University of Global Health Equity, Kigali, Rwanda.
Maternal, Child, and Community Health Division, Rwanda Biomedical Center, Kigali, Rwanda.
Ann Glob Health. 2024 Jul 23;90(1):47. doi: 10.5334/aogh.4348. eCollection 2024.
The COVID-19 pandemic resulted in drops in access to and availability of a number of evidence-based interventions (EBIs) known to reduce under-5 mortality (U5M) across a wide range of countries, including Rwanda. We aimed to understand the strategies and contextual factors associated with preventing or mitigating drops nationally and subnationally, and the extent to which previous efforts to reduce U5M supported the maintenance of healthcare delivery. We used a convergent mixed methods implementation science approach, guided by hybrid implementation research and resiliency frameworks. We triangulated data from three sources: desk review of available documents, existing routine data from the health management information system, and key informant interviews (KIIs). We analyzed quantitative data through scatter plots using interrupted time series analysis to describe changes in EBI access, uptake, and delivery. We used a Poisson regression model to estimate the impact of COVID-19 on health management information system indicators, adjusting for seasonality. We used thematic analysis of coded interviews to identify emerging patterns and themes. We found moderate 4% (IRR = 0.96; 95%CI: 0.93, 1.00) and 5% (IRR = 0.95; 95%CI: 0.92, 0.99) drops in pentavalent and rotavirus 2 doses vaccines administered, respectively. Nationally, there was a 5% drop in facility-based delivery (IRR = 0.95; 95%CI: 0.92, 0.99). Lockdown and movement restrictions and community and health-worker fear of COVID-19 were barriers to service delivery early in the pandemic. Key implementation strategies to prevent or respond to EBI drops included leveraging community-based healthcare delivery, data use for decision-making, mentorship and supervision, and use of digital platform. While Rwanda had drops in some EBIs early in the pandemic, especially during the initial lockdown, this was rapidly identified, and response implemented. The resiliency of the health system was associated with the Rwandan health system's ability to learn and adapt, encouraging a flexible response to fit the situation.
新冠疫情导致许多已知能够降低 5 岁以下儿童死亡率（U5M）的循证干预措施（EBIs）在包括卢旺达在内的许多国家的获取和提供都出现了下降。我们旨在了解国家和次国家一级预防或减轻这些下降的策略和背景因素，以及过去减少 U5M 的努力在多大程度上支持了医疗保健的提供。我们使用了一种收敛性混合方法实施科学方法，该方法由混合实施研究和弹性框架指导。我们从三个来源综合了数据：对现有文件的案头审查、来自健康管理信息系统的现有常规数据以及关键知情者访谈（KII）。我们通过使用中断时间序列分析的散点图分析来描述 EBIs 的获取、采用和提供的变化，以分析定量数据。我们使用泊松回归模型来估计 COVID-19 对健康管理信息系统指标的影响，同时调整季节性因素。我们使用主题分析对编码访谈进行分析，以确定新兴模式和主题。我们发现，五联疫苗和轮状病毒 2 型疫苗的接种量分别适度下降了 4%（IRR=0.96；95%CI：0.93，1.00）和 5%（IRR=0.95；95%CI：0.92，0.99）。全国范围内，基于设施的分娩量下降了 5%（IRR=0.95；95%CI：0.92，0.99）。疫情早期，封锁和行动限制以及社区和卫生工作者对 COVID-19 的恐惧是服务提供的障碍。预防或应对 EBIs 下降的关键实施策略包括利用基于社区的医疗保健提供、数据用于决策、指导和监督以及使用数字平台。尽管卢旺达在疫情早期的一些 EBIs 中出现了下降，尤其是在最初的封锁期间，但这很快得到了识别，并实施了应对措施。卫生系统的弹性与卢旺达卫生系统的学习和适应能力有关，这鼓励了灵活的应对措施以适应情况。
