Magister Scientiae (Physiotherapy) - MSc(Physio) / The aim of this study was to establish the factors associated with sports injuries among first division Rwandan female soccer players. Conclusion: Advocacy about the safety and improvement of Rwandan female soccer through workshops and trainings involving players, coaches and team owners need to be emphasised. / South Africa

Philosophiae Doctor - PhD / This study explores second and third year students' and teachers‟ views on factors that hinder or facilitate the mastery of English for Academic Purposes (EAP) in the Science and Engineering Technology Higher Institutions of learning in Rwanda (KIST) and seeks to establish the extent to which the current programme meets the needs of the students. This is done by highlighting a whole range of teacher and student perspectives on the EAP programme. Two key requirements invite students to write their academic assignments in the form of research proposals and research project reports. In order to help them perform well in their field subjects, KIST introduced a department of English with a General English Programme under the umbrella of the then School of Language Studies (SORAS) in 1997. The department‟s first assigned mission was to teach English to students in all departments in a bid to support and encourage them to cope with their field specific courses which are taught in English. Rwanda‟s National Council for Higher Education (2007), on language teaching and learning, states that the trio, that is Kinyarwanda (the Mother Tongue and national language) and English and French (as foreign languages), should be taught at primary, secondary and higher education levels in order to reconcile the divide between Rwandan returnees (who had lived abroad for many decades) and locals. It is in this context that KIST, one of the institutions of higher learning, adopted the bilingual policy to cater to students‟ needs to learn both French and English as media of academic communication. However, after Rwanda‟s integration into the East African Community and the Commonwealth, English has been officially adopted as the medium of instruction in all schools and higher institutions of education. That is why there was a sudden language shift in 2006 from French to English as a medium of instruction at KIST. French and Kinyarwanda are now merely taught as subjects. The motive behind the move was to cater for Rwanda‟s needs to fully participate in the economic community of East African Community in general and in the global economy in particular. The move drastically affected students‟ ability to read and write English in their respective disciplines. The move also affected lecturers of other speciality areas. To avert the obvious challenges emanating from this sudden shift in language policy, the Institute introduced the English for Specific Purposes (ESP) and English for Academic Purposes (EAP) programmes under the then KIST School of Language Studies (SOLAS) and the KIST Language Centre. However, appropriate instructional materials for such courses have not been easily available. Given this situation, English teachers have had to create their own materials rather than the existing generalised and pre-packaged language teaching materials. As a result, students‟ specific needs for induction into a scientific writing community at tertiary level have rarely been met. It is against this background that the study seeks to investigate factors that are facilitating and the mastery of EAP. The study operates on post-colonial/post-structuralist theoretical perspectives. These were founded on the analytical framework that is guided by thematic and/or conceptual underpinnings of language policy in the post-colonial Africa. Thus, English Language Teaching (ELT), developed into English as a second and additional language that is multi-semiotic and multi-modality in EAP and science genres, focusing mostly on its academic literacy, identity, ideology, power and agency, as well as its investment in language teaching and learning and the scientific community practice. Using a combination of ethnographic principles/practices like participants‟ observations, oneto- one interviews, focus group discussions and documentary review in data collection, the study utilises thematic/conceptual analysis to draw its conclusions. Drawing from the above conceptual perspectives, therefore, as well as from the methodological approach, this thesis emphasises the fact that the inability of students to successfully master EAP is caused by various factors, including the choice of English language learning materials. Contradictory approaches to language learning and to academic literacy practices create further challenges to the Rwandan students‟ advancement in English mastery. These same practices also serve to limit the students‟ ability to learn this language and complicate their access to local and global cultural exposure that is necessary for their socio-economic development of Rwanda. The study also reveals lack of appropriate discursive competence and multi-semiotic repertoires as some of the major factors inhibiting students‟ academic progress. This is partly explained by the nature of the English language learning and teaching materials that is in use which neither provides general nor disciplinary specific academic and learning opportunities in English. Similarly, a range of structural and professional constraints on „agency‟ exists for teachers of English in Rwanda as an additional language to the students, including lack of induction into scientific discourses or the EAP community of language practice. The overall lack of power and agency by teachers also contributes to constraints and constrictions in English language learning practices for these students in Rwanda. The study, however, observes that this situation is not only peculiar to KIST, as it is also common in almost all tertiary institutions in Rwanda. Specific recommendations are made in the study to improve the quality of English language learning and teaching in general and EAP in particular at KIST as an institution of higher learning, through the establishment of a clearer language policy and training opportunities for staff to update and develop required language skills in EAP, especially with regards to writing skills in sciences and engineering. The government of Rwanda, under the umbrella of Rwanda Education Board (REB) and the contribution of English language experts at the Institute, should provide a clearer direction of the language policy and curriculum that addresses Rwandan students‟ specific needs. KIST, as an institution of higher learning, should value and facilitate the teaching and learning of English in general and the teaching of EAP in particular, bearing in mind its assigned mission. The management of the Institute should encourage interaction between EAP and subject area lecturers to discuss and agree upon, text types to be used by EAP lecturers in teaching. KIST management should also provide room for regular interactions with English lecturers to listen to their views and offer them further language training opportunities in order to update and develop the required skills in EAP, especially with regards to writing skills in science and engineering. / South Africa

Magister Legum - LLM / South Africa

Masters of Science / Hypertension is the leading cause of cardiovascular diseases worldwide. There is evidence of the rising incidence and prevalence of chronic diseases of lifestyle in developing countries. Physical activity has been regarded as a commonly accepted modality for treating hypertension. The aim of this study was to determine if physical activity levels are associated with hypertension among employees of Kigali Institute Science and Technology in Kigali, Rwanda. A quantitative, cross- sectional design was used and all staff members (325 employees) of Kigali Institute of Science and Technology (KIST) represented the study population. Random sampling was used to determine the study sample. Data was collected by means of a self-administered questionnaire adopted from The International Physical Activity Questionnaire (IPAQ).Data analysis was done using Statistical Package for Social Sciences (SPSS) software version 15.0. Descriptive statistics using frequencies, percentages, means, and standard deviations and inferential statistics using Chi-square tests were employed. The data were presented with use of tables, figures, graphs, and pie charts. Ethical issues including obtaining permission for conducting the study,informed consent,anonymity,confidentiality, voluntary participation, and the right to withdraw from the study was observed in this study. The study found a prevalence of 34% participants with hypertension. The prevalence of hypertension was associated with age, smoking, drinking alcohol, suffering for diabetes mellitus, and body mass index (BMI). Over one-fifth of the participants in the physically active group were hypertensive while 68% of the participants in the physically inactive group were hypertensive. This study shows that hypertension status is strongly associated with physical activity levels [X² = 20.381 with(P<0.001)].The study further showed that smoking and suffering from diabetes mellitus were also associated with levels of physical activity (P = 0.003 and p = 0.004 respectively). The current study concludes that physical activity is needed for employees at Kigali Institute of Science and Technology as part of preventive measures for chronic diseases of lifestyle.Therefore, the recommendations were proposed to various categories of people and stakeholders to be actively involved in the promotion of physical activity among employees of Kigali Universities in Rwanda.

Magister Scientiae (Physiotherapy) - MSc(Physio) / Hypertension is one of the most common non-communicable diseases, and it is the leading cause of cardiovascular diseases, death and disability worldwide, especially in developing countries. Physical activity has been regarded as a commonly accepted modality for preventing and treating hypertension. However, despite its known benefits, this modality of treatment and prevention of hypertension continues to be underused.The present study aimed to determine the demographic, social and health-related factors that are associated with levels of physical activity participation among adults with hypertension in Kigali, Rwanda. This cross-sectional study was conducted with 252 adults with hypertension and 87 healthcare professionals through the Godin Leisure-Time Exercise Questionnaire (GLTEQ) and Physical Activity Exit Interview (PAEI). Two thirds of the participants (69.44%) were classified as sedentary. The following factors were found to be significantly (P<0.05) associated with the levels of physical activity:age, marital status, and level of education, residence, tobacco; past and current users, alcohol; current user, diabetes mellitus, BMI, perceived health status, self-efficacy, and blood pressure. None of the healthcare professionals were considered good physical activity counsellor. The findings of the present study highlight the need for the implementation of health promotion strategies aimed at promoting physical activity lifestyle among individuals with hypertension in Rwanda. Efforts should be made in educating people with hypertension on the benefits of integrating regular physical activity in their daily lives. Furthermore, healthcare professionals should be educated concerning how to promote physical activity to all patients especially those with hypertension.

Philosophiae Doctor - PhD / This study explores second and third year students' and teachers‟ views on factors that hinder or facilitate the mastery of English for Academic Purposes (EAP) in the Science and Engineering Technology Higher Institutions of learning in Rwanda (KIST) and seeks to establish the extent to which the current programme meets the needs of the students. This is done by highlighting a whole range of teacher and student perspectives on the EAP programme. Two key requirements invite students to write their academic assignments in the form of research proposals and research project reports. In order to help them perform well in their field subjects, KIST introduced a department of English with a General English Programme under the umbrella of the then School of Language Studies (SORAS) in 1997. The department‟s first assigned mission was to teach English to students in all departments in a bid to support and encourage them to cope with their field specific courses which are taught in English. Rwanda‟s National Council for Higher Education (2007), on language teaching and learning, states that the trio, that is Kinyarwanda (the Mother Tongue and national language) and English and French (as foreign languages), should be taught at primary, secondary and higher iv education levels in order to reconcile the divide between Rwandan returnees (who had lived abroad for many decades) and locals. It is in this context that KIST, one of the institutions of higher learning, adopted the bilingual policy to cater to students‟ needs to learn both French and English as media of academic communication. However, after Rwanda‟s integration into the East African Community and the Commonwealth, English has been officially adopted as the medium of instruction in all schools and higher institutions of education. That is why there was a sudden language shift in 2006 from French to English as a medium of instruction at KIST. French and Kinyarwanda are now merely taught as subjects. The motive behind the move was to cater for Rwanda‟s needs to fully participate in the economic community of East African Community in general and in the global economy in particular. The move drastically affected students‟ ability to read and write English in their respective disciplines. The move also affected lecturers of other speciality areas. To avert the obvious challenges emanating from this sudden shift in language policy, the Institute introduced the English for Specific Purposes (ESP) and English for Academic Purposes (EAP) programmes under the then KIST School of Language Studies (SOLAS) and the KIST Language Centre. However, appropriate instructional materials for such courses have not been easily available. Given this situation, English teachers have had to create their own materials rather than the existing generalised and pre-packaged language teaching materials. As a result, students‟ specific needs for induction into a scientific writing community at tertiary level have rarely been met. It is against this background that the study seeks to investigate factors that are facilitating and the mastery of EAP. The study operates on post-colonial/post-structuralist theoretical perspectives. These were founded on the analytical framework that is guided by thematic and/or conceptual underpinnings of language policy in the post-colonial Africa. Thus, English Language Teaching (ELT), developed into v English as a second and additional language that is multi-semiotic and multi-modality in EAP and science genres, focusing mostly on its academic literacy, identity, ideology, power and agency, as well as its investment in language teaching and learning and the scientific community practice.

Magister Public Health - MPH / In the context of human resource crisis in African countries, the World Health Organization has proposed task-shifting as an approach to meet the ever-increasing need for HIV/AIDS care and treatment services. Rwanda started the process of task shifting towards nurse-based care in ART services in June 2010. After one year of implementation, a need to determine whether task shifting program has been implemented as intended and if it achieved its primary goal of increasing accessibility of people living with HIV to ARV therapy and improving nurse capacity in HIV patient care was imperative.A multi-method program evaluation study design, combining cross sectional, retrospective review and retrospective cohort sub-studies were used to evaluate the implementation,maintenance processes and outcomes of task shifting in 13 Health Centres (HCs) located in the catchment area of Kibagabaga District Hospital, in Rwanda. The study population consisted of HCs providing task shifted care (n=13), nurses working in the ART services of the 13 HCs(n=36), and more than 9,000 patients enrolled in ART care in the 13 HCs since 2006. All 13 HCs and 36 nurses were included in the evaluation. Routine data on patients enrolled in the pre-task shifting period (n=6 876) were compared with the post task shifting period (n=2 159), with a specific focus on data in the 20-months periods prior to and after task shifting. A cohort of patients 15 years and older, initiated onto ART specifically by nurses from June to December 2010 was sampled (n=170) and data extracted from patients medical files.Data collection was guided by a set of selected indicators. Three different data collection tools were used to extract data related to planning, overall programmatic data and individual data from respectively, the program action plans/reports, HIV central databases and patients medical files. Descriptive analysis was performed using frequencies, means and standard deviations (SD). The paired and un-paired t-tests were used to compare means, and chi-square test was used to compare categorical variables. To compare and to test statistical difference between two repeated measurements on a single sample but with non-normally distributed data, Wilcoxon signed rank test was used. To judge if current task shifted care is better, similar or worse than non-task shifted care, comparisons were made of program outputs and outcomes from the central database prior to and after the period of task shifting, and also with the cohort of nurse initiated patients.Results showed that 61% of nurses working in the ART program were fully trained and certificated to provide ART. Seven out of 13 HCs met the target of a minimum of 2 nurses trained in ART service delivery. Supervision and mentorship systems for the 13 HCs were well organized on paper, although no evidence documenting visits by mentors from the local district hospital to clinics was found. In term of accessibility, the mean number of patients newly initiated on ART per month in the HCs increased significantly, from 77.8/month (SD=22.7) to 93.9/month (SD=20.9) (t test (df=38), p=0.025). A small minority of patients was enrolled in late stages of HIV, with only 15% of the patient cohort having CD4 counts of less than 100 cell /μL at initiation on ART. The baseline median CD4 cell count was 267.5 cells /μL in the cohort as a whole. With respect to quality of care, only 8.8% of patients in the cohort had respected all appointments over a mean follow up period of 17.2 months; and although follow up CD4 counts had been performed on the majority of patients (80%), it was done after a mean of 8.5 months(SD=2.7) on ART, and only a quarter (24.7%) had been tested by 6 months (as stipulated by guidelines). From central ART program data, a small but significant increase of patients on 2nd line drugs was observed after implementation of task shifting (from 1.98% to 3.00%, 2=13.26,p<0.001), although the meaning of this shift is not entirely clear.The median weight gain was 1 kg and median CD4 increase was 89.5 cells /μL in the cohort after 6 months of receiving task shifted care and treatment. These increases were statistically significant for both male and female patients (Wilcoxon signed rank test, p<0.001). With regard to loss to follow up, only three of the 170 patients in the cohort followed up by nurses had been lost to follow-up after a mean of 17.2 months on treatment. The routine data showed a decrease of patients lost to follow up, from 7.0% in the pre-task shifting period to 2.5% in the post-task shifting period. In general, the mortality rate was slightly lower in the post-task shifting period than in the pre-task shifting (5.5% vs 6.9% respectively), although this was not statistically significant (2=2.4, df=1, p=0.1209).This study indicates that, after over one year of implementation of task shifting, task shifting enabled the transfer of required capacity to a relatively high number of nurses. In an already well established programme, task shifting achieved moderate improvements in uptake (access) to ART, significant reductions in loss to follow up, and good clinical outcomes. However,evaluation of process quality highlighted some concerns with respect to adherence to testing guidelines on the part of providers and follow up visits on the part of patients. Improvements in processes of monitoring and follow up are imperative for optimal mid-term and long-term task shifting in the ART program.

Magister Public Health - MPH / Background: Adequate human resources for health play a crucial role in improving access to services and quality of care. Human resources for health are often inequitably distributed between rural and urban areas within countries. In Rwanda, almost 88% of physicians and 58% of nurses in the country work in urban areas, despite the fact that 82% of the population lives in rural areas. Kabaya is located in a remote rural area in Ngororero District; its health facilities consist of one hospital and four health centers. Living and working conditions are poor for health workers. This results in constant migration out of health workers, which has negative impacts on service delivery and quality of care provided to the population. Aim and Objectives: This study aimed to assess factors that influence the intention to stay in Kabaya amongst health workers currently in Kabaya's health facilities. The specific objectives were to analyze the associations between the following factors and intention to stay among health workers in Kabaya: socio-demographic and job characteristics; working and living conditions; and financial and non-financial incentives. Study design: An analytical, cross-sectional survey of all health workers from five facilities in Kabaya was conducted. Methods: A self-administered questionnaire, adapted from one used in a study in Uganda (Hagopian, Zuyderduin, Kyobutungi & Yunkella, 2006), was used to collect data. Data were entered in Epi- Info 3.4 and analyzed using SPSS 16.0. Descriptive analyses and inferential statistics (Chisquare,Fisher‟s Exact) were done to test for associations with the main outcome, intention to stay. Results Out of 155 employees working in Kabaya‟s health facilities, 111 (72%) accepted to participate in the study. Of the 111 respondents, 34 (31%) indicated they intended to stay working in Kabaya indefinitely. Intention to stay (bivariate analysis) was associated with:  employment category (p=0.001) and age (p<0.001);  rural background - born in Kabaya (p<0.001); and born (p=0.001), grew up (p=0.001) and studied in a rural area (p<0.001); good quality supervision - encouraging employee development (p=0.029), caring for the employee as a person (p=0.011), and competent and committed facility managers(p=0.039);  presence of workplace friends (p<0.001);  conducive work and living environments - manageable workloads (p<0.001); good infrastructure (p<0.001); access to safe and clean water at work (p<0.001); adequate housing at home (p<0.001); having time to take lunch at work (p=0.001); access to adequate transportation to work (p=0.004); adequate shopping and entertainment(p=0.001);  adequate incentives - sufficient salary (p<0.001); recognition for doing a good work(p<0.001); and adequate training (p<0.001). The small study sample precluded multi-variate analyses and it was therefore not possible to control for potential confounders such as age, sex and profession in the analysis of workplace factors. Conclusions: Intention to stay in Kabaya appears to be influenced by a complex set of factors that include: individual (age, profession, rural background), workplace, human, social, career and salaryrelated factors. Promoting retention in Kabaya‟s health facilities requires multi-faceted interventions, without which the majority of the employees are likely to continue to migrate away from the area.

Philosophiae Doctor - PhD / Findings also indicate other drawbacks such as some teachers' transmission of errors due to their low proficiency in the English language, their lack of common and well-designed EAP curricula, their lack of cooperation with non-language teachers, their delayed starting of classes and allowing a kind of laissez-faire and laissez-aller approach in classrooms, their lack of promotion of students' learning autonomy and problem-solving skills, their lack of language support to students, to cite but a few. Findings also indicate that teachers over-used pre-established materials that they had been recommended to use, using a teaching methodology known as PPP (Present Practise Produce) according to which teachers present an item or a skill and students are required to practise it before they become conversant with it. Furthermore, findings indicate a severe shortage of teaching and learning facilities. Findings concerning the language of instruction (English) indicate that it challenged students with an educational background in French. However, the students' French background and the widespread use of Kinyarwanda were also seen as an impediment to the implementation of EAP courses, but findings show that the shift from English to Kinyarwanda would help students understand the difficult concepts used in their academic subjects and safeguard Rwandan culture. Findings with regard to students' needs and expectations indicate that no opportunities were created for classroom interaction to enable students to think critically and comprehend the world and the word. Furthermore, teachers would fail to adjust the teaching and learning materials to suit students' needs. These materials were neither discipline-nor culture-related. To address the above-mentioned shortcomings, findings indicate that teaching and learning materials which incorporate discipline-related terminologies, Rwandan cultural artifacts, and world Englishes bear meaningful input and can raise students' motivation. They also indicate that students communicate better in Kinyarwanda and that the use of code switching helps students acquire both Basic Interpersonal Communication Skills (BICS) and Cognitive Academic Language proficiency (CALP). Concerning the above findings, therefore, recommendations are made to help the CBE and other institutions of higher learning in Rwanda and tertiary education settings in non-native English-speaking countries around the world to use EAP courses as a solution to students' language- related problems. Such recommendations are, to cite a few, teachers' shift from a banking to a problem-solving model of education, their switch to modes of communication other than the language of instruction to facilitate the teaching and learning process, teacher and student autonomy, accommodating students' voice in the teaching and learning process, the revision of criteria relied on to select language teachers, and in-service training for novice teachers. Other recommendations are CBE's partnership with other institutions of higher learning nationwide and worldwide, provision of learning and teaching materials, the government's mass consultation before the promulgation and implementation of any language policy, and the consideration of student errors as part of the learning process.

Magister Scientiae (Physiotherapy) - MSc(Physio) / Low back pain among high school children is perceived to be uncommon in the clinic setting. However, previous studies have suggested that it may be an important and increasing problem to be managed in this age group. The overall aim of this study was to determine the prevalence, the predisposing factors and management of low back pain among high school children in Nyamasheke district in Rwanda. A cross– sectional descriptive study was conducted using a combination of quantitative and qualitative research methods. The study included a population of 10 330 high school children aged 13- 21 years old registered in high schools of Nyamasheke district. In addition, 13 service providers involved in addressing low back pain were included in the study. The study was conducted in ten schools selected randomly, four schools from nine urban schools and six schools from 15 rural schools. The sample size included 1 000 participants selected by a simple random sampling method and six service providers selected by purposive sampling method. A self-administered questionnaire was given to high school learners. Semi-structured interviews amongst service providers were conducted to validate information given by high school learners. The software SPSS version 19.0 for windows and Microsoft Excel package 2010 were used to analyze the quantitative data. Descriptive statistics using frequencies, percentages, means, and standard deviations and inferential statistics using chi-square and correlation tests were calculated to examine the association between variables. For qualitative findings, audiotaped interviews were transcribed and translated from Kinyarwanda into English, and the expressed ideas were coded and reduced into themes and categories. Permission to conduct this study was obtained from the Senate Research Grants and Study Leave Committee at the University of the Western Cape, and the concerned authorities in Rwanda. Individual participants and their parents/guardians were informed of the study through an information sheet and written informed consent or assent was then obtained from the participants. The mean age of the quantitative study sample was 17 years, and 48.2% were females compared to 51.8% of males. The response rate was 96.2%. The low back pain prevalence was found to be 66.1%. The mean age of the first occurrence of low back pain was 14.5(SD = 2.28). One year prevalence was found to be 25.4% whereas the one month prevalence was 13.7%. Males were the most to report low back pain comparatively to females with 53.1% and 43.9% respectively. There was significant relationship between age group and low back pain (p = 0.000). High school children from the rural region were the most to report low back pain in comparison to those from urban region with 61.5% against 38.5% respectively. Regarding the predisposing factors to low back pain, a strong relationship was found between low back pain and posture (sitting and standing position) (p=0.000) with 83.2%. The findings of the interviews conducted among service providers showed that the main predisposing factors for low back pain could be posture/position in class and psychological factors. The study found that most of the participants do not attend medical services. The study highlighted that the impact of low back pain included medical costs, missing class when attending medical services and difficult to perform normal usual activities. It was found that the level of education in health promotion as preventive measures of low back pain is still at low level.