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The study concluded that the overall job satisfaction was positive among the staff though certain areas required to be reviewed.

Supplemental Digital Content is available in the text.Of 277 HIV-infected children in rural Rwanda enrolled in a community-based accompaniment program, 95.0% were retained in care 5 years after treatment initiation, with only 9 (3.3%) deaths and 3 (1.1%) defaults. Of 235 (84.8%) children with a documented viral load result, 201 (85.5%) demonstrated viral load suppression (<1000 copies/mL).

This study sought to describe a decentralized strategy for heart failure diagnosis and management and report the clinical epidemiology at district hospitals in rural Rwanda.

The objective of this study is to examine current activities, barriers, and capacity needs for the assessment and management of smoking, nutrition, alcohol and physical activity behavioural risk factors in rural and urban general practices. A cross-sectional survey of 287 general practitioners (GPs) was conducted in a rural and urban Division of General Practice in NSW. A total of 146 GPs responded yielding Divisional response rates of 51% rural and 61% urban. For each of the SNAP risk factors, between 37% and 46% of GPs report using guidelines. Verbal advice is given "very often" for smoking by 68% of GPs, for nutrition and alcohol by 48%, and physical activity by 60%. Guideline use is associated with increased frequency of advising patients. Patient compliance is the most frequently reported barrier to giving advice, especially for smoking and alcohol. GPs report that they "often" or "very often" refer patients due to nutritional risk factors (48%), with lower referral rates reported for physical activity and alcohol risk factors (28% and 27% respectively). Only 10% refer patients "often" or "very often" for smoking management, and referral for smoking management and physical activity increase as a result of training in these areas. There is considerable variability in smoking, nutrition, alcohol and physical activity risk factor intervention and management in the general practice setting. A range of strategies is required to improve the systematic management of risk factors including training, use of guidelines, referral networks, and patient education.

ABSTRACTBackground: Promoting national health research agendas in low- and middle-income countries (LMICs) requires adequate numbers of individuals with skills to initiate and conduct research. Recently, non-governmental organizations (NGOs) have joined research capacity building efforts to increase research leadership by LMIC nationals. Partners In Health, an international NGO operating in Rwanda, implemented its first Intermediate Operational Research Training (IORT) course to cultivate Rwandan research talent and generate evidence to improve health care delivery.Objective: This paper describes the implementation of IORT to share experiences with other organizations interested in developing similar training programmes.Methods: The Intermediate Operational Research Training utilized a deliverable-driven training model, using learning-by-doing pedagogy with intensive hands-on mentorship to build research skills from protocol development to scientific publication. The course had short (two-day) but frequent training sessions (seven sessions over eight months). Trainees were clinical and programme staff working at the district level who were paired to jointly lead a research project.Results: Of 10 trainees admitted to the course from a pool of 24 applicants, nine trainees completed the course with five research projects published in peer-reviewed journals. Strengths of the course included supportive national and institutional research capacity guidelines, building from a successful training model, and trainee commitment. Challenges included delays in ethical review, high mentorship workload of up to 250 hours of practicum mentorship, lack of access to literature in subscription journals and high costs of open access publication.Conclusions: The IORT course was an effective way to support the district-based government and NGO staff in gaining research skills, as well as answering research questions relevant to health service delivery at district hospitals. Other NGOs should build on successful programmes while adapting course elements to address context-specific challenges. Mentorship for LMIC trainees is critical for effectiveness of research capacity building initiatives.

BackgroundHealth data can be useful for effective service delivery, decision making, and evaluating existing programs in order to maintain high quality of healthcare. Studies have shown variability in data quality from national health management information systems (HMISs) in sub-Saharan Africa which threatens utility of these data as a tool to improve health systems. The purpose of this study is to assess the quality of Rwanda's HMIS data over a 5-year period.MethodsThe World Health Organization (WHO) data quality report card framework was used to assess the quality of HMIS data captured from 2008 to 2012 and is a census of all 495 publicly funded health facilities in Rwanda. Factors assessed included completeness and internal consistency of 10 indicators selected based on WHO recommendations and priority areas for the Rwanda national health sector. Completeness was measured as percentage of non-missing reports. Consistency was measured as the absence of extreme outliers, internal consistency between related indicators, and consistency of indicators over time. These assessments were done at the district and national level.ResultsNationally, the average monthly district reporting completeness rate was 98% across 10 key indicators from 2008 to 2012. Completeness of indicator data increased over time: 2008, 88%; 2009, 91%; 2010, 89%; 2011, 90%; and 2012, 95% (p<0.0001). Comparing 2011 and 2012 health events to the mean of the three preceding years, service output increased from 3% (2011) to 9% (2012). Eighty-three percent of districts reported ratios between related indicators (ANC/DTP1, DTP1/DTP3) consistent with HMIS national ratios.Conclusion and policy implicationsOur findings suggest that HMIS data quality in Rwanda has been improving over time. We recommend maintaining these assessments to identify remaining gaps in data quality and that results are shared publicly to support increased use of HMIS data.