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Geographical Locations - Rwanda
 The WWW Virtual Library: Public Health
Categories
Country Information
- (Statistical) Number of Inhabitants per Doctor: 40,610
- CIA World Factbook : Rwanda
Organisations and Networks
UN and Multinational
Government
Non-Government
- Care in Rwanda
CARE International projects in Rwanda include STD/AIDS prevention, water systems, rehabilitation and community management of water systems, health education, agroforestry and sustainable land use management, community assisted shelter projects and promotion of women's agricultural production.
- IRC Rwanda
Founded in 1933, the International Rescue Committee is a world leader in relief, rehabilitation, protection, post-conflict development, resettlement services and advocacy for those uprooted or affected by violent conflict and oppression. This site outlines IRC activities in Rwanda.
- Médecins Sans Frontières MSF in Rwanda
Médecins Sans Frontières is the world’s leading independent humanitarian organisation for medical aid. Anually, some 3,000 volunteer doctors, nurses and support staff work in trouble spots around the world helping those living on the edge of human tolerance. This site provides information on MSF's involvement in Rwanda.
Academic Institutions
- Universite Nationale du Rwanda
The primary mission of the University of Rwanda is to provide the country with the badly needed skilled manpower for the reconstruction effort. With a population of 7,609 students, the University offers basic subjects in Science and Technology, Social Sciences, Arts and Humanities.
- National University of Rwanda School of Public Health
The National University of Rwanda School of Public Health provides both postgraduate and undergraduate training in public health in order to provide experienced health officers with the competencies needed for planning, managing and assessing health services.
National Policy and Related Documents
Reports, Guidelines, and Projects
- Associations between maternal experiences of intimate partner violence and child nutrition and mortality: findings from Demographic and Health Surveys in Egypt, Honduras, Kenya, Malawi and Rwanda
Background: If effective interventions are to be used to address child mortality and malnutrition, then it is important that we understand the different pathways operating within the framework of child health. More attention needs to be given to understanding the contribution of social influences such as intimate partner violence (IPV). Aim: To investigate the relationship between maternal exposure to IPV and child mortality and malnutrition using data from five developing countries. Methods: Population data from Egypt, Honduras, Kenya, Malawi and Rwanda were analysed. Logistic regression analysis was used to generate odds ratios of the associations between several categories of maternal exposure to IPV since the age of 15 and three child outcomes: under-2-year-old (U2) mortality and moderate and severe stunting (<-2 Z-score height-for-age and <-3 Z-score height-for-age) in 6e59-month-old children. Analyses were adjusted for potential confounders, and the role of mediating factors was explored. Results: The prevalence of physical and/or sexual IPV since the age of 15 years ranged from 15.5% (Honduras) to 46.2% (Kenya). For child stunting, prevalence ranged from 25.4% (Egypt) to 58.0% (Malawi) and for U2 mortality from 3.6% (Honduras) to 15.2% (Rwanda). In Kenya, maternal exposure to IPV was associated with higher U2 mortality (adjusted odds ratio (OR)=1.42, 95% CI 1.18 to 1.71) and child stunting (adjusted OR=1.36, 95% CI 1.16 to 1.61). In Malawi and Honduras, marginal associations were observed between IPV and severe stunting and U2 mortality, respectively, with strength of associations varying by type of violence. Conclusion: The relationship between IPV and U2 mortality and stunting in Kenya, Honduras and Malawi suggests that, in these countries, IPV plays a role in child malnutrition and mortality. This contributes to a growing body of evidence that broader public health benefits may be incurred if efforts to address IPV are incorporated into a wider range of maternal and child health programmes; however, the authors highlight the need for more research that can establish temporality, use data collected on the basis of the study’s objectives, and further explore the causal framework of this relationship using more advanced statistical analysis. [author abstract] [J Epidemiol Community Health (2010), jech.2008.081810 - Published Online: 14 September 2010]
- Availability and use of emergency obstetric services: Kenya, Rwanda, Southern Sudan, and Uganda
The article summarises the baseline assessments of emergency obstetric care (EmOC) carried out in Uganda, Kenya, Southern Sudan, and Rwanda in 2003 and 2004. Objectives: Our objectives were to: (1) set up program baselines on the availability and utilization of EmOC services in these countries; (2) identify gaps and obstacles in providing EmOC services; and (3) make recommendations to governments based on evidence generated. Methods: Data were collected from clinical record reviews, provider and client interviews, observations, and focus group discussions. Either random or universal sampling was applied in the selection of health facilities assessed. Local nurses and midwives participated in the data collection and, to some extent, data processing and analysis. Results: The coverage of basic EmOC services ranged 0—1.1/500,000 population compared to the UN-recommended level of 4/ 500,000. The coverage of comprehensive EmOC services ranged 0.5—4.3/500,000 compared to the recommended level of 1/500,000. Between 0.6% and 8.8% of all births took place in EmOC facilities, and 2.1% and 18.5% of all expected direct obstetric complications were treated. Cesarean section as a proportion of all births was between 0.1% and 1%. Shortage of trained staff especially mid-level providers, poor basic infrastructure such as lack of electricity and water supplies, inadequate supply of drugs and essential equipment, poor working conditions and staff morale, lack of communication and referral facilities, cost of treatment, and lack of accountability and proper management were identified as the main obstacles in providing 24-h quality EmOC services especially in remote and rural areas. Conclusions: Lack of basic EmOC services limits women’s access to life-saving services during obstetric complications. To reduce maternal mortality ratio the states and development partners need to focus their effort to improve the coverage, quality, and utilization of EmOC services through supportive national policy, effective program strategies, increased budget allocation to maternal health program, rural infrastructure development, and regular monitoring, and evaluation of progress. [author abstract] [International Journal of Gynecology and Obstetrics (2005) 88, 208-215]
- Child Survival and the Fertility of Refugees in Rwanda after the Genocide
In the 1960s and 1990s, internal strife in Rwanda has caused a mass flow of refugees into neighbouring countries. This article explores the cumulated fertility of Rwandan refugee women and the survival of their children. To this end, we use a national survey covering 6420 former refugee and non-refugee households conducted between 1999 and 2001. The findings support old-age security theories of reproductive behaviour: refugee women had higher fertility but their children had lower survival chances. Newborn girls suffered more than boys, suggesting that the usual sex differential in child survival observed in most populations changes under extreme living conditions. [author abstract] [European Journal of Population, 21: 271–290]
- Delivering Antiretroviral Therapy in Resource Constrained Settings: Lessons from Kenya, Ghana and Rwanda
This document is intended for governments, development partners, and public and private health facilities seeking to integrate antiretroviral therapy (ART) into existing HIV services. It describes lessons learned from a Family Health International pilot project establishing ART sites in Ghana, Kenya, and Rwanda.
- Integrating Population, Health, and Environment in Rwanda
"Rwanda faces various challenges, many related to the complex relationships between population trends, poverty, and environmental conditions. Rapid population growth and the resultant dwindling landholdings, for example, have pushed more people onto landscapes poorly suited for agriculture, grazing, and settlement, such as steep hillsides and urban watersheds. As a result, an increasing number of households are vulnerable to food shortages and water scarcity and are more susceptible to disease and poor health. Thus, continued improvement in the quality of life of Rwanda’s citizens depends in large part on finding innovative and integrated solutions to complex population, health, and environment problems. Fortunately, the links between population, health, and environment are now largely recognized by policymakers in Rwanda, especially since the end of the transition period in 2003. Indeed, almost all of Rwanda’s national-level policies acknowledge the need for cross-sectoral collaboration in order to effectively address the complex problems and issues currently facing the country. In practice, however, institutional coordination and integrated planning and program implementation are happening slowly and sporadically, with few projects and programs to date successfully integrating cross-sector initiatives." [Population Reference Bureau Policy Brief, February 2009]
- Promotion of couples' voluntary counselling and testing for HIV through influential networks in two African capital cities
Background: Most new HIV infections in Africa are acquired from cohabiting heterosexual partners. Couples' Voluntary Counselling and Testing (CVCT) is an effective prevention strategy for this group. We present our experience with a community-based program for the promotion of CVCT in Kigali, Rwanda and Lusaka, Zambia. Methods: Influence Network Agents (INAs) from the health, religious, non-governmental, and private sectors were trained to invite couples for CVCT. Predictors of successful promotion were identified using a multi-level hierarchical analysis. Results: In 4 months, 9,900 invitations were distributed by 61 INAs, with 1,411 (14.3%) couples requesting CVCT. INAs in Rwanda distributed fewer invitations (2,680 vs. 7,220) and had higher response rates (26.9% vs. 9.6%), than INAs in Zambia. Context of the invitation event, including a discreet location such as the INA's home (OR 3.3–3.4), delivery of the invitation to both partners in the couple (OR 1.6–1.7) or to someone known to the INA (OR 1.7–1.8), and use of public endorsement (OR 1.7–1.8) were stronger predictors of success than INA or couple-level characteristics. Conclusion: Predictors of successful CVCT promotion included strategies that can be easily implemented in Africa. As new resources become available for Africans with HIV, CVCT should be broadly implemented as a point of entry for prevention, care and support. [author abstract] [BMC Public Health 2007, 7:349]
- Rwanda: Introducing the Standard Days Method into Public, Private and Church Based Services
The Institute for Reproductive Health, Georgetown University collaborated with INTRAH/ PRIME II and Rwanda’s Ministry of Health to introduce the Standard Days Method* (SDM) into 13 sites, including 7 public health clinics, 5 clinics run by religious organizations and one IPPF affiliate. One year after introducing the SDM, a qualitative assessment was conducted to learn about SDM acceptance among clients and providers. The study found that in all sites, the SDM was well accepted and in high demand. Almost all users found the method easy to use and liked it because it has no side effects and is compatible with their religious beliefs. They also liked the fact that the method did not require frequent visits to the health center and that it offered them an easy to use natural method for spacing births. An overwhelming majority of couples managed the fertile days by abstaining or using a condom. Male involvement played a key role in the successful use of the method. Use of the SDM helped improve communication and mutual trust among couples. Providers’ experiences were also very positive, though finding the time to offer SDM counseling was challenging. Service data showed that 96% of the women who accepted the SDM were first time users of family planning and that only 4.6% of women discontinued use of the method. [author abstract] [Institute for Reproductive Health, Georgetown University, no date]
- Sharing the burden of sickness: mutual health insurance in Rwanda
"Mandatory participation in mutual health insurance schemes and public subsidies for the poor have led to considerable improvement in public health and health care in Rwanda, but even at US$ 2 a year, the price for some members of the population remains prohibitively high." [Bulletin of the World Health Organization, November 2008, 86(11): 823-824]
- Strengthening the psychosocial well-being of youth-headed households in Rwanda: Baseline findings from an intervention trial
"For children in Rwanda, the combined effects of the 1994 genocide and the HIV/AIDS pandemic have been devastating, resulting in one of the world’s highest percentages of orphans among children 17 years or younger (17 percent) (UNAIDS, UNICEF, and USAID 2004). There are also large numbers of child-headed households—with estimates ranging from 65,000 to 227,500—leaving many children living without adult care and supervision (Human Rights Watch 2003). These young people are “left behind,” not only by parents and other caregivers who have died, but also by extended families, communities, formal structures, and the government who fail to adequately provide for their protection and care… To respond to this gap, Tulane University School of Public Health, Rwanda School of Public Health, World Vision Rwanda (WVR), and the Horizons Program formed a partnership to assess the impact of participation in an adult mentorship program on the psychosocial well-being of youth living in Gikongoro province of Rwanda and of the adult mentors. In addition, the study aims to develop, pilot, and refine a reliable and valid instrument to assess community-based psychosocial interventions. This report presents key findings from the baseline data collected as part of this collaborative project." [Horizons Research Update, Population Council, 2005]
- Towards Universal Health Coverage in Rwanda: Summary Notes from Briefing by Caroline Kayonga (Permanent Secretary, Ministry of Health, Rwanda)
"The government implemented user-fees in 1994 to supplement meager health center budgets. However, a survey in 2001 found that utilization of primary care declined to just 23% of the population, and health outcomes were deteriorating, with HIV/AIDS and other infectious disease burdens on the rise. The decline in utilization and health indicators was attributed to high user-fees for primary-, secondary-, and tertiary-level care… To increase utilization and improve health outcomes, the ministry of health decided in 2001 that changes would have to be made to the overall vision for the nation’s healthcare. This new vision was comprised of three pillars: (i) Investment in strong prevention interventions of major diseases: Prevention services should be delivered free-of-charge to the entire population; (ii) Access to curative care through voluntary, pre-paid health insurance: Curative care will be accessible to Rwandan citizens via voluntary, community-based health insurance schemes; [and] (iii) Performance based financing to improve quality of care: All entities involved in health care and insurance delivery and management will engage in performance-based contracts and financing to encourage high quality of care. This national-level strategy was supported by district-level governing bodies, as well as sector- and local-level government and organizations. In addition, development partners and faith-based organizations played a role in supporting (via financing and service delivery) the ministry’s vision." [Brookings Institution, October 2007]
- United Nations General Assembly Special Session on HIV/AIDS – Country Report: Rwanda
"The most recent Rwanda Demographic and Health Survey (RDHS) was conducted in 2005. In this nationally representative population-based survey, adult HIV prevalence was found to be 3.0% (95% CI 2.6-3.4). According to the national estimates (through the Spectrum software), the total number of people currently living with HIV in Rwanda is 150,347 (2007). At the time of the RDHS in 2005, great variation was observed between urban areas (7.3%) and rural areas (2.2%). In spite of the differences by location at that time, given the high population density in Rwanda and the relative ease of movement within this small country, the 83% rural population is at risk of increased infection due to frequent contact with people in urban areas. Substantial differences in prevalence were also found between men and women. HIV prevalence among men was 2.3% while HIV prevalence among women was 3.6%."
Educational Resources
Original website founded Lucien E. Schlosser and Eberhard Wenzel, 1997.
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