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Article ; Online: Spatio-Temporal Bayesian Models for Malaria Risk Using Survey and Health Facility Routine Data in Rwanda

Muhammed Semakula / François Niragire / Christel Faes

International Journal of Environmental Research and Public Health, Vol 20, Iss 4283, p

2023 Volume 4283

Abstract: Introduction: Malaria is a life-threatening disease ocuring mainly in developing countries. Almost half of the world’s population was at risk of malaria in 2020. Children under five years age are among the population groups at considerably higher risk of ...

Abstract	Introduction: Malaria is a life-threatening disease ocuring mainly in developing countries. Almost half of the world’s population was at risk of malaria in 2020. Children under five years age are among the population groups at considerably higher risk of contracting malaria and developing severe disease. Most countries use Demographic and Health Survey (DHS) data for health programs and evaluation. However, malaria elimination strategies require a real-time, locally-tailored response based on malaria risk estimates at the lowest administrative levels. In this paper, we propose a two-step modeling framework using survey and routine data to improve estimates of malaria risk incidence in small areas and enable quantifying malaria trends. Methods: To improve estimates, we suggest an alternative approach to modeling malaria relative risk by combining information from survey and routine data through Bayesian spatio-temporal models. We model malaria risk using two steps: (1) fitting a binomial model to the survey data, and (2) extracting fitted values and using them in the Poison model as nonlinear effects in the routine data. We modeled malaria relative risk among under-five-year old children in Rwanda. Results: The estimation of malaria prevalence among children who are under five years old using Rwanda demographic and health survey data for the years 2019–2020 alone showed a higher prevalence in the southwest, central, and northeast of Rwanda than the rest of the country. Combining with routine health facility data, we detected clusters that were undetected based on the survey data alone. The proposed approach enabled spatial and temporal trend effect estimation of relative risk in local/small areas in Rwanda. Conclusions: The findings of this analysis suggest that using DHS combined with routine health services data for active malaria surveillance may provide provide more precise estimates of the malaria burden, which can be used toward malaria elimination targets. We compared findings from geostatistical modeling ...
Keywords	malaria ; survey data ; routine data ; spatio-temporal models ; Medicine ; R
Subject code	310
Language	English
Publishing date	2023-02-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Spatio-temporal dynamic of the COVID-19 epidemic and the impact of imported cases in Rwanda

Muhammed Semakula / François Niragire / Sabin Nsanzimana / Eric Remera / Christel Faes

BMC Public Health, Vol 23, Iss 1, Pp 1-

2023 Volume 13

Abstract: Abstract Introduction Africa was threatened by the coronavirus disease 2019 (COVID-19) due to the limited health care infrastructure. Rwanda has consistently used non-pharmaceutical strategies, such as lockdown, curfew, and enforcement of prevention ... ...

Abstract	Abstract Introduction Africa was threatened by the coronavirus disease 2019 (COVID-19) due to the limited health care infrastructure. Rwanda has consistently used non-pharmaceutical strategies, such as lockdown, curfew, and enforcement of prevention measures to control the spread of COVID-19. Despite the mitigation measures taken, the country has faced a series of outbreaks in 2020 and 2021. In this paper, we investigate the nature of epidemic phenomena in Rwanda and the impact of imported cases on the spread of COVID-19 using endemic-epidemic spatio-temporal models. Our study provides a framework for understanding the dynamics of the epidemic in Rwanda and monitoring its phenomena to inform public health decision-makers for timely and targeted interventions. Results The findings provide insights into the effects of lockdown and imported infections in Rwanda’s COVID-19 outbreaks. The findings showed that imported infections are dominated by locally transmitted cases. The high incidence was predominant in urban areas and at the borders of Rwanda with its neighboring countries. The inter-district spread of COVID-19 was very limited due to mitigation measures taken in Rwanda. Conclusion The study recommends using evidence-based decisions in the management of epidemics and integrating statistical models in the analytics component of the health information system.
Keywords	COVID-19 ; Spatio-temporal models ; Epidemiology ; Public aspects of medicine ; RA1-1270
Subject code	390
Language	English
Publishing date	2023-05-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Bayesian spatio-temporal modeling of malaria risk in Rwanda

Muhammed Semakula / Franco̧is Niragire / Christel Faes / Emanuele Giorgi

PLoS ONE, Vol 15, Iss

2020 Volume 9

Abstract: Every year, 435,000 people worldwide die from Malaria, mainly in Africa and Asia. However, malaria is a curable and preventable disease. Most countries are developing malaria elimination plans to meet sustainable development goal three, target 3.3, which ...

Abstract	Every year, 435,000 people worldwide die from Malaria, mainly in Africa and Asia. However, malaria is a curable and preventable disease. Most countries are developing malaria elimination plans to meet sustainable development goal three, target 3.3, which includes ending the epidemic of malaria by 2030. Rwanda, through the malaria strategic plan 2012-2018 set a target to reduce malaria incidence by 42% from 2012 to 2018. Assessing the health policy and taking a decision using the incidence rate approach is becoming more challenging. We are proposing suitable statistical methods that handle spatial structure and uncertainty on the relative risk that is relevant to National Malaria Control Program. We used a spatio-temporal model to estimate the excess probability for decision making at a small area on evaluating reduction of incidence. SIR and BYM models were developed using routine data from Health facilities for the period from 2012 to 2018 in Rwanda. The fitted model was used to generate relative risk (RR) estimates comparing the risk with the malaria risk in 2012, and to assess the probability of attaining the set target goal per area. The results showed an overall increase in malaria in 2013 to 2018 as compared to 2012. Ofall sectors in Rwanda, 47.36% failed to meet targeted reduction in incidence from 2012 to 2018. Our approach of using excess probability method to evaluate attainment of target or identifying threshold is a relevant statistical method, which will enable the Rwandan Government to sustain malaria control and monitor the effectiveness of targeted interventions.
Keywords	Medicine ; R ; Science ; Q
Language	English
Publishing date	2020-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Bayesian spatio-temporal modeling of malaria risk in Rwanda.

Muhammed Semakula / Franco Is Niragire / Christel Faes

PLoS ONE, Vol 15, Iss 9, p e

2020 Volume 0238504

Abstract	Every year, 435,000 people worldwide die from Malaria, mainly in Africa and Asia. However, malaria is a curable and preventable disease. Most countries are developing malaria elimination plans to meet sustainable development goal three, target 3.3, which includes ending the epidemic of malaria by 2030. Rwanda, through the malaria strategic plan 2012-2018 set a target to reduce malaria incidence by 42% from 2012 to 2018. Assessing the health policy and taking a decision using the incidence rate approach is becoming more challenging. We are proposing suitable statistical methods that handle spatial structure and uncertainty on the relative risk that is relevant to National Malaria Control Program. We used a spatio-temporal model to estimate the excess probability for decision making at a small area on evaluating reduction of incidence. SIR and BYM models were developed using routine data from Health facilities for the period from 2012 to 2018 in Rwanda. The fitted model was used to generate relative risk (RR) estimates comparing the risk with the malaria risk in 2012, and to assess the probability of attaining the set target goal per area. The results showed an overall increase in malaria in 2013 to 2018 as compared to 2012. Ofall sectors in Rwanda, 47.36% failed to meet targeted reduction in incidence from 2012 to 2018. Our approach of using excess probability method to evaluate attainment of target or identifying threshold is a relevant statistical method, which will enable the Rwandan Government to sustain malaria control and monitor the effectiveness of targeted interventions.
Keywords	Medicine ; R ; Science ; Q
Language	English
Publishing date	2020-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Digital mHealth and Virtual Care Use During COVID-19 in 4 Countries: Rapid Landscape Review.

Müller, Alison / Cau, Alessandro / Muhammed, Semakula / Abdullahi, Osman / Hayward, Andrew / Nsanzimana, Sabin / Lester, Richard

JMIR formative research

2022 Volume 6, Issue 11, Page(s) e26041

Abstract: Background: As a result of the COVID-19 pandemic, providing health care while maintaining social distancing has resulted in the need to provide care remotely, support quarantined or isolated individuals, monitor infected individuals and their close ... ...

Abstract	Background: As a result of the COVID-19 pandemic, providing health care while maintaining social distancing has resulted in the need to provide care remotely, support quarantined or isolated individuals, monitor infected individuals and their close contacts, as well as disseminate accurate information regarding COVID-19 to the public. This has led to an unprecedented rapid expansion of digital tools to provide digitized virtual care globally, especially mobile phone-facilitated health interventions, called mHealth. To help keep abreast of different mHealth and virtual care technologies being used internationally to facilitate patient care and public health during the COVID-19 pandemic, we carried out a rapid investigation of solutions being deployed and considered in 4 countries. Objective: The aim of this paper was to describe mHealth and the digital and contact tracing technologies being used in the health care management of the COVID-19 pandemic among 2 high-income and 2 low-middle income countries. Methods: We compared virtual care interventions used for COVID-19 management among 2 high-income countries (the United Kingdom and Canada) and 2 low-middle income (Kenya and Rwanda) countries. We focused on interventions used to facilitate patient care and public health. Information regarding specific virtual care technologies was procured from a variety of resources including gray literature, government and health organization websites, and coauthors' personal experiences as implementers of COVID-19 virtual care strategies. Search engine queries were performed to find health information that would be easily accessible to the general public, with keywords including "COVID-19," "contact-tracing," "tool-kit," "telehealth," and "virtual care," in conjunction with corresponding national health authorities. Results: We identified a variety of technologies in Canada, the United Kingdom, Rwanda, and Kenya being used for patient care and public health. These countries are using both video and text message-based platforms to facilitate communication with health care providers (eg, WelTel and Zoom). Nationally developed contact tracing apps are provided free to the public, with most of them using Bluetooth-based technology. We identified that often multiple complimentary technologies are being utilized for different aspects of patient care and public health with the common purpose to disseminate information safely. There was a negligible difference among the types of technologies used in both high-income and low-middle income countries, although the latter implemented virtual care interventions earlier during the pandemic's first wave, which may account for their effective response. Conclusions: Virtual care and mHealth technologies have evolved rapidly as a tool for health care support for both patient care and public health. It is evident that, on an international level, a variety of mHealth and virtual care interventions, often in combination, are required to be able to address patient care and public health concerns during the COVID-19 pandemic, independent of a country's economic standing.
Language	English
Publishing date	2022-11-30
Publishing country	Canada
Document type	Journal Article ; Review
ISSN	2561-326X
ISSN (online)	2561-326X
DOI	10.2196/26041
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: The secondary transmission pattern of COVID-19 based on contact tracing in Rwanda

Sabin Nsanzimana / Muhammed Semakula / Christel Faes / Thierry Nyatanyi / Eric Remera / FranÇois Niragire / Angela Umutoni / Vedaste Ndahindwa / Edison Rwagasore

BMJ Global Health, Vol 6, Iss

2021 Volume 6

Abstract: Introduction COVID-19 has shown an exceptionally high spread rate across and within countries worldwide. Understanding the dynamics of such an infectious disease transmission is critical for devising strategies to control its spread. In particular, ... ...

Abstract	Introduction COVID-19 has shown an exceptionally high spread rate across and within countries worldwide. Understanding the dynamics of such an infectious disease transmission is critical for devising strategies to control its spread. In particular, Rwanda was one of the African countries that started COVID-19 preparedness early in January 2020, and a total lockdown was imposed when the country had only 18 COVID-19 confirmed cases known. Using intensive contact tracing, several infections were identified, with the majority of them being returning travellers and their close contacts. We used the contact tracing data in Rwanda for understanding the geographic patterns of COVID-19 to inform targeted interventions.Methods We estimated the attack rates and identified risk factors associated to COVID-19 spread. We used Bayesian disease mapping models to assess the spatial pattern of COVID-19 and to identify areas characterised by unusually high or low relative risk. In addition, we used multiple variable conditional logistic regression to assess the impact of the risk factors.Results The results showed that COVID-19 cases in Rwanda are localised mainly in the central regions and in the southwest of Rwanda and that some clusters occurred in the northeast of Rwanda. Relationship to the index case, being male and coworkers are the important risk factors for COVID-19 transmission in Rwanda.Conclusion The analysis of contact tracing data using spatial modelling allowed us to identify high-risk areas at subnational level in Rwanda. Estimating risk factors for infection with SARS-CoV-2 is vital in identifying the clusters in low spread of SARS-CoV-2 subnational level. It is imperative to understand the interactions between the index case and contacts to identify superspreaders, risk factors and high-risk places. The findings recommend that self-isolation at home in Rwanda should be reviewed to limit secondary cases from the same households and spatiotemporal analysis should be introduced in routine monitoring of COVID-19 in Rwanda for policy making decision on real time.
Keywords	Medicine (General) ; R5-920 ; Infectious and parasitic diseases ; RC109-216
Subject code	390
Language	English
Publishing date	2021-06-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: The Global Cohort of Doctoral Students

Semira Abdelmenan / Christopher T. Andersen / Fentabil Getnet / Hari S. Iyer / Kesaobaka Molebatsi / Simone Passarelli / Sara M. Sauer / Muhammed Semakula

Annals of Global Health, Vol 87, Iss

Building Shared Global Health Research Capacity in High- Income and Low- and Middle-Income Countries

2021 Volume 1

Abstract: Doctoral students in high- and low-income countries pursuing careers in global health face gaps in their training that could be readily filled through structured peer-learning activities with students based at partnering institutions in complimentary ... ...

Abstract	Doctoral students in high- and low-income countries pursuing careers in global health face gaps in their training that could be readily filled through structured peer-learning activities with students based at partnering institutions in complimentary settings. We share lessons learned from the Global Cohort of Doctoral Students, a community of doctoral students based at the Harvard T. H. Chan School of Public Health, Haramaya University, University of Gondar, University of Botswana, and University of Rwanda College of Medicine and Health Sciences. Students in the Global Cohort program engage in collaborative research, forums for constructive feedback, and professional development activities. We describe the motivation for the program, core activities, and early successes.
Keywords	Infectious and parasitic diseases ; RC109-216 ; Public aspects of medicine ; RA1-1270
Subject code	020
Language	English
Publishing date	2021-01-01T00:00:00Z
Publisher	Ubiquity Press
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: One hundred thirty-three observed COVID-19 deaths in 10 months

Sabin Nsanzimana / Fredrick Kateera / Bethany L Hedt-Gauthier / Megan B Murray / Clarisse Musanabaganwa / Vincent Cubaka / Etienne Mpabuka / Muhammed Semakula / Ernest Nahayo / Kamela C S Ng / Leon Mutesa

BMJ Global Health, Vol 6, Iss

unpacking lower than predicted mortality in Rwanda

2021 Volume 2

Abstract: The African region was predicted to have worse COVID-19 infection and death rates due to challenging health systems and social determinants of health. However, in the 10 months after its first case, Rwanda recorded 10316 cases and 133 COVID-19-related ... ...

Abstract	The African region was predicted to have worse COVID-19 infection and death rates due to challenging health systems and social determinants of health. However, in the 10 months after its first case, Rwanda recorded 10316 cases and 133 COVID-19-related deaths translating to a case fatality rate (CFR) of 1.3%, which raised the question: why does Rwanda have a low COVID-19 CFR? Here we analysed COVID-19 data and explored possible explanations to better understand the disease burden in the context of Rwanda’s infection control strategies.We investigated whether the age distribution plays a role in the observed low CFR in Rwanda by comparing the expected number of deaths for 10-year age bands based on the CFR reported in other countries with the observed number of deaths for each age group. We found that the age-specific CFRs in Rwanda are similar to or, in some older age groups, slightly higher than those in other countries, suggesting that the lower population level CFR reflects the younger age structure in Rwanda, rather than a lower risk of death conditional on age. We also accounted for Rwanda’s comprehensive SARS-CoV-2 testing strategies and reliable documentation of COVID-19-related deaths and deduced that these measures may have allowed them to likely identify more asymptomatic or mild cases than other countries and reduced their reported CFR.Overall, the observed low COVID-19 deaths in Rwanda is likely influenced by the combination of effective infection control strategies, reliable identification of cases and reporting of deaths, and the population’s young age structure.
Keywords	Medicine (General) ; R5-920 ; Infectious and parasitic diseases ; RC109-216
Language	English
Publishing date	2021-02-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: An Assessment of the Knowledge and Perceptions of Precision Medicine (PM) in the Rwandan Healthcare Setting

Journal of Personalized Medicine, Vol 13, Iss 12, p

2023 Volume 1707

Abstract: Introduction: Precision medicine (PM) or personalized medicine is an innovative approach that aims to tailor disease prevention and treatment to consider the differences in people’s genes, environments, and lifestyles. Although many efforts have been ... ...

Abstract	Introduction: Precision medicine (PM) or personalized medicine is an innovative approach that aims to tailor disease prevention and treatment to consider the differences in people’s genes, environments, and lifestyles. Although many efforts have been made to accelerate the universal adoption of PM, several challenges need to be addressed in order to advance PM in Africa. Therefore, our study aimed to establish baseline data on the knowledge and perceptions of the implementation of PM in the Rwandan healthcare setting. Method: A descriptive qualitative study was conducted in five hospitals offering diagnostics and oncology services to cancer patients in Rwanda. To understand the existing policies regarding PM implementation in the country, two additional institutions were surveyed: the Ministry of Health (MOH), which creates and sets policies for the overall vision of the health sector, and the Rwanda Biomedical Center (RBC), which coordinates the implementation of health sector policies in the country. The researchers conducted 32 key informant interviews and assessed the functionality of available PM equipment in the 5 selected health facilities. The data were thematically categorized and analyzed. Results: The study revealed that PM is perceived as a complex and expensive program by most health managers and health providers. The most cited challenges to implementing PM included the following: the lack of policies and guidelines; the lack of supportive infrastructures and limited suppliers of required equipment and laboratory consumables; financial constraints; cultural, behavioral, and religious beliefs; and limited trained, motivated, and specialized healthcare providers. Regarding access to health services for cancer treatment, patients with health insurance pay 10% of their medical costs, which is still too expensive for Rwandans. Conclusion: The study participants highlighted the importance of PM to enhance healthcare delivery if the identified barriers are addressed. For instance, Rwandan health sector ...
Keywords	precision or personalized medicine ; breast cancer ; healthcare providers ; national policies ; cancer healthcare services ; Medicine ; R
Subject code	360 ; 027
Language	English
Publishing date	2023-12-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Child mortality associated with maternal HIV status

Agnes Binagwaho / Sabin Nsanzimana / Edward J Mills / Frédérique Chammartin / Marie Paul Nisingizwe / Placidie Mugwaneza / Heiner Bucher / Nathan Ford / Muhammed Semakula / Eric Remera / Jamie Ian Forrest / Gerald E Smith / Samuel S Malamba / Jeanine U Condo / David J Riedel

BMJ Global Health, Vol 6, Iss

a retrospective analysis in Rwanda, 2005-2015

2021 Volume 5

Abstract: Introduction Child mortality remains highest in regions of the world most affected by HIV/AIDS. The aim of this study was to assess child mortality rates in relation to maternal HIV status from 2005 to 2015, the period of rapid HIV treatment scale-up in ... ...

Abstract	Introduction Child mortality remains highest in regions of the world most affected by HIV/AIDS. The aim of this study was to assess child mortality rates in relation to maternal HIV status from 2005 to 2015, the period of rapid HIV treatment scale-up in Rwanda.Methods We used data from the 2005, 2010 and 2015 Rwanda Demographic Health Surveys to derive under-2 mortality rates by survey year and mother’s HIV status and to build a multivariable logistic regression model to establish the association of independent predictors of under-2 mortality stratified by mother’s HIV status.Results In total, 12 010 live births were reported by mothers in the study period. Our findings show a higher mortality among children born to mothers with HIV compared with HIV negative mothers in 2005 (216.9 vs 100.7 per 1000 live births) and a significant reduction in mortality for both groups in 2015 (72.0 and 42.4 per 1000 live births, respectively). In the pooled reduced multivariable model, the odds of child mortality was higher among children born to mothers with HIV, (adjusted OR, AOR 2.09; 95% CI 1.57 to 2.78). The odds of child mortality were reduced in 2010 (AOR 0.69; 95% CI 0.59 to 0.81) and 2015 (AOR 0.35; 95% CI 0.28 to 0.44) compared with 2005. Other independent predictors of under-2 mortality included living in smaller families of 1–2 members (AOR 5.25; 95% CI 3.59 to 7.68), being twin (AOR 4.93; 95% CI 3.51 to 6.92) and being offspring from mothers not using contraceptives at the time of the survey (AOR 1.6; 95% CI 1.38 to 1.99). Higher education of mothers (completed primary school: (AOR 0.74; 95% CI 0.64 to 0.87) and secondary or higher education: (AOR 0.53; 95% CI 0.38 to 0.74)) was also associated with reduced child mortality.Conclusions This study shows an important decline in under-2 child mortality among children born to both mothers with and without HIV in Rwanda over a 10-year span.
Keywords	Medicine (General) ; R5-920 ; Infectious and parasitic diseases ; RC109-216
Subject code	310 ; 360
Language	English
Publishing date	2021-05-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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