Silicosis Prevalence and Related Knowledge, Attitudes and Practices Among Mine Workers in Rural Rwanda
Conditions: Silicosis, Silicotic Fibrosis (Massive) of Lung
Sponsor: Samuel Hatfield

__________________________________________________________________ 
 
Silicosis Prevalence and Related Knowledge, Attitudes and 
Practices Among Rural Mine Workers in Rwanda 
 
A Study Supported by Partners in Health/Inshuti Mu Buzima Non-
Communicable Disease Programs 
 
RNEC Approval 4/11/2022 
 
NCT05538299 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
 
Project Summary: 
Silicosis is the most prevalent occupational lung disease in low- and middle-income countries 
(LMICs) with “tens of millions” estimated to suffer from the disease according to the World 
Health Organization (WHO). To date, there is little published data on silicosis in LMICs and the 
burden of silicosis in Rwanda has not been well-defined. Silicosis among local mine workers is a 
common reason for hospitalization and death at Rwinkwavu District Hospital, located in 
Rwanda’s Kayonza District. 
The objectives of this study are: 
1. To assess the prevalence of silicosis among workers in four mines located in the Kayonza 
District of Rwanda 
2. To adapt a validated screening tool testing in Dutch construction workers for Rwandan 
miners  
3. To implement an occupational health education program and assess the change of before 
and after intervention that target towards proper use of PPE and individual risk 
assessment in mine workers using knowledge-attitudes-practice tool 
 
Investigators: 
Name  
Relevant Title and 
Institution  
Location  Research Role  
Peter Barebwanuwe, 
MPH 
Director of Social and 
Community Medicine , 
PIH  
Rwanda  
General project oversight, study design, 
results interpretation, manuscript writing 
and review. 
Samuel Hatfield, MD 
Internal Medicine 
Doctor  
Rwanda 
and USA 
General project oversight, study design, 
results interpretation, manuscript writing 
and review. 
Daniel Mays, MD MSc 
Internal Medicine 
Doctor 
Rwanda 
and USA 
General project oversight, study design, 
results interpretation, manuscript writing 
and review. 
Vincent K. Cubaka, MD 
Director of Research 
and Training, PIH 
Rwanda  
General project oversight, study design, 
results interpretation, manuscript writing 
and review 
Alphonse Nshimyiryo 
Data analyst, PIH  
Rwanda  
Support study design, data management, 
analysis, interpretation, manuscript 
writing. 
Wellars Dusingizimana, 
MD 
Internal Medicine 
Doctor, RDH  
Rwanda 
General project oversight, study design, 
results interpretation, manuscript writing 
and review. 

Evgeniya Krapivinsky, 
MD 
Assistant Professor, 
Medicine, UCSF 
USA 
Study design, data interpretation, 
manuscript review, dissemination 
Esperence Uwayitu, MD 
Director General, RDH  Rwanda 
Study design, data interpretation, 
manuscript review, dissemination 
Ainé Niyonkuru, MD 
Clinical Director, RDH  Rwanda 
Data collection, data analysis, results 
interpretation, manuscript writing and 
review 
Egide Mpanumusingo, 
MD 
District Program 
Director, PIH  
Rwanda 
Study design, tools development, data 
analysis, results interpretation, 
manuscript review, dissemination 
Paul Sonenthal, MD 
Associate Director, 
Inpatient Medicine and 
Critical Care, PIH 
Instructor in Medicine, 
Harvard Medical 
School 
and 
Associate Physician, 
Division of Pulmonary 
& Critical Care 
Medicine, Brigham & 
Women’s Hospital 
USA 
Study design, tools development, data 
analysis, results interpretation, 
manuscript review, dissemination 
Mr. Tharcisse 
Basigayabo 
 
Coordinator of 
exploitation and 
exploration.  
Rwanda 
Study design, results interpretation, 
manuscript review 
Jean Nepomuscene 
Renzaho  
Social and Community 
Medicine Manager, 
PIH  
Rwanda 
Data collection, data analysis, results 
interpretation, manuscript writing and 
review 
Symaque Dusabeyezu, 
MPH 
Manager of NCD, PIH 
Rwanda 
Data collection, data analysis, results 
interpretation, manuscript writing and 
review 
Loise Mwihaki Ng'ang'a 
NCD Research 
Manager, PIH 
Rwanda 
Support study design, data management, 
analysis, interpretation, manuscript 
writing 
Richard Nduwayezu, 
MD 
Head of Primary Health 
Care Department, UR  
Rwanda 
Study design, data interpretation, 
manuscript review, dissemination 
Jean Claude Byiringiro, 
MD 
School of Medicine and 
Pharmacy Dean, UR  
Rwanda 
Study design, data interpretation, 
manuscript review, dissemination 
Fredelick Kateera, MD 
 
Chief Medical Officer, 
PIH 
Rwanda 
Study design, data interpretation, 
manuscript review, dissemination 
Mr. Adrien Habineza  
Associate Director of 
Training, PIH 
Rwanda 
Tools development, Data collection, 
results interpretation, manuscript writing 
and dissemination 

Stella Savarimurtha, MD 
Fellow, Pulmonary 
Medicine, Yale 
University 
USA 
Implementation, data interpretation, 
study execution 
Akiiki Florence 
Bitalabeho, MD  
Director of Community 
Based Education, PIH 
Rwanda 
Study design, data interpretation, 
manuscript review, dissemination 
Mr. Innocent Kamali  
Associate Director of 
NCD, PIH 
Rwanda 
General project oversight, study design, 
results interpretation, manuscript 
Mr. Aphrodis Ndayisaba  Associate Director of 
Quality Improvement, 
PIH 
Rwanda 
Data collection, results interpretation, 
manuscript writing and dissemination 
 
Research site: Rwinkwavu District Hospital 
Study subjects: Mine workers and supervisors at three Kayonza District mining sites 
(Rwinkwavu, Murama, Ruramira, and mwili sectors) 
 
Sponsor: Partners in Health / Inshuti Mu Buzima 
Main Departments:  Department of Research and training, PIH  
Department of Internal Medicine, RDH 
 
 
      
Department for Non-Communicable Diseases, RDH 
 
 
 
Department of Medical Imaging, RDH 
 
 
        
Department for Integrated Non-Communicable Diseases, PIH 
Department of Primary Health Care, School of Medicine and Pharmacy, 
University of Rwanda 
Background  
Silicosis, a form of occupational pneumoconiosis, is a chronic, incurable lung disease caused by 
inhaling silica dust that leads to lung inflammation and the formation of irreversible fibrosis. In 
many cases, silicosis results in premature cardiopulmonary failure and death. Silicon dioxide, 
commonly called “silica,” is the most abundant mineral on earth. Silica dust, or respirable 
crystalline silica (RCS), consists of tiny particles less than 10 micrometers in diameter and is 
commonly generated, or entrained into the air, during mining operations and a variety of other 
industries (Fig. 1).  
Figure 1 - Occupations with high exposure to respirable crystalline silica 

Source: Leung et al. Lancet 2012; 379: 2008–18 
 
The current global prevalence of silicosis is not well defined, as surveillance is poor or absent in 
many LMICs. The WHO estimates “tens of millions of workers” suffer from silicosis worldwide. 
The burden is particularly severe in LMICs, with data suggesting 30-50% of workers in high-risk 
sectors eventually develop silicosis. The burden of silicosis in Rwanda is not well defined. In 
years past, silicosis has been on the agendas of the International Labour Organization (ILO) and 
WHO, and today the disease remains an urgent public health issue for people who work in 
mining and other high-risk industries. One study of South African gold miners found more than 
25% had silicosis on autopsy with prevalence rates increasing significantly from 1975 and 2007, 
particularly among Black miners. A recent survey of underground miners in Brazil identified 
silicosis prevalence rates as high as 37%. 
Silicosis is deadly, but it is also preventable. In recent decades, incidence rates have declined in 
some countries after the institution of effective occupational health measures. Eliminating the 
medical and socioeconomic toll of silicosis requires primary prevention through a hierarchy of 
controls as shown in Fig. 2 and early detection and mitigation through screening and 
surveillance. Mining operations will always encounter silica dust and this hazard cannot be 
substituted. Therefore, the most effective and practical approach to silicosis prevention in mining 
operations involves engineering controls, which isolate workers from RCS. Commonly used 
engineering controls in mining include ventilation systems, enclosed cabs or booths with air 
filtration, and water spray and other wetting systems to reduce dust entrainment. Administrative 
controls, such as hazard education, worker hygiene and job rotation, along with personal 
protective equipment (PPE) such as air filtration masks supplement the protective effect of 
engineering controls, however they are somewhat less effective. Administrative controls and 
PPE also depend on the behavior of each individual worker, and are therefore less reliable. 
Primary prevention through dust control along with early detection of disease, health education, 
and strong regulatory oversight, are consistent with joint ILO/WHO Global Programme for the 
Elimination of Silicosis (GPES). 
Figure 2 – Hierarchy of controls in occupational health 
- Construction (including sandblasting, drilling, tunneling and demolition) 
- Mining and quarrying 
- Hydraulic fracturing 
- Foundries 
- Pottery and jewelry-making 
- Stone-cutting 

Source: United States National Institute for Occupational Safety and Health (NIOSH) 
 
Silicosis is an insidious disease, commonly taking years to develop into clinically identifiable 
signs or symptoms. In the absence of regular screening and surveillance, the diagnosis of 
silicosis is usually not made until an extensive level of irreversible lung damage and significant 
physical debility have already occurred. Among workers exposed to RCS, chest radiography, 
commonly referred to as Chest X-ray, is among the most important clinical tools for identifying 
silicosis, along with spirometry, which carefully measures airflow dynamics during breathing, 
and symptom checklists. 
 
Recurrent exposure to RCS is the single most important risk factor for developing silicosis. Both 
disease risk and severity increase proportionally with the total cumulative amount of inhaled 
RCS over person’s lifetime. Other factors associated with silicosis are well-documented, 
including tobacco smoking, older age, limited education, migrant status, and delays in medical 
care. An array of additional factors, from individual education and income levels to political 
economy in poor communities, shape how silicosis arises and makes an impact both in the 
individual and collective, fractal life of each person living with silicosis. We have developed a 
biosocial conceptual framework for understanding silicosis, specifically as it manifests in 
Rwanda. 
 
Figure 3 – Biosocial conceptual framework for silicosis in Rwanda 

 
Based on the clinical experience of the authors and their network, silicosis morbidity and 
mortality have been consistently encountered among Rwandans with dust and mining exposure, 
however Rwanda currently lacks an existing body of data on current silicosis prevalence and a 
surveillance system for ongoing monitoring and interventions. According to the WHO, disease 
surveillance programs should include periodic identification and collection of health information, 
evaluation and interpretation of the information, and reporting and interventions for the purpose 
of prevention. The goal of surveillance is to monitor the trends in disease incidence over time 
across a particular domain, define the magnitude or relative magnitude of a problem and target 
and evaluate interventions. Here, we propose a study of silicosis-related data from mine workers 
in Rwanda’s Eastern Province through the development of a silicosis surveillance and health 
education program at Rwinkwavu District Hospital. 
Study Goal and Objectives 
1. To assess the prevalence of silicosis among workers in four mines located in the Kayonza 
District of Rwanda 
2. To adapt a validated screening tool testing in Dutch construction workers for Rwandan 
miners  

3. To implement an occupational health education program and assess the change of before 
and after intervention that target towards proper use of PPE and individual risk 
assessment in mine workers using knowledge-attitudes-practice tool 
Methodology: 
Study setting: 
This study will be conducted in four sectors (Rwinkwavu, Murama, Ruramira, and Mwiri) of 
Kayonza district in eastern Rwanda. There are 9 [Migera, Gihinga, Nyarunazi, Gahengeli, 
Gashushyi, Rutonde, Raveri, Bugambira, Rukira] mining sites in Rwinkwavu, Murama, 
Ruramira and Mwiri, and all mining activities in these sites are supervised by Wolfram Mining 
and Processing LTD. All these sectors are located in the Rwinkwavu District Hospital catchment 
area. 
Study design: 
This will be a combination of a cross-sectional study to determine the prevalence of silicosis and 
a pre- and post-design to assess the silicosis-related knowledge, attitudes and practices (KAP) 
among mining workers before and after the implementation of a health education program. 
The study design will be cross-sectional study and is further detailed in Figure 4. There are three 
main objectives: silicosis prevalence; baseline silicosis-related knowledge, attitudes and practices 
(KAP); and the impact of occupational health education. A team of clinical and public health 
professionals affiliated with Partners In Health/Inshuti Mu Buzima and Rwinkwavu District 
Hospital will carry out the study with data collection assistance from trained fourth-year medical 
students from the University of Rwanda during their social medicine rotation. The preparation 
phase will involve contacting and establishing agreements with stakeholders from key 
organizations including Rwinkwavu District Hospital, Wolfram Mining and Processing Ltd., 
University of Rwanda and Partners in Health/Inshuti Mu Buzima. This phase will involve 
training medical student data collectors and recruiting study subjects. The study execution phase 
will firstly consist of a cross-sectional analysis of silicosis prevalence, adapting a validated 
silicosis questionnaire screening tool to the target study population and performing spirometry 
and chest radiography to all targeted miners [Suarthana, Eva, et al. “A Simple Diagnostic Model for 
Ruling Out Pneumoconiosis among Construction Workers.” Occupational and Environmental 
Medicine, JSTOR]. This screening tool for ruling out occupational pneumoconioses, and silicosis 
specifically, was developed by researchers in the Netherlands. We will adapt and validate the use 
of this screening tool to Rwandan mine workers by comparing the screening results with 
objective spirometry and chest radiograph findings on all subjects who have spent at least one 
cumulative year working directly with mining products. Secondly, the execution phase will 
involve an analysis of existing silicosis-related KAP and the delivery of targeted occupational 
health education to study subjects followed by a reassessment of knowledge and attitudes. We 
will perform initial education program and KAP survey at the time of questionnaire based 
screening with re-assessment at 2-week time point. There are approximately 995 mine workers in 
the cachement are of this study and our goal is to try and involve all of these stakeholders. 
Baseline KAP survey will be done prior to our health education program on PPE, environmental 

controls and personal safety assessment and deployment of the screening questionnaire. Silicosis 
related KAP data will be collected by skilled data collectors after a two week training program.  
Figure 4 – Study roadmap 
 
KAP: knowledge, attitudes and practices 
 
Study population: 
All eligible mine workers in Kayonza District in four sectors including: Rwinkwavu, Murama, 
Ruramira, and Mwiri sectors, located in the Rwinkwavu DH catchment area will be included in 
the study. Those miners with potential risk for RCS exposure, including those who handle 
mining either underground or above ground will be included. People who work in WOLFRAM 
administration (office) and never directly touch mines will not be included.   
 
Study sample: 
For the aim to determine the prevalence of silicosis, we used the single population proportion 
formula to calculate the required sample size. With the existing literature that silicosis prevalence 
among high-risk populations in LMICs may range between 30-50% [Trapido, A.S. et al (1998) 
Prevalence of occupational lung disease in a random sample of former mineworkers, Libode 
District, Eastern Cape Province, South Africa. American Journal of Industrial Medicine, Antão 
VC, Pinheiro GA, et al., High prevalence of silicosis among stone carvers in Brazil. Am J Ind 
Med. 2004], we used the most conservative estimate of 50% for a maximum sample size, with a 
level of confidence of 95%, 0.8 power and a level of precision of +/- 10% - a sample of 189 
individuals will be required. For the silicosis-related KAP part of this study, we also used the 
most conservative estimate of 50%, a 95% confidence level, and a 0.8 power to detect a 20% 
difference from pre- to post-intervention. This gave us a required total sample size of 186 
individuals (a minimum sample of 93 individuals will be required for the pre- and post-survey), 

however the required sample size would increase to 224 individuals (112 individuals in each 
survey) after accounting for a 20% non-response rate. We estimate our study sample to be 
around 995 mine workers, so we will have ample participants to conduct our study. Our goal is 
to sample the complete mining population so as to obtain accurate prevalence of the full cohort 
of miners within the RDH catchment area, which may also allow us to detect asymptomatic 
disease in certain miners, and to enroll these patients in future surveillance programs 
 
Recruitment of study participants and consent to participate 
Participants will be recruited from the mining and processing company Wolfram Mining and 
Processing Ltd., which operates in Rwinkwavu, Murama, Mwili, and Rurambira sectors. 
Inclusion criteria for all three study objectives, including silicosis screening, KAP assessment 
and education programs are: adult residents of Kayonza District aged 18 years or older who 
regularly (at least once per week) works in direct physical proximity with mining products in 
operations managed by Wolfram Ltd. at the present time or those who regularly worked in such 
mining operations for at least one cumulative year within the last 10 years. Exclusion criteria 
include those who have a significant impairment in speech or hearing due to the limited 
availability of adequate accessibility provisions for such study subjects, or other physical or 
medical disability that may limit involvement. Patients who are illiterate may still participate in 
the study with help from data collectors who can help study candidates complete forms and 
assessments. Recruitment procedures will be proposed to the managers of Wolfram Ltd. and 
finalized through consensus. We will propose that those who meet inclusion criteria be informed 
of the opportunity to receive a free medical screening and important information on staying 
healthy while working in the mining industry. Mine workers who accept to be a part of study, 
will avail him/herself two half days. Workers are in the mine in two possible shifts, typical shifts 
are from 6am-2pm (One site has a night shift from 4pm-early am). We plan to perform screening 
and education from 2-4pm at each site for workers who agree to participate so that all miners 
have access to the program. All relevant ethical information, including the risks and benefits of 
study participation will be provided to each prospective study subject in an informed consent 
document that will be made available in written and oral form in both Kinyarwanda and English. 
 
Data collection 
Questionnaire data will be collected by trained data collectors and supervised by faculty and 
other health professionals including Internal Medicine Doctors, and trained healthcare 
professionals. Data will be collected across two visits, two to four weeks apart. At the first visit, 
each mine worker and supervisor at mining site will privately undergo a guided oral and 
structured questionnaire on demographic, socio-economic, and KAP related to silicosis and 
mining data will be collected.  Each participant will be reassured and reminded that individual 
responses are confidential, inaccessible by the Wolfram Ltd. Company and will be anonymized 
prior to publication. Mine workers will also undergo an oral and structured questionnaire-based 
screening for silicosis symptoms. All subjects will then be assembled in small groups to receive 
targeted health education. At the second visit, mine workers and mining site supervisors will 

undergo structured interview for retention of health education by fulfilling a repeat KAP 
questionnaire, identical to the original. Data collected will include percentage of questions 
answered correctly, and will be further analyzed based on content areas. Mine workers who have 
worked in mining for at least one cumulative year will also undergo chest radiography and 
spirometry performed by trained clinical staff at Rwinkwavu District Hospital during their first 
visit with results interpreted by physician specialists. All questionnaire responses will be 
documented by data collectors and entered into a computerized database as the questionnaire is 
being performed. Data will be stored digitally on password-protected hard drives, tablets, and 
secure cloud servers. 
The published sensitivity and specificity of the silicosis screening questionnaire will be 
reassessed in this study population by comparing the questionnaire results to chest radiography 
and spirometry findings from each subject. 
Pilot Study 
Questionnaires and other study tools will be pre-tested in a pilot study conducted over the course 
of two days among 20 mine workers in Rwamagana District. We preferred to not use people 
under study area for avoiding any familiarity of tools before execution of the study which can be 
transmitted among miners which could tamper results. Feedback will be requested from these 
participants. Data collection and other tools will be adjusted and improved following the 
feedback and observations from the pilot study. In addition to sharpening the study methods, this 
pilot study will allow the study team to review pilot data to determine its accuracy and decide 
whether a retraining session will be necessary. 
 
Data management, interpretation and analysis 
All data of this study will be recorded and stored in REDCap before they will be exported into 
Stata v15.1 (Stata Corp, College Station, TX, USA) for analysis. Only the study team will have 
access to raw data and de-identified data will be kept in the analyzable dataset. We will use 
frequencies and percentages to summarize categorical data and median and interquartile ranges 
for continuous data. The pre-education KAP questionnaire responses will be compared to post-
education responses and analyzed for statistically significant changes in KAP. 
Institutionalized linkage to care and follow-up 
For two years subsequent to this study, all mine workers who participate in this study along with 
local mine workers who do not participate will be provided with annual follow-up visits at 
Rwinkwavu District Hospital and those who were screened positive for silicosis will be seen 
every six months (or at internal medicine physicians discretion) depending on disease severity as 
an establishment of surveillance program for miners and Rwinkwavu District Hospital. Further 
program institutionalization will occur at the discretion of the Rwinkwavu District Hospital 
Director General and the Ministry of Health. 
Expected Outcome 

We expect to have a robust understanding of the prevalence of silicosis among Rwandan mine 
workers along with an understanding of their KAP related to this disease. We expect to see the 
change of before and after an educational program on silicosis-related KAP. The long-term 
impact of this study will be to support the institutionalization of a permanent silicosis 
surveillance and prevention program at Rwinkwavu District Hospital.  This will be achieved by 
first establishing prevalence of silicosis among miners in Kayonza district, and enrollment of 
miners into a protocolized surveillance program to prevent disease progression and 
identify/prevent new cases. By further extension, this study is intended to bolster efforts to 
prevent silicosis through health education and policy change and identify and manage the disease 
at early stages through universal screening and prompt referral for further medical evaluation and 
care. Ultimately, impact of surveillance program will be measured by new incidence of silicosis 
in our study population against average case rates in the general population, as well as retention 
rates in surveillance protocols.  
Dissemination of Results and Publication 
We anticipate that the results of the study will be relevant to the larger medical, research, and 
mining community and will be of particular interest to those clinicians who are practicing in 
LMICs as well as areas with high prevalence of silicosis and other occupational 
pneumoconioses. We aim to publish this study in a peer-reviewed journal focused on 
occupational health, public health, global health or respiratory disease. Lead authors will be 
those who have contributed most significantly to the successful conceptualization and execution 
of the project.  
Implications for practice, public health and policy 
This study will help all stakeholders in mining-related policy formation, decision making, and 
interventions to eliminate silicosis among miners. These data will inform mining-related 
occupational health policies in Rwanda and elsewhere. These data will serve as a model for other 
health facilities and health systems to institutionalize silicosis education and surveillance. The 
information gleaned and delivered in this study will inform individual health care providers, 
hospitals and mining company employees and stakeholders regarding the nature of silicosis in 
Rwanda and mechanisms to prevent, identify, mitigate and ultimately eliminate the disease from 
this population.  
Duration 
Duration of project, including recruitment, deliver health education, screening, data collection, 
data analysis, and manuscript preparation, is expected to take 1 year. 
Phase one: January 2022 – September 2022: preparation time. Designing study tools, collecting 
study approvals, contacting stakeholders, and testing study tools.  
Phase two: October 2022-January 2023: implementation time. Training, collection, managing, 
analysis of data, and educating subjects on KAP.  
Phase three: February – July 2023: Dissemination phase.  

 
Anticipated Problems 
We anticipate potential conflicts of interest between the hospital and the mining company and 
potentially losing subjects to follow-up. Also, difficulty in obtaining desired clinical data. The 
study team will do our best to limit anticipated errors 
Ethical review and board approval  
Approval from IMB Research committee and ethical clearance from RNEC will be requested along 
with a formal authorizing letter will be presented to Rwinkwavu District Hospital, Partners in 
Health (PIH) leadership, and local and mining company leaders for obtaining approval. During the 
recruitment stage, it will be declared to each stakeholder and prospective participant that, beyond 
the direct benefits of free medical screening and education, no study subject will be compensated 
or receive any other benefits in return for participation. There will be no penalty for declining to 
participate and participants may withdraw from the study any time without penalty.  
Participants’ privacy and confidentiality will be considered by using both people initials/ IDs 
for research reason and names for clinical/ treatment purpose. Privacy at health mining site and 
hospital will be ensured by identifying the private room/ place before starting screening and data 
collection. This means that the PI will visit screening site and district hospital prior to screening 
and the data collection for prior place setting and ensure privacy for screening and interviewees. 
In order to ensure the confidentiality, the study team explained the interviewees that nobody will 
be shared the information; only study team will share for research purpose. There will be no 
risks to the participants in this study, this means the study doesn’t aim to harm the people and 
patients but to inform decision makers for preventing silicosis at early stage for risky people/ 
miners and improving health care. Also, the participants will be informed that there is no 
compensation/ direct benefit from participating in this study. The benefit of this study is to 
ensure effective silicosis prevention and improve quality of life for people tested silicosis 
positive.  The researchers will request participants’ consent to participate. Those who are able to 
read will be given consent form and read for themselves and those who weren’t able to read 
researcher or data collector read for them. Researcher/ data collector and people will sign 
consent form. Data collectors were trained on research ethics prior to data collection and also 
training will be conducted for allowing them being familiar to study tools and ensure ethic 
consideration. Data will be both collectors will be fourth year medical students who will collect 
data during screening and hired qualified study coordinator.  
See also attached for both English and Kinyarwanda versions of the consent form and 
questionnaire. 
Budget: detailed in below table  
# 
Item  
Frequency  Cost  
Times/ month  
Total  
1 
Research coordinator 
salary, half-time  
1           400,000  
12 
           
4,800,000  

2 
Research coordinator 
airtime 
1             15,000  
12 
              
180,000  
3 Focal people's airtime  
4             12,500  
12 
              
600,000  
4 Projects updates meeting 
1           250,000  
4 
           
1,000,000  
5 Travel fee 
1             30,000  
6 
              
180,000  
6 Printings  
1             25,000  
12 
              
300,000  
9 CXR-cost  
900               6,528  
1 
           
5,875,200  
10 Dissemination fee 
1 
  
4,000,000  
1 
           
4,000,000  
Total  
    16,935,200  
 
Collaborators  
Tentatively, recruitment will be limited to WOLFRAM-Miners leadership Rwinkwavu District 
Hospital, Partners In Health, and University of Rwanda, School of Medicine and pharmacy-
Department of primary health care staff. 
Investigators:  
 Project Management 
Anticipated team roles include but not limited to project overall management, team coordination, 
data collection, data management, data analysis, data interpretation, and dissemination of results.  
Project team: 
 
Peter Barebwanuwe, MPH 
 
Samuel Hatfield, MD  
 
Vincent K. Cubaka, MD 
 
Danny Mays, MD 
 
Jean Nepomuscene Renzaho, MPH  
 
Wellars Dusingizimana, MD 
 
Dr Egide Mpanumusingo, MD  
 
Symaque Dusabeyezu, MPH 
 
Alphonse Nshimyiryo 

 
Loise Mwihaki Ng'ang'a 
 
Richard Nduwayezu, MD  
 
Jean Claude Byiringiro, MD  
 
Esperence Uwayitu, MD 
 
Aime Ernest Niyonkuru, MD 
Krapivinsky, Evgeniya, MD 
Fredelick Kateera, MD 
Stella Savarimuthi, MD 
Paul Sonenthal, MD 
Akiiki Florence Bitalabeho, MD 
Mr. Tharcisse Basigayabo 
Mr. Adrien Habineza  
Mr. Innocent Kamali  
Mr. Aphrodis Ndayisaba