cyprien Baribwira - Academia.edu (original) (raw)

Papers by cyprien Baribwira

Maternal and child nutrition, Mar 22, 2024

clinics in Mother and Child Health, 2008

A very unusual case of geophagia in a 10 year old female patient, with a history of HIV and tuber... more A very unusual case of geophagia in a 10 year old female patient, with a history of HIV and tuberculosis is reported. While the real prevalence and the pathogenesis of pica are unknown, the associated factors described in this case presentation are multiple. Association between geophagia and HIV or tuberculosis has not been documented. Case management consists of screening for soil-transmitted helminthes infection, anemia and iron depletion. Surgical complications can be serious but fortunately seldom occur. Un cas inhabituel de geophagie chez une jeune fille de 10 ans, souffrant du VIH associe a une tuberculose, est decrit. La pathogenese de cette condition reste inconnue, tout comme sa prevalence, alors que les facteurs de risque associes sont nombreux. Une association de la geophagie avec le VIH et la tuberculose n\'est pas decrite. La prise en charge de la geophagie consiste essentiellement a rechercher les verminoses, l\'anemie et la depletion en fer qui peuvent etre associees. Les complications chirurgicales sont serieuses mais surviennent rarement. Keywords : Geophagie, Sol - Helminthiase - Anemie - VIH. Clinics in Mother and Child Health Vol. 5 (2) 2008: pp. 933-935

Médecine d'Afrique Noire, 1990

Journal of Public Health in Africa

Rwanda has prioritized the decentralization and integration of HIV services over the past decade ... more Rwanda has prioritized the decentralization and integration of HIV services over the past decade to ensure universal access to HIV services throughout the nation. Improving the capacity of healthcare providers to provide high-quality HIV prevention and treatment services was a crucial component of this process. In partnership with the authors, Rwanda’s national health implementation agency developed a national clinical mentorship program from 2011 to 2017 to facilitate this transition. The Rwanda Clinical Mentorship Model aims to effectively manage HIV-infected patients across all levels of healthcare delivery, implement task shifting, and adhere to national guidelines. The clinical care of HIV-positive individuals was transferred from HIV specialists to family physicians and nurses. The facility team was trained, supervised, and mentored by a multidisciplinary team. Mentorship consisted of routine site visits during which clinical case reviews, clinical supervision teaching, and da...

To combat morbidity and mortality from the worldwide epidemic of the human immunodeficiency virus... more To combat morbidity and mortality from the worldwide epidemic of the human immunodeficiency virus (HIV), the United States Congress implemented a President’s Emergency Plan for AIDS Relief (PEPFAR) in 30 resource-limited countries to integrate combination antiretroviral therapy (ART) for both prevention and cure. Over 35 % of eligible persons have been successfully treated. Initial legislation cited palliative care as an essential aspect of this plan but overall health strengthening became critical to sustainability of programing and funding priorities shifted to assure staffing for care delivery sites; laboratory and pharmaceutical infrastructure; data collection and reporting; and financial management as individual countries are being encouraged to assume control of in-country funding. Given infrastructure requisites, individual care delivery beyond ART management alone has received minimal funding yet care remains necessary for durable viral suppression and overall quality of lif...

Journal of Pain and Symptom Management, 2015

Palliative care (PC), introduced early in the management of chronic illness, improves patient out... more Palliative care (PC), introduced early in the management of chronic illness, improves patient outcomes. Early integration of a palliative approach for persons with HIV has been documented to be effective in identifying and managing patient-level concerns over the past decade in African settings. The experience of implementing PC in multiple African and other resource-constrained settings (RCSs) emphasizes the need for essential palliative competencies that can be integrated with chronic disease management for patients and their families facing life-limiting illness. This article is an historical description of how basic palliative competencies were observed to be acceptable for health workers providing outpatient HIV care and treatment during eight years of U.S. implementation of ''care and support,'' a term coined to represent PC for persons living with HIV in RCS. The need for team building and interprofessional education is highlighted. The model is currently being tested in one U.S. city and may represent a mechanism for expanding the palliative approach into management of chronic disease. Such competencies may play a role in the development of the patient-centered medical home, a critical component of U.S. health care reform.

Case study C. (DOC 23 kb)

Case study B. (DOC 22 kb)

Case study A. (DOC 22 kb)

Trends and social differentials in child mortality in

Journal of interferon & cytokine research : the official journal of the International Society for Interferon and Cytokine Research, 2021

There remains a dearth of data regarding the association between chronic inflammation and hyperte... more There remains a dearth of data regarding the association between chronic inflammation and hypertension (HTN) in sub-Saharan Africa, a region that accounts for >70% of the global burden of HIV infection. Therefore, we assessed the levels of biomarkers among HIV+ individuals and its associations with HTN in Tanzania. A cross-sectional study was conducted at one of the largest clinics in Tanzania and data from 261 HIV+ patients were analyzed. Standardized tools were used to collect data. Blood pressure was measured using Omron® M2 blood pressure monitor. Enzyme-linked immunosorbent assay was used to test for inflammatory markers [C-reactive protein (CRP), interleukin (IL)-6, IL-18, soluble tumor necrosis factor receptor type I (sTNFRI), sTNFRII]. Bivariate and multivariable analysis was conducted to examine association between the biomarkers and HTN. We further conducted age-sex-alcohol-adjusted models to control for any confounders. The prevalence of HTN was 43% with a high prevale...

Antiviral Therapy

Background We assessed the prevalence of acquired HIV drug resistance (HIVDR) and associated fact... more Background We assessed the prevalence of acquired HIV drug resistance (HIVDR) and associated factors among patients receiving first-line antiretroviral therapy (ART) in Rwanda. Methods This cross-sectional study included 702 patients receiving first-line ART for at least 6 months with last viral load (VL) results ≥1000 copies/mL. Blood plasma samples were subjected to VL testing; specimens with unsuppressed VL were genotyped to identify HIVDR-associated mutations. Data were analysed using STATA/SE. Results Median time on ART was 86.4 months (interquartile range [IQR], 44.8–130.2 months), and median CD4 count at ART initiation was 311 cells/mm3 (IQR, 197–484 cells/mm3). Of 414 (68.2%) samples with unsuppressed VL, 378 (88.3%) were genotyped. HIVDR included 347 (90.4%) non-nucleoside reverse transcriptase inhibitor- (NNRTI), 291 (75.5%) nucleoside reverse transcriptase inhibitor- (NRTI) and 13 (3.5%) protease inhibitor (PI) resistance-associated mutations. The most common HIVDR mutati...

Background: Clinical assessment of neonatal jaundice is inaccurate and results in a significant n... more Background: Clinical assessment of neonatal jaundice is inaccurate and results in a significant number of blood tests in otherwise well babies. The number of these blood tests could be reduced, with benefit to the neonates and potential cost savings by using a noninvasive transcutaneous bilirubinometer. Objective: The aim of our study was to evaluate the accuracy of one of the birubinometer JM-102(Minolta/Hill-Rom Air-Shields ® JM-102), in dark skin term and preterm neonates old less than two weeks compared to the gold standard which is the measurement of serum bilirubin (SBR) and to identify the most informative value of transcutaneous bilirubinometer (TcB) in terms of sensitivity and specificity. Methods: The study included 275 jaundiced neonates who were less than 14 days and consulted neonatology unit of University teaching hospital during the study period. Neonates with severe conditions (hypothermia, respiratory distress, cardiovascular disorders, and neurological disorders) a...

American Journal of Pediatrics, 2016

Neonates who require treatment and venous drawing of blood samples in the newborn units are subje... more Neonates who require treatment and venous drawing of blood samples in the newborn units are subjected to acute and painfully invasive procedures. Several tools to assess pain among newborns have been developed and are widely used in developed countries, but in Africa, there is limited experience in the assessment pain among newborns. This study assessed physiological and behavioral responses to pain among neonates during invasive procedures performed in a newborn unit in Rwanda. A total of 60 neonates born at gestational age of 28-42 weeks at the National University of Rwanda Teaching and Referral Hospital in the year 2005 were enrolled into this study. Blood pressures, heart and respiratory rates, oxygen saturation levels, the Neonatal Facing Coding System (NFCS) and Neonatal Acute Pain (APN) pain tools were and scores recorded before, immediately and 5, 10, 15 and 20 minutes after procedures were recorded. Physiological parameters were compared using the Wilcoxon Signed Ranks Test while the NFCS and APN were compared using the McNemar Test. All (100%) neonates experienced acutely peak pain in the first 5 minutes of the invasive procedures with peak responses recorded at 2.5 minutes and no pain (resolution) after 15 minutes among 81% of the neonates and only 6% experienced pain after 20 minutes. The increases in systolic blood pressures immediately after inflicting pain, 5, 10, 15 and 20 minutes were statistically significant (p<0.001, p<0.001, p<0.005 and p<0.046) respectively compared to the diastolic blood pressures whose significant increases were at 5 and 10 minutes, (p<0.001 and p<0.001) respectively. Respiratory rates were significantly high at the onset (p<0.001), 5 minutes (p<0.001) and 10 minutes later (p<0.002). Heart rates significantly increased at the onset of the procedures (p<0.000), 5 minutes (p<0.001) and after 10 minutes (p<0.033). Decrease in oxygen saturation immediately after the procedures was significant (p<0.001). Oxygen saturation immediately after the procedures significantly increased up to 5 minutes (p<0.001) and 10 minutes (p<0.001). Invasive procedures caused acute pain among neonates in the African settings but to date, neonatal practice had not been given its due consideration with the aim of reducing pain among African neonates.

The Pediatric Infectious Disease Journal

International journal of STD & AIDS, 2018

The Rwanda national HIV program has been successful at scaling up antiretroviral therapy (ART) to... more The Rwanda national HIV program has been successful at scaling up antiretroviral therapy (ART) to achieve universal access. The AIDSRelief Model of Care focuses on four key principles: (1) earlier initiation of ART; (2) use of durable, highly-potent, and sequence-friendly first-line ART regimens; (3) early detection of treatment failure; and (4) provision of community-based care and support to ensure optimal adherence and follow up/engagement in care. We conducted a retrospective cohort study of randomly-selected HIV-infected patients at AIDSRelief-supported sites using a stratified, random sample of 583 adults (>15 years) who initiated ART from 30 June 2008 to 1 February 2010. At ART initiation, the median patient age was 38 years, and 67% were female. The baseline median CD4+ cell count was 309 cells/mm. Overall virologic suppression was 91%. Married/ever married status (adjusted prevalence odds ratio [aPOR] 3.75, 95% confidence interval [CI] 1.30-10.78) and self-reported adher...

BMC Pregnancy and Childbirth, 2017

Background: Perinatal audit and the three-delays model are increasingly being employed to analyse... more Background: Perinatal audit and the three-delays model are increasingly being employed to analyse barriers to perinatal health, at both community and facility level. Using these approaches, our aim was to assess factors that could contribute to perinatal mortality and potentially avoidable deaths at Rwandan hospitals. Methods: Perinatal audits were carried out at two main urban hospitals, one at district level and the other at tertiary level, in Kigali, Rwanda, from July 2012 to May 2013. Stillbirths and early neonatal deaths occurring after 22 completed weeks of gestation or more, or weighing at least 500 g, were included in the study. Factors contributing to mortality and potentially avoidable deaths, considering the local resources and feasibility, were identified using a three-delays model. Results: Out of 8424 births, there were 269 perinatal deaths (106 macerated stillbirths, 63 fresh stillbirths, 100 early neonatal deaths) corresponding to a stillbirth rate of 20/1000 births and a perinatal mortality rate of 32/1000 births. In total, 250 perinatal deaths were available for audit. Factors contributing to mortality were ascertained for 79% of deaths. Delay in care-seeking was identified in 39% of deaths, delay in arriving at the health facility in 10%, and provision of suboptimal care at the health facility in 37%. Delay in seeking adequate care was commonly characterized by difficulties in recognising or reporting pregnancy-related danger signs. Lack of money was the major cause of delay in reaching a health facility. Delay in referrals, diagnosis and management of emergency obstetric cases were the most prominent contributors affecting the provision of appropriate and timely care by healthcare providers. Half of the perinatal deaths were judged to be potentially avoidable and 70% of these were fresh stillbirths and early neonatal deaths. Conclusions: Factors contributing to delays underlying perinatal mortality were identified in more than threequarters of deaths. Half of the perinatal deaths were considered likely to be preventable and mainly related to modifiable maternal inadequate health-seeking behaviours and intrapartum suboptimal care. Strengthening the current roadmap strategy for accelerating the reduction of maternal and neonatal morbidity and mortality is needed for improved perinatal survival.