Background: Stunting is one of the most public health burdens in Rwanda. Most deaths due to stunting are associated with inappropriate feeding practices that occur in the first 5 years of life. This study aimed at determining the risk factors for stunting in children under 5 years of age in the Eastern and Western provinces of Rwanda. Method: Cross-sectional study using secondary data from Rwanda Demographic Health Survey 2014/2015. Results: Stunting was highly prevalent in eastern province compared to Western province. It was also highly prevalent in rural area in both provinces. Results indicated a significant association between maternal education and stunting (x²<![CDATA[${x^2}$]]>=6.868; p=0.001), maternal age group (x²<![CDATA[${x^2}$]]>=15.44; p=0.017), maternal occupation (x²<![CDATA[${x^2}$]]>=30.012; p=0.000), wealth index (x²<![CDATA[${x^2}$]]>=14.327; p=0.006), sex of child (x²<![CDATA[${x^2}$]]>=2.91; p=0.008) and giving child fortified food (x²<![CDATA[${x^2}$]]>=4.256; p=0.039). Results indicated that antenatal care visits were significantly associated with stunting (x²<![CDATA[${x^2}$]]>=6.653; p=0.01). Sharing a toilet was significantly associated with stunting (x²<![CDATA[${x^2}$]]>=25.88; p=0.000). Multiple logistic regression indicated that the gender of child [OR=1.08; 95% CI (1.057–1.093), p=0.008], household wealth index [OR=0.386; 95% CI (0.357–0.414)] and breastfeeding [OR=0.02; 95% CI (0.004–0.036), p=0.013] were the risk factors of stunting in eastern and western provinces. Conclusion: Immediate and appropriate interventions targeted at community management of acute malnutrition and stunting are needed to manage the associated morbidity and mortality. Strengthening the health system for improving child health through prioritizing maternal and child by addressing poverty and increase food access is mostly needed. These tactics yield more sustainable improvement in child nutrition within Eastern and Western provinces.

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

Background: Risky sexual behaviors (RSBs) remain public health concerns in adolescents from sub-Saharan Africa (SSA), and these practices may increase vulnerability to reproductive health problems if no early healthcare strategies are implemented. While previous studies reported that adolescents are engaged in these RSBs due to diverse influences such as the teenage stage, urbanization, and change in the environment they experience, there is a shortage of studies on RSB among adolescents in SSA. This study assessed the magnitude of RSBs and the RSB-associated factors among in-school adolescents.Methods: School-based cross-sectional study was conducted among 263 Saint Andre school students in Kigali, Rwanda, from July 3, 2020, to September 30, 2020. Systematic random sampling techniques were employed. All data were entered into Epi-Data and analyzed using SPSS version 25. Chi-square tests and multivariable logistic regression analyses were applied to determine factors associated with risky sexual behaviors. Confidence intervals (CIs) of 95% and 5% for statistical significance were maintained.Results: Of 263 participants, 109 (41%) experienced RSB in their lifetime. Among them, 66 respondents (60.55%) utilized contraceptive methods to prevent sexual and reproductive problems that can be caused by unprotected sexual intercourse. The students who experienced domestic violence had increased odds of experiencing RSB [odds ratio (OR) = 4.22; 95% CI: 1.6–11.23] than their counterparts. Those in grade 11 (OR = 2.68; 95% CI: 1.06–6.78) and grade 12 (OR = 4.39; 95% CI: 1.82–10.56) were more likely to practice RSB than those in grade 10. Alcohol users were almost more likely to experience RSB (OR = 3.9; 95% CI: 1.97–5.5) than their counterparts. Those who lived away from their biological parents had higher likelihood of experiencing RSB (OR = 2.5; 95% CI: 1.14–4.42) than those who lived with one or both parents. Students who experienced peer pressure were more likely to engage in RSB (OR = 3.9; 95% CI: 2.01–7.51) than their counterparts.Conclusion: Promoting specific intervention programs built upon the factors associated with RSB among high school students needs to be prioritized.

Background: The practice of Pharmacists has changed worldwide over the past years. Today, health promotion is better known as an important part of modern pharmacy practice. Involving Community Pharmacists in health promotion is thus considered a valuable option in addressing public health issues. However, the literature on this practice remains unsubstantiated in African countries. In Rwanda, Community Pharmacists are believed to be solely involved in dispensing and very little has been studied about their role in health promotion. Thus, this study aimed to evaluate attitudes, perceptions, and barriers of Community Pharmacists in Rwanda towards their involvement in health promotion. Methods: A cross-sectional study was conducted among 236 licensed Community Pharmacists in Rwanda from 23rd January to 23rd June, 2021. A list of all respondents was obtained from Rwanda Food and Drugs Authority. All participants were randomly enrolled. Each community pharmacy was represented by one Pharmacist. We collected data from community pharmacy settings using a self-administered questionnaire made of close and open-ended questions. Statistical analyses were performed using Statistical Packages for Social Sciences (SPSS) version 25. Results: Of the 236 respondents, (n = 149, 63.1%) were male and (n = 87,37%) were female. The average age was 38.1 years (SD = 4.3). More than half confirmed that professional curriculum is adequate for offering health promotion services (n = 152, 64.4%).Majority responded that health promotion is part of their responsibility, and they are willing to provide health promotion services (n = 233,98.7%).The statement that “Pharmacists should not be involved in public health activities “was opposed by many (n=174,73.7%).The most sought-after service provided was education to drug misuse (n=211, 89.4%).Three major barriers to provision of health promotion were: lack of coordination with other healthcare professionals(n=106,69%),structure of healthcare system (n=157,67%),and lack of equipment (n=144,61%).Most Pharmacists disagreed with the statement that “patients are not interested in getting health promotion services”(n = 134,57%). Conclusion: Though Community Pharmacists faced several challenges that hindered their participation in health promotion, they had positive attitudes towards promoting public health messages. There are several barriers like lack of structure to provide health promotion services that need to be addressed to boost more active participation of Pharmacists in health promotion.

Background: Although HIV pre-exposure prophylaxis (PrEP) is known for its effectiveness in preventing HIV transmission; there is a global rise in HIV infection rates, particularly prominent in sub-Saharan Africa. This health concern is mostly evident among high-risk groups, namely Female Sex Workers (FSWs) and Men who have Sex with Men (MSMs), both of whom are more susceptible to sexually transmissible infections. This research examined the persistence, uptake, and associated predictors of PrEP utilization within the FSW and MSM populations. Methods: A cross-sectional study design was conducted involving 4872 individuals from the FSW and MSM groups who were enrolled in a PrEP program across 10 health centers participating in a pilot initiative. The study population was subject to a year-long follow-up period commencing on March 1st, 2019. To evaluate the determinants of PrEP utilization within FSW and MSM groups, bivariate logistic analyses and multivariate logistic regression models were employed. Results: The findings revealed that the occurrence of PrEP uptake was 45.55% (n=2219) among FSWs and 35.42% (n=17 participants) among MSM. Regarding PrEP persistence, MSM (88.24%, n=15 participants) presented higher PrEP proportion than FSWs (78.5%, n=1742 women). Our findings disclosed that individuals aged 25– 34 years (aOR=0.82; 95% CI=0.72– 0.93, p=0.002), 35– 44 years (aOR=0.83; 95% CI=0.71– 0.97, p=0.017), and 55 years and older (OR=0.14; 95% CI=0.04– 0.48, p=0.002) exhibited lower likelihoods of having low PrEP uptake than those aged 15– 19 years. Moreover, individuals residing with their families (aOR=0.71; 95% CI=0.58– 0.87, p< 0.001), living with roommates (aOR=0.7; 95% CI=0.5– 0.97, p=0.032) displayed lower odds for experiencing low PrEP uptake than their counterparts living alone. Conclusion: This study highlighted the low uptake of PrEP among participants when compared to previous studies. These results revealed significant influences of age and living conditions on PrEP usage.

Mental health among survivors of the 1994 Tutsi genocide in Rwanda remains poor, even after multiple efforts to assist those recovering from this trauma. The Community Resilience Model (CRM) is a biologically based set of skills that can be delivered in community settings by trained lay persons and has shown to significantly improve mental health in a number of settings and populations, though it has not been used with genocide survivors in Rwanda. This study assessed if the CRM training was able to improve mental health among genocide survivors. A quasi-experimental design was used to evaluate the CRM intervention among Tutsi genocide survivors from the Huye, Nyamagabe and Nyaruguru districts in Southern Rwanda. Consenting participants completed a questionnaire before and six months after the training to assess their level of trauma, secondary traumatic stress, depression and skills to teach CRM skills to others. The findings revealed significant improvements across all trauma symptoms between the intervention and control group (t = 37, p<0.001). The CRM trainings also resulted in significant within-person declines of depressive symptoms (p < 0.001), perceived secondary traumatic stress (p = 0.003) and trauma-related symptoms (p = 0.002). Training participants also reported significant increases in perceived CRM benefits and satisfaction (p < 0.001). The CRM intervention was found to be effective for improving mental health in 1994 Tutsi genocide survivors. Since CRM can be delivered by trained persons to groups of persons in community settings, it has a high potential for successful broader implementation and sustainability, which is critically important in an environment with few mental health resources.