Tracheostomy is a lifesaving, essential procedure performed for airway obstruction in the case of head and neck cancers, prolonged ventilator use, and for long-term pulmonary care. While successful quality improvement interventions in high-income countries such as through the Global Tracheostomy Collaborative significantly reduced length of hospital stay and decreased levels of anxiety among patients, limited literature exists regarding tracheostomy care and practices in low and middle-income countries (LMIC), where most of the world resides. Given limited literature, this scoping review aims to summarize published tracheostomy studies in LMICs and highlight areas in need of quality improvement and clinical research efforts. Based on the PRISMA guidelines, a scoping review of the literature was performed through MEDLINE/PubMed and Embase using terms related to tracheostomy, educational and quality improvement interventions, and LMICs. Publications from 2000–2022 in English were included. Eighteen publications representing 10 countries were included in the final analysis. Seven studies described baseline needs assessments, 3 development of training programs for caregivers, 6 trialed home-based or hospital-based interventions, and finally 2 articles discussed development of standardized protocols. Overall, studies highlighted the unique challenges to tracheostomy care in LMICs including language, literacy barriers, resource availability (running water and electricity in patient homes), and health system access (financial costs of travel and follow-up). There is currently limited published literature on tracheostomy quality improvement and care in LMICs. Opportunities to improve quality of care include increased efforts to measure complications and outcomes, implementing evidence-based interventions tailored to LMIC settings, and using an implementation science framework to study tracheostomy care in LMICs.

Objective: This scoping review aims to contribute a descriptive analysis of the craniomaxillofacial trauma (CMF trauma) literature in low‐ and middle‐income countries (LMICs) to identify knowledge gaps, direct future research, and inform policy.Data Sources: PubMed/MEDLINE, Cochrane Review, EMBASE, ClinicalTrials.gov, and Google Scholar from January 1, 2012 to December 10, 2023.Review Methods: The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses Extension for Scoping Reviews (PRISMA‐ScR) guided reporting, and the PRISMA flowchart documented database searches. Specific, predefined search terms and inclusion criteria were used for screening, and the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist was used for quality assessment. The search yielded 54 articles, with 13 meeting the inclusion criteria. Key findings were summarized and divided into 7 categories.Results: There were 10,420 patients (7739 [74.3%] male, 2681 [25.7%] female) with a male‐to‐female ratio of 2.9:1. The mean peak age of incidence of CMF trauma was 30.8 years, ranging from 20 to 40 years. Road traffic accidents were the leading cause (60.4%), followed by assault (27.2%) and falls (12.2%). The most common injuries were soft tissue injury (31.7%), isolated mandibular fracture (22.8%), and isolated middle‐third of mandible fracture (18.1%). The most common treatments were closed reduction and immobilization (29.5%), conservative management (27.6%), and open reduction and internal fixation (19.6%). Most patients (77.8%) experienced a treatment delay due to a lack of fixation materials (54.8%) or surgeon unavailability (35.7%).Conclusion: CMF trauma remains a significant cause of global morbidity, yet there remains a lack of high‐quality, CMF trauma‐specific data in LMICs. Country‐specific investigations are required to enhance knowledge and inform novel interventions. Implementing policy change must be community‐specific and account for unique cultural barriers, attitudes, and behaviors to maximize patient care outcomes.

Background Deep neck space infection (DNSI) mostly arise from the local extension of dental, tonsils and parotid gland infections. Early diagnosis and management is the key to avoid associated complications. Objective Our study aimed at evaluating the clinical presentation and factors related to complications of DNSIs at the University Teaching Hospital of Kigali. Methods This cross-sectional study was conducted at the University teaching hospital of Kigali from September 2017 to November 2018. It enrolled 66 participants. Patient information was recorded using a questionnaire and analyzed using Epidata 3.1 software. The data were processed using SPSS 16.0. Comparison of categorical variables were performed using the chi-square test. Associations with p-values=0.05 were considered statistically significant. Results Males accounted for 35 (53%) of DNSIs. The majority (97%) presented with neck pain and 21% with a history of tooth extraction. The submandibular space was the most involved in 33 (50%) cases. The average duration of symptoms at presentation was 11 days. Delayed consultation and advanced age (>40years) were associated with complications and hospital stay with (p value=0.022) and (p=0.015) respectively. Conclusion Neck pain on background of tooth extraction is the most common presentation of patients with DNSIs. Delayed presentation and advanced age are central factors for complications and longer hospital stay. Rwanda J Med Health Sci 2021;4(1):8-19

Background: Over three-quarters of the people living with hearing impairment (HI) live in low- and middle-income countries. However, Rwanda has limited data on the clinical profile of HI. Aim: We used community-based nationwide recruitment of participants to determine the etiology of early-onset (<7 years of age) HI in Rwanda. Methods: Participants were included after clinical examination, including audiological assessment by pure tone audiometry and/or auditory brainstem response. DNA was extracted from peripheral blood, and the entire coding region of GJB2 was interrogated using Sanger sequencing. Multiplex PCR and Sanger sequencing were used to analyze the prevalence of the GJB6-D3S1830 deletion. Results: The participants were recruited from seven inclusive schools, one university teaching hospital, and four independent communities nationwide. We reviewed the clinical histories of 422 individuals affected by early-onset HI from 348 families and found that 21.18% (n = 89/422) was linked to early childhood meningitis infection while 51.23% (n = 216/422) was categorized as unknown HI etiology. Because of putative genetic causes, 82/348 (23.6%) families were reviewed and identified for genetic testing. Within the 82 families with potential genetic causes, 122 individuals were affected by HI, and 205 were unaffected. The male/female ratio of those enrolled for genetic investigations was 0.79 (n = 145/182). The mean age of diagnosis of HI was 4.3 ± 2.6 years. Most cases (89.36%, n = 109/122) reviewed were prelingual. Pedigree analysis suggested autosomal recessive inheritance in 46.3% (n = 38/82) of families. Most HI participants from familial cases had nonsyndromic HI (94.2%, n = 115/122). Waardenburg syndrome was found in three participants out of seven participants who presented with syndromic HI, while three other participants manifested signs of Usher syndrome and one with suspected Noonan syndrome. Molecular analysis did not find pathogenic variants in GJB2 or GJB6-D3S1830 deletion in any of the probands tested (n = 27/122; 22.13%) or 100 non-affected control participants. Conclusions: This study revealed an overall late diagnosis (mean at 4.3 years) of HI in Rwanda. Most cases were of unknown origin or putative environmental origin (76.4%), with meningitis predominating as the acquired cause of early-onset HI. Among cases of putative genetic etiology, nonsyndromic HI accounted for the large majority (94.2%). However, GJB2 and GJB6 pathogenic variants were not identified in the screened proportion of the cohort. This study calls for the implementation of neonatal hearing screening as well as reinforcement of immunization programs to reduce the burden of acquired early-onset HI in Rwanda. Additional genomic studies, ideally using exome sequencing for familial cases, are needed.

Introduction: The COVID-19 pandemic significantly disrupted global healthcare, with Rwanda reporting 133,078 cases and 1,468 deaths by January 2023. Lockdowns, healthcare worker shortages, and resource reallocation affected surgical care. This study evaluates the impact of COVID-19 and lockdown measures on surgical outpatient consultations, procedural volumes, and inpatient outcomes in Rwanda. Methods: A retrospective, multicentre cross-sectional study was conducted across 22 hospitals, covering university teaching, referral, provincial, district, and private facilities. Data were extracted from hospital records for two periods: pre-pandemic (March 2019–February 2020) and pandemic (March 2020–February 2021). Lockdown phases were classified into country-wide and district-specific restrictions. Primary outcomes included outpatient consultation volumes, surgical procedures, and inpatient metrics (ICU admissions, length of stay, mortality, and transfers). Statistical analysis used general linear models to adjust for confounders. Results: The study included 507,627 surgical outpatients and 68,701 inpatients. While total outpatient consultations increased slightly during the pandemic year (264,114 vs. 243,513 pre-pandemic), consultations dropped by 39% during country-wide lockdowns. The total number of surgical procedures remained stable (34,192 vs. 34,509 pre-pandemic), though emergency surgeries declined. Surgical volumes decreased during district lockdowns but increased slightly during national lockdowns. ICU admissions were lower (0.6% vs. 0.9%), while hospital length of stay remained largely unchanged. Surgical patient mortality decreased from 0.66% to 0.36%, with a decline in interhospital transfers, particularly from district hospitals. Conclusion: Despite pandemic-related disruptions, Rwanda’s surgical service delivery remained resilient, likely due to proactive public health measures and resource management. While lockdowns affected surgical access, overall surgical volumes and patient outcomes were preserved. These findings highlight the importance of strategic planning in maintaining essential surgical care during health crises.