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The purpose of this study is to describe how the hospital influenced the practice of corticosteroids and aminophylline administration by applying strategic problem solving. Under five child mortality is a challenge in Rwanda. Although it has been shown that administering corticosteroids and aminophylline can reduce the mortality of premature neonates, the use of these medications were low at Mibilizi District Hospital in Rwanda.

This project used a pre- and post-intervention study design, utilizing patient file audit to evaluate the impact of our intervention on the compliance of corticosteroids administration to pregnant mothers in premature labour and aminophylline to premature neonates, using the Strategic Problem Solving approach.

The intervention significantly increased the rate of giving corticosteroids to mothers at risk of premature delivery from 26 per cent to 60 per cent p-value = 0.009. The provision of aminophylline to premature neonates under 34 weeks of gestation significantly increased from 65 per cent to 100 per cent p-value = 0.002.

This study illustrates how a multidisciplinary team was able to use the eight steps of strategic problem solving to increase the administration rates of corticosteroids and aminophylline. The hospital should continue to support quality improvement efforts using strategic problem solving approach to prevent premature neonatal deaths and improve quality of care.

Findings from this study may be useful for hospitals in resource-challenged settings seeking to improve the administration of corticosteroids and aminophylline to prevent premature neonatal deaths.

Caesarean section (CS) is one of the most common surgeries in the world. Although the procedure saves lives, it poses important risks such as post-caesarean surgical site infection (PCS-SSI). Basic patient care procedures can prevent PCS-SSI, however, they are not always followed. The purpose of this study is to describe how strategic problem solving (SPS) was used to implement a wound dressing protocol in a district hospital in Rwanda to reduce PCS-SSI rates.

To address variations in wound care practice, a new clinical protocol was developed and implemented by a quality improvement team which included clinicians. Training and supervision was also provided to the maternity team.

The intervention reduced PCS-SSI from 5.1 to 1.8 per cent. It also significantly improved the compliance to recommended wound dressing practices.

By applying SPS and effective leadership skills, the authors secured buy-in and support from stakeholders and introduced a wound management protocol in a district hospital of Rwanda. The intervention significantly improved wound management practice; however, long term follow-up will be necessary to sustain the improvements.

The results will inform hospitals in resource-limited settings of how to improve basic standards of care using SPS and leadership without additional cost to the hospital.

Smallholder farmers have always been profoundly the first to be impacted by climate change, and therefore, farmers understanding of climate change and accessibility to alternative adaptation strategies are crucial for reducing the effect of climate change. The purpose of this study is to assess the perception of farmers to climate change, adaptation strategies and determinants of adaptation choice in central Ethiopia.

The study used data from randomly selected 240 farm households. Descriptive statistics were used to describe farmers’ perceptions of climate change and adaptation strategies. Also, a multivariate probit model was used to identify the major factors affecting farmers’ choice of adaptation strategies to climate change in central Ethiopia.

Smallholder farmers perceive climate change in the past two decades in response; the majority (91.47%) of farmers used adaptation options. Improved crop varieties and input intensity, crop diversification, planting date adjustment, soil and water conservation activities and changing of the crop type were used as adaptation options in the study area. A few of these strategies were significantly confirmed a complementary and supplementary relationship. The study identified sex, family size, agroecology, climate information, crop-fail history and formal extension service as significant determinants for farmers’ adaptation choices as these variables significantly affected more than two farmers’ adaptation strategies simultaneously.

Farmers’ choice of adaptation was highly constrained by institutional factors and all these identified factors can be possibly addressed through a better institutional service provision system. It is, therefore, recommended that local administrators should explore the institutional service provision system for a better farm-level adaptation while considering demographic characteristics as well.

This study identified factors affecting farmers’ several adaptation strategies at a time and provides information for the policymaker to make cost-effective interventions for better farm-level adaptation practices.