The incidence of human brucellosis is not documented in Rwanda despite several reports on the disease in cattle. Because brucellosis has been associated with abortion, the aim of this study was to investigate the prevalence of positive serology in women presenting with abortion and/or stillbirth. The study was done in Huye District, in the Southern Province of Rwanda, and the patients were recruited from both the University Teaching Hospital of Butare (CHUB) and Kabutare District Hospital. Serum samples were collected and the Rose Bengal plate test (RBPT) was performed on each sample. A questionnaire was also used to investigate potential contacts with animals and/or consumption of raw milk. A total of 60 women were recruited and 15 (i.e., 25%) were Brucella seropositive. The questionnaire showed that those with seropositivity either were in contact with domestic animals (cattle, goat, or sheep) or were consuming raw cow's milk. Human brucellosis appears to be of public health importance in Rwanda and more attention should be drawn on the disease. The current study provides a basis for larger studies to establish the incidence of human brucellosis in Rwanda. More mechanistic studies will also demonstrate the pathogenicity of Brucella in human placentas.
ABSTRACT Background Intestinal parasitic infections (IPIs) are a public health issue affecting young children in low and middle income countries (LMICs). These factors may induce malnutrition, as well as systemic and/or intestinal inflammation, depending on the species, intensity of infection, and host response. This study aimed at determining the effect of intestinal parasites on nutritional status and inflammatory responses in pre- and school-aged children in rural areas of the southern province of Rwanda. Methods A cross-sectional study involving 127 children under 12 years of age was conducted at two health centers in Huye District, Southern Province, Rwanda, from January to February 2022. A structured questionnaire was used to collect sociodemographic information, feeding habits, anthropometric measurements, and information on infection/malnutrition risk factors. Stool samples were collected to test for intestinal parasites by using microscope, while serum was collected to measure (anti)inflammatory markers [interleukin-10 (IL-10), tumour necrosis factor-alpha (TNF-α), total protein, and C-reactive protein (CRP)]. Results The overall prevalence of IPIs was 38.6%, with non-pathogenic Entamoeba coli being the most prevalent (21.3%), followed by Ascaris lumbricoides (18.1%), Entamoeba histolytica (11.8%), and Trichuris trichiura (1.6%). Coinfections accounted for 12.6% of the infections. Moreover, 48.0%, 25.2%, and 9.4% of the children were stunted, underweight, and stunted, respectively. Underweight, IL-10, and total protein levels were significantly associated with IPIs. Our findings also indicated that food supplements had a significant positive effect on stunting. Conclusion Ascaris lumbricoides , Entamoeba histolytica , and Trichuris trichiura were the predominant parasites. Intestinal parasitic infections in preschool children and schoolchildren affect the nutritional status, possibly through chronic inflammation. Further mechanistic investigations will shed more light on the regulation of the inflammatory response.
Background Morbidity due to schistosomiasis is currently controlled by treatment of schistosome infected people with the antihelminthic drug praziquantel (PZQ). Children aged up to 5 years are currently excluded from schistosome control programmes largely due to the lack of PZQ safety data in this age group. This study investigated the safety and efficacy of PZQ treatment in such children. Methods Zimbabwean children aged 1–5 years (n = 104) were treated with PZQ tablets and side effects were assessed by questionnaire administered to their caregivers within 24 hours of taking PZQ. Treatment efficacy was determined 6 weeks after PZQ administration through schistosome egg counts in urine. The change in infection levels in the children 1–5 years old (n = 100) was compared to that in 6–10 year old children (n = 435). Principal Findings Pre-treatment S. haematobium infection intensity in 1–5 year olds was 14.6 eggs/10 ml urine and prevalence was 21%. Of the 104 children, 3.8% reported side effects within 24 hours of taking PZQ treatment. These were stomach ache, loss of appetite, lethargy and inflammation of the face and body. PZQ treatment significantly reduced schistosome infection levels in 1–5 year olds with an egg reduction rate (ERR) of 99% and cure rate (CR) of 92%. This was comparable to the efficacy of praziquantel in 6–10 year olds where ERR was 96% and CR was 67%. Interpretation/Significance PZQ treatment is as safe and efficacious in children aged 1–5 years as it is in older children aged 6–10 years in whom PZQ is the drug of choice for control of schistosome infections.
For effective treatments and preventive measures against severe COVID-19, it is essential to determine early markers of disease severity in different populations. We analysed the cytokine kinetics of 129 COVID-19 patients with mild symptoms, 68 severe cases, and 20 healthy controls for the first time in Rwanda. Pro-inflammatory (IFNγ, IL-6, TNFα), Treg (IL-10, TGFβ1, TGFβ3), Th9 (IL-9), Th17 (IL-17), and Th2 (IL-4, IL-13) cytokines, total IgM and IgG, as well as gene expressions of FoxP3, STAT5+, IFNγ-R1, and ROR alpha+, were measured at day 1, day 7, day 14, day 21, and day 28 post-infection. Severe cases showed a significantly stronger increase than mild patients in levels of all cytokines (except IL-9) and all gene expression on day 1 of infection. Some cytokine levels dropped to levels comparable to mild cases at later time points. Further analysis identified IFNγ as a marker of severity throughout the disease course, while TGFβ1, IL-6, and IL-17 were markers of severity only at an early phase. Importantly, this study revealed a striking low IL-9 level and high IFNγ/IL-9 ratio in the plasma of patients who later died compared to mild and severe cases who recovered, suggesting that this could be an important biomarker for predicting the severity of COVID-19 and post-COVID-19 syndrome.
The global prevalence of gestational diabetes (GDM) in pregnant 20-49 year old women has increased to 16.9%, although data from Africa on GDM are scarce, and risk exposure to pregnant women is unknown. Among the 288 pregnant women screened in Rwanda, 8.3% of women with FPG >126 mg/dL (>6.9 mmol/L) had GDM. Age >41 years (45.8% vs. 18.9%; p<0.001), first-family history of T2D (29.2% vs. 3.4%; p<0.001) and gravidity ≥3 pregnancies (79.2% vs. 29.2%; p=0.05) were associated with GDM. Gestational diabetes is a high risk factor for T2D, and increases the risk to T2D for women and their offspring later in life. Thus, improving maternal and child cardiometabolic health in Africa is needed through integrated gestational diabetes screening, and cost-effective sustainable strategies to build healthcare staff capacity, and to prioritize relevant evidence-based research and healthcare.Keywords: Gestational diabetes, Rwanda, Africa, Women
<b><i>Background:</i></b> Protective acquired immunity against helminths and allergic sensitisation are both characterised by high IgE antibody levels. Levels of IgE antibodies are naturally tightly regulated by several mechanisms including binding of the CD23 receptor. Following observations that helminth infections and allergic sensitisation may co-present, the current study aims to investigate the relationship between the soluble CD23 (sCD23) receptor, parasite-specific IgE responses and allergic sensitisation in people exposed to the helminth parasite <i>Schistosoma haematobium</i>. <b><i>Methods:</i></b> A cohort of 434 participants was recruited in two villages with different levels of <i>S. haematobium</i> infection in Zimbabwe. Serum levels of the 25-kDa fragment of sCD23 were related to levels of schistosome infection intensity, allergen (house dust mite, HDM) and schistosome-specific IgE, total IgE and skin sensitisation to HDM. <b><i>Results:</i></b> sCD23 levels rose significantly with schistosome infection intensity but declined significantly with schistosome-specific IgE levels. Furthermore, sCD23 levels were negatively associated with skin sensitisation and IgE reactivity against HDM, but showed no relationship with total IgE. <b><i>Conclusion:</i></b> The results are consistent with the suppression of parasite and allergen-specific IgE levels by sCD23. Further mechanistic studies will determine the relevance of this potential regulatory mechanism in the development of helminth-specific immune responses in atopic individuals.
Visual impairment and blindness affect an estimated 2.2 billion people worldwide. Accessible low-cost diagnostic tools and interprofessional education and collaborative practice are part of ongoing strategies to improve eye care services. This study evaluated the impact of an interprofessional Arclight workshop on undergraduate healthcare students' clinical identification skills related to eye health, and self-reported confidence in ophthalmic skills. Undergraduate students from clinical medical officer, ophthalmic clinical officer, Bachelors and Diploma nursing, and medical programs at the University of Rwanda participated in a pilot interprofessional eye health workshop. The Arclight device, a low-cost ophthalmoscope and simulation eyes were used to enable students to practice ophthalmic skills and thereafter equip them. Clinical identification skills related to common eye conditions, and self-reported confidence in ophthalmic skills were assessed pre and post workshop. Overall, students' ability to identify common eye conditions, and self-reported confidence in relation to all skills statistically improved post workshop, with some differences between professional groups in relation to eye health skills. This IPE experience used the Arclight package as a vehicle for IPE, enabling healthcare students to share and acquire new skills and confidence in relation to recognizing common eye conditions and assessing eye health.
Schistosoma mansoni is endemic in Rwanda, and control programs have been implemented with a special focus on school-age children (SAC), ignoring pre-school age children (pre-SAC) for which the actual prevalence of the disease is not well established. This study consisted of a cross-sectional quantitative mapping of the distribution of Schistosoma mansoni and identification of associated risk factors among pre-SAC throughout the country. The study covered all the 17 districts of Rwanda endemic for Schistosoma mansoni, with a total sample of 4,675 children enrolled from 80 purposively selected villages. The parasitological assessment of children's urine and stool samples was conducted using CCA and Kato Katz methods, respectively, for infection detection. A standard questionnaire was used to collect data on the risk factors, and geospatial assessment was performed using tablets and GPS to record geographic coordinates for plotting locations on maps using ArcGIS software. The overall prevalence of S. mansoni infection across the surveyed areas was 24 and 0.8% by CCA and Kato-Katz, respectively. Infection was significantly associated with bathing children in open water bodies. Furthermore, pre-SAC looked after by siblings (sisters) were two times as much likely to be infected compared to those looked after by mothers. Schistosomiasis control interventions are needed for pre-SAC to limit their exposure to open water bodies with expectations of adapted chemotherapy to be availed. Community-based deworming campaigns may be the best way to ensure good treatment coverage of pre-SAC in Rwanda.
Suppressing SARS-CoV-2 will likely require the rapid identification and isolation of infected individuals, on an ongoing basis. RT-PCR (reverse transcription polymerase chain reaction) tests are accurate but costly, making regular testing of every individual expensive. The costs are a challenge for all countries and particularly for developing countries. Cost reductions can be achieved by combining samples and testing them in groups. We propose an algorithm for grouping subsamples, prior to testing, based on the geometry of a hypercube. At low prevalence, this testing procedure uniquely identifies infected individuals in a small number of tests. We discuss the optimal group size and explain why, given the highly infectious nature of the disease, parallel searches are preferred. We report proof of concept experiments in which a positive sample was detected even when diluted a hundred-fold with negative samples. Using these methods, the costs of mass testing could be reduced by a factor of ten to a hundred or more. If infected individuals are quickly and effectively quarantined, the prevalence will fall and so will the costs of regularly testing everyone. Such a strategy provides a possible pathway to the longterm elimination of SARS-CoV-2. Field trials of our approach are now under way in Rwanda and initial data from these are reported here.
Abstract Schistosomiasis is endemic in Rwanda and control programs have been implemented with a special focus on school-aged children (SAC) ignoring pre-school aged children (pre-SAC) for which the actual prevalence of the disease is not well established. This study consisted of a cross-sectional quantitative mapping of the distribution of schistosomiasis and identification of associated risk factors among pre-SAC throughout the country. The study covered all the 17 Districts of Rwanda endemic for schistosomiasis with a total sample of 4675 children enrolled from 80 purposively selected villages. The Parasitological assessment of children’s urine and stool samples was conducted using CCA and Kato Katz methods respectively for infection detection. A standard questionnaire was used to collect data on the risk factors and geospatial assessment was performed using tablets and GPS to record geographic coordinates for plotting locations on maps using ArcGIS software. The overall prevalence of S mansoni infection across the surveyed areas was 24% and 0.8 by CCA and Kato-Katz, respectively. Infection was significantly associated with bathing children in open water bodies. Furthermore, pre-SAC looked after by siblings (sisters) were twice as much likely to be infected compared to those looked after by mothers. Schistosomiasis control interventions are needed for pre-SAC to limit their exposure to open water bodies with expectations of adapted chemotherapy to be availed. Community based deworming campaigns may be the best way to ensure good treatment coverage of pre-SAC in Rwanda. Author summary Schistosomiasis is one of the Neglected Tropical Diseases (NTD) of public health concern in Rwanda like in many tropical countries. The recently published NTD roadmap by the World Health Organization indicates that schistosomiasis is targeted for elimination as a public health problem worldwide by 2030. For this target to be achieved, all at risk populations should be reached by control programs’ interventions such as preventive chemotherapy, health education as well as water, sanitation and hygiene (WASH) practices. However, pre-school children (pre-SAC) are among populations at risk for whom infection burden is not fully documented. Implementation of the recent WHO guideline on schistosomiasis control and elimination that recommend inclusion of pre-SAC in control programs will be informed by detailed assessment of the infection burden and distribution in endemic countries. This study is showing for the first time a high burden of schistosomiasis among pre-SAC in high-risk areas of Rwanda. With the imminent availability of the paediatric formulation of Praziquantel (the drug of choice against the disease), the findings should guide the country in implementation strategies that include these children in mass deworming. The findings also highlight a number of risk factors including the passive exposure of these young children by their siblings while bathing them in open waters and the lack of knowledge of parents/guardians on the disease. Additional integrated interventions such as health education, improvement of water supply and sanitation as well as snail surveillance will lead to more sustainable solutions in the march towards schistosomiasis elimination.
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