Rwanda Journal of Medicine and Health Sciences最新文献

{"title":"Reflective Practice in Anesthesia Clinical Teaching","authors":"A. Yamuragiye, Elizabeth Anne Kinsella","doi":"10.4314/rjmhs.v4i3.10","DOIUrl":"https://doi.org/10.4314/rjmhs.v4i3.10","url":null,"abstract":"BackgroundReflective practice is an essential aspect of knowledge generation for professional practice. By reflecting on action, professionals learn to improve their practices. Through processes of reflection, practitioners participate in a dialogue between theory and practice. Even though reflective practice is an important approach for learning from experience, its place remains unclear in anesthesia clinical education as well as anesthesia practice in a broad sense.AimThe aim of this paper was to examine the affordances of reflective practice in anesthesia clinical education.MethodsTwo cases, illustrating critical incidents in the anesthesia clinical teaching environment, were examined to consider how incorporating reflective practice into clinical education can advance knowledge generation in the field.FindingsThe two cases studies show how reflective practice can contribute to experiential learning, particularly through reflection on critical incidents.ConclusionReflective practice can help bridge the gap between theoretical knowledge and practice in anesthesia education and practice.Rwanda J Med Health Sci 2021;4(3):406-411","PeriodicalId":315881,"journal":{"name":"Rwanda Journal of Medicine and Health Sciences","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125237934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and Reasons for a Surgical Cancellation at a Hospital in Rwanda","authors":"Thierry Uwera, Joselyne Mukantwari, David Ryamukuru, Lilian A. Omondi","doi":"10.4314/rjmhs.v4i3.7","DOIUrl":"https://doi.org/10.4314/rjmhs.v4i3.7","url":null,"abstract":"BackgroundSurgery cancellation is a challenging and costly event resulting in operating theatre inefficiency and psychological and financial problems for the patients and their families. This study aimed to find out the incidence and reasons for surgical cancellation at a Rwandan hospital.MethodsA retrospective study was conducted on 736 patients’ files obtained from theatre registry lists of surgical operations done from January to March 2017. The American Association of Perioperative Nurses (AORN) checklist for documenting cancelled surgical cases was used to establish the rate and reasons for cancellation. Data were analyzed using frequency and percentage descriptive statistics.ResultsOut of the 736 surgeries booked, 179 (24.3%) were cancelled as follows: Orthopedic and general surgeries (28.2%) respectively, gynecology and obstetrics (27.4%), urology surgeries (15.5%), maxillofacial surgeries (15.9%), ENT (15.6%) and plastic surgeries (13.3%). Time constrain/long list (19.6%), acute change in medical status (10.6%), non-turn-up of the patient (8.4%), and abnormal lab findings (7.8%) were the most prevalent reasons.ConclusionThe surgical cancellation rate at the study hospital was 24%, increasing with the number of patients booked and the type of surgical procedure. A prospective study is required to gain more insight into the reason for cancellations, mostly amenable to mitigation measures.Rwanda J Med Health Sci 2021;4(3):379-386","PeriodicalId":315881,"journal":{"name":"Rwanda Journal of Medicine and Health Sciences","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129795456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The use of Public-Private Partnerships in Health Supply Chain Management in Rwanda","authors":"E. Byomuhangi, P. C. Kayumba, Stella M Umuhoza","doi":"10.4314/rjmhs.v4i2.4","DOIUrl":"https://doi.org/10.4314/rjmhs.v4i2.4","url":null,"abstract":"BackgroundThe Government of Rwanda considers the private sector to play an important role in supporting provision of strategic national investments through Public-Private Partnerships (PPPs).ObjectiveThis study aims to describe the various aspects of PPPs in Health Supply Chain Management (HSCM) in Rwanda.MethodsA questionnaire was used to collect data from health professionals and individuals familiar with HSCM Public-Private Partnerships for this descriptive, cross-sectional and quantitative study.ResultsThe PPP interventional areas used in HSCM in Rwanda were namely supply of commodities (99%), delivered health Information Technology (IT) supplies and equipment (operate) (53%), finance (52%), and maintenance area (40%). The main challenges were limited conversation and absence of formal platforms for public and private engagement (83.7%) and complex procurement requirements for medical products and equipment by public institutions (73.3%). The strategies to improve the PPPs in HSCM were effective coordination of PPPs (93.3%) and improved dialogue and formal platforms (90.6%)ConclusionThese findings indicated that private sector through PPPs plays an important role in HSCM in Rwanda. The engagement of the private sector can increase the financial support in terms of financing HSCM activities like supply of health commodities and equipment. \u0000Rwanda J Med Health Sci 2021;4(2): 237-256","PeriodicalId":315881,"journal":{"name":"Rwanda Journal of Medicine and Health Sciences","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125230862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Influencing Annual Procurement Planning of Medicines and Medical Supplies in Public Health Facilities in Kampala District","authors":"Martha Grace Ajulong, J. Okiria, Martin Owako","doi":"10.4314/rjmhs.v4i2.8","DOIUrl":"https://doi.org/10.4314/rjmhs.v4i2.8","url":null,"abstract":"BackgroundDespite significant progress made by many countries towards meeting the millennium development goals and now sustainable development goals, there has been little improvement in access to essential medicines in developing countries.ObjectivesThe main aim of this study is to assess the factors influencing annual procurement planning of medicines and medical supplies in the public health facilities in Kampala district.MethodsThis study targeted respondents from government Health facilities in Kampala with a total population of 424 employees and applied simple random sampling to select 206 health workers. The researcher adopted mixed research approach with application of descriptive statistics, correlational and explanatory research designs that were used to maximize reliability and validity of findings. While the qualitative data was gathered through reviewing logistics tools, a physical count of the 30% purposively selected stock cards and interview of the staffs was carried out in health facilities in Kampala district, a Statistical Package for Social Science (SPSS) version 20 was used to analyze the quantitative data. Accordingly, a chi-square was used to determine the association between independent and dependent variables.ResultsThe findings indicated that 37.8% of the staff responded positively about the availability of annual procurement plan while the rest were from various health facilities. A significant association was observed between knowledge and availability of annual Procurement planning (X2 = 34.7; p value =.0001), as well as management support and Annual Procurement Planning (X2 = 9.87; P value = .008).ConclusionIn conclusion, the finding generated from analysis of quantitative and qualitative data revealed that a majority of the factors influencing annual procurement planning had a positive effect on medical supplies in public health facilities in Uganda although the capacity and capability of health workers, quality of logistics management information systems, and management support desires improvement. \u0000Rwanda J Med Health Sci 2021;4(2): 292-309","PeriodicalId":315881,"journal":{"name":"Rwanda Journal of Medicine and Health Sciences","volume":"69 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115302259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of Factors Contributing to Medicine Expiry in Rwanda: Case of the Medical Procurement and Production Division","authors":"Theogene Hakuzimana, P. Kayumba, I. Hahirwa, Max Kabalisa","doi":"10.4314/rjmhs.v4i2.7","DOIUrl":"https://doi.org/10.4314/rjmhs.v4i2.7","url":null,"abstract":"BackgroundRegardless of the significant efforts used and put in place to enhance supply chain performance in Rwanda, there is still poor inventory management and big loss due to expiry of medicines at Medical Procurement and Production Division (MPPD).ObjectiveTo assess the factors that contributes to expiry of medicines at MPPD and formulate recommendations for the improvement of the current situation.MethodsThis is a descriptive cross-sectional study used for 25 respondents. A questionnaire containing closed-ended questions was used focusing on factors contributing to expiries of medicines for each product category managed by MPPD from 2014-2018. Additionally, the researcher reviewed all inventory reports, including expiries for the same period under study. The study focused on targeting respondents working at MPPD as pharmacists both technical and administrative, also other non-pharmacist working in the warehouse were considered as respondents. The hard copy of questionnaire was handed over to 26 respondents and requested to provide filled questionnaire within seven days. Twenty-five respondents were able to return the filled questionnaire on time, giving 96% response rate.ResultsThe study found that in MPPD, medicines are still expiring. During five years (from 2014 up to 2018) the total expired products were valued at RWF 6,046,778,655 for all program categories: HIV commodities had the largest share 53.3%, Essential Medicines 22.5%, Malaria 13%, Maternal Child Health commodities 5.7%, Products used for Community health workers 4.5%, TB products 1% and 0.1% for Family Planning products. The study found that major contributing factors for expiry of health commodities at MPPD, are ranked as follows: Supply chain management 90%, other factors 73%, Poor storage management 68% and Excessive drug supply 67%. \u0000ConclusionConsidering the study results, it looks like no significant effect of excessive drug supply and inventory management on the expiration of medicines at MPPD. However, the Supply Chain Management components are the most vulnerable to contribute to the expiration of medicines at MPPD. There are many changes to be done inside the institution to remedy the issue of expiration like working according to the standard operating procedures, improving the Skills of personnel in supply chain management, empowering the procurement unit with skilled personnel and improving the communication with stakeholders to facilitate the smooth and quick replenishment and distribution of the stock. \u0000Rwanda J Med Health Sci 2021;4(2): 281-291","PeriodicalId":315881,"journal":{"name":"Rwanda Journal of Medicine and Health Sciences","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123548255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inventory Management Practices and Supply Chain Performance of Antiretroviral Medicines in Public Hospitals in Nyamira County, Kenya","authors":"A. Johnson, Karimi Peter, Maru Shital","doi":"10.4314/rjmhs.v4i2.5","DOIUrl":"https://doi.org/10.4314/rjmhs.v4i2.5","url":null,"abstract":"BackgroundUnreliable supply systems have plagued the provision of an uninterrupted supply of life- saving medicines in many developing countries, with antiretroviral (ARV) medicines having the worst repercussions.ObjectiveTo identify the inventory management practices used, evaluate the supply chain performance, and determine the challenges affecting inventory management of ARV medicines in public hospitals.MethodsThe study used a descriptive cross-sectional design, gathering snapshot data on inventory management practices happening in all the 8 public hospitals across Nyamira County. Data collection was done using structured questionnaires, key informant interviews, checklists and data from the national health information system.ResultsThe response rate was 97.3% for the questionnaires and 100% for the key informant interviews. The prevailing inventory management practices were: use of scheduled inventory control model (80.95%), forecasting demand using previous consumption data (100%), keeping accurate and updated stock records for each commodity (92.31%), having essential logistical data in reports (100%), including safety stock (61.54%) when ordering and keeping ARV medicines in dedicated stores (75%). With the exception of order lead time (17.98 days), the other supply chain performance metrics namely stock out rate (52.12%), stock wastage rate (43.2%), and reporting rates (70.84%) were found to be deficient. The challenges mostly affecting inventory management included inadequate staff and training, lack of proper storage, and unreliable supply of medicines.ConclusionInventory management practices were according to the recommended best approaches despite various challenges. The supply chain performance metrics evaluated, with the exception of order lead time, were all found to be unsatisfactory owing to the high stock out rates, below par reporting rates and high stock wastage rate due to expiries discovered. Adoption of an electronic inventory system, use of data for decision making, dedicated storage of ARV medicines, and inclusion of buffer stock, are some strategies to improve inventory management.Rwanda J Med Health Sci 2021;4(2): 257-268","PeriodicalId":315881,"journal":{"name":"Rwanda Journal of Medicine and Health Sciences","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129643803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Universal Health Coverage on the Availability of Medicines in Public Health Facilities in Kisumu County, in Kenya","authors":"George Walukana, S. Maru, P. Karimi, P. Kayumba","doi":"10.4314/rjmhs.v4i2.6","DOIUrl":"https://doi.org/10.4314/rjmhs.v4i2.6","url":null,"abstract":"BackgroundStock outs of medicines and unaffordable cost are two major barriers of access to healthcare. Universal Health Coverage (UHC) seeks to ensure that all people have access to quality essential health services without suffering financial hardship.ObjectiveThe main objective of the study was to determine the effect and challenges of UHC program on the availability of medicines in public health facilities in Kisumu County.MethodologyThe study used a Pretest - posttest research design. The study was carried out in twenty-nine health facilities that were selected using stratified random sampling. Data was collected using key informant interviews with a health worker in each facility. Participants also involved four hundred and forty-four patients selected from the chosen facilities using consecutive sampling. Data from patients was collected using researcher administered questionnaires.ResultsThe availability of medicines improved by 3.4% for 20 tracer medicines since the introduction of the pilot UHC in Kisumu County. This was also supported from the patient’s perspective (n= 444; 79.5%). \u0000conclusion \u0000In spite of this, health workers experienced challenges which included inadequate supply, delays and stock out of some medicines. Other challenges were overworking, shortage of qualified staff and inconsistent supplies. \u0000Rwanda J Med Health Sci 2021;4(2): 269-280","PeriodicalId":315881,"journal":{"name":"Rwanda Journal of Medicine and Health Sciences","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132971958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of Storage and Inventory Practices to Improve Medicine Supply Chain in Jubek State South Sudan","authors":"Adut Jervase Manyuat, Kashi Carasso, Mulatedzi Makhado","doi":"10.4314/rjmhs.v4i2.9","DOIUrl":"https://doi.org/10.4314/rjmhs.v4i2.9","url":null,"abstract":"BackgroundIn order to deliver quality health services, safe, effective, affordable and quality medicines are needed. Inappropriate storage conditions, poor infrastructure and poor medicine management practices may lead to poor medicines quality, stock damage and expiration.ObjectiveAssess storage and inventory practices to improve the medicine supply chain in South Sudan.MethodologyThe study used a descriptive cross-sectional design. The study population comprised 12 Health Centers in Juba where inventory management was practiced. Both questionnaire‐guided interviews for staff self‐assessment, and observer assessment were used by the researcher. With regard to storage and inventory management, the researcher collected data on the condition of storerooms with regards to availability of enough storage space, availability of enough storage equipment, and temperature conditions of the medicines stores, among others.ResultsThe study found that store and inventory management practices varied widely in the different health facilities. Hospitals and central medical stores exhibited good or average inventory and storeroom management practices, respectively. The two hospitals and medical stores scored 100% in the elements in the assessment of storerooms and stock management. Some primary health care centers exhibited good inventory and store room management practice, whilst others were rated as average or poor. Most of the elements assessed scored 37% in storeroom assessment while elements assessed for inventory management scored less than 75%. There was great similarity between the observation assessment and the self-assessment.ConclusionIn conclusion, store and inventory management practices and knowledge of the respondents varied in the different health facilities. Hospitals and central medical stores exhibited good, average and poor inventory and storeroom management practices assessed through self-assessment and observation assessment by the researcher. There was a great similarity between the observation assessment and the self-assessment. \u0000Rwanda J Med Health Sci 2021;4(2): 310-320","PeriodicalId":315881,"journal":{"name":"Rwanda Journal of Medicine and Health Sciences","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131128566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost Analysis of Current Distribution and Redesigned Distribution Systems for Vaccines in Rwanda","authors":"Evodie Mudaheranwa, Stany Stany, Hassan Sibomana, R. Hitimana, M. Nzayirambaho","doi":"10.4314/rjmhs.v4i2.2","DOIUrl":"https://doi.org/10.4314/rjmhs.v4i2.2","url":null,"abstract":"Background \u0000Immunization supply chain management is among the components of immunization program, making vaccines delivery possible to reach every child. Nevertheless, it has been found to be static with rapid changes linked to the introduction of new vaccines. The success of Rwanda immunization program with coverage of 94.3% was attributed to human resource and capital investment from both the Ministry of Health and its development partners. However, the current distribution system design does not contribute to self-financing of the program in the long-run considering the distribution mode and frequency applied. The cost analysis study has never been done before and is expected to address the issue of long-term sustainability of the program as it will inform the system re-design activities.   \u0000Objective \u0000Assessing how much the program would save if the system is re-designed by changing distribution mode and frequency from the Central Vaccine Store to District Vaccine Stores. \u0000Methods \u0000Administrative and financial records were reviewed to determine the cost of the current vaccine distribution system to be compared to estimated cost of a proposed distribution system with reduced frequencies between Central Vaccine Store and District Vaccine Stores. \u0000Results \u0000By comparing the costs of the two systems, applying the proposed distribution model with less distribution frequencies reduced the current cost by 37%. \u0000Conclusion \u0000The findings confirm a huge opportunity of getting the current vaccine distribution costs reduced when the distribution system is redesigned, hence contributing to financial sustainability of the vaccination program. \u0000Rwanda J Med Health Sci 2021;4(2): 207-221","PeriodicalId":315881,"journal":{"name":"Rwanda Journal of Medicine and Health Sciences","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116711653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electronic Immunization Registry in Improving Vaccine Supply Chain Availability in Tanga City Council, Tanzania","authors":"E. Yohana, Shiferaw Mitiku, P. C. Kayumba, Omary Swalehe","doi":"10.4314/rjmhs.v4i2.3","DOIUrl":"https://doi.org/10.4314/rjmhs.v4i2.3","url":null,"abstract":"BackgroundDespite the advantages of the electronic registry which has been explained in other areas of health and other parts of the world, there has been no empirical research conducted with the aim of assessing the impact of the electronic immunization registry practices on the availability of immunization commodities.ObjectivesTo assess the effect of electronic immunization registry practices on the availability of immunization commodities.MethodsA cross-sectional study was carried out to health facilities providing vaccination services in Tanga City Council. A total of 27 health care workers in 27 health facilities were interviewed for availability of vaccines and their experience in using electronic immunization system in supply chain system functioning using structured questionnaires. The data from the vaccines manual ledger and electronic TImR system were also collected administered in April-June, 2019 specifically for Bacillus-Calmette Guerin (BCG), Diphtheria-Pertussis-Tetanus-Hepatis B-Haemophilus influenza type b (DPT-HepB-Hib), bi-oral polio vaccine (bOPV), Measles-Rubella and Human Papilloma Virus Vaccine (HPV). These data were analyzed by statistical software SPSS using one sample T test and 95% confidence interval.ResultsThe study affirmed that the mean numbers of children registered at the health facilities using electronic immunization registry was 1.5-3 times higher than the target population for the three months preceding the study given by the National Bureau of Statistics (NBS). The number of doses for the studied vaccines (DPT-HepB-Hib, measles rubella, HPV, BCG and bOPV) were found to be different in the manual and electronic TImR systems. Also, the number of doses available at the health facilities increased significantly with the number of the electronic system registered children.ConclusionThis study found that the adoption of Electronic immunization registry has improved the health supply chain in terms of improving the vaccines availability. Rwanda J Med Health Sci 2021;4(2): 223-236","PeriodicalId":315881,"journal":{"name":"Rwanda Journal of Medicine and Health Sciences","volume":"155 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122559794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}