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Proximal deep vein thrombosis among hospitalised medical and obstetric patients in Rwandan university teaching hospitals: prevalence and associated risk factors: a cross-sectional study
  1. Regine Mugeni1,
  2. Eugene Nkusi2,
  3. Eric Rutaganda3,4,
  4. Sanctus Musafiri3,4,
  5. Florence Masaisa3,4,
  6. Kayan Lea Lewis5,
  7. Marc Simpao6,
  8. Pierrot Lundimu Tugirimana7,
  9. Timothy David Walker8,9
  1. 1 Internal Medicine, Rwamagana Hospital, Rwamagana, Eastern, Rwanda
  2. 2 Internal Medicine, Butaro Hospital, Burera, Northern, Rwanda
  3. 3 Internal Medicine, Centre Hospitalier Universitaire de Kigali, Kigali City, Rwanda
  4. 4 College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
  5. 5 School of Public Health, University of Texas, Houston, Texas, USA
  6. 6 Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
  7. 7 Internal Medicine, University of Goma, Goma, Nord-Kivu, Democratic Republic of the Congo
  8. 8 Internal Medicine, Calvary Mater Newcastle, Hunter Region Mail Centre, New South Wales, Australia
  9. 9 School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
  1. Correspondence to Dr Regine Mugeni; pacisreg{at}gmail.com

Abstract

Objectives To determine the prevalence of proximal deep vein thrombosis (DVT) by ultrasound scanning, as well as associated clinical features and known risk factors, among medical and obstetrics–gynaecology inpatients in two Rwandan tertiary hospitals.

Design Cross-sectional study.

Settings Rwanda teaching hospitals: Kigali and Butare University Teaching Hospitals.

Participants 901 adult patients admitted to the Departments of Internal Medicine and Obstetrics–Gynecology (O&G) who were at least 21 years of age and willing to provide a consent.

Outcomes Prevalence of proximal DVT, clinical features and known risk factors associated with DVT.

Methods Between August 2015 and August 2016, participants were screened for DVT by compressive ultrasound of femoral and popliteal veins, conducted as a monthly cross-sectional survey of all consenting eligible inpatients. Patients completed a self-report survey on DVT risk factors. Prevalence of proximal DVT by compression ultrasonography was the primary endpoint, with univariate and multivariate regression analyses performed to assess associated clinical features and risk factors.

Results Proximal DVT was found in 5.5% of the study population, with similar rates in medical and O&G inpatients. The mean age was 41±16 SD (range, 21–91), 70% were female and 7% were pregnant. Univariate analysis showed active malignancy, immobilisation, prolonged recent travel and history of DVT to be significant risk factors for proximal DVT (all p values <0.05); while only active malignancy was an independent risk factor on multivariate regression (OR 5.2; 95% CI 2.0 to 13). Leg pain or tenderness, increased calf circumference, unilateral limb swelling or pitting oedema were predictive clinical features of DVT on both univariate analysis and multivariate regression (all p values <0.05).

Conclusion Proximal DVT prevalence is high among hospitalised medical and O&G patients in two tertiary hospitals in Rwanda. For reducing morbidity and mortality, research to develop Africa-specific clinical prediction tools for DVT and interventions to increase thromboprophylaxis use in the region are urgently needed.

  • deep vein thrombosis
  • Sub-Saharan Africa
  • prevelance

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Footnotes

  • Contributors RM, TDW, MS, KLL, SM, PLT, FM and EN conceptualised the research study. RM, ER and EN contributed to the acquisition of data. RM, KLL, MS and ER performed the statistical analysis. RM, SM, TDW and MS contributed to the interpretation of data, writing and editing the manuscript. All authors reviewed the manuscript for important intellectual content and approved the final version.

  • Funding The study was funded by the Swedish International Development Cooperation Agency (SIDA), under a University of Rwanda–Sweden Collaboration.The funding covered study materials such as ultrasound gel, paper, printing and travel for research staff from one site to another.

  • Disclaimer The funder of the study had no role in study design, data collection, data analysis, data interpretation or writing of the paper.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Ethics approval The study was approved by the Institutional Review Board of the College of Medicine and Health Sciences, University of Rwanda (CMHS/IRB/64/2015). As the study was simultaneously conducted in two teaching hospitals, the Research and Ethics Committees of CHUK and CHUB and the Directors General of each hospital also approved the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.

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