financing approach with both the public and private nonprofit health facilities is feasible in low-income countries. Incentives reward both quantity and quality of curative, maternal and child health, and HIV / AIDS services. Donor-funded pilots provided the evidence for the government of Rwanda to implement performance incentives as well as a menu of options that informed the design of a unified national model. Language: English Keywords: RWANDA | RESEARCH REPORT | PILOT PROJECTS | HEALTH SERVICES | MALNUTRITION | FERTILITY | CHILD MORTALITY | MATERNAL MORTALITY | HIV INFECTIONS | INTERVENTIONS | PROGRAM ACTIVITIES | EVALUATION | Africa, Central | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Delivery of Health Care | Health | Nutrition Disorders | Diseases | Population Dynamics | Demographic Factors | Population | Mortality | Viral Diseases | Programs | Organization and Administration Document Number: 331457 |
| 22. Peer Reviewed Title: Human papillomavirus infection and cervical cytology in HIV-infected and HIV-uninfected Rwandan women. Author: Singh DK; Anastos K; Hoover DR; Burk RD; Shi Q; Ngendahayo L; Mutimura E; Cajigas A; Bigirimani V; Cai X; Rwamwejo J; Vuolo M; Cohen M; Castle PE Source: Journal of Infectious Diseases. 2009 Jun 15;199(12):1851-61. Abstract: BACKGROUND: Data on human papillomavirus (HPV) prevalence are essential for developing cost-effective cervical cancer prevention programs. METHODS: In 2005, 710 human immunodeficiency virus (HIV)-positive and 226 HIV-negative Rwandan women enrolled in an observational prospective cohort study. Sociodemographic data, CD4+ cell counts, and cervical specimens were obtained. Cervicovaginal lavage specimens were collected from each woman and tested for >40 HPV types by a polymerase chain reaction assay; HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68 were considered primary carcinogenic HPV types. RESULTS: The prevalence of HPV was higher in HIV-positive women than in HIV-negative women in all age groups. Among HIV-infected women, 69% were positive for >or=1 HPV type, 46% for a carcinogenic HPV type, and 10% for HPV-16. HPV prevalence peaked at 75% in the HIV-positive women aged 25-34 years and then declined with age to 37.5% in those >or=55 years old (Ptrend<.001). A significant trend of higher prevalence of HPV and carcinogenic HPV with lower CD4+ cell counts and increasing cytologic severity was seen among HIV-positive women. CONCLUSIONS: We found a higher prevalence of HPV infection in HIV-positive than in HIV-negative Rwandan women, and the prevalence of HPV and carcinogenic HPV infection decreased with age. Language: English Keywords: RWANDA | RESEARCH REPORT | PREVALENCE | WOMEN | PERSONS LIVING WITH HIV/AIDS | CERVICAL CANCER | COST BENEFIT ANALYSIS | PREVENTION AND CONTROL | CYTOLOGY | PROGRAM EVALUATION | Africa, Central | Africa, Sub Saharan | Africa | Developing Countries | Measurement | Research Methodology | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Cancer | Neoplasms | Quantitative Evaluation | Evaluation | Biology | Programs | Organization and Administration Document Number: 342067 |
| 23. Title: High prevalence of undiagnosed chronic kidney disease among at-risk population in Kinshasa, the Democratic Republic of Congo. Author: Sumaili EK; Cohen EP; Zinga CV; Krzesinski JM; Pakasa NM; Nseka NM Source: BMC Nephrology. 2009;10:18. Abstract: BACKGROUND: There is limited knowledge of Chronic Kidney Disease (CKD) among high risk populations, especially in the developing countries. We report our study of testing for CKD in at-risk subjects. METHODS: In a cross-sectional study, 527 people from primary and secondary health care areas in the city of Kinshasa were studied from a random sample of at-risk out-patients with hypertension, diabetes, obesity, or HIV+. We measured blood pressure (BP), blood glucose level, proteinuria, body mass index, and estimated glomerular filtration rate (eGFR by MDRD equation) using calibrated creatinine levels based on one random measurement. The associations between health characteristics, indicators of kidney damage (proteinuria) and kidney function (<60 ml/min/1.73 m2) were also examined. RESULTS: The prevalence of CKD in this study was 36%, but only 12% were aware of their condition. 4% of patients had stage 1 CKD, 6% stage 2, 18% stage 3, 2% stage 4, and 6% had stage 5. 24 hour quantitative proteinuria (>300 mg/day) was found in 19%. In those with the at-risk conditions, the % of CKD was: 44% in patients with hypertension, 39% in those with diabetes; 16% in the obese and 12% in those who were HIV+. 82% of those with a history of diabetes had elevated serum glucose levels at screening (>or= 126 mg/dl). Only 6% of individuals with hypertension having CKD had reduced BP to lower than 130/80 mmHg. In multivariate analysis, diabetes, proteinuria and hypertension were the strongest determinants of CKD 3+. CONCLUSION: It appears that one out of three people in this at-risk population has undiagnosed CKD and poorly controlled CKD risk factors. This growing problem poses clear challenges to this developing country. Therefore, CKD should be addressed through the development of multidisciplinary teams and improved communication between traditional health care givers and nephrology services. Attention to CKD risk factors must become a priority. Language: English Keywords: DEMOCRATIC REPUBLIC OF THE CONGO | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | POPULATION AT RISK | RENAL EFFECTS | PREVALENCE | EXAMINATIONS AND DIAGNOSES | RISK FACTORS | Developing Countries | Africa, Central | Africa, Sub Saharan | Africa | Research Methodology | Urogenital Effects | Urogenital System | Physiology | Biology | Measurement | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 342965 |
| 24. Title: Discordant immunologic and virologic responses to antiretroviral therapy and associated mortality in a large treatment program in Rwanda [letter] Author: van Griensven J; Zachariah R; Rasschaert F; Reid T Source: Journal of Acquired Immune Deficiency Syndromes. 2009 Apr 15;50(5):556-8. Abstract: Discordant responders and concordant nonresponders are a population at risk in low-income countries meriting targeted medical attention. Better understanding of the mechanisms underlying discordant responses would allow the design of management strategies to reduce associated mortality in low-income countries. With currently more than 3 million patients on highly active antiretroviral treatment in low-income countries, of whom, approximately 1 in 3 (30%) might be discordant responders who are at relatively high risk of death even while on ART, this issue is of high relevance to clinical management and public health. (excerpt) Language: English Keywords: RWANDA | RESEARCH REPORT | CLINICAL RESEARCH | EPIDEMIOLOGIC METHODS | LONGITUDINAL STUDIES | PERSONS LIVING WITH HIV/AIDS | URBAN POPULATION | ANTIRETROVIRAL THERAPY | DEATH RATE | IMMUNOLOGICAL EFFECTS | VIRAL DISEASES | LONGTERM EFFECTS | USER COMPLIANCE | AGE FACTORS | SEX FACTORS | Africa, Central | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Studies | HIV Infections | Diseases | Population Characteristics | Demographic Factors | Population | HIV | Mortality | Population Dynamics | Immunity | Immune System | Physiology | Biology | Time Factors | Behavior Document Number: 331233 |
| 25. Peer Reviewed Title: Weight evolution in HIV-1 infected women in Rwanda after stavudine substitution due to lipoatrophy: comparison of zidovudine with tenofovir/abacavir. Author: van Griensven J; Zachariah R; Rasschaert F; Atte EF; Reid T Source: Transactions of the Royal Society of Tropical Medicine and Hygiene. 2009 Jun;103(6):613-9. Abstract: This cohort study was conducted amongst female patients manifesting lipoatrophy while receiving stavudine-containing first-line antiretroviral treatment regimens at two urban health centres in Rwanda. The objectives were to assess weight evolution after stavudine substitution and to describe any significant difference in weight evolution when zidovudine or tenofovir/abacavir was used for substitution. All adult patients on stavudine-containing first-line regimens who developed lipoatrophy (diagnosed using a lipodystrophy case definition study-based questionnaire) and whose treatment regimen was changed were included (n=114). In the most severe cases stavudine was replaced with tenofovir or abacavir (n=39), and in the remainder with zidovudine (n=75). For patients changed to zidovudine a progressive weight loss was seen, while those on tenofovir/abacavir showed a progressive weight increase from six months. The between-group difference in weight evolution was significant from nine months (difference at 12 months: 2.3 kg, P=0.02). These differences were confirmed by follow-up lipoatrophy scores. In multivariate analysis, substitution with tenofovir/abacavir remained significantly associated with weight gain. This is the first study in Africa assessing weight gain as a proxy for recovery after stavudine substitution due to lipoatrophy, providing supporting evidence that tenofovir/abacavir is superior to zidovudine. The weight loss with zidovudine might justify earlier substitution and access to better alternatives like tenofovir/abacavir. Language: English Keywords: RWANDA | RESEARCH REPORT | COHORT ANALYSIS | COMPARATIVE STUDIES | WOMEN | BODY WEIGHT | HIV | DRUGS | HIV TESTING | ANTIRETROVIRAL THERAPY | COUNSELING | SIDE EFFECTS | SIGNS AND SYMPTOMS | Africa, Central | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Studies | Demographic Factors | Population | Physiology | Biology | HIV Infections | Viral Diseases | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Clinic Activities | Program Activities | Programs | Organization and Administration Document Number: 342755 |
| 26. Title: Reproductive health-care provision in emergencies: preventing needless suffering. Author: van Min M Source: Forced Migration Review. 2009 Apr;(32):68-69. Abstract: This article discusses the need for comprehensive reproductive health services in all situations to prevent unnecessary deaths. It opens with a gripping story of a woman in birth reaching a hospital too late and not equipped with the proper supplies. It argues that not enough emphasis is placed on RH supplies and services and talks about solutions to overcome these challenges. Language: English Keywords: DEMOCRATIC REPUBLIC OF THE CONGO | RESEARCH REPORT | EQUIPMENT AND SUPPLIES | REPRODUCTIVE HEALTH | CLINICAL DISTRIBUTION | EMERGENCY SERVICES | MATERNAL HEALTH | LOGISTICS | PREVENTION AND CONTROL | DELIVERY OF HEALTH CARE | Developing Countries | Africa, Central | Africa, Sub Saharan | Africa | Medical Procedures | Medicine | Health Services | Health | Distributional Activities | Program Activities | Programs | Organization and Administration | Management | Diseases Document Number: 340195 |
| 27. Peer Reviewed Title: Rwanda 2005: Results from the Demographic and Health Survey. Source: Studies in Family Planning. 2008 Jun;39(2):147-152. Abstract: The Rwanda Demographic and Health Survey 2005 (RDHS-III) was conducted by the Institut National de la Statistique du Rwanda (INSR) with technical assistance from ORC Macro. Data for the nationally representative RDHS-III were collected from 10,272 households, and complete interviews were conducted with 11,321 women aged 15-49 and 4,820 men aged 15-59. The fieldwork took place from 28 February to 13 July 2005. The summary statistics presented below were taken from the Rwanda country report,1 with exceptions as noted. (excerpt) Language: English Keywords: RWANDA | TABLES AND CHARTS | DEMOGRAPHIC AND HEALTH SURVEYS | KAP SURVEYS | POPULATION | FERTILITY RATE | DIFFERENTIAL FERTILITY | CONTRACEPTION | FERTILITY PREFERENCES | MARRIAGE PATTERNS | INFANT MORTALITY | NUTRITION INDEXES | HIV PREVENTION | Developing Countries | Africa, Central | Africa, Sub Saharan | Africa | Demographic Surveys | Population Dynamics | Demographic Factors | Surveys | Sampling Studies | Studies | Research Methodology | Birth Rate | Fertility Measurements | Fertility | Family Planning | Marriage | Nuptiality | Mortality | Nutrition | Health | HIV Infections | Viral Diseases | Diseases Document Number: 326976 |
| 28. Title: NGO report on violence against women in Burundi. Executive summary. CEDAW, January 2008. Author: Action des Chretiens pour l'Abolition de la Torture [ACAT Burundi]; Organisation Mondiale Contre la Torture [OMCT] Source: [Bujumbura], Burundi, ACAT Burundi, 2008. 7 p. http://www.omct.org/pdf/VAW/2008/CEDAW40th_Rep_alt_Burundi_fr.pdf (French full report) Abstract: The aim of the report is to show the difficulties faced by thousands of women in Burundi due to the increase of violence against women. It is based on General Recommendation No19 of the Committee that affirms gender-based violence is a prohibited form of discrimination and recommends that States parties: take concrete and efficient measures to eradicate violence against women; ensure sufficient legal protection to all women against every form of gender based violence, including violence within the family, and the respect of their integrity and dignity; establish statistics on the scope, causes and consequences of violence against women and on the efficiency of measures intended to prevent and fight against this kind of violence. Unfortunately, the Government of Burundi has taken few measures to implement this recommendation. (excerpt) Language: English Keywords: BURUNDI | CRITIQUE | RECOMMENDATIONS | EVALUATION | WOMEN IN DEVELOPMENT | POLICYMAKERS | POLICE | DOMESTIC VIOLENCE | VIOLENCE | RAPE | WOMEN'S HEALTH | LEGISLATION | PREVENTION AND CONTROL | LITIGATION | SOCIAL POLICY | Developing Countries | Africa, Central | Africa, Sub Saharan | Africa | Economic Development | Economic Factors | Administrative Personnel | Organization and Administration | Corrections Officers | Government | Political Factors | Sociocultural Factors | Crime | Social Problems | Behavior | Health | Diseases | Policy Document Number: 326332 |
| 29. Title: Achieving the MDGs: the contribution of family planning. Democratic Republic of Congo. Author: Futures Group International. Health Policy Initiative Source: Washington, D.C., Futures Group International, Health Policy Initiative, [2008]. [2] p. Abstract: The Millennium Development Goals (MDGs) -- a set of eight important, timebound goals ranging from reducing poverty by half to providing universal primary education -- represent a blueprint for global development agreed to by member states of the United Nations and international development institutions. However, achieving them will be a major challenge for the Democratic Republic of Congo and many other developing countries that are not "on track" to meet the goals by the target date of 2015. As stated by former United Nations Secretary-General Kofi Annan, it will take time and commitment to mobilize the necessary resources, train the required personnel, and establish the needed infrastructure to meet the MDGs. In the Democratic Republic of Congo and other African countries, one major factor contributing to the challenge is the continued rapid growth of the population. The number of people in need of health, education, economic, and other services is large and increasing, which, in turn, means that the amount of resources, personnel, and infrastructure required to meet the MDGs is also increasing. In light of this fact, development efforts in support of the MDGs should not overlook the importance and benefits of slowing population growth. This brief looks at how one strategy -- meeting the need for family planning -- can reduce population growth and make achieving the MDGs more affordable in the Democratic Republic of Congo, in addition to directly contributing to the goals of reducing child mortality and improving maternal health. Language: English Keywords: DEMOCRATIC REPUBLIC OF THE CONGO | SUMMARY REPORT | GOALS | FAMILY PLANNING | CHILD MORTALITY | MATERNAL HEALTH | POVERTY | NEEDS | DISEASE PREVENTION | EDUCATION | PREVENTION AND CONTROL | Developing Countries | Africa, Central | Africa, Sub Saharan | Africa | Planning | Organization and Administration | Mortality | Population Dynamics | Demographic Factors | Population | Health | Socioeconomic Factors | Economic Factors | Diseases Document Number: 331538 |
| 30. Title: Assessing the impact of scaling-up the Standard Days Method in India, Peru, and Rwanda. Author: Georgetown University. Institute for Reproductive Health. AWARENESS Project Source: Washington, D.C., Georgetown University, Institute for Reproductive Health, 2008 Feb. [225] p. (USAID Cooperative Agreement No. HRN-A-00-97-00011-00) Abstract: This study was designed to assess the impact of integrating the Standard Days Method® (SDM) into existing services in India, Peru, and Rwanda. The method was introduced on a large scale and information was collected for two years through simulated clients, survey statistics, and household surveys in the intervention and control areas. Results of this study will help shape efforts to scale-up the SDM in various countries. The specific objectives of the study were to test the effect of SDM integration on provider behavior, client behavior and community perceptions, attitudes, and practices. The study spanned three years, beginning in the second half of 2004 and ending in early 2007. It was implemented in each country by local research organizations with supervision from the IRH local office and IRH-Washington. The intervention was tailored to each country and involved integrating the SDM into existing public health and family planning services in all facilities in the intervention areas, so that it became one of the family planning options available to couples. Integration included advocating at the national, regional, and local level, making CycleBeads® available in all area facilities, training providers and supervisors to provide the SDM, monitoring and supervising services, and extensive information, education and communication (IEC) activities. In some areas the SDM was also made available in selected non-governmental organizations and private facilities. (excerpt) Language: English Keywords: INDIA | PERU | RWANDA | TECHNICAL REPORT | FERTILITY AWARENESS | FAMILY PLANNING, BEHAVIORAL METHODS | INTEGRATED PROGRAMS | HEALTH SERVICES | NEEDS | PROVIDERS WITH CLIENTS | CLIENT-STAFF RELATIONS | QUESTIONNAIRES | Asia, Southern | Asia | Developing Countries | South America, Western | South America | Latin America | Americas | Africa, Central | Africa, Sub Saharan | Africa | Family Planning | Family Planning, Behavioral Methods | Programs | Organization and Administration | Delivery of Health Care | Health | Economic Factors | Interpersonal Relations | Behavior Document Number: 327613 |
 |
||
 |
Information & Knowledge for Optimal Health (INFO) Project 111 Market Place Suite 310, Baltimore, MD 21202 Phone: 410-659-6300 Fax: 410-659-6266 Security & Privacy Policy |  |