3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item Predictors of weight loss in HIV-infected women on antiretroviral therapy in Rwanda.(2014-03-28) Kimenyi, Jean PaulBackground: Highly Active Antiretroviral Treatment (HAART) has reduced the frequency of weight loss/wasting associated with HIV infection. However, weight loss remains a problem, even in the HAART era. Objectives: This study was carried out to assess weight change in a cohort of HIV-infected women on HAART in Rwanda, from 2005 to 2008, and to identify factors that predict weight loss in this cohort. Methods: Data from a cohort of 449 HIV-positive women on HAART enrolled in the Rwanda Women’s Inter-association Study and Assessment (RWISA), starting in May 2005, and followed at six monthly intervals until December 2008, were analysed. The outcome assessed in this study was change in weight, measured in kilograms at 6, 12 and 24 months after HAART initiation. Nutritional status was recorded and laboratory measurements (weight, height and CD4 cell count) were taken prior and after HAART initiation. All covariates were time dependent, except for the history of weight loss which was recorded at baseline only. Generalized Estimating Equation (GEE) using the linear link (Gaussian [normal]), exchangeable covariance structure and robust standard error was used to assess the factors associated with changes in weight (weight loss or weight gain) and to control for potential confounders. Results: Prior to HAART initiation, the mean weight of the study participants was 53.1 kg (SD 9.5). The mean BMI was 21.3 kg/m2 (SD 3.6) and the mean CD4 cell count was 222.9 cells/μL (SD 120.6) [47.6% had CD4 cell counts <200 cells/μL, 52.2% had CD4 cell counts ≥200 cells/μL]. Overall, the participants gained weight from baseline to 12 months after HAART initiation. The mean weight change was 1.9 kg (SD 7.8) (p<0.001) 6 months after HAART initiation, 2.9 kg (SD 5.9) (p <0.001) 12 months after HAART initiation, and 2.4 kg (SD 6.5) (p <0.001) 24 months after HAART initiation. Six months after HAART initiation, 48.3% of participants had gained weight, and 21.0% had lost weight. Twelve months after HAART initiation, 56.9% had gained weight, and 18.3% had lost weight, Twenty-four months after HAART initiation, 56.6% had gained weight, and 22.6% had lost weight. Participants with CD4 cell counts ≤ 200 cells/μL at baseline gained more weight than those with CD4 cell counts > 200 cells/μL at 6, 12 and 24 months after HAART initiation. Participants who were underweight (BMI <18.5 kg/m2) at baseline gained more weight than other participants three months after HAART initiation. Time-dependent diarrhoea for more than two weeks and a CD4 cell count of 200 - 350 cells/μL were significantly associated with weight loss (p≤ 0.05). Others factors, such as time-dependent education level (completion of secondary school), marital status (married legally and status other than married legally or widowed), and increases in CD4 cell counts, were associated with weight gain (p≤ 0.05). Conclusion: Although the majority of participants gained weight during the first 12 months of being on HAART, a significant proportion of participants lost weight while on HAART. The findings on the predictors of weight change in HIV-positive women on HAART can be used to promote weight gain in women who start HAART. Clinicians who take care of HIV-infected patients on HAART should pay attention to those who lose weight, and those who present with diarrhoea or with CD4 cell counts of <350 cells/μL at follow-up visits, since these factors are associated with weight loss in the HAART era.Item Instigation to commit crimes against humanity under Article 6(1) of the Statute of the International Criminal Tribunal for Rwanda: a critique of the jurisprudence of the Trial and Appeal Chambers(2013-04-04) Agbor, Avitas AIn the decades after attaining independence from its colonial masters, Rwanda’s two principal ethnic groups, the Hutus and the Tutsis, suffered worsening tensions which often resulted in the perpetration of atrocities. Peace agreements brokered by the international community did not ease these ethnic tensions. In April 1994, the ethnic crisis took a different dimension following the assassination of the Presidents of Rwanda and Burundi. A full-blown genocide was committed by the Hutus who targeted their Tutsi and Hutu-moderates victims because of their ethnic identity and tolerant political views respectively. In a hundred days, about a million Tutsis and Hutu-moderates were massacred. Gross violations of human rights had been committed. The planning, preparation and execution of these atrocities were done by almost everyone within the Hutu majority: the leadership (both civilian and military), business men, the clergy, artists, professors, journalists, militias, the commoners, and other civil society actors. The Rwandan Patriotic Front (RPF) under the leadership of General Paul Kagame overthrew the Rwandan Armed Forces (RAF) and brought the genocide to an end. In an effort to build a government of national unity, the Government of Rwanda under the leadership of President Paul Kagame requested the United Nations Security Council to establish a tribunal for the trial of persons who bear responsibility for the atrocities committed in Rwanda. In response to this request, the United Nations Security Council passed Resolution 955 (8 November 1994) creating the second United Nations’ ad hoc international criminal tribunal, the International Criminal Tribunal for Rwanda (ICTR). Annexed to Resolution 955 was the Statute of the ICTR. The Statute gave the Tribunal jurisdiction over three crimes: genocide, crimes against humanity and violations of Article 3 common to the Geneva Conventions and of Additional Protocol II. Amongst other things, it also defined on which individuals it would impose criminal responsibility. The definition of genocide and the punishable acts as contained in the Statute of the ICTR (Article 2) were simply imported from the United Nations’ Convention on the Prevention and Punishment of the Crime of Genocide, 1948 (Article III). One of these punishable acts is direct and public incitement to commit genocide (Article 2(3)(c) of the Statute of the ICTR). As seen in Article 6(1) of the Statute of the ICTR, there are five different modes of participation that would lead to the imposition of criminal responsibility: planning, instigating, ordering, committing or otherwise aiding and abetting. Instigation is one of these modes of participation. An examination of the jurisprudence of both the Trial and Appeal Chambers of the ICTR reveals that there is an overlap between direct and public incitement to commit genocide under Article 2(3)(c) and instigation as a mode of participation under Article 6(1). The Trial and Appeal Chambers have contributed enormously to the development of the jurisprudence of direct and public incitement to commit genocide under Article 2(3)(c). Now settled as an inchoate crime in international criminal law, criminal responsibility is imposed irrespective of whether the direct and public incitement successfully results in the commission of genocide. On the other hand, instigation is one of the modes of participation which would lead to the imposition of criminal responsibility. Participation under Article 6(1) is not limited to any particular crime, but extends to all the crimes over which the ICTR has jurisdiction – genocide, crimes against humanity and violations of Article 3 common to the Geneva Conventions and of Additional Protocol II. The jurisprudence of the Trial and Appeal Chambers on Article 6(1) states that criminal responsibility can only be imposed where it is proved that the accused’s mode of participation substantially contributed to the commission of the crime. Therefore, instigation, which is one of the modes of participation, must be shown to have substantially contributed to the commission of the crime for criminal responsibility to be imposed. In my opinion, this requirement of substantial contribution for the imposition of criminal responsibility is wrong. It emanates from a poor understanding of Article 6(1) and the construction of the words therein. It is a judicial invention which does not square with established principles of criminal responsibility in general and inchoate crimes in particular. This thesis critiques the jurisprudence of the ICTR on instigation as a mode of participation under Article 6(1). Instigation is a recognised mode of participation in international crimes. Under the common law system, it is also an inchoate crime. International instruments and the jurisprudence of the Trial and Appeal Chambers have recognised the inchoate nature of incitement. However, in the construction of Article 6(1) wherein instigation features as a mode of participation, the Trial and Appeal Chambers erred. I illustrate in this thesis that a correct construction and understanding of Article 6(1) shows its inchoate and bifurcated character: first, any of the modes of participation must lead to any of the stages of any of the crimes (planning, preparation or execution). These modes of participation are not limited to any particular crime. Therefore, if instigation leads to the planning or preparation of any of the crimes, that renders it inchoate (which is understood to mean a criminal activity that is incomplete, still at its initial stage). Second, the imposition of criminal responsibility is bifurcated. In other words, it must go through two stages: first, there must be a mode of participation, and second, it must lead to any of the stages of the crimes. Third, the substantial contribution requirement does not square with a strict construction of Article 6(1). In articulating the different stages that a mode of participation must lead to, it states ‘planning, preparation or execution’ of any of the crimes. The use of a disjunctive word ‘or’ rather than a conjunctive word ‘and’ suggests that any of the modes of participation that leads to any of these stages (planning, preparation or execution) of any of these crimes (genocide, crimes against humanity, violations of Article 3 common to the Geneva Conventions and of Additional Protocol II) would suffice. Therefore, to require that there must be a substantial contribution to commission of a crime before criminal responsibility can be imposed under Article 6(1) is a clear limitation to the last stage of the crime, which is execution (or commission). As evidenced by the cases tried at the Tribunal, Article 2(3)(c) which addresses the inchoate crime of direct and public incitement to commit genocide and Article 6(1) which deals with the imposition of criminal responsibility, do overlap. In other words, incitement that qualifies as direct and public incitement to commit genocide under Article 2(3)(c) may as well qualify as instigation to any of the crimes over which the ICTR has jurisdiction under Article 6(1). From the delivery of its first judgment in the case of The Prosecutor v Jean-Paul Akayesu,1 the Trial Chambers did not recognise the confluence 1 Judgment, Case No. ICTR-96-4. T. Ch. I, 2 September 1998. between these two Articles. However, in the case of The Prosecutor v Callixte Kalimanzira,2 the Trial Chambers made this observation, and outlined a set of guidelines on how to resolve cases of overlap. Though a colossal step in fixing this problem, the guidelines are faulted because they repeat the same mistakes made by previous Trial Chambers: first, they limit instigation only to genocide even under Article 6(1); second, they still hold that criminal responsibility can be imposed under Article 6(1) only when it is proved that the mode of participation substantially contributed to the commission of the crime. While it resonates with conventional wisdom today that incitement, synonymous with instigation, is limited to the crime of genocide, this thesis critiques the jurisprudence of both the Trial and Appeal Chambers of the ICTR and argues that instigation is a mode of participation in crimes against humanity following a strict construction of Article 6(1). Furthermore, incitement that qualifies as ‘direct and public incitement’ to commit genocide under Article 2(3)(c) may also qualify as instigation to commit genocide, crimes against humanity, or both under Article 6(1). Third, ‘direct and public incitement’ to commit genocide under Article 2(3)(c) is limited to the crime of genocide, and must fulfil the caveats of ‘direct’ and ‘public’. Meanwhile, instigation under Article 6(1) does not need to meet any requirement as long as it leads to the ‘planning, preparation or execution’ of any of the crimes over which the ICTR has jurisdiction. The poor construction of Article 6(1) has resulted in huge controversies about instigation as a mode of participation in crimes over which the ICTR has jurisdiction under Article 6(1). More specifically, instigation, which is one of the modes, overlaps with the wording of Article 2(3)(c) which deals with the inchoate crime of direct and public incitement to commit genocide. The substantial contribution requirement is a judicial invention which does not align squarely with established principles of criminal responsibility for inchoate crimes. It is the unfortunate outcome of a poor construction of Article 6(1) and has orchestrated a confused understanding of instigation as a mode of participation. It has blurred and obfuscated instigation as a mode of participation in crimes against humanity; stagnated the evolution of the jurisprudence on instigation to 2 Judgment, Case No. ICTR-05-88-T, T. Ch. III, 22 June 2009. commit crimes against humanity; and above all, propelled international criminal law on an ambitious and controversial mission from which it must retreatItem The role of telecentres in promoting socio-economic development in Rwanda.(2013-02-21) Buhigiro, SethTelecentres are an important tool for promoting socio-economic development in areas with very low levels of e-access. They have the potential to offer benefits to rural communities in education, health, agriculture and business. The purpose of this study was to explore the strengths and weaknesses of telecentres in promoting specific socio-economic objectives set in Rwanda’s National Information and Communication Infrastructure (NICI II) plan 2006 - 2010. The findings were that telecentres have been effective in contributing to community development through access to information, skills development, job creation, study opportunities, low cost in telecentre services and increased income. The three main challenges that hinder rural communities from advanced e-access were found to be literacy and level of education, language barriers, and lack of skills and awareness. Future policy requires comprehensive guidelines to guide the deployment of rich local content in telecentres that will enable more effective use of these facilities to promote socio-economic development through e-Soko type projects, Umuganda activities and other community or egovernment initiatives.Item The regulation of interconnection in Rwanda.(2012-10-16) Nkurunziza, Alex.The aim of this research is to explore the regulation of interconnection in Rwanda by investigating whether the current interconnection regime has ensured fair and reasonable interconnection rates that can enhance efficiency and effective competition. A qualitative research approach was used and the data were collected using semi-structured interviews and documentary analysis. The findings reveal that although RURA adopted a cost-based interconnection approach to ensure a fair and reasonable interconnection rate, its poor implementation resulted in an inefficient level of fixed and mobile interconnection rates. The study found an inconsistent application of the regime by incumbents, lack of sufficient regulatory capacity and lack of clear and comprehensive policy instruments. More recently, RURA is making efforts towards adopting a new regime to address the current interconnection rate issues in Rwanda. This study demonstrates that the current interconnection rate regime requires extensive rethinking about appropriate costing models and regulatory capacity, in order to enhance market efficiency and promote effective competition.Item Policy insights from an assessment of NEPAD e-schools in Rwanda : a case study of three NEPAD schools in Rwanda.(2012-10-16) Karangwa, EugeneThe purpose of this research is to investigate how the Rwanda NEPAD e-schools project is achieving its objectives, in order to draw lessons for policy. Case studies of three NEPAD e-schools were conducted to explore the integration of ICT in schools. This qualitative research was based on semi-structured interviews with Ministry of Education staff, school personnel and students, as well as a review of policy documents. The literature review identified a number of factors that hinder the use of ICT, which factors were also evident in the research findings. It was found that greater support is required to overcome the barriers, including lack of policy, teaching and learning, funding, access, training and professional development, curriculum content, technical support, time and attitudes towards ICTs. The analysis of the position in these e-schools offers lessons for policy and practice in Rwanda and with regard to the NEPAD e-schools programme on the continent. Ministries of Education in African countries should align ICT in education policy with other education strategic and operational policies to ensure that ICT initiatives are in line with national developmental goals and objectives.Item The role of land consolidation programme in household food security in Rwanda : a case study of household farmers of Gisenyi Village of Bugesera District.(2012-08-28) Ntirenganya, JulesThe aim of this study is to investigate the outcomes of the Land Consolidation Programme (LCP) in household food productivity. The implementation of the 2004 Rwandan National Land Policy (which incorporates LCP) has been one of the Rwandan government strategic attempts to improve the livelihood of the Rwandans. In this study we look at some of the social-economic factorsbenefited by household farmers through the LCP since its implementation in 2007. In Sub-Saharan Africa many people depend on land for their livelihood and consequently, one of the obvious negative impacts has been the fragmentation of land. Historically the customary land management, in which inheritance is the major mode of land acquisition, has been the main way of allocating land in African societies. This communal tenure is viewed as unstable and leads to detrimental implications, in the form of mismanagement and overexploitation of the available land. The demographic pressure has also aggravated the issue of land scarcity and land fragmentation. The latter has consequences on agricultural productivity since it makes harder the efficient use of land. In this study the researcher explores the outcomes of the LCP in Rwanda as a type of land reform that aims at preventing fragmentation of land and enhancing the livelihood of household farmers. For achieving this objective, the study used a case study of household farmers from Gisenyi village of Bugesera district (in Rwanda) who are involved in the LCP since its implementation. Empirical data was obtained through in-depth interviews with 20 household farmers and 8 key informants. The emphasis in the study was put on investigating the state of household food productivity in Gisenyi. The study was guided by the property right theory and its basic conceptual assumption of enhancing the income through credit access. The findings of the study demonstrate that household farmers in Gisenyi village have benefited from the LCP. Household farmers confirmed that agricultural productivity has increased due to the new farming techniques brought by the programme. The study concludes that once the programme is properly and fully implemented, the LCP will highly enhance food self-sufficiency situation in Rwanda, improving also the livelihood of rural areas through other benefits such as infrastructure development.Item Effective private schooling in post-conflict contexts : a case study of Apefe Mweya Groupe Scolaire in Rubavu District, Rwanda.(2012-02-29) Habiyambere, Jean PhilippeThe aim of this case study project was to understand the factors that determine the effectiveness at Groupe Scolaire APEFE Mweya, a parent private school in Rubavu District, Rwanda. It was motivated by a persistent decline in school quality for many public elementary schools in Rwanda while on the other hand some private schools have recorded very good results in national examinations. The review of the literature revealed the important attributes of school effectiveness research in developing countries. An enquiry was conducted using personal interviews of a small sample of fourteen participants together with observation and analysis of school documents. The findings suggest that Mweya School owes its success to adopting the moral inclusion of Hutu and Tutsi ethnic groups as a sign of overcoming historical racial discrimination, and secondly to its committed teachers (work ethos) and learners; organisation and accountability of teaching and learning; private supplementary tutoring; the recognition of work done and the motivation of the teachers and learners. The findings also found that the leadership style of the principal was not delivering according to expectations and suggestions were provided to maintain the momentum of good results.Item Risks of urban agriculture: lead and cadmium intake by Kigali residents from locally grown produce(2011-07-07) Etale, AnitaThis study determined the concentrations of lead and cadmium in edible parts of Colocasia esculenta, Amaranthus spp.and Ipomoea batata cultivated on farms in industrially polluted sections of Nyabugogo Marsh in Kigali, Rwanda. The concentrations in all three crops exceeded European Union (EU) standards for metal concentration in food crops. C. esculenta roots (Taro) contained the highest concentration of lead (1.02 mg kg-1) and cadmium (0.56 mg kg-1), approximately ten and six times over the EU limits, respectively. Even though I. batata (sweet potato) contained the lowest concentrations of lead (0.75 mg kg-1), this is almost eight times the upper limit. The highest bioaccumulation factors (the ratio of plant metal concentration to that of the soil in which it is found growing) for both metals were observed in amaranth plants. The concentrations of lead and cadmium in the farm soils were all acceptable based on EU standards (300mg kg-1 for lead and 3mg kg-1 respectively. The average daily consumption by an adult in the community living around the Marsh and where some of the produce is sold is 50g of amaranth, 120g of taro and 180g of sweet potato. Based on the metal concentration and these rates of consumption, the daily dietary intake of lead by an adult in the community from amaranth, taro and sweet potato is 1 x 10-4, 3 x 10-4 and 4 x 10-4 mg kg-1 respectively. The daily intake of cadmium is 4 x 10-4, 1.7 x 10-4 and 1.2 x 10-4 mg kg-1 for amaranth, taro and sweet potato respectively. These metal intakes are well within the recommendations set forth by the World Health Organisation. The community also has access to multiple sources of dietary and non dietary zinc such as beans, milk and rain water collected from zinc coated roofing sheets, which serves to ameliorate the effects of cadmium. It is however worth noting that survey data may have yielded overestimates of these zinc sources, due to the conditions under which the surveys were conducted i.e. in the hearing of neighbors due to the cramped nature of housing, which may have prompted respondents to inflate consumption quantities of expensive food items. The calculated maximum recommended quantities for daily intake of the crops are very large and are unlikely to be consumed by the population i.e. >2kg of amaranth, >2 kg of taro and 3 kg of sweet potato per day for an adult. Additionally, because this is a poor community, access to such quantities of food on a daily basis is not likely. The community is therefore not exposed to health risks from consuming metal contaminated crops, largely because of the small quantities consumed. The local population is therefore at no immediate risk to exceeding metal consumption limits by consuming vegetables grown in the Nyabugogo Marsh, but the threats will likely increase if the pollution of the Marsh is not addressed.Item Determinants of the utilisation of delivery services by pregnant women in Rwanda(2011-03-10) Umurungi, Serubibi YvonneObjective: To identify determinants for the utilisation of delivery services by pregnant women in Rwanda, considering individual and demographic, socioeconomic and health service factors. Design: A secondary data analysis of the third (2005) Rwandan Demographic Health Survey (RDHS III) was conducted. Women who had at least one live birth during the fiveyear period prior to the survey were included in the analysis. Bivariate and multivariate analyses were undertaken. Results: A total of 5235 participants fulfilled the study eligibility criteria and were included in the analysis. Although more than 90% of participants attended an antenatal service, only 30% delivered at a health facility. The predictors of a home delivery were higher parity (OR=5.01, 95% CI: 4.11-6.31 for parity of 6 or more), place of residence (OR=1.86, 95% CI: 1.55-2.23 for rural women), lower household wealth (OR=4.37, 95% CI: 3.43-5.56 for the poorest quintile), lower education level (OR=3.61, 95% CI: 2.73-4.76 for no education), none or one antenatal care visit (OR=3.62, 95% CI: 2.76-4.74 for one antenatal care visit) and the lack of antenatal counselling about pregnancy complications (OR=1.83, 95% CI:1.40-2.40). Conclusion Utilisation of maternal health services, particularly health facility delivery services, remains low in Rwanda. The promotion of at least four standard antenatal care visits, as well as efforts targeting specific risk groups, such as higher parity, rural and less educated women living in poorer households are critical if the country wishes to reduce maternal and neonatal mortality and morbidity.Item A comparison of HIV status among women who visit antenatal clinics with those who do not.(2009-03-06T07:50:48Z) Niwemahoro, CelineFor monitoring the spread of HIV epidemic, both national population-based surveys and antenatal clinics (ANC) are used. However, in all cases, there are potential biases. Bias associated with ANC data includes whether the pregnant women who attend public ANC are representative of all pregnant women. Reduced fertility among HIV-infected women, selection for sexual activity and under-representation of smaller rural sites in surveillance systems are other factors that may be source of biases (Boerma et al. 2003 & Walker et al. 2003). So, the question arising is how women who attend ANC could be representative of the general female population. Evidently, not all women become pregnant and not all pregnant women attend ANC. This research project has been designed to address those biases especially in Rwanda and Malawi. It focused on investigating the significance of this bias by doing a comparative analysis of sero prevalence between both those using ANC and those who do not. This study, therefore, intends to test whether women attending ANC may be representative to the general female population of both Rwanda and Malawi using respectively 2004 MDHS and 2005 RDHS. Using statistical techniques with the aid of STATA software program, univariate, bivariate and logistic regression (bivariate and multivariate) were performed for 11321 women in Rwanda and 11698 in Malawi aged between 15 and 49. However, among them, those who had live birth in last five years prior to the surveys were the most interested on in this study; that is especially, 5390 in Rwanda and 7304 in Malawi. Besides, HIV status of respondents was an important variable. Considering both women who had live birth and those who did not have live birth, I find that women who had live birth in Rwanda are 0.62 times less likely to be HIV positive and 0.48 times less likely to be infected for those who had live birth in Malawi. When controlling for women who had live birth, I find that in both countries women who use ANC are less likely to be infected compared to those who do not (0.53 times less likely in Rwanda and 0.58 times less likely in Malawi). Based on these findings, relying only on data from ANC may lead to biases in HIV prevalence estimates; particularly referring to 2004 MDHS and 2005RDHS. Besides, considering the level of significance of the difference between HIV status between those who use ANC and those who do not, I find that this is not identical in Rwanda (5% level of significance) and in Malawi (10% level of significance). Thus, these results suggest, briefly, that not only the degree of ANC data representativeness is changing depending on various stages of HIV epidemic as Fylkesnes said (1998), but also is affected by the amount of women who had live birth and their respective HIV status. In fact, this difference may be based on the fact that in Malawi, HIV prevalence is high compared to Rwanda and those who had live birth were in high percentage comparing to Rwanda.