Background: Narrative Therapy is an efficacious treatment approach widely practiced for various psychological conditions. However, few studies have examined its effectiveness on resilience, a robust determinant of one\'s mental health, and there has been no randomized controlled trial in sub-Saharan Africa.Objective: This study sought to evaluate the efficacy of narrative therapy for the resilience of orphaned and abandoned children in Rwanda.Method: This study was a \'parallel randomized controlled trial\' in which participants (n = 72) were recruited from SOS Children\'s Village. Half of the participants (n = 36) were randomly allocated to the intervention group and the rest to the delayed narrative therapy group. For the intervention group, children attended ten sessions (55 min each) over 2.5 months. Data were collected using the Child and Youth Resilience Measure (CYRM) and analyzed using mixed ANOVA within SPSS version 28.Result: The results from ANOVA indicated a significant main effect of time and group for resilience total scores. Of interest, there was a significant time by group interaction effect for resilience. Pairwise comparison analyses within-group showed a significant increase in resilience in the intervention group, and the effect size was relatively large in this group.Conclusion: Our findings highlight the notable efficacy of narrative therapy for children\'s resilience in the intervention group. Therefore, health professionals and organizations working with orphaned and abandoned children will apply narrative therapy to strengthen their resilience and improve mental health.Trial registration: Pan African Clinical Trial Registry identifier: PACTR202107499406828..
The effect size of narrative therapy for resilience was relatively large in the intervention group.Narrative therapy is an efficacious approach for resilience elevation in orphaned and abandoned children.Close attention should be paid to the implementation of narrative therapy for strengthening children’s resilience as an everyday tool in foster care.

We delivered a point-of-care ultrasound training programme in a resource-limited setting in Rwanda, and sought to determine participants\' knowledge and skill retention. We also measured trainees\' assessment of the usefulness of ultrasound in clinical practice.
This was a prospective cohort study of 17 Rwandan physicians participating in a point-of-care ultrasound training programme. The follow-up period was 1 year. Participants completed a 10-day ultrasound course, with follow-up training delivered over the subsequent 12 months. Trainee knowledge acquisition and skill retention were assessed via observed structured clinical examinations (OSCEs) administered at six points during the study, and an image-based assessment completed at three points.
Trainees reported minimal structured ultrasound education and little confidence using point-of-care ultrasound before the training. Mean scores on the image-based assessment increased from 36.9% (95% CI 32-41.8%) before the initial 10-day training to 74.3% afterwards (95% CI 69.4-79.2; P < 0.001). The mean score on the initial OSCE after the introductory course was 81.7% (95% CI 78-85.4%). The mean OSCE performance at each subsequent evaluation was at least 75%, and the mean OSCE score at the 58-week follow up was 84.9% (95% CI 80.9-88.9%).
Physicians providing acute care in a resource-limited setting demonstrated sustained improvement in their ultrasound knowledge and skill 1 year after completing a clinical ultrasound training programme. They also reported improvements in their ability to provide patient care and in job satisfaction.

To explore Rwandan physicians\' experiences and views on the role of obstetric ultrasound in clinical management of pregnancy, and in situations where maternal and fetal health interests conflict.
Physicians (n = 19) in public and private health facilities in urban and rural Rwanda were interviewed in 2015 as part of the CROss-Country Ultrasound Study (CROCUS). Data were analysed qualitatively.
Ultrasound was described as an important tool in maternity care. Availability and quality of equipment varied across sites, and considerable disparities in obstetric ultrasound utilisation between rural and urban areas were described. The physicians wanted more ultrasound training and saw the potential for midwives to perform basic scans. Information about fetal sex and well-being was described as women\'s main expectations of ultrasound. Although women\'s right to autonomy in pregnancy was supported in principle by participating physicians, fetal rights were sometimes seen as needing physician \'protection\'.
There appears to be increasing use and demand for obstetric ultrasound in Rwanda, particularly in urban areas. It seems important to monitor this development closely to secure wise and fair allocation of scarce obstetric expertise and resources and to prevent overuse or misuse of ultrasound. Raising awareness about the benefits of all aspects of antenatal care, including ultrasound may be an important step to improve pregnant women\'s uptake of services. Increased opportunities for formal ultrasound training, including the training of midwives to perform basic scans, seem warranted. Moreover, in parallel with the transition to more medico-technical maternity care, a dialogue about maternal rights to autonomy in pregnancy and childbirth is imperative.

To evaluate HIV drug resistance (HIVDR) and determinants of virological failure in a large cohort of patients receiving first-line tenofovir-based antiretroviral therapy (ART) regimens.
A nationwide retrospective cohort from 42 health facilities was assessed for virological failure and development of HIVDR mutations. Data were collected at ART initiation and at 12 months of ART on patients with available HIV-1 viral load (VL) and ART adherence measurements. HIV resistance genotyping was performed on patients with VL ≥1000 copies/ml. Multiple logistic regression was used to determine factors associated with treatment failure.
Of 828 patients, 66% were women, and the median age was 37 years. Of the 597 patients from whom blood samples were collected, 86.9% were virologically suppressed, while 11.9% were not. Virological failure was strongly associated with age <25 years (adjusted odds ratio [aOR]: 6.4; 95% confidence interval [CI]: 3.2-12.9), low adherence (aOR: 2.87; 95% CI: 1.5-5.0) and baseline CD4 counts <200 cells/μl (aOR 3.4; 95% CI: 1.9-6.2). Overall, 9.1% of all patients on ART had drug resistance mutations after 1 year of ART; 27% of the patients who failed treatment had no evidence of HIVDR mutations. HIVDR mutations were not observed in patients on the recommended second-line ART regimen in Rwanda.
The last step of the UNAIDS 90-90-90 target appears within grasp, with some viral failures still due to non-adherence. Nonetheless, youth and late initiators are at higher risk of virological failure. Youth-focused programmes could help prevent further drug HIVDR development.

OBJECTIVE: To examine sex differences in nutritional status in relation to feeding practices over time in a cohort of HIV-exposed children participating in a complementary feeding programme in Rwanda.
METHODS: We applied a longitudinal design with three measurements 2-3 months apart among infants participating in a complementary feeding programme who were 6-12 months old at baseline. Using early feeding practices and a composite infant and child feeding index (ICFI) as indicators of dietary patterns, we conducted a multivariate analysis using a cross-sectional time series to assess sex differences in nutritional status and to determine whether there was a link to discrepancies in dietary patterns.
RESULTS: Among 222 boys and 258 girls, the mean (±SD) Z-score of stunting, wasting and underweight was -2.01 (±1.59), -0.15 (±1.46), -1.19 (±1.29) for boys; for girls they were -1.46 (±1.56), 0.22 (±1.29), -0.63 (±1.19); all sex differences in all three indicators were statistically significant (P < 0.001). However, there were only minor differences in early feeding practices and none in the ICFI by sex.
CONCLUSIONS: HIV-exposed male children may be at higher risk of malnutrition in low-resource setting countries than their female counterparts. However, at least in a setting where complementary foods are being provided, explanations may lie outside the sphere of dietary patterns.

OBJECTIVE: To evaluate the knowledge, attitude and behaviours of university students on the use of antibiotics.
METHODS: A knowledge-attitude-practice questionnaire was developed and distributed to undergraduate students of Xi\'an Jiaotong University, comprising 18 schools/colleges in Shaanxi Province, western China. Chi-square test and logistic regression analysis were applied to identify risk factors associated with self-medication with antibiotics.
RESULTS: Of the 731 respondents (response rate = 73.1%), 294 (40.2%) had self-medicated with antibiotics in the past 6 months. Most of the antibiotics (59.2%) for self-medication were purchased without prescription in retail pharmacies. The median score of students\' knowledge about antibiotics was 4 (IQR: 3-6) of a maximum possible score of 10. Students had moderately accurate beliefs towards antibiotics. More than half of the students (56.5%) were storing antibiotics frequently. During self-medication, 16.7% of students claimed to have experienced adverse reactions, and 30.6% had used antibiotics to prevent common colds. The majority preferred to use broad-spectrum antibiotics, and nearly half preferred intravenous antibiotics. Over 44% of students had changed antibiotic dosage, and 36.5% had switched to another antibiotic during the treatment course. Logistic regression analysis identified college and home town as independent risk factors for self-medication with antibiotics (P < 0.01).
CONCLUSIONS: Undergraduate students had inadequate knowledge, moderately accurate beliefs and inappropriate practices concerning antibiotics, and a high rate of self-medication. This highlights the need for focused educational intervention and stricter governmental regulation concerning antibiotic use and sale in retail pharmacies.