Background: Blood transfusion is a critical intervention for severe anemia, hemorrhage, and other life-threatening conditions. However, transfusions carry risks such as circulatory overload, transfusion-related acute lung injury, and hemolytic reactions. Data on transfusion practices and patient perceptions in Rwanda are limited. This study aimed to characterize transfusion indications and adverse events, and assess patient knowledge and attitudes, in the internal medicine wards of the University Teaching Hospital of Kigali (CHUK). Methods: We performed a retrospective chart review of all adult patients (≥ 15 years) who received blood transfusions on the internal medicine wards from January 2020 through December 2021. Demographics, diagnoses, and documented transfusion reactions were recorded. Additionally, a prospective survey (April–May 2023) of transfused patients used a structured questionnaire to assess knowledge of indications, awareness of side effects, and willingness to accept transfusion. Data were analyzed using SPSS version 25; categorical variables were summarized as frequencies and percentages, and associations tested using chi-square or Fisher’s exact test as appropriate. Ethics approval was obtained from the University of Rwanda and CHUK, and informed consent was obtained for all interviews. Results: During the two years, 307 transfusions were given to 280 patients (51.5% female; 62% aged 30–65 years, mean ≈ 54 years). The most common underlying conditions were HIV infection (14.0%), chronic kidney disease (13.4%), and upper gastrointestinal bleeding or gastric cancer (~ 15% combined). Only 10 reactions (3.25%) were recorded, most frequently fever (0.6%). In the prospective survey (n = 71), 94.4% reported receiving a transfusion for anemia, 46.5% could not identify other indications, and 80.3% knew of no side effects. Despite limited knowledge, 88.7% were willing to accept transfusion if recommended, while 35.7% expressed concern about disease transmission. Post-transfusion symptoms included fever (7%), chills (5.6%), and dizziness (4.2%), while 70.4% reported none. Conclusions: In this tertiary-care Rwandan setting, blood transfusions were primarily used for chronic anemia associated with HIV and kidney disease. Documented adverse reactions were rare, though likely under-reported. Patients showed high acceptance but limited awareness of transfusion risks, underscoring the need for stronger hemovigilance and targeted patient education.
Background Consultation liaison psychiatry (CLP) remains a minimally researched area in sub-Saharan Africa. This study examined the profiles of patients referred for psychiatric consultation at the University Teaching Hospital Kigali (CHUK), Rwanda. Methods All adult patients who were referred or consulted for psychiatry evaluation between September to December 2024 were included, and descriptive analysis was conducted. Further in-depth individual interview of non-mental health specialists was employed. Result A total of 53 adult patients were received from other non-mental health departments. The median age was 38 years (IQR: 27-49), and the patients were predominantly female (n=36, 68%). Internal Medicine was the most frequent source of consultation, accounting for 32.7% (n=17) of referrals. From the outpatient consultation, the most common psychiatric diagnosis was somatic symptom disorder (n=13, 34.2%), followed by major depressive disorder (n=10, 26.3%). Among inpatients, delirium was the most common psychiatric diagnosis (7/15). Most of the patients were managed by either psychotherapy (n=19, 35.8%), or psychotherapy plus psychotropic medication (n=18, 34%). In-depth individual interviews with seven non-mental health specialists revealed general satisfaction with the CLP service of the hospital, with further room to improve the service by continuity of care and integrated communication. Conclusion The profile of patients referred for CLP service at CHUK closely resembles researches from other Sub-Saharan countries, with predominance of depression and delirium diagnoses. Providing multidisciplinary care for patients with comorbid medical and psychiatric conditions is essential for achieving improved health outcomes.
Pancreatic tuberculosis is a rare disease. It mimics both benign and malignant conditions of the pancreas. We describe the case of a man who presented with repetitive epigastric pain and elevated pancreatic enzymes, leading to a presumptive diagnosis of alcohol-induced pancreatitis. Imaging revealed pancreatic pseudocyst, omental thickening, multiple loculated ascites, and bilateral pleural effusions. Despite supportive management for pancreatitis, the patient's symptoms worsened. Further evaluation raised the suspicion of tuberculosis. He was started on antituberculosis therapy. There was complete resolution of his symptoms, pseudocyst and ascites on follow-up imaging. Early suspicion and management of pancreatic tuberculosis may lead to excellent outcomes.
BACKGROUND:The number of Rwandan women of reproductive age receiving mechanical heart valve prostheses for rheumatic heart disease is increasing. Effective anticoagulation management during pregnancy is essential to prevent valve thrombosis but poses significant risks to both mother and foetus if not carefully tailored. OBJECTIVE:This article describes the multidisciplinary development of national guidelines for anticoagulation management in pregnant women with mechanical heart valves in Rwanda, integrating local clinical realities with international best practices. METHODS:Guideline development involved a three-stage process: (1) a stakeholder workshop to assess current practices and challenges, (2) iterative drafting and feedback from clinicians and policymakers, and (3) validation by representatives from key medical specialties. The process incorporated evidence from local studies, international guidelines, and the lived experiences of patients and providers. RESULTS:The resulting guidelines emphasise preconception counselling, individualised risk assessment, and clear algorithms for adjusting anticoagulation regimens by gestational age. Practical considerations such as medication availability, laboratory capacity, and provider training are addressed to ensure feasibility in low-resource settings. CONCLUSION:These national guidelines aim to standardise anticoagulation management for pregnant women with mechanical heart valves in Rwanda, improving maternal and foetal outcomes. The approach provides a model for adapting evidence-based care to resource-limited environments.
