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Plasmodium falciparum multidrug resistance-1 gene ( pfmdr1 ) polymorphisms associate with altered antimalarial susceptibility. Between 2010 and 2018/2019, we observed that the prevalence of the wild-type allele N86 and the wild-type combination NYD increased 10-fold (4% versus 40%) and more than 2-fold (18% versus 44%), respectively.

Plasmodium falciparummultidrug resistance-1 gene (pfmdr1) polymorphisms associate with altered antimalarial susceptibility. Between 2010 and 2018/2019, we observed that the prevalence of the wild-type allele N86 and the wild-type combination NYD increased 10-fold (4% versus 40%) and more than 2-fold (18% versus 44%), respectively. Haplotypes other than NYD or NFD declined by up to >90%. Our molecular data suggest the pfmdr1 pattern shifted toward one associated with artemether-lumefantrine resistance.

Co-infections with Plasmodium, Ascaris and Giardia are common in sub-Saharan Africa but epidemiological and clinical data are rare. We examined factors associated with co-infections and their clinical manifestation among Rwandan schoolchildren.Schoolchildren aged 6-10 years attending 12 schools in Huye district, Rwanda, were recruited preceding routine deworming. Data on socioeconomic status (SES) and children's histories were obtained, and children were clinically and anthropometrically examined. Blood and stool samples were collected, and infections with Plasmodium, Ascaris and Giardia were determined by microscopy and PCR assays.Among 878 schoolchildren, Plasmodium, Ascaris and Giardia were present in 22%, 35% and 36%, respectively. Co-infections with two or more parasites were found in 24%; only one-third of the children did not harbour any of the parasites examined. Factors associated with parasite (co-)infections largely overlapped and reflected low SES, in addition to a few specific risk factors. Clinically, most children were asymptomatic but anaemia (38%), underweight (17%), and reported signs and symptoms in the preceding 2 weeks (46%) were common. Many of the reported and assessed signs and symptoms were associated with Plasmodium infection, and co-infection with Ascaris and/or Giardia did basically not modify the clinical picture. One exception was malnutrition, which was pronounced in Ascaris-Giardia co-infection vs. individual mono-infections.Parasitic co-infections are common in Rwandan schoolchildren, and are associated with a rather silent clinical manifestation that nevertheless may affect school performance and long-term development. School-based health interventions should target such co-infections in an integrated manner.Les coinfections par Plasmodium, Ascaris et Giardia sont courantes en Afrique subsaharienne, mais les données épidémiologiques et cliniques sont rares. Nous avons examiné les facteurs associés aux coinfections et leurs manifestations cliniques chez les écoliers rwandais. MÉTHODES: Des écoliers âgés de 6 à 10 ans fréquentant 12 écoles du district de Huye au Rwanda ont été recrutés avant le déparasitage de routine. Les données sur le statut socioéconomique (SSE) et les antécédents des enfants ont été obtenues et les enfants ont été examinés cliniquement et anthropométriquement. Des échantillons de sang et de selles ont été recueillis et les infections à Plasmodium, Ascaris et Giardia ont été déterminées par microscopie et par PCR. RÉSULTATS: sur 878 écoliers, Plasmodium, Ascaris et Giardia étaient présents chez 22%, 35% et 36%, respectivement. Des coinfections avec deux parasites ou plus ont été trouvées chez 24%; seul un tiers des enfants n'hébergeait aucun des parasites examinés. Les facteurs associés aux (co)infections parasitaires se chevauchaient largement et reflétaient un faible statut SSE, en plus de quelques facteurs de risque spécifiques. Sur le plan clinique, la plupart des enfants étaient asymptomatiques mais l'anémie (38%), l'insuffisance pondérale (17%) et les signes et symptômes rapportés au cours des deux semaines précédentes (46%) étaient fréquents. De nombreux signes et symptômes rapportés et évalués étaient associés à l'infection au Plasmodium et la coinfection par Ascaris et/ou Giardia n'a fondamentalement pas modifié le tableau clinique. Une exception était la malnutrition, qui était prononcée dans la coinfection Ascaris-Giardia par rapport aux mono-infections individuelles.Les coinfections parasitaires sont courantes chez les écoliers rwandais et sont associées à une manifestation clinique plutôt silencieuse qui peut néanmoins affecter les performances scolaires et le développement à long terme. Les interventions de santé en milieu scolaire devraient cibler ces coinfections de manière intégrée.

Background Strongyloides stercoralis is one of the most neglected tropical diseases. Sparse, dated central African and Rwandan data on seroprevalence are available to guide public health efforts and clinical care. Methods In February 2016 we conducted a community-based cross-sectional study among 539 asymptomatic participants in a rural area in the Gisagara District, Southern Province, Rwanda. Direct faecal smear (DFS) and modified Koga agar plate culture (APC) were used to detect S. stercoralis infection in a single stool sample. Data on other soil-transmitted helminths diagnosed by DFS were also recorded. Results Four intestinal helminth infections were diagnosed, with S. stercoralis (17.4%) and hookworms (8.2%) seen most often. APC, compared with DFS, increased the diagnosis rate for S. stercoralis from 1.9% to 17.4% (p

Background: Hospital acquired infection (HAI) also called nosocomial infection is an infection acquired in hospital or other healthcare facilities. HAIs are a major public health problem all over the world, but particularly in developing nations and they are among the major causes of death and increased morbidity among hospitalized patients. It was found that HAI in sub-Saharan Africa is the major cause of illness and death in children.Aim: The aim of this study was to provide knowledge on the prevalence of hospital acquired infection in pediatric unit of the University Teaching Hospital of Butare (Rwanda).Methods: Hospital acquired infections surveillance method and definition of infections described by CDC/NHSN were used.Results and conclusion: This study showed that the prevalence of HAI was very high (12.1 %) and the main bacteria causing NIs in pediatric unit were Kleblesiela pneumonia, followed by E. coli and Staphylococcus aureus. Low Respiratory HAIs were the most prevalent.Keywords: Prevalence, Hospital Acquired infection, Pediatrics

Multidrug-resistant gram-negative (MRGN) bacteria are a serious threat to global health. We used genomics to study MRGN obtained from houseflies in a tertiary Rwandan hospital. Our analysis revealed a high abundance of different MRGN including E. coli pathogenic lineage ST131 suggesting the important role of flies in disseminating highly virulent pathogens in clinical settings and beyond.

Objectives To assess the presence and risk factors of intestinal carriage of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) among patients admitted to the University Teaching Hospital of Butare and among their attending caregivers, and to analyse the acquisition of ESBL-PE carriage during hospital stay and associated factors. Methods We screened 392 patients and their attending caregivers at admission and discharge for ESBL-PE carriage. Bacterial species were determined using the API-20E system, and antimicrobial susceptibility testing was performed by agar disc diffusion. Data on socio-economic status, diet, behaviour, household assets, livestock and hospital procedures were collected. Results At admission, 50% of the patients showed intestinal ESBL-PE carriage (Escherichia coli, 51%; Klebsiella pneumoniae, 39%; Enterobacter cloacae, 19%) as did 37% of their caregivers. Co-resistance was common but no carbapenem resistance was detected. At discharge, the proportion of ESBL-PE-colonised patients increased to 65% (caregivers, 47%) with almost complete carriage in paediatric patients (93%). The acquisition rate among initially non-colonised patients was 55% (or, 71/1000 patient days). Independent predictors of admission carriage included a colonised caregiver, prior antibiotic intake, egg consumption and neglecting to boil drinking water, whereas being a paediatric patient, undergoing surgery and male gender predicted acquisition during hospitalisation. Conclusions Abundant admission carriage of ESBL-PE and a high acquisition rate in a Rwandan university hospital point to potential intrahospital transmission and community dissemination. Caregivers are an additional source of possible spread. Risk factors of colonisation such as diet and water source need to be tackled to prevent the further emergence and spread of ESBL-PE.

Emerging artemisinin resistance is a threat to global malaria control. Mutations in the Plasmodium falciparum Kelch 13 (K13) propeller domain confer artemisinin resistance and constitute molecular markers for its detection and monitoring. We sequenced 222 P. falciparum isolates obtained from community children in the Huye District of southern Rwanda in 2010, 2014, and 2015 to investigate the presence of K13 polymorphisms. No polymorphisms were observed in 2010 but they were present in 2.5% and 4.5% in 2014 and 2015, respectively. In 2015, two isolates showed candidate K13 resistance mutations (P574L and A675V), which are common in southeast Asia and associated with delayed parasite clearance. K13 polymorphisms in southern Rwanda are infrequent but include variants associated with artemisinin resistance. Establishing correlations with local treatment response and in vitro resistance assays are needed in addition to further monitoring K13 polymorphisms in the study area.

Background: Successful H. pylori treatment requires the knowledge of local antimicrobial resistance. Data on the efficacy of H. pylori eradication regimens available in sub-Saharan Africa are scant, hence the optimal treatment is unknown. Our goals were to determine the efficacy of available regimens in Rwanda as well as evaluate the effect of treatment on health-related quality of life (HRQoL) in patients undergoing esophagogastroduodenoscopy. Methods: This is a randomized controlled trial conducted from November 2015 to October 2016 at a tertiary hospital in Rwanda. Enrollees were 299 patients (35% male, age 42 ± 16 years (mean ± SD)) who had a positive modified rapid urease test on endoscopic biopsies. After a fecal antigen test (FAT) and HRQoL assessment by the Short Form Nepean Dyspepsia Index (SF-NDI) questionnaire, patients were randomized 1:1:1:1 to either a triple therapy combining omeprazole, amoxicillin and one of clarithromycin/ciprofloxacin/metronidazole or a quadruple therapy combining omeprazole, amoxicillin, ciprofloxacin and doxycycline. All therapies were given for a duration of 10 days. The outcome measures were the persistence of positive FAT (treatment failure) 4 to 6 weeks after treatment and change in HRQoL scores. Results: The treatment success rate was 80% in the total population and 78% in patients with a history of prior triple therapy. Significant improvement in HRQoL in the total group (HRQoL mean scores before and after treatment respectively: 76 ± 11 and 32 ± 11, p

Background Plasmodium infection and malaria in school children are increasingly recognized as a relevant public health problem, but data on actual prevalence and health consequences are insufficient. The present study from highland southern Rwanda aimed at estimating infection prevalence among children attending school, at identifying associated factors and at assessing the clinical consequences of these infections. Methods In a survey including 12 schools in the Huye district of Rwanda, 1089 children aged 6–10 years were clinically and anthropometrically examined, malaria parasites were diagnosed by microscopy and PCR, haemoglobin concentrations were measured, and socio- economic and behavioural parameters as well as medical histories were obtained. Results Upon examination, the vast majority of children was asymptomatic (fever 2.7%). Plasmodium infection was detected in 22.4% (Plasmodium falciparum, 18.8%); 41% of these were submicroscopic. Independent predictors of infection included low altitude, higher age, preceding antimalarial treatment, and absence of electricity or a bicycle in the household. Plasmodium infection was associated with anaemia (mean haemoglobin difference of −1.2 g/dL; 95% CI, −0.8 to −1.5 g/dL), fever, underweight, clinically assessed malnutrition and histories of fever, tiredness, weakness, poor appetite, abdominal pain, and vomiting. With the exception of underweight, these conditions were also increased at submicroscopic infection. Conclusion Malaria infection is frequent among children attending school in southern highland Rwanda. Although seemingly asymptomatic in the vast majority of cases, infection is associated with a number of non-specific symptoms in the children´s histories, in addition to the impact on anaemia. This argues for improved malaria surveillance and control activities among school children.

The aim of this study was to obtain data on susceptibility patterns of pathogens responsible for both community and hospital urinary tract infections (UTIs); and analyzed risk factors for infection caused by ciprofloxacin-resistant Escherichia coli and extended-spectrum β-lactamace (ESBL)-producing strains in Rwanda. Of 1,012 urine cultures prospectively studied, a total of 196 (19.3%) yielded significant growth of a single organism. The most common isolate (60.7%) was Escherichia coli. The antibiotics commonly used in UTIs are less effective except Fosfomycin-trometamol and imipinem. The use of ciprofloxacin in the previous 6 months (odds ratio [OR] = 7.59 [1.75–32.74]), use of other antibiotics in the previous 6 months (OR = 1.02 [1.02–2.34]), and production of ESBL (OR = 19.32 [2.62–142.16]) were found to be associated with ciprofloxacin resistance among the E. coli isolates. Risk factors for ESBL positivity were the use of ciprofloxacin and third-generation cephalosporin in the preceding 6 months (OR = 3.05 [1.42–6.58] and OR = 9.78 [2.71–35.25], respectively); and being an inpatient (OR = 2.27 [1.79–2.89]). Fosfomycin-trometamol could be included as a reasonable alternative for the therapy of uncomplicated UTI in Rwanda.

Oral infections can act as the site of origin for dissemination of periodonto-bacteria and their toxins as well as induce inflammatory mechanisms to distant body sites, thus linking periodontal diseases to pre-term delivery of low birth weight (PLBW) infants. Periodontal disease is an infection of the tissues surrounding and supporting the teeth. Researchers showed that between 18 and 50 % of all pre-term deliveries are associated with periodontal disease. Porphyromonasgingivalis, Treponema denticola and Tannerella forsythia are among the subgingival microflora most frequently associated with periodontal disease. The presence of these bacteria can be identified by their ability to hydrolyse BANA. BANA is a rapid and effective diagnostic aid shown to correlate well with the clinical indices used to diagnose periodontal disease. The objective of this study was to investigate the association between the presence of member of the red complex (BANA positive species) in subgingival plaque and pre-term delivery of low birth weight in a Rwandan population. Three clinical indices (PI,GI and PD) were measured for each patient. Plaque sample were collected by inserting a sterile probe into the base of the pocket and this served for the measurement of the BANA enzyme test. The age of the population study was between 18 and 47 years with a mean of 30.8 (± 5.34). Among the 450 women examined, 57.1 % had a PI score of 2, 56.0 % had GI score of 2 and 89.6 % had a PD between 4-6 mm. At a level of 5%, a significant association of p-value=0.000 was found between PI vs BANA, GI vs BANA and PD vs BANA. No significant association (p-value=0.073) was found between BANA and mothers who delivered preterm of low birth weight (PLBW). In conclusion, findings of this study showed that BANA cannot be used for now as screening test for mother at risk for preterm delivery, while waiting for a multicenter study which will help to verify the cause of these discrepancies of results. In the other hand we can recommend BANA to be used as a routine test for the detection of periodontal disease due it strong relationship with clinical indices used to diagnose periodontal disease.

The objective of this study was to obtain data on susceptibility patterns of pathogens responsible for UTIs. In addition, for the first time, the prevalence and risk factors of ESBL-producing strains in Rwanda are described. Urinary isolates from symptomatic UTI patients’ cases attending to the University Teaching Hospital-Kigali and University teaching Hospital-Butare were identified by conventional methods. Antimicrobial susceptibility testing was performed by Kirby Bauer's disc diffusion method. Isolates resistant to third generation cephalosporin were tested for ESBL production by double disk synergy test method. Escherichia coli was the most common uropathogen, accounting for infections in 119 (60.7%) of the 196 cases; and occurred significantly more frequently in urines from outpatients (70.6%) than from inpatients (50%). Antimiocrobial agents commonly used for the treatment of UTI in Rwanda such as nalidixic acid, nitrofurantoin and ciprofloxacin are far from effective except Fosfomycin-trometamol and imipinem. ESBLs were detected in 38.3 % (36/94) of the strains from inpatients (13.8% of E.coli) and 5.9% (6/102) of all strains from outpatients (1.9% of E.coli). The use of ciprofloxacin and third-generation cephalosporin in the preceding 6 months (OR: 3.05; 95% CI 1.42–6.58; P = 0.04 and OR: 9.78; 95% CI 2.71–35.25; P = 0.01 respectively); and being inpatient (OR: 2.27; 95% CI 1.79–2.89; P < 0.001) were independently associated with ESBL production. In conclusion, ESBL producers are, as in many countries, frequent in enterobacteriaceae in Rwanda. On the basis of our findings, we suggest that antimicrobial agent such as fosfomycin-trometamol could be alternative therapy for uncomplicated UTI, and should be introduced in the national guidelines. Keywords : Urinary tract infection, antimicrobial resistance, ciprofloxacin, ESBL production, Rwanda

Reports show that more than 20 million infants world-wide are born prematurely with 95% of all pre-term births occurring in developing countries. Oral colonization of gram-negative anaerobes has been implicated as a risk factor for preterm delivery of low birth weight infants.This study comprised 200 women admitted to the department of obstetrics and gynecology of the teaching hospital of Butare in Rwanda. Gingival crevicular fluid was collected from each quadrant of the mother's mouth (using paper points) within 24 hours of delivery. A dichotomous score of presence or absence of gingival inflammation was recorded for each patient along with demographic data such as age, marital status etc. Samples were examined by PCR for the presence of Aggregatibacter actinomycetemcomitans and selected members of the red and orange complexes described by Socransky et al., (1998), and their presence associated with age, gingival inflammation and pregnancy outcomes.Association of bacterial species with the risk of periodontal disease and thus the risk of preterm delivery was only observed when they occurred in pairs or groups of three or more. Aa appeared to be a necessary co-factor for significant associations of bacterial groups with the variables recorded.

Increased levels of oestrogen and progesterone during pregnancy may lead to periodontal disease. The anaerobic Gram-negative bacteria classified as the "red complex" (Porphyromonas gingivalis, Tannerella forsythia and Treponema denticola) are frequently associated with periodontal disease. Periodontopathogens produce toxins and enzymes that can enter the bloodstream and cross the placenta to harm the foetus. The response of the mother's immune system to infection by these periodontopathogens brings about the release of inflammatory mediators which may trigger preterm labour or result in low birth-weight infants. The purpose of this study was to examine the use of Perioscan as a potential screening test for mothers at risk for pre-term delivery of low birth weight infants due to periodontal disease. Subgingival plaque samples were obtained from pregnant women between the ages of 17 to 45 years attending an ante-natal clinic in the Western Cape in South Africa. Plaque samples were analyzed by the enzymatic Perioscan test for detection of the red complex in 372 sites from 66 women. Results were confirmed by polymerase chain reaction (PCR) detection of the three species of the red complex. Seventeen (25.75%) of the population group tested positive with Perioscan but only 27 (7.25%) of the 372 sites were positive. Of the 66 mothers examined, we managed to retrieve 29 records post-delivery. In all the mothers examined, Perioscan results showed an association with the indices used to diagnose periodontal disease, and could also be associated with preterm delivery of low birth-weight infants in two of the 29 maternal records recovered.

Entamoeba histolytica is a protozoan parasite causing amebiasis. It occurs usually in the large intestine and causes internal inflammation as its name means (histo = tissue, lytic = destroying). Between 40 and 50 million people are infected worldwide, mostly in tropical countries, in areas of poor sanitation. The infection occurs by ingestion of mature cyst in fecally contaminated food, water or hands. The disease shows different symptoms including vomiting, abdominal pain, nausea, watery and bloody diarrhea. While the infection becomes extra intestinal, it may cause abscess in other organs such as liver, kidney, brain and lungs. The present study was carried out to determine the prevalence of E. histolytica in stool specimens at Muhondo Health Center. A total of 103 fecal specimens were collected over a period of three months. Out of 103 specimens, only 26 (25.2%) were positive for E. histolytica . Out of the 26 specimens positive for E. histolytica , 17 (16.5%) and 9 (8.7%) were from males and females respectively. Furthermore, of the 26 Specimens positive for E. histolytica , 15 (14.6%) and 11 (10.7%) were from people ≤ 15 and >15 years of age respectively. Entamoeba histolytica was more prevalent 26 (25.2%) than other parasites including Giardia with 15 (14.6%), Ascaris sp with 5 (4.9%), Trichomonas intestinalis with 16 (15.5%) and Entamoeba coli with 1 (1%). In order to reduce Entamoeba histolytica contamination and infections, the following recommendations were pointed out: (i) improving personal hygiene (washing hand before eating and after using latrines) ; (ii) avoiding fecal contamination of food, water, and utensils ; and (iii) boiling drinking water before consumption. Keywords: Parasites , Prevalence, Entamoeba histolytica , amebiasis, Stool specimens, Muhondo Health Center