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Background: Leeches are hermaphroditic rare blood-sucking human endoparasitesof phylum Annelida and class Hirudinea. Leech infestation is a zoonotic disease acquired by drinking contaminated water, swimming in ponds and streams .1Epidemiology of leech bites in literature is limited and the majority of existing data are case reports from the tropics or subtropics.2–4 Leech bites can occur on various orifices of the body including internal body cavities and orifices, such as the uterus, rectum, urinary bladder, vulva, nasal cavity, peritoneal cavity, nasopharynx, oropharynx, oesophagus, trachea, bronchi and the vagina.5 Different chemicals for leech removal have been utilized and include anesthetics drugs like lidocaine and topical anesthetic spray. Salt, saline, vinegar, alcohol, and heat are also viable options. Of these, saltwater has been shown to be effective in causing the leech to relax and release.Vaginal bleeding resulting from leech bite is rare, but when it occurs, it may be of severe morbidity.2–4 In the present case report that happened at Kabaya district hospital, a six year old child with vaginal bleeding that turned out to be caused by vaginal leech infestation is presented. Kabaya district hospital is a rural hospital with 144-bed capacity and serves 188,902 inhabitants and is geographically difficult to access due to the lack of reliable roads and bridges, especially in the rainy season.

Background: The 2019-20 Rwanda demographic health survey revealed an overall use of modern contraceptives of 58% but participants were not likely to use family planning in the postpartum period. Three quarters of participants intended to use contraception only after they had resumed menses and not breastfeeding. This study intended to measure post-abortion contraception uptake and to evaluate factors affecting immediate post abortion contraception uptake among patients consulting two public hospitals in Kigali, Rwanda. Methods: This is an observational cross-sectional study of women admitted for abortion in 2 hospitals’ obstetric units in Kigali; the University Teaching Hospital of Kigali (CHUK) and Muhima District Hospital (MH) from November 2019 to April 2020. Admission registry was accessed daily to determine abortion admissions. After informed consent, participants underwent a standardised interview prior to their discharge from respective hospital. Results: There were 252 participants over 6 months; 88.5% were counselled for post-abortion contraception and 52% desired contraception prior to hospital discharge. Upon discharge, 70.2% of the study participants who wished immediate post abortion contraception received it before discharge and 29.8% had no contraception despite having expressed interest for immediate post abortion contraception. Being married and involving husband in choosing post-abortion contraception were significantly associated with use of post-abortion contraception. Conclusion: Post-abortion contraception uptake in 2 large public hospitals in Kigali remains low. Being married and involving husband in choosing post-abortion contraception are positive factors associated with post-abortion contraception uptake while choosing a permanent contraception is associated with not receiving any contraception at the time of discharge from hospital. There is a need to consider prescribing an alternative interim methods of contraception to women desiring permanent sterilisation.