Vongai Christine Mlambo

All Publications

• Short term outcomes of the first pediatric cardiac surgery program in Rwanda. Journal of cardiothoracic surgery Ejigu, Y., Mlambo, V. C., Neil, K. L., Sime, H., Wong, R., Gatera, M. R., Nyirigira, G., Sewnet, Y. C., Lin, Y., Byishimo, B., Rukomeza, G., Mutabandama, Y., Rusingiza, E. 2024; 19 (1): 699

  Abstract

  While the number of cardiac surgery programs in sub-Saharan Africa are increasing, it is still insufficient. With only 0.08 pediatric cardiac surgeons per million people, few cardiac centers routinely perform pediatric cardiac surgery. This has led to reliance on humanitarian medical missions or referral abroad for most African nations. This study outlines the outcomes of Rwanda's first sustainable pediatric cardiac surgery program.A retrospective chart review was performed for all pediatric patients who received cardiac surgery between October 2022 and April 2024. Patient demographics, procedures, operative times, length of stay, complications, and 30-day mortality were synthesized. Perioperative factors associated with complications and prolonged intensive care unit length of stay were evaluated using logistic and linear regression analysis, respectively.207 patients received 240 cardiac procedures. At time of surgery, 45% of patients were 1-5 years old (n = 95). The top five procedures were repair of Ventricular Septal Defect, Patent Ductus Arteriosus, Atrial Septal Defect, Tetralogy of Fallot and Coarctation of the Aorta. 30-day mortality was 1.9% (n = 4) and 6.3% (n = 13) experienced a major complication. Additionally, 24% (n = 50) experienced minor complications, most commonly, pneumonia. The linear combination of surgery duration, cross clamp and bypass time was significantly associated with having complications (aOR = 0.67, p = 0.01). Younger age, longer operative times, number of inotropes and the presence of complications were associated with an increased intensive care unit stay.The 30-day surgical outcomes are favorable compared to programs with a similar case mix, showing that pediatric cardiac surgery can be safely performed in developing countries with local cardiac teams. Prolonged bypass and cross clamp times were associated with higher complication rates and increased inotrope use was associated with longer intensive care unit stay.

  View details for DOI 10.1186/s13019-024-03295-5

  View details for PubMedID 39736735

  View details for PubMedCentralID 5978758

• Cost-effectiveness analysis of pediatric cardiac surgery for common lesions in Rwanda. International journal of cardiology Mlambo, V. C., Ejigu, Y., Neil, K. L., Sendegeya, A., Ntihabose, C., Bendavid, E., d'Aci, P. R., Lin, Y. 2024: 132909

  Abstract

  Only 3 % of children in sub-Saharan Africa with congenital heart disease (CHD) have access to life-saving surgery. There is an urgent need to scale up the volume of cardiac procedures. Cost-utility analysis can assess the health economic impacts of performing congenital heart surgery in this region.We performed a cost-utility analysis comparing surgical intervention and medical management for a weighted case mix of the four most common CHDs in Rwanda. A Markov model was constructed to simulate the course of each strategy. Probability of peri-operative complications was derived from the local pediatric cardiac surgery program and risks of long-term outcomes from large, published cohort studies. Micro-costing was used to calculate expenses from program cost data. Health benefits were measured in quality-adjusted life years (QALYs). Deterministic and probabilistic sensitivity analysis was performed. Incremental cost-effectiveness ratios (ICER) were compared to a willingness-to-pay threshold three times the GDP per capita of Rwanda (USD$2898·60).Surgical intervention provided 17·15 additional discounted QALYs compared to medical management for an extra USD$6738·23. The ICER for surgical intervention was USD$269·52/QALY. Increasing the cost of surgery raised the ICER to a maximum of USD$580/QALY. In the probabilistic sensitivity analysis, surgery was cost-effective 100 % of the time including at one-times GDP per capita.Surgical intervention for common CHD in Rwanda is very cost-effective. The initial cost of surgery is compensated for by decades of additional life years. Increasing case complexity and decreasing the initial cost of surgery can make surgery even more cost-effective.

  View details for DOI 10.1016/j.ijcard.2024.132909

  View details for PubMedID 39710349

• Cost-effectiveness analysis of valvular surgery in high- and low- to middle-income countries: A scoping review. World journal of surgery Mlambo, V., Hyles, K., Wang, S., Lin, Y. 2024

  Abstract

  Global disparities in valvular surgery services exist. Cost-effectiveness analysis (CEA) and cost-utility analysis can be used to guide national investment decisions. This scoping review aims to synthesize economic evaluations for valvular surgery by income settings and provide recommendations.A systematic literature review identified primary CEAs or CUAs in English comparing surgical management strategies for valvular heart disease. MEDLINE, Embase, CINAHL, Web of Science, and Business Source Complete were searched using keywords "valvular surgery," "valve disease," "cost-effectiveness," and "cost-benefit analysis". Articles comparing outcomes or costs only were excluded. Search results were uploaded and screened on COVIDENCE. Variables from eligible articles were charted in a spreadsheet.Twenty articles were eligible, six from low- and middle-income countries (LMICs) and 14 from high-income countries (HICs). In HICs, the top conditions were degenerative aortic valve disease (7/14) and mitral valve disease (4/14) compared to congenital (2/6) and rheumatic heart diseases (2/6) in LMICs. HICs evaluated new technologies and techniques, whereas LMICs compared different valve types or surgery versus no intervention. Most articles used published studies (12/20) or databases (7/20) to conduct their CEA and quality-adjusted life years was the most common effectiveness measure (12/20). Comparator interventions were cost-effective in all LMIC articles and in 8/14 for HICs.Economic evaluations are mostly conducted in HICs and for adult conditions. More analyses in LMICs are needed. This can be facilitated by maintaining databases, documenting costs, and implementing quality of life assessments.

  View details for DOI 10.1002/wjs.12381

  View details for PubMedID 39428550

• Teaching With the GlobalSurgBox: Trainer Perceptions of a Portable Surgical Simulator. Journal of surgical education Mlambo, V. C., Kirsch, M. J., Masimbi, O., Gasakure, M., Alayande, B., Lin, Y. 2024; 81 (10): 1331-1338

  Abstract

  OBJECTIVES: Evaluate the utility of a low cost, portable surgical simulator (GlobalSurgBox) for surgical teaching and its ability to dismantle barriers faced by trainers when attempting to use surgical simulation.DESIGN: An anonymous survey was administered to surgical trainers who were involved in leading simulation events using the GlobalSurgBox in the past 2 years. The survey was designed to understand current barriers to using simulation as a trainer, and the utility of the GlobalSurgBox in overcoming these barriers.SETTING: Academic medical training centers or conferences in the United States, Rwanda and Kenya.PARTICIPANTS: 10 practicing surgeons, 3 practicing physicians, 11 surgical residents, 15 medical students and 1 anesthesia resident.RESULTS: The top 3 barriers for effective teaching were lack of convenient access to the simulator (50%), lack of trainer time (43%) and cost (28%). After using the GlobalSurgBox, 100% and 98% of respondents felt that it encourages more practice and offers significant advantages over current simulators in their program. About 90%, 88% and 70% of respondents believed that the GlobalSurgBox makes surgical simulation more convenient, affordable, and compatible with trainer time limitations, respectively. 83% of trainers agreed that it is a good replica of the operating room experience, and 85% practicing physicians were more likely to give autonomy to trainees after demonstrating competence on the GlobalSurgBox.CONCLUSION: The GlobalSurgBox mitigates several barriers surgical educators experience when practicing surgical skills with trainees. The convenience of the GlobalSurgBox can help facilitate the development of foundational surgical skills outside of the operating room.

  View details for DOI 10.1016/j.jsurg.2024.07.019

  View details for PubMedID 39153328

• Development of a Medical Social Media Ethics Scale and Assessment of #IRad, #CardioTwitter, and #MedTwitter Posts: Mixed Methods Study. JMIR infodemiology Mlambo, V. C., Keller, E., Mussatto, C., Hwang, G. 2024; 4: e47770

  Abstract

  Social media posts by clinicians are not bound by the same rules as peer-reviewed publications, raising ethical concerns that have not been extensively characterized or quantified.We aim to develop a scale to assess ethical issues on medical social media (SoMe) and use it to determine the prevalence of these issues among posts with 3 different hashtags: #MedTwitter, #IRad, and #CardioTwitter.A scale was developed based on previous descriptions of professionalism and validated via semistructured cognitive interviewing with a sample of 11 clinicians and trainees, interrater agreement, and correlation of 100 posts. The final scale assessed social media posts in 6 domains. This was used to analyze 1500 Twitter posts, 500 each from the 3 hashtags. Analysis of posts was limited to original Twitter posts in English made by health care professionals in North America. The prevalence of potential issues was determined using descriptive statistics and compared across hashtags using the Fisher exact and χ2 tests with Yates correction.The final scale was considered reflective of potential ethical issues of SoMe by participants. There was good interrater agreement (Cohen κ=0.620, P<.01) and moderate to strong positive interrater correlation (=0.602, P<.001). The 6 scale domains showed minimal to no interrelation (Cronbach α=0.206). Ethical concerns across all hashtags had a prevalence of 1.5% or less except the conflict of interest concerns on #IRad, which had a prevalence of 3.6% (n=18). Compared to #MedTwitter, posts with specialty-specific hashtags had more patient privacy and conflict of interest concerns.The SoMe professionalism scale we developed reliably reflects potential ethical issues. Ethical issues on SoMe are rare but important and vary in prevalence across medical communities.

  View details for DOI 10.2196/47770

  View details for PubMedID 38536206

• Rotations. Families, systems & health : the journal of collaborative family healthcare Mlambo, V. C. 2023; 41 (3): 405-406

  Abstract

  The author expresses themselves with poetry about their medical education, experiences, and rotations. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

  View details for DOI 10.1037/fsh0000784

  View details for PubMedID 37732982

• Chronic social stress blunts core body temperature and molecular rhythms of Rbm3 and Cirbp in mouse lateral habenula OPEN BIOLOGY Haniffa, S., Narain, P., Hughes, M., Petkovic, A., Susic, M., Mlambo, V., Chaudhury, D. 2023; 13 (7): 220380

  Abstract

  Chronic social stress in mice causes behavioural and physiological changes that result in perturbed rhythms of body temperature, activity and sleep-wake cycle. To further understand the link between mood disorders and temperature rhythmicity in mice that are resilient or susceptible to stress, we measured core body temperature (Tcore) before and after exposure to chronic social defeat stress (CSDS). We found that Tcore amplitudes of stress-resilient and susceptible mice are dampened during exposure to CSDS. However, following CSDS, resilient mice recovered temperature amplitude faster than susceptible mice. Furthermore, the interdaily stability (IS) of temperature rhythms was fragmented in stress-exposed mice during CSDS, which recovered to control levels following stress. There were minimal changes in locomotor activity after stress exposure which correlates with regular rhythmic expression of Prok2 - an output signal of the suprachiasmatic nucleus. We also determined that expression of thermosensitive genes Rbm3 and Cirbp in the lateral habenula (LHb) were blunted 1 day after CSDS. Rhythmic expression of these genes recovered 10 days later. Overall, we show that CSDS blunts Tcore and thermosensitive gene rhythms. Tcore rhythm recovery is faster in stress-resilient mice, but Rbm3 and Cirbp recovery is uniform across the phenotypes.

  View details for DOI 10.1098/rsob.220380

  View details for Web of Science ID 001030703500002

  View details for PubMedID 37463657

  View details for PubMedCentralID PMC10353891

• Impact of Abnormal Potassium on Arrhythmia Risk During Pediatric Digoxin Therapy. Pediatric cardiology Mlambo, V. C., Algaze, C. A., Mak, K., Collins, R. T. 2022

  Abstract

  Digoxin is used in children with heart failure and tachyarrhythmia. Its use in patients with single ventricle anatomy has increased following evidence of improved interstage survival after the Norwood procedure. Digoxin has a narrow therapeutic window and may alter serum potassium balance, inducing arrhythmias. We hypothesized digoxin use in the setting of abnormal serum potassium levels is associated with arrhythmias. We reviewed all patients≤18years who received digoxin while admitted at our institution from 2014 to 2021. Admissions<2 nights were excluded. We compared patients with a hemodynamically significant arrhythmia to those without. We performed adjusted mixed-effects logistic regression with arrhythmia as the outcome variable and potassium status as the predictor variable; adjusting for weight, route of digoxin administration, digoxin indication, serum creatinine, and number of interacting drugs prescribed. Abnormal potassium was defined as serum levels<3.5mmol/L or>6.0mmol/L. There were 268 encounters in 171 patients. Potassium levels were abnormal in 75.5% of patients who experienced an arrhythmia during digoxin administration, compared to 42.6% who did not (p<0.001). Odds of arrhythmia was 138% higher in patients with abnormal potassium receiving digoxin (AOR=2.38, 95% CI 1.07-5.29, p=0.03). Receiving intravenous digoxin was also associated with a 7.35 odds of cardiac arrhythmia (AOR 7.35, p=0.006, 95% CI 1.79-30.26). Odds of arrhythmia is increased during digoxin administration when pediatric patients have abnormal potassium levels. Vigilant attention to potassium levels is essential to prevent adverse outcomes during digoxin therapy.

  View details for DOI 10.1007/s00246-022-03051-3

  View details for PubMedID 36403164

• #PauseBeforeYouPost: Ethical and Legal Issues Involving Medical Social Media. Seminars in interventional radiology Keller, E. J., Mlambo, V. C., Resnick, S. A., Vogelzang, R. L. 2022; 39 (2): 203-206

  View details for DOI 10.1055/s-0042-1745717

  View details for PubMedID 35781993

• Inclusion of children with disabilities in qualitative health research: A scoping review. PloS one Njelesani, J., Mlambo, V., Denekew, T., Hunleth, J. 2022; 17 (9): e0273784

  Abstract

  BACKGROUND: Children with disabilities have the right to participate in health research so their priorities, needs, and experiences are included. Health research based primarily on adult report risks misrepresenting children with disabilities and their needs, and contributes to exclusion and a lack of diversity in the experiences being captured. Prioritizing the participation of children with disabilities enhances the relevance, meaningfulness, and impact of research.METHODS: A scoping review was conducted to critically examine the participation of children with disabilities in qualitative health research. The electronic databases PubMed, PsychInfo, Embase, and Google Scholar were searched. Inclusion criteria included qualitative health studies conducted with children with disabilities, published between 2007 and 2020, and written in English. Articles were screened by two reviewers and the synthesis of data was performed using numeric and content analysis.RESULTS: A total of 62 studies met inclusion criteria. Rationales for including children with disabilities included child-focused, medical model of disability, and disability rights rationales. Participation of children with disabilities in qualitative health research was limited, with the majority of studies conducting research on rather than in partnership with or by children. Findings emphasize that children with disabilities are not participating in the design and implementation of health research.CONCLUSION: Further effort should be made by health researchers to incorporate children with a broad range of impairments drawing on theory and methodology from disability and childhood studies and collaborating with people who have expertise in these areas. Furthermore, an array of multi-method inclusive, accessible, adaptable, and non-ableist methods should be available to enable different ways of expression.

  View details for DOI 10.1371/journal.pone.0273784

  View details for PubMedID 36048816

• The ethics of #MedTwitter and medical social media Mlambo, V. C., Hwang, G. L., Keller , E. J. IR Quarterly. 2021
• What it takes to be at the top: The interrelationship between chronic social stress and social dominance BRAIN AND BEHAVIOR Sabanovic, M., Liu, H., Mlambo, V., Aqel, H., Chaudhury, D. 2020: e01896

  Abstract

  Dominance hierarchies of social animal groups are very sensitive to stress. Stress experienced prior to social interactions between conspecifics may be a determinant of their future social dynamics. Additionally, long-term occupancy of a specific hierarchical rank can have psychophysiological effects which increase vulnerability to future stressors.We aimed to delineate differential effects of stress acting before or after hierarchy formation. We studied whether exposure to the chronic social defeat stress (CSDS) paradigm before a two-week-long hierarchy formation affected the attainment of a dominant status using the social confrontation tube test (TT). These animals were singly housed for at least one week before CSDS to decrease confounding effects of prior hierarchy experience. Additionally, we investigated whether social rank predicted vulnerability to CSDS, measured by a social interaction test.In TT, mice termed as dominant (high rank) win the majority of social confrontations, while the subordinates (low rank) lose more often. Within newly established hierarchies of stress-naïve mice, the subordinate, but not dominant, mice exhibited significantly greater avoidance of novel social targets. However, following exposure to CSDS, both lowest- and highest-ranked mice exhibited susceptibility to stress as measured by decreased interactions with a novel social target. In contrast, after CSDS, both stress-susceptible (socially avoidant) and stress-resilient (social) mice were able to attain dominant ranks in newly established hierarchies.These results suggest that the response to CSDS did not determine social rank in new cohorts, but low-status mice in newly established groups exhibited lower sociability to novel social targets. Interestingly, exposure of a hierarchical social group to chronic social stress led to stress susceptibility in both high- and low-status mice as measured by social interaction.

  View details for DOI 10.1002/brb3.1896

  View details for Web of Science ID 000578378700001

  View details for PubMedID 33070476