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Complete health documentation during childbirth can reduce complications and improve maternal and foetal outcomes. One such document is the partograph which allows health workers to record and follow the labour progress. However, the completion rates of partograph remain low in some hospitals. This study describes the implementation of a quality improvement project to increase the completion rate of partograph in a district hospital in Rwanda.

The project team tackled the root cause of partograph incompletion by implementing a labour monitoring guideline, assigning patients and duties to midwives and by providing support and supervision.

The intervention successfully increased overall partograph completion rates from 11 to 61 per cent, p < 0.001. This study also showed that completeness of the partograph was statistically associated with a decrease in foetal deaths and higher Apgar score with p < 0.001 for both.

This study describes the establishment of a quality improvement project following the strategic problem solving approach to increase the completion rate of partograph documentation. The intervention was simple, data-driven and cost-neutral. The team achieved its objectives by integrating staff input, obtaining commitment from the multidisciplinary team and applying leadership skills.

The results are useful for hospitals in limited resources settings wishing to improve overall partograph completion and improve foetal and maternal outcomes during labour, in an efficient and cost-neutral way.

The purpose of this paper is to describe the quality improvement project to increase the medical record documentation completion rate in a district hospital in Rwanda. Despite the importance of medical records to support high quality and efficient care, incomplete documentation is common in many hospitals.

The pre- and post-intervention record completion rate in the maternity unit was assessed. Intervention included assigned nurse to specific patients, developed guideline, provided trainings and supervisions.

The documentation completion rate significantly increased from 25 per cent pre-intervention to 67 per cent post-intervention, p < 0.001. The completeness of seven out of the ten elements of medical records also significantly increased.

The quality improvement project created a cost-effective intervention that successfully improved the documentation completion rate. Ongoing monitoring should be continued to learn sustainability.

The results are useful for hospitals with similar settings to improve completion of nursing documentation and increase nursing accountability on patient care.

Improving healthcare quality has become a worldwide effort. Strategic problem solving (SPS) is one approach to improve quality in healthcare settings. This case study aims to illustrate the process of applying the SPS approach in implementing a quality improvement project in a referral hospital.

A project team was formed to reduce the hospital-acquired infection (HAI) rate in the neonatology unit. A new injection policy was implemented according to the root cause identified.

The HAI rate decreased from 6.4 per cent pre-intervention to 4.2 per cent post-intervention. The compliance of performing the aseptic injection technique significantly improved by 60 per cent.

This case study illustrated the detailed application of the SPS approach in establishing a quality improvement project to address HAI and injection technique compliance, cost-effectively. Other departments or hospitals can apply the same approach to improve quality of care.

This study helps inform other hospitals in similar settings, the steps to create a quality improvement project using the SPS approach.

The purpose of this study is to improve the hand hygiene compliance in a hospital in Rwanda. Hand hygiene is a fundamental routine practice that can greatly reduce risk of hospital-acquired infections; however, hand hygiene compliance in the hospital was low.

A multiple-strategy intervention was implemented with a focus on ensuring stable water supply was available through installing mobile hand hygiene facilities.

The intervention significantly increased the overall hand hygiene compliance rate by 35 per cent. The compliance for all of the five hand hygiene moments and all professions also significantly increased.

By implementing an intervention that involved multiple strategies to address the root causes of the problem, this quality improvement project successfully created an enabling environment to increase hand hygiene compliance. The hospital should encourage using the strategic problem-solving method to conduct more quality improvement projects in other departments.

Findings from this study may be useful for hospitals in similar settings seeking to improve hand hygiene compliance.

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.

This paper aims to assess the knowledge, perceptions and mental health impact of COVID-19 among students in Rwanda.

This paper is a cross-sectional online survey questionnaire.

The mean knowledge score among the 375 respondents was 75.14% (SD ± 19.1), with 195 (55.1%) of the respondents scoring below 80%. Students who believed that COVID-19 education was sufficient were more likely to have lower knowledge levels (OR = 1.84, 95% CI = 1.15; 2.94). While most respondents were aware of their vulnerability to the virus, they did not see themselves at risk of becoming infected. The percentage of respondents reported to have some form of mental health issues was 49.7%. The three most important factors in influencing mental health were age, history of mental health issues, and the way news was reported. Education quality was less affected for those who received online schooling (OR = 0.55, 95% CI = 0.33, 0.94).

Education about COVID-19 should be strengthened by capitalizing on existing online and offline learning platforms to frequently update new or changing information.

This paper was the first study assessing the knowledge, perception and mental health impact of COVID-19 among Rwanda students.

Hospitals are responsible for protecting the well-being of their patients and staff. To do so, accurate information is needed for the hospital to make appropriate decisions and allocate resources efficiently. This study aims to describe the implementation process of a surveillance system to reduce hospital-acquired infection (HAI) reporting errors in the maternity unit of a district hospital in Rwanda.

The team adapted an evidence-based tool to identify and report HAI, provided training to staff and distributed reporting responsibilities equally between the maternity staff to improve accuracy in HAI reporting.

The intervention successfully reduced the reporting discrepancy of HAI from 6.5 to 1.9 per cent: p < 0.05.

This case study described the implementation process of a surveillance system using strategic problem solving to reduce HAI reporting errors. The results can inform hospitals in similar settings of the steps to follow to implement a cost-neutral HAI surveillance system to reduce reporting errors. The accurate data will enable the hospital to take corrective measures to address HAI in the future.

The results will inform hospitals in similar settings of steps to follow to implement a cost-neutral HAI surveillance system using the SPS approach to reduce reporting errors.

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.

Post-cesarean wound infection (PCWI) is a common post-operative complication that can negatively affect patients and health systems. Poor hand hygiene practice of health care professionals is a common cause of PCWI. This case study aims to describe how strategic problem solving was used to introduce an alcohol-based hand rub in a district hospital in Rwanda to improve hand hygiene compliance among health care workers and reduce PCWI.

Pre- and post-intervention study design was used to address the poor hand hygiene compliance in the maternity unit. The hospital availed an alcohol-based hand rub and the team provided training on the importance of hand hygiene. A chart audit was conducted to assess the PCWI, and an observational study was used to assess hand hygiene compliance.

The intervention successfully increased hand hygiene compliance of health care workers from 38.2 to 89.7 per cent, p < 0.001, and was associated with reduced hospital-acquired infection rates from 6.2 to 2.5 per cent, p = 0.083.

This case study describes the implementation process of a quality improvement project using the eight steps of strategic problem solving to introduce an alcohol-based hand rub in a district hospital in Rwanda. The intervention improved hand hygiene compliance among health care workers and reduced PCWI using available resources and effective leadership skills.

The results will inform hospitals with similar settings of steps to create an environment that enables hand hygiene practice, and in turn reduces PCWI, using available resources and strategic problem solving.