Kigali

This research aims to evaluate and improve how appendicitis, the most common emergency surgery, is managed worldwide. Appendicitis requires timely diagnosis and treatment to prevent complications and reduce healthcare costs. By using appendicitis as a "tracer condition," the study examines emergency care systems across different countries, focusing on access to care, treatment quality, and efficiency. The goal is to find gaps in emergency surgical care, especially in low- and middle-income countries, to guide future improvements. The study will collect data from about 500 hospitals globally between February 3 and May 25, 2025. Each hospital will gather information over 14 days on patients undergoing appendicectomy, which includes open, laparoscopic, and robotic surgeries, as well as cases converted from minimally invasive to open surgery. The study also includes two sub-studies: one exploring sustainability and waste management in operating rooms, and another examining the financial impact of appendicectomy on patients, particularly in lower-income settings. Participants include all patients having appendicectomy for suspected or confirmed appendicitis during the study period. Data will be collected from routine health records without additional follow-up. Researchers will measure key outcomes such as time to surgical assessment, rates of laparoscopic surgery, postoperative complications, length of hospital stay, and financial costs to patients. The study aims to capture data on about 14,000 patients to understand how differences in hospital resources affect care and outcomes worldwide.

Researchers are evaluating the safety and immune response of reduced doses and different vaccination schedules of the RTS,S/AS01E malaria vaccine in healthy children aged 5 to 60 months living in areas where malaria is common. This Phase 2a open-label randomized study aims to find alternative ways to protect young children against malaria by adjusting the vaccine dose and timing. The RTS,S/AS01E vaccine is given as an injection into the muscle. The study compares various vaccination regimens and reduced antigen doses to understand their effects on safety and immune response. Participants receive their vaccine doses according to the assigned schedules during the study. Participants will be monitored for their immune response by measuring specific antibody levels 12 months after the third vaccine dose. Researchers will also assess safety through medical history, clinical exams, and laboratory tests, including screening for infections and hemoglobin levels. The total follow-up includes visits for vaccination and assessments over more than a year to track responses and any side effects.

Pregnancy is an important time to assess and manage risks related to heart and blood vessel health for both mothers and their babies. This research focuses on using the American Heart Association's new cardiovascular health measure, called "Life's Essential 8," to better understand heart health during pregnancy. The goal is to explore how this measure can be applied to pregnant women and to develop appropriate standards for cardiovascular health during pregnancy. Participants will complete questionnaires and provide biological samples. They will also have regular clinical follow-ups at the research center. This study involves observing natural pregnancies with single babies, tracking maternal and newborn health outcomes through delivery, up to 42 weeks. Throughout the study, researchers will collect and analyze health information from both mothers and newborns. They will monitor pregnancy and birth outcomes, as well as cardiovascular health indicators. The total participation includes questionnaires, specimen collection, and clinical monitoring during routine prenatal visits until delivery is complete.

Acute hypoxemia, a serious condition with low blood oxygen, often leads to high death rates in resource-limited hospitals. Researchers are evaluating whether high flow oxygen therapy compared to standard flow oxygen improves survival in adult patients with this condition in five hospitals across low and lower-middle income countries. The study also explores challenges and benefits related to using high flow oxygen and compares oxygen usage between the two methods. Participants will be randomly assigned to receive either humidified and heated high flow oxygen through a large nasal cannula targeting oxygen saturation between 90-94%, or standard flow oxygen delivered via nasal cannula, facemask, or non-rebreather mask with the same oxygen saturation target. This comparison aims to determine if one oxygen delivery method leads to better patient outcomes or is more practical to use in these settings. During the study, researchers will monitor patient survival up to 90 days after hospital admission. They will also gather information on oxygen consumption and factors influencing the use of high flow oxygen devices. Patients will be assessed for oxygen levels, treatment adherence, and overall condition throughout their hospital stay to understand the effectiveness and feasibility of both oxygen therapies.

This research investigates whether wearable wireless sensors can help detect early signs of patient deterioration after surgery. Patients who become critically unwell after operations often experience delayed recognition of complications, which can lead to harm or death. The study focuses on surgical inpatients undergoing major open surgery across various countries and aims to see if data from wearable monitors is acceptable to patients and healthcare staff while potentially improving early detection of problems. Participants will wear wireless sensors placed on their chest and fingers before, during, and after surgery for up to 10 days. These sensors record vital signs like heart rate, oxygen levels, and body temperature continuously but do not affect patient care, as clinical teams will not have access to the sensor data during the study. The study is device-agnostic but initially uses the Sibel ANNEae One device, a wireless dual sensor system that stores real-time physiological data. During the study, researchers will collect and analyze physiological data alongside clinical event information to explore links between vital sign changes and patient deterioration. Participants will be monitored through wearable sensors for up to 10 days postoperatively, with no changes to standard care. The study takes place in general surgery departments in several countries and includes usability assessments and baseline monitoring practice evaluations in earlier stages.

Researchers are evaluating how national medical oxygen strategies impact health systems and policy contexts in Africa and Asia. This study focuses on understanding the challenges and solutions related to medical oxygen access in six countries participating in the MOXY program: Uganda, Nigeria, Rwanda, Liberia, Lao PDR, and Cambodia. The research aims to inform national and global policy by involving stakeholders such as policymakers, implementers, and oxygen users, and by analyzing the costs and impacts of these strategies over four years. The study uses a mixed-methods approach with three embedded sub-studies: stakeholder analysis to understand the policy environment; policy-implementation gap analysis to examine differences between policy goals and actual practices; and comparative country case studies to identify unique challenges and solutions across different contexts. Researchers will employ co-design methods and annual stakeholder meetings to adapt the study to each country's needs. Participants, who are key informants from government, non-governmental agencies, professional groups, private sector, and civil society, will be interviewed at national, provincial, and local levels. Data collection includes interviews, policy reviews, program data, and surveys on facility readiness and clinical practices. The study will provide lessons and validated findings through national stakeholder dialogues and aims to improve medical oxygen service coverage and program implementation across countries.

Researchers are investigating Mpox, a viral disease with growing cases in Central and East Africa since late 2022, focusing on new immune diagnostics to understand disease prevalence and support vaccine use. The study addresses two Mpox virus strains circulating in the Democratic Republic of Congo, especially a newer strain with mutations that increase human transmission. Given the public health emergency declared by WHO and significant case numbers with fatalities, this research aims to better identify exposure and immunity in at-risk populations. Participants are grouped based on their exposure or vaccination status: those suspected of exposure living near affected areas or close contacts of confirmed cases; those previously infected or vaccinated either within or beyond one month; and a control group with no known exposure. The study uses diagnostic tests including Mpox-specific antibody ELISA and a dried blood spot lateral flow assay to detect immune response markers. During the study, participants will provide biological samples and clinical data to help develop tests estimating Mpox exposure and immunity. Researchers will detect specific antibodies and evaluate rapid diagnostic tests for confirming Mpox exposure. The study involves collecting information on vaccination and infection status, with careful monitoring to support vaccine prioritization. Participant involvement includes consenting, sample collection, and adherence to study procedures, contributing crucial data over the course of the investigation.

Researchers are conducting a Phase 3, double-blinded, placebo-controlled, multicenter trial to assess whether azithromycin taken as a preventive treatment can reduce death rates in adults with advanced HIV disease. Participants eligible for the study must have confirmed HIV infection with low CD4 counts or specific treatment histories, reflecting advanced immunosuppression. The trial aims to better understand mortality outcomes related to this preventive approach in this population. Participants will be randomly assigned to receive either azithromycin tablets or placebo tablets for 28 days. All participants will be followed for 24 weeks after randomization to measure the main outcome of death from any cause, with total follow-up lasting 48 weeks. The study compares the effects of azithromycin prophylaxis against an inactive placebo to evaluate its impact on survival. During the study, participants will be monitored regularly to track health outcomes, particularly mortality. They must be able to start or adjust antiretroviral therapy within four weeks of joining the trial. Researchers will closely observe for any adverse effects, treatment adherence, and overall health status throughout the follow-up period to assess the safety and effectiveness of the intervention.

Mental disorders are a major global health burden, and in Rwanda, the long-lasting mental health effects of the 1994 Genocide against the Tutsi, combined with poverty, have led to about 20% of the population experiencing one or more mental disorders. This research focuses on expanding an evidence-based home-visiting program called Sugira Muryango, which aims to improve caregiver mental health and family functioning. The study evaluates a technology-enhanced delivery model designed to meet Rwanda's needs for scaling mental health and social services. The study compares two ways of delivering the Sugira Muryango intervention: one supported by a Digital Dashboard tool and the other using usual care methods. The Digital Dashboard helps collect data on intervention quality and reach, enhances visibility of implementation data, supports referrals and follow-up for caregivers, and provides training resources to improve the skills of non-specialist workers delivering the intervention. The study uses a Hybrid Type 3 implementation-effectiveness design with cluster randomization in Kirehe District, Rwanda, to test these delivery methods. Participants include program beneficiaries, interventionists, supervisors, and community stakeholders who will be assessed for program effectiveness, delivery quality, feasibility, and acceptability over about four months. Outcomes measured include intervention quality, provider self-efficacy, leadership and sustainability scales, social network characteristics, caregiver and child mental health, family violence, and quality of life. The study also analyzes cost-effectiveness and the return on investment of the Digital Dashboard-supported delivery compared to standard delivery.