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Background: Monitoring and evaluation is vital in the quest to improve the quality of care and to reduce the morbidity and mortality of neonates in a resource-limited setting. Databases offer several advantages such as data on large cohorts of neonates and from multiple centres. Aim: To establish a minimal dataset neonatal database in Kigali, Rwanda and to assess the quality and timing of the data entry process. Secondary objectives were to describe survival rates and associated risk factors. Methods: A cross-sectional, observational study was undertaken at a tertiary hospital in Kigali, Rwanda. The Rwanda Neonatal Data Collection Form was designed specifically for the database, based on the Vermont–Oxford Network neonatal data-collection tool with locally relevant amendments. All admitted neonates were enrolled during the study period of 2011–2017 with ongoing data-collection. Infants were recruited and data collected prospectively and cross-checked retrospectively with the inclusion of basic data on neonates who were not initially recruited prospectively. Results: 3391 analysable cases were recruited: 1420 prospective and 1971 retrospective cases. Prospective data collection peaked at 90%. Data entry was not always complete with data-points left blank with only 21% having adequate data available (0–25% missing). All-cause mortality during the study period was 16% and annual mortality ranged from 12% to 24%. On multivariate analysis, place of birth (AOR 2.17), small-for-gestational-age (AOR 2.05) and gestational age were all positively associated with survival. Conclusions: An academic setting in a low- or middle-income country can create and maintain a neonatal database without funding and produce a wealth of actionable results. Throughout the process, there were considerable challenges which must be addressed if such a database is to be optimised, maintained and created in other clinical sites. Abbreviations: CHUK: Centre Hospitalier et Universitaire de Kigali (University Teaching Hospital of Kigali); CPAP: continuous positive airway pressure; HCP: Healthcare professional; HRH, Human Resources for Health Programme; LMIC: low- and middle-income countries; MeSH: Medical subject headings; MoH: Ministry of Health; NAR: Newborn admission record; QI: Quality improvement; REDCap: Research electronic data capture; RNDB: Rwanda neonatal database; RNDCF: Rwanda neonatal data collecion form; SGA: Small for gestational age; STROBE: Strengthening the reporting of observational studies in epidemiology; VON: The Vermont–Oxford Network.

Background Exposure to the sunlight contributes largely to the production of vitamin D. However, vitamin D deficiency is a reality in tropical countries, despite enjoying enough sunlight, especially bearing women in their last trimester whose foetuses exclusively depend on their reserves. This work aimed at demonstrating the state of vitamin D in mother–baby pairs and associated factors in one of the University Hospitals in Rwanda. Methods This cross-sectional prospective study was performed on mother–baby pairs at Kigali University Hospital. Mother’s serum 25-hydroxyvitamin D levels were considered as outcomes compared with demographic, clinical and biological markers. Correlation analysis was conducted in order to assess the association between serum 25-hydroxyvitamin D levels for the couple mothers–babies. Results Approximately 38% of women and 65% of neonates had deficiency in 25-hydroxyvitamin D ( Conclusions There was a high rate of vitamin D deficiency in mothers and their babies. Babies born from women with deficiency were likely to develop low levels of vitamin D. This stresses on the need to strengthen the interventions for preventing vitamin D deficiency in the couple mothers–babies such as supplement in vitamin D before and after delivery, improving the quality of meals and regular contact with sunlight.

Introduction: small for gestational age (SGA) is defined as birth weight less than the 10th percentile with a population prevalence of 17% in sub-Saharan Africa. Mortality and morbidity are worse in SGA neonates and there are long term implications from fetal growth restriction. Objective: the goal of this study was to evaluate and report the case-load, associated characteristics and outcomes of neonates admitted with SGA at the largest tertiary public hospital in Kigali, Rwanda. Methods: a prospective, cross-sectional, observational study was performed. We defined SGA as birth weight less than10th percentile by gender according to the Alexander reference population. Eligible infants were identified through the neonatal registry. Results: of 1184 admitted neonates, 38% were SGA. Mortality in these SGA neonates (16%) was higher than appropriate for gestational age neonates (AGA, 13.4%) (AOR=2.03, CI: 1.1-3.5, p=0.011). SGA neonates, compared to their AGA peers, had a more extended hospital stay, and displayed faster postnatal growth. Conclusion: the case-load of SGA neonates in this reference hospital setting is high. The poorer outcomes in SGA neonates speaks to the need for: i. continued improvements in antenatal care throughout the health system to decrease the prevalence of small for gestation age and therefore case-load and ii. Optimisation of direct care for SGA neonates in order to minimise negative outcomes.

Thermoregulation remains a key physiological challenge faced by a neonate after delivery. We assessed the prevalence, risk factors and outcomes of hypothermia in admitted neonates at a tertiary teaching hospital of Kigali city in Rwanda.A cross-sectional study was conducted, from July 2013 to September 2017, of neonates who were admitted in the neonatology unit of the University Teaching Hospital of Kigali (CHUK) and whose admission temperature were recorded. Data were extracted from the neonatal database (registry).The neonatal database contained 1021 eligible neonates of which 15% were outborn. Hypothermia was found at admission in 280 of the 1021 eligible neonates (27%). The extremely preterm (28 weeks) were significantly more likely to become hypothermic compared to term neonates (AOR = 6.81, CI: 3.39-13.71,Thermal protection of the neonate immediately after birth is essential. In our tertiary neonatal unit, we identify nearly one-third of neonates are hypothermic at admission and this is associated with higher mortality and increased length of hospital stay. The ten-steps of the WHO "warm chain" may present an analytic roster for maternity and neonatal teams to pinpoint targets for interventional research and quality improvement work in order to achieve better outcomes.

Aims To evaluate the prevalence, risk factors and outcomes of small for gestation age (SGA) neonates admitted to a neonatal unit born SGA and the impact of SGA on outcomes. Methods A prospective cross-sectional study was undertaken. The data was collected from July 2013 up to September 2017 using the Rwanda Neonatal Database (NDB). We defined SGA neonates as birth weight less than 10th percentile by gender using Alexander reference population US national reference. The primary outcome was mortality. Results 1184 admitted neonates have been included in the study, of which 444 (38%) were SGA. SGA neonates had increased the risks of mortality (16% vs 13%) (AOR=2.0, CI: 1.1–3.5, p=0.01). SGA neonates had a longer length-of-stay (LoS) (5.3 days versus 2.2 days, p=0.001). Conclusion SGA is a common indication for admission and is associated with significantly increased mortality and length of stay. Neonatal mortality continues to be significant in Rwanda and globally. Improved maternal antenatal care along with bespoke neonatal care could see improvements in outcomes for these high-risk neonates. Table 1: Significant risk factors and outcomes for SGA.

Aims This study aimed to assess the prevalence of hypothermia, risk factors and outcomes of in admitted neonates at the Neonatology Unit of a tertiary teaching hospital in Rwanda. Methods A prospective, cross-sectional study was performed. Hypothermia was defined, as per the WHO, as an admission temperature of Results 1021 infants were included in the analysis. Hypothermia was found in 280 neonates (27%). Multivariate analysis identified that gestation, mode of delivery and place of birth were statistically significantly associated with hypothermia. Gestation Conclusion Thermal protection of the neonate is paramount in order to reduce neonatal mortality. Thermal protection measures such as the WHO 10-steps are well described. Education and quality improvement initiatives are required to reduce the prevalence and associated outcomes. Awareness and education about the risks for hypothermia can allow targeted intervention to those at risk (e.g. prematurity and SGA infants).

Introduction: Congenital heart diseases (CHD) are commonly associated with genetic defects. Our study aimed at determining the occurrence and pattern of CHD association with genetic defects among pediatric patients in Rwanda.Methods: A total of 125 patients with clinical features suggestive of genetic defects were recruited. Echocardiography and standard karyotype studies were performed in all patients.Results: CHDs were detected in the majority of patients with genetic defects. The commonest isolated CHD was ventricular septal defect found in many cases of Down syndrome. In total, chromosomal abnormalities represented the majority of cases in our cohort and were associated with various types of CHDs.Conclusion: Our findings showed that CHDs are common in Rwandan pediatric patients with genetic defects. These results suggest that a routine echocardiography assessment combined with systematic genetic investigations including standard karyotype should be mandatory in patients presenting characteristic clinical features in whom CHD is suspected to be associated with genetic defect.Key words: Congenital heart disease, genetic defects, pediatric patients, Rwanda