Rwanda Biomedical Center, Kigali, Rwanda.
University of Global Health Equity, Kigali, Rwanda.
BMC Pediatr. 2024 Feb 28;23(Suppl 1):649. doi: 10.1186/s12887-023-03888-4.
Over the last eight decades, many evidence-based interventions (EBIs) have been developed to reduce amenable under-5 mortality (U5M). Implementation research can help reduce the lag between discovery and delivery, including as new EBIs emerge, or as existing ones are adapted based on new research. Rwanda was the first low-income African country to implement the rotavirus vaccine (RTV) and also adopted Option B+ for effective prevention of mother-to-child transmission (PMTCT) before the World Health Organization's (WHO) recommendation. We use implementation research to identify contextual factors and strategies associated with Rwanda's rapid uptake of these two EBIs developed or adapted during the study period.
We conducted a mixed methods case study informed by a hybrid implementation research framework to understand how Rwanda outperformed regional and economic peers in reducing U5M, focusing on the implementation of health system-delivered EBIs. The research included review of existing literature and data, and key informant interviews to identify implementation strategies and contextual factors that influenced implementation outcomes. We extracted relevant results from the broader case study and used convergent methods to understand successes and challenges of implementation of RTV, a newly introduced EBI, and PMTCT, an adapted EBI reflecting new research.
We found several cross-cutting strategies that supported the rapid uptake and implementation of PMTCT, RTV, and leveraging facilitating contextual factors and identifying and addressing challenging ones. Key implementation strategies included community and stakeholder involvement and education, leveraging of in-country research capacity to drive adoption and adaptation, coordination of donors and implementing partners, data audit and feedback of coverage, a focus on equity, and integration into pre-existing systems, including community health workers and primary care. The availability of donor funding, culture of evidence-based decision-making, preexisting accountability systems, and rapid adoption of innovation were facilitating contextual factors.
Implementation strategies which are generalizable to other settings were key to success in rapidly achieving high acceptability and coverage of both a new and an evolving EBI. Choosing strategies which leverage their facilitating factors and address barriers are important for other countries working to accelerate uptake of new EBIs and implement needed adaptations based on emerging evidence.
在过去的八十年中，已经开发了许多基于证据的干预措施（EBIs）来降低可避免的 5 岁以下儿童死亡率（U5M）。实施研究可以帮助减少从发现到实施之间的滞后，包括在出现新的 EBI 时，或根据新的研究对现有 EBI 进行调整时。卢旺达是第一个实施轮状病毒疫苗（RTV）的低收入非洲国家，并且在世界卫生组织（WHO）建议之前，采用了选项 B+来有效预防母婴传播（PMTCT）。我们利用实施研究来确定与卢旺达在研究期间迅速采用这两种 EBI 相关的背景因素和策略。
我们进行了一项混合方法案例研究，该研究以混合实施研究框架为指导，以了解卢旺达如何在降低 U5M 方面超过区域和经济同行，重点是实施卫生系统提供的 EBI。研究包括审查现有文献和数据，以及进行关键知情人访谈，以确定影响实施结果的实施策略和背景因素。我们从更广泛的案例研究中提取了相关结果，并使用收敛方法来了解新引入的 EBI——RTV 和反映新研究的适应性 EBI——PMTCT 的实施成功和挑战。
我们发现了一些交叉策略，这些策略支持了 PMTCT、RTV 的快速采用和实施，以及利用有利的背景因素，并确定和解决具有挑战性的因素。关键的实施策略包括社区和利益相关者的参与和教育，利用国内研究能力来推动采用和适应，协调捐助者和实施伙伴，对覆盖率进行数据审核和反馈，关注公平性，并将其纳入现有的系统，包括社区卫生工作者和初级保健。可用的捐助资金、基于证据的决策文化、现有的问责制度以及快速采用创新是有利的背景因素。
可推广到其他环境的实施策略是迅速实现新的和不断发展的 EBI 高度可接受性和覆盖率的关键。选择利用其有利因素并解决障碍的策略对于其他国家加快采用新的 EBI 并根据新出现的证据实施必要的调整非常重要。
