The evidence from the literature review and qualitative interviews on each evidence-based intervention are shown in the table below against the implementation science framework used for the research.
| REDUCTION IN UNDER-5 MORTALITY RATE (U5MR) FROM THIS CAUSE OF DEATH, 2000 - 2015 | EVIDENCE-BASED INTERVENTION | ACCEPTABILITY | FEASIBILITY | FIDELITY | EFFECTIVENESS/REACH |
|---|---|---|---|---|---|
Malaria 88% decline in U5MR | ITNs | N/A | Over 3 million ITNs distributed during 2006-2007 and 6.1 million distributed during 2008-2009. | ITN utilization is approximately 10% less than ITN possession (KI). | Percent of children under-5 sleeping under ITNs increased to 68% by 2015. |
IRS | General acceptability came about after seeing the lack of mosquitoes following the first round of spraying. | In the districts chosen, 87-99% of targeted buildings are sprayed. | N/A | Seven districts covered by IRS represent 70% of the malaria burden for the country. | |
Lower Respiratory Infections 76% decline in U5MR | PCV | The communities generally accepted the benefits of the vaccination because “[Rwanda’s] population trusts very much their government and what they are doing and that [the MOH’s] main interest is our beneficiaries” (KI). | No stockouts occurred during the vaccine rollout. | The roll out was completed as planned within 5 months. | After introduction, PCV coverage quickly increased up to 97% by 2010 with a concurrent reduction in child hospitalization due to pneumonia of 53% between the periods of 2007-2009 (prior to introduction of PCV7) and 2010-2013 (after introduction of PCV7). |
Diarrheal Diseases 86% decline in U5MR | Rota Vx | High coverage rates reflecting community acceptance “it was very easy to administer the vaccine because mothers were not afraid of it.” | Rotavirus vaccine was delivered nationally. | Three doses of rotavirus vaccine are being given at 6, 10 and 14 weeks as recommended with the rollout completed as planned (partner engagement and coordination, community sensitization, integrated strengthening of supply and M and E systems). | Rotavirus vaccination in children under 1-year of age increased from 50% in 2012 and to 99% in 2013. Hospital admissions for diarrhea in children under-5 fell by 49% between 2011 and 2013. |
HIV 93% decline in U5MR | PMTCT | N/A | Increased ANC services available led to increased availability of PMTCT (KI). The number of health facilities offering PMTCT increased from 53 in 2003 to 382 in 2010. | N/A | 98% of women coming in for antenatal care are tested for HIV and 99% of HIV-positive pregnant women receive ART to reduce MTCT (KI). MTCT rates have dropped from 9.7% in 2006 to 2.4% in 2010 and 1.8% in 2015. Adoption of improved treatments often prior to international recommendations by WHO and other bodies - most notably, Option B+. In 2015, 92.2% of pregnant women received HIV testing during ANC, and less than 1% were HIV-positive. All Heath Centers by 2009 offered ART including PMTCT. |
ART | Turnaround time from collection of sample to receipt of results by the provider decreased from 144 days to 20 days. | Health facilities offering ART increased from 4 in 2002 to 465 in 2013. EID for infants born to HIV-positive mothers in 2011 was 72-94% In 2013, 60% of HIV-positive children ages 0-14 years were receiving ART | |||
Measles 97% decline in U5MR | Measles vaccination | Coverage with the MR vaccine estimated at 95% in 2015. | Regular response to new needs and cases possible through leveraging of existing platforms. | N/A | Measles vaccine coverage was maintained above 80% from 2003 to 2009. In 2010, there was a vaccine coverage rate of 95% and 121 identified cases of measles nationwide. No extended outbreaks identified despite influx of new unvaccinated populations. |
Nutritional deficiencies 81% decline in U5MR | Severe acute malnutrition identification and monitoring | 82% of children under-5 were screened for malnutrition in 2014. Wasting (low weight-for-height and therefore a marker for acute malnutrition) decreased from 6.8% of children under-5 in 2000, to 5% in 2005, 3% in 2010, and 2% in 2015. Note that similar success was not seen in markers of more chronic malnutrition including stunting. | |||
Neonatal disorders 51% decline in U5MR | Neonatal interventions | Partographs, while available were not widely used completely. Only 7% of women getting active management of the third stage of labor (AMSTL) received all components. | Rates of C-section increased from 2.1% of deliveries in 2000, to 2.9% in 2005, 7.1% in 2010 and 13.0% in 2015.23 Women having a post-partum checkup within the first 2 days following delivery increased from 2.9% in 2000 to 43% in 2015. |