Amberbir Alemayehu, Cyuzuzo Callixte, Boah Michael, Uwinkindi Francois, Kalinda Chester, Yohannes Tsion, Isano Sandra, Ojiambo Robert, Greig Carolyn A, Davies Justine, Hirschhorn Lisa R
Center for Population Health, University of Global Health Equity, Kigali, Rwanda.
Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda.
BMJ Open. 2025 Mar 17;15(3):e089344. doi: 10.1136/bmjopen-2024-089344.
Ageing is often accompanied by chronic diseases, multimorbidity and frailty, increasing the need for clinical and social care to support healthy ageing and manage these conditions. We are currently in the UN Decade of Ageing, and there is a growing focus on the need to prevent or delay some of these conditions through the 'Healthy Ageing' initiative of the WHO. However, there are limited data available to inform prioritisation of interventions, particularly for countries in sub-Saharan Africa.
This study will use a mixed-methods, stepwise approach to identify the current needs for older people in Rwanda, health system capacity and possible solutions to unmet need. First, we will conduct a household survey in the City of Kigali (predominantly urban) and Northern Province Burera district (predominantly rural) to determine the burden of multimorbidity, frailty, access to care, and experiences and responsiveness of care in older people. This work will be supplemented by secondary analysis of data from the Rwandan STEPwise approach to non-communicable disease risk factor surveillance (STEPs) survey of 2021. Second, we will conduct a health facility readiness assessment and healthcare provider survey to assess health system capacity and gaps to deliver effective primary care to older people in Rwanda. Third, to capture the voices of older people, we will explore the quality of healthcare as experienced by them using in-depth interviews. Fourth, we will synthesise data using mixed methods to understand barriers to access to quality of care among people of older ages based on a Three Delays framework (seeking, reaching and receiving quality healthcare). Finally, the project will culminate in a stakeholder workshop to ensure results are contextually appropriate and disseminated, and gaps identified are prioritised to design novel interventions to promote healthy ageing in Rwanda and the region.
The study has received ethics approval from the Rwanda National Ethics Committee, Northwestern University, USA, and the University of Birmingham, UK. This study will deliver impactful research by using multiple methodologies and working with in-country partners to develop a deep knowledge and understanding of healthcare systems experienced by older people in Rwanda. It will also provide a framework for sustainable healthy ageing research and policy engagement to benefit older adults living in Rwanda and inform similar work in low- and middle-income countries during this Decade of Healthy Ageing and beyond.
衰老往往伴随着慢性病、多种疾病并存和身体虚弱，这增加了对临床和社会护理的需求，以支持健康老龄化并管理这些状况。我们目前处于联合国老龄问题十年，并且越来越关注通过世界卫生组织的“健康老龄化”倡议来预防或延缓其中一些状况的必要性。然而，可用于为干预措施确定优先次序的数据有限，特别是对于撒哈拉以南非洲国家而言。
本研究将采用混合方法、逐步推进的方式，以确定卢旺达老年人的当前需求、卫生系统能力以及满足未满足需求的可能解决方案。首先，我们将在基加利市（主要为城市地区）和北部省布雷拉区（主要为农村地区）进行家庭调查，以确定老年人多种疾病并存、身体虚弱的负担、获得护理的情况以及护理体验和护理反应能力。这项工作将通过对2021年卢旺达非传染性疾病风险因素监测（STEP）调查数据的二次分析来补充。其次，我们将进行卫生设施准备情况评估和医疗服务提供者调查，以评估卢旺达为老年人提供有效初级护理的卫生系统能力和差距。第三，为了了解老年人的声音，我们将通过深入访谈来探究他们所体验到的医疗保健质量。第四，我们将使用混合方法综合数据，基于“三个延误”框架（寻求、到达和接受高质量医疗保健）来了解老年人获得优质护理的障碍。最后，该项目将以一次利益相关者研讨会告终，以确保研究结果符合实际情况并得到传播，并对已确定的差距进行优先排序，以设计新的干预措施，促进卢旺达及该地区的健康老龄化。
该研究已获得卢旺达国家伦理委员会、美国西北大学和英国伯明翰大学的伦理批准。本研究将通过使用多种方法并与国内合作伙伴合作，深入了解卢旺达老年人所经历的医疗保健系统，从而开展有影响力的研究。它还将为可持续的健康老龄化研究和政策参与提供一个框架，以造福生活在卢旺达的老年人，并为“健康老龄化十年”及以后的低收入和中等收入国家的类似工作提供参考。
