Rwandan national, Dr Madeleine Mukeshimana graduates with a PhD in Nursing.Rwandan National Graduates with PhD in Nursing
Dr Madeleine Mukeshimana of Rwanda graduated from UKZN with a PhD in Nursing following her study on a Collaborative Care Model (CCM) in Rwanda.
Supervised by Nursing Academic Leader, Professor Gugu Mchunu, her thesis was titled: “A Collaborative Care Model (CCM) for Management of Co-Morbid Depression and Selected Chronic Non-Communicable Diseases for Rwandan Health Facilities: Model Adaptation and Justification”.
The study explored the management of co-morbid depression and chronic non-communicable diseases (NCDs) in Rwanda, in order to adapt the CCM to the Rwandan healthcare services.
The CCM is a systematic approach to the treatment of depression and anxiety in primary care settings that involves the integration of care managers and consultant psychiatrists, with primary care physician oversight, to more proactively manage mental disorders as chronic diseases, rather than treating acute symptoms.
According to Mukeshimana’s research, Rwanda has no protocol/interventions to manage this co-morbidity.
She first explored the prevalence of depression in patients with chronic NCDs represented by diabetes and hypertension. ‘I also explored the current situation regarding management of co-morbidity of depression and chronic NCDs and adapted a CCM to the Rwandan context.’
She found high prevalence of depression among diabetic and hypertensive patients. ‘The new adapted model was perceived by participants and implementers to be applicable, acceptable and important for management of this co-morbidity.’
Mukeshimana recommends implementation of CCM in all Rwandan district hospitals in the hope of improving quality of care for patients with this co-morbidity.
‘The model is recommended by the World Health Organization to be implemented in all countries to manage this co-morbidity,’ said Mukeshimana.
Her study used a mixed-methods approach guided by an action research sequential explanatory design.
It was conducted in three cycles. A quantitative method was used in an exploratory cycle and qualitative method was used in analysis and action cycles.
For the quantitative cycle, which explored the prevalence of depression in a random sample of 385 people, 334 volunteers participated in the study with a response rate of 88%.
Patient Health Questionnaire 9 (PHQ-9) was used to screen depression. The research team of 14 mental and medical health professionals were involved in the second and third cycles which analysed, adapted and implemented the model.
The model was tested over a period of six weeks with 30 patients. Quantitative data was analysed with Stata 13.0 and qualitative content was analysed using an inductive approach.
The results showed a high prevalence of depression (83.8%) with confidence intervals of 95% among diabetic and hypertensive patients.
Mukeshimana is currently the Head of the Nursing Department and Co-ordinator of Masters of Science in Nursing at the University of Rwanda. She hopes to implement the Adapted Collaborative Care Model in all Rwandan district hospitals.
Mukeshimana completed her undergraduate degree at UKZN, completing her master’s degree in 2010. ‘When I finished my Bachelor’s degree I got financial support because of my good marks to do a masters. From that time, UKZN became my second home. Then when I got the chance to do a PhD with assistance from the Rwandan government I did not hesitate to apply at UKZN.’