A retrospective review of the Pediatric Development Clinic implementation: a model to improve medical, nutritional and developmental outcomes of at-risk under-five children in rural Rwanda

Ngabireyimana, Eric; Mutaganzwa, Christine; Kirk, Catherine M.; Miller, Ann C.; Wilson, Kim; Dushimimana, E.; Bigirumwami, Olivier; Mukakabano, Evelyne S.; Nkikabahizi, Fulgence; Magge, Hema

doi:10.1186/s40748-017-0052-2

Cited by 11 publications

(12 citation statements)

References 31 publications

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“…This cross-sectional study targeted patients enrolled in one of five chronic care programs: a) the HIV program; b) the non-communicable diseases (NCD) program, which provides care for patients with type 1 and type 2 diabetes, asthma, hypertension and heart failure; c) the mental health (MH) program, which treats patients with depression and other mental health disorders as well as epilepsy; d) the pediatric development clinics (PDC), which provide clinical and nutritional follow-up to vulnerable children under-5 with developmental delays associated with various conditions, including prematurity, low birth weight and hypoxic ischemic encephalopathy [ 18 ]; and e) the oncology program. The HIV, NCD, and MH programs are currently active in all three districts; the PDC program is active in Kirehe and Kayonza districts whilst the oncology program is located in Burera district.…”

Section: Methodsmentioning

confidence: 99%

Barriers and coping mechanisms to accessing healthcare during the COVID-19 lockdown: a cross-sectional survey among patients with chronic diseases in rural Rwanda

Nshimyiryo¹,

Barnhart

Cubaka³

et al. 2021

BMC Public Health

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Background Large scale physical distancing measures and movement restrictions imposed to contain COVID-19, often referred to as ‘lockdowns’, abruptly and ubiquitously restricted access to routine healthcare services. This study describes reported barriers and coping mechanisms to accessing healthcare among chronic care patients during the nationwide COVID-19 lockdown in Rwanda. Methods This cross-sectional study was conducted among chronic care patients enrolled in pediatric development, HIV/AIDS, non-communicable diseases, mental health, and oncology programs at 3 rural Rwandan districts. Active patients with an appointment scheduled between March–June 2020 and a phone number recorded in the electronic medical record system were eligible. Data were collected by telephone interviews between 23rd April and 11th May 2020, with proxy reporting by caregivers for children and critically ill-patients. Fisher’s exact tests were used to measure associations. Logistic regression analysis was also used to assess factors associated with reporting at least one barrier to accessing healthcare during the lockdown. Results Of 220 patient respondents, 44% reported at least one barrier to accessing healthcare. Barriers included lack of access to emergency care (n = 50; 22.7%), lack of access to medication (n = 44; 20.0%) and skipping clinical appointments (n = 37; 16.8%). Experiencing barriers was associated with the clinical program (p < 0.001), with oncology patients being highly affected (64.5%), and with increasing distance from home to the health facility (p = 0.031). In the adjusted logistic regression model, reporting at least one barrier to accessing healthcare was associated with the patient's clinical program and district of residence. Forty (18.2%) patients identified positive coping mechanisms to ensure continuation of care, such as walking long distances during suspension of public transport (n = 21; 9.6%), contacting clinicians via telephone for guidance or rescheduling appointments (n = 15; 6.8%), and delegating someone else for medication pick-up (n = 6; 2.7%). Of 124 patients who reported no barriers to accessing healthcare, 9% used positive coping mechanisms. Conclusion A large proportion of chronic care patients experienced barriers to accessing healthcare during the COVID-19 lockdown. However, many patients also independently identified positive coping mechanisms to ensure continuation of care - strategies that could be formally adopted by healthcare systems in Rwanda and similar settings to mitigate effects of future lockdowns on patients.

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Section: Methodsmentioning

confidence: 99%

Barriers and coping mechanisms to accessing healthcare during the COVID-19 lockdown: a cross-sectional survey among patients with chronic diseases in rural Rwanda

Nshimyiryo¹,

Barnhart

Cubaka³

et al. 2021

BMC Public Health

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“…In May 2016, a Pediatric Development Clinic (PDC) was established at Kirehe District Hospital through the collaboration of Partners In Health/Inshuti Mu Buzima and the MOH to provide clinical, nutritional, and developmental follow-up to children discharged from the Kirehe District Hospital neonatol care unit (NCU). Detailed information on PDC can be found elsewhere [ 37 ].…”

Section: Methodsmentioning

confidence: 99%

Assessing factors associated with poor maternal mental health among mothers of children born small and sick at 24–47 months in rural Rwanda

Abimana

Karangwa

Hakizimana

et al. 2020

BMC Pregnancy Childbirth

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Background Global investments in neonatal survival have resulted in a growing number of children with morbidities surviving and requiring ongoing care. Little is known about the caregivers of these children in low- and middle-income countries, including maternal mental health which can further negatively impact child health and development outcomes. We aimed to assess the prevalence and factors associated with poor maternal mental health in mothers of children born preterm, low birthweight (LBW), and with hypoxic ischemic encephalopathy (HIE) at 24–47 months of age in rural Rwanda. Methods Cross-sectional study of children 24–47 months born preterm, LBW, or with HIE, and their mothers discharged from the Neonatal Care Unit (NCU) at Kirehe Hospital between May 2015–April 2016 or discharged and enrolled in a NCU follow-up program from May 2016–November 2017. Households were interviewed between October 2018 and June 2019. Mothers reported on their mental health and their child’s development; children’s anthropometrics were measured directly. Backwards stepwise procedures were used to assess factors associated with poor maternal mental health using logistic regression. Results Of 287 total children, 189 (65.9%) were born preterm/LBW and 34.1% had HIE and 213 (74.2%) screened positive for potential caregiver-reported disability. Half (n = 148, 51.6%) of mothers reported poor mental health. In the final model, poor maternal mental health was significantly associated with use of violent discipline (Odds Ratio [OR] 2.29, 95% Confidence Interval [CI] 1.17,4.45) and having a child with caregiver-reported disability (OR 2.96, 95% CI 1.55, 5.67). Greater household food security (OR 0.80, 95% CI 0.70–0.92) and being married (OR = 0.12, 95% CI 0.04–0.36) or living together as if married (OR = 0.13, 95% CI 0.05, 0.37) reduced the odds of poor mental health. Conclusions Half of mothers of children born preterm, LBW and with HIE had poor mental health indicating a need for interventions to identify and address maternal mental health in this population. Mother’s poor mental health was also associated with negative parenting practices. Specific interventions targeting mothers of children with disabilities, single mothers, and food insecure households could be additionally beneficial given their strong association with poor maternal mental health.

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“…Through the efforts to improve care for sick and small newborns, more preterm and/or LBW babies are surviving into childhood, but little is known about their long-term outcomes. The Rwanda Ministry of Health (MOH) has invested in Pediatric Developmental Clinics (PDCs) for the developmental and nutritional follow-up of high-risk babies, including those born preterm and LBW [23].…”

Section: Introductionmentioning

confidence: 99%

Developmental Outcomes of Preterm and Low Birth Weight Toddlers and Term Peers in Rwanda

Ahishakiye¹,

Abimana²,

Beck³

et al. 2019

Annals of Global Health

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Background:As neonatal care improves in low-resource settings, more preterm or low birth weight (LBW) babies are surviving, but little is known about their long-term outcomes. Globally, preterm and/or LBW babies are at increased risk of mortality, malnutrition, and developmental delay.Objectives:We aim to describe the differences in development in rural Rwandan children at 24–36 months of age born preterm and/or LBW compared to their peers born term or normal birth weight (term/NBW), and to assess factors associated with poor development.Methods:We conducted a cross-sectional study using secondary data analysis from two combined datasets from 2014, using Ages and Stages Questionnaire (ASQ-3) for developmental assessment and anthropometrics for nutritional status (stunting and wasting). Demographic and clinical factors associated with poor developmental outcomes in univariate regression at α = 0.20 were included in a full model; we used backward stepwise penalized multivariable logistic regression to identify a final model at α = 0.05.Findings:In total, 445 children were included; 405 term/NBW, and 40 preterm and/or LBW. Half of them (n = 234; 52.6%) had developmental delay, including 207 (51.1%) among term/NBW and 27 (67.5%) among preterm and/or LBW (p = 0.048). In the final model, term/NBW children with stunting alone had a significant increase in the odds of developmental delay (OR 2.05, 95% CI 1.37–3.07), and children with wasting had a borderline statistically significant increased odds of developmental delay (OR 5.79, 95% CI 0.98-34.39). Being preterm and/or LBW and not stunted completely predicted delay.Conclusion:Half of the children had developmental delay in our sample from rural Rwanda. Preterm and/or LBW infants were more likely to have developmental delay, and the main predictor of developmental delay was stunting, with high rates of stunting observed also in term/NBW infants. Interventions to reduce undernutrition and prevent prematurity and LBW, alongside investments to promote early stimulation for optimal development, are needed if gains in addressing developmental delay are to be made.

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A retrospective review of the Pediatric Development Clinic implementation: a model to improve medical, nutritional and developmental outcomes of at-risk under-five children in rural Rwanda

Cited by 11 publications

References 31 publications

Barriers and coping mechanisms to accessing healthcare during the COVID-19 lockdown: a cross-sectional survey among patients with chronic diseases in rural Rwanda

Barriers and coping mechanisms to accessing healthcare during the COVID-19 lockdown: a cross-sectional survey among patients with chronic diseases in rural Rwanda

Assessing factors associated with poor maternal mental health among mothers of children born small and sick at 24–47 months in rural Rwanda

Developmental Outcomes of Preterm and Low Birth Weight Toddlers and Term Peers in Rwanda

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