IntroductionCOVID-19 has shown an exceptionally high spread rate across and within countries worldwide. Understanding the dynamics of such an infectious disease transmission is critical for devising strategies to control its spread. In particular, Rwanda was one of the African countries that started COVID-19 preparedness early in January 2020, and a total lockdown was imposed when the country had only 18 COVID-19 confirmed cases known. Using intensive contact tracing, several infections were identified, with the majority of them being returning travellers and their close contacts. We used the contact tracing data in Rwanda for understanding the geographic patterns of COVID-19 to inform targeted interventions.MethodsWe estimated the attack rates and identified risk factors associated to COVID-19 spread. We used Bayesian disease mapping models to assess the spatial pattern of COVID-19 and to identify areas characterised by unusually high or low relative risk. In addition, we used multiple variable conditional logistic regression to assess the impact of the risk factors.ResultsThe results showed that COVID-19 cases in Rwanda are localised mainly in the central regions and in the southwest of Rwanda and that some clusters occurred in the northeast of Rwanda. Relationship to the index case, being male and coworkers are the important risk factors for COVID-19 transmission in Rwanda.ConclusionThe analysis of contact tracing data using spatial modelling allowed us to identify high-risk areas at subnational level in Rwanda. Estimating risk factors for infection with SARS-CoV-2 is vital in identifying the clusters in low spread of SARS-CoV-2 subnational level. It is imperative to understand the interactions between the index case and contacts to identify superspreaders, risk factors and high-risk places. The findings recommend that self-isolation at home in Rwanda should be reviewed to limit secondary cases from the same households and spatiotemporal analysis should be introduced in routine monitoring of COVID-19 in Rwanda for policy making decision on real time.

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We reported the findings of the first Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) four clusters identified in Rwanda. Case-investigations included contact elicitation, testing, and isolation/quarantine of confirmed cases. Socio-demographic and clinical data on cases and contacts were collected. A confirmed case was a person with laboratory confirmation of SARS-CoV-2 infection (PCR) while a contact was any person who had contact with a SARS-CoV-2 confirmed case within 72 h prior, to 14 days after symptom onset; or 14 days before collection of the laboratory-positive sample for asymptomatic cases. High risk contacts were those who had come into unprotected face-to-face contact or had been in a closed environment with a SARS-CoV-2 case for >15 min. Forty cases were reported from four clusters by 22 April 2020, accounting for 61% of locally transmitted cases within six weeks. Clusters A, B, C and D were associated with two nightclubs, one house party, and different families or households living in the same compound (multi-family dwelling). Thirty-six of the 1035 contacts tested were positive (secondary attack rate: 3.5%). Positivity rates were highest among the high-risk contacts compared to low-risk contacts (10% vs. 2.2%). Index cases in three of the clusters were imported through international travelling. Fifteen of the 40 cases (38%) were asymptomatic while 13/25 (52%) and 8/25 (32%) of symptomatic cases had a cough and fever respectively. Gatherings in closed spaces were the main early drivers of transmission. Systematic case-investigations contact tracing and testing likely contributed to the early containment of SARS-CoV-2 in Rwanda.

Background The World Health Organization declared coronavirus disease 2019 (COVID-19) as a global pandemic on the 11th of March, 2020. Hotels and other public establishments have been associated with higher transmission rates. Sensitisation of staff and strengthening of Infection Prevention and Control (IPC) practices in such settings are important interventions. This study assessed the baseline knowledge and attitudes on COVID-19 among hotels’ representatives in Kigali, Rwanda. Methods A cross-sectional study was conducted among hotels’ staff in Kigali in July 2020. A structured questionnaire was self-administered to 104 participants. Baseline knowledge and attitudes were assessed using a number of pre-test questions and mean scores were used to dichotomise the participants’ responses as satisfactory or unsatisfactory. Results All of the 104 hotels’ staff completed the self-administered questionnaires. Sixty-seven percent (n = 70) were male and 58% (n = 60) were aged between 30 and 44 years. The satisfactory rate of correct answers was 63%±2.4 (n = 66) on knowledge and 68%±1.7 (n = 71) on attitudes evaluation. Participants with University education were more likely to have satisfactory knowledge (AOR: 2.6, 95% C.I: 1.07–6.58) than those with secondary education or less. The staff working in the front-office (AOR: 0.05; 95% CI 0.01–0.54) and housekeeping (AOR: 0.09; 95% C.I: 0.01–0.87) were less likely to have satisfactory attitudes than those working in the administration. Conclusions Hotels’ staff based in the capital of Rwanda have shown satisfactory knowledge and attitudes regarding appropriate IPC practices for preventing the COVID-19 transmission. Educational interventions are needed to improve their knowledge and attitudes for better prevention in this setting.