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James Gafirita,1,&ast; Cuthbert Musarurwa,1,&ast; Evariste Ntaganda,2,&ast; Marguerite Uwimana,3,&ast; Aime Dieudonne Hirwa,4,&ast; Mediatrice Mukahigiro,5,&ast; Laetitia Twizelimana,6,&ast; Marie Louise Nshimirimana,6,&ast; Stephen Rulisa,7,8 Charlotte Bavuma,8,9,&ast; Emile Ivan,10 David K Tumusiime11,&ast; 1Department of Biomedical Laboratory Sciences College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda; 2Division of Non-Communicable Diseases, Rwanda Biomedical Center (RBC), Ministry of Health, Kigali, Rwanda; 3Department of NCD, Ruhengeri Provincial Hospital, Musanze, Northern Province, Rwanda; 4Department of Surgery, Ruhengeri Provincial Hospital, Musanze, Northern Province, Rwanda; 5Department of Laboratory Diagnosis, Ruhengeri Provincial Hospital, Musanze, Northern Province, Rwanda; 6Department of Internal Medicine, Ruhengeri Provincial Hospital, Musanze, Northern Province, Rwanda; 7Department of Obstetrics and Gynecology, Kigali University Teaching Hospital, Kigali, Rwanda; 8Department of Obstetrics and Gynecology School of Medicine and Pharmacy, College of Medicine and Health Science, University of Rwanda, Kigali, Rwanda; 9Department of Internal Medicine, Kigali University Teaching Hospital, Kigali, Rwanda; 10Department of Drugs Assessment and Registration, Division of Human Medicine and Device Registration, Rwanda Food and Drugs Authority, Kigali, Rwanda; 11Department of Physiotherapy School of Health Sciences, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda&ast;These authors contributed equally to this workCorrespondence: James Gafirita, Email jgafirita@gmail.comBackground: The prevalence of cardiometabolic diseases is escalating in sub-Saharan Africa (SSA) alongside the prevailing high burden of communicable diseases. Although many countries in SSA, including Rwanda, have existing data on the prevalence of individual components of the MetS, many SSA countries have insufficient data to guide policy makers on the magnitude of MetS. This study sought to determine the magnitude of MetS and its associated risk factors by sex at a referral teaching hospital in Rwanda.Methods: A cross-sectional, study was conducted among adults aged 35 to 65 years presenting at Ruhengeri Referral Teaching Hospital, Rwanda. We collected socio-clinicodemographic data using the World Health Organization (WHO) STEPwise tool for non-communicable diseases. We used the National Cholesterol Education Program Adult Treatment Panel III criteria for MetS.Results: Overall, 99 (23.5%) males and 322 (76.5%) female participants with mean ± SD age 47.5 ± 8.2 years were enrolled. The overall frequency of MetS was 51.9% (95% CI: 47.0– 56.8) and was significantly higher (p < 0.001) in females 193 (59.4%) compared to males 26 (26.3%). Significant differences by sex were also noted in the proportions of visceral obesity; 70.4% vs 7.1% (p < 0.001), hypoalphalipoproteinaemia 36.1% vs 69.7% (p < 0.0001), type 2 diabetes mellitus; 18.4% vs 31.6% (p = 0.020) and body mass index 25.9 ± 15.6 vs 28.2 ± 6.4 (p = 0.032). On multivariate logistic regression, older age (odds ratio (OR) 1.05; 95% confidence interval ((CI) 1.01– 1.10)), higher body weight (OR 1.06; 95% CI 1.04– 1.08) and higher total cholesterol (1.25; 95% CI 1.05 − 1.74) were significantly associated with MetS in females; whereas only higher body weight (OR1.10; 95% CI 1.04– 1.18) was significantly associated with MetS in males.Conclusion: A high frequency of MetS was observed in the present study, which was higher among females. Our findings emphasize the need for tailored prevention and intervention strategies to mitigate the long-term impact of MetS.Keywords: frequency, metabolic syndrome, non-communicable diseases, Rwanda

Background: Surgical conditions represent up to 30% of the global burden of diseases. The aim of this study was to assess the delays in patients transferred to a tertiary referral hospital from district hospitals (DHs) in Rwanda with emergency general surgery (EGS) conditions., Methods: We performed a prospective review of all EGS patients referred from DH over a 3-month period to assess delays in transfer and accessing care. We then surveyed general practitioners to define their perspective on delays in surgical care., Results: Over a 3-month period, there were 86 patients transferred from DH with EGS conditions. The most common diagnoses were bowel obstruction (n = 22, 26%) and trauma (n = 19, 22%). The most common performed operations were laparotomy (n = 21, 24%) and bowel resection (n = 20, 23%). The mortality rate was 12%, and the intensive care unit admission rate was 4%. In transfer to the referral hospital, 5% patients were delayed for financial reasons and 2% due to lack of insurance. After reaching CHUK, 5% patients were delayed due to laboratory and radiology issues. Other delays included no operating theater available (4%) and no surgeon available (1%). Providers' perceptions for not performing surgeries at DH were predominantly the lack of a competent surgical provider or anesthesia staff., Conclusion: EGS patients represent a broad range of diagnoses. Delays were noted at each step in the referral process with multiple areas for potential improvement. Expanding surgical access at the DH has the potential to decrease delays and thereby improves patient outcomes.