{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T07:34:26Z","timestamp":1781336066206,"version":"3.54.1"},"reference-count":46,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2021,8,30]],"date-time":"2021-08-30T00:00:00Z","timestamp":1630281600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,1,13]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Implementing context-appropriate neonatal and paediatric advanced life support management interventions has increasingly been recommended as one of the approaches to reduce under-five mortality in resource-constrained settings like Rwanda. One such intervention is ETAT+, which stands for Emergency Triage, Assessment and Treatment plus Admission care for severely ill newborns and children. In 2013, ETAT+ was implemented in Rwandan district hospitals. We evaluated the impact of the ETAT+ intervention on newborn and child health outcomes. We used monthly time-series data from the DHIS2-enabled Rwanda Health Management Information System from 2012 to 2016 to examine neonatal and paediatric hospital mortality rates. Each hospital contributed data for 12 and 36\u2009months before and after ETAT+ implementation, respectively. Using controlled interrupted time-series analysis and segmented regression model, we estimated longitudinal changes in neonatal and paediatric hospital mortality rates in intervention hospitals relative to matched concurrent control hospitals. We also studied changes in case fatality rate specifically for ETAT+-targeted conditions. Our study cohort consisted of 7 intervention hospitals and 14 matched control hospitals contributing 142 424 neonatal and paediatric hospital admissions. After controlling for secular trends and autocorrelations, we found that the ETAT+ implementation had no statistically significant impact on the rate of all-cause neonatal and paediatric hospital mortality in intervention hospitals relative to control hospitals. However, the case fatality rate for ETAT+-targeted neonatal conditions decreased immediately following implementation by 5% (95% confidence interval: \u22129.25, \u22120.77) and over time by 0.8% monthly (95% confidence interval: \u22121.36, \u22120.25) in intervention hospitals compared with control hospitals. Case fatality rate for ETAT+-targeted paediatric conditions did not decrease following the ETAT+ implementation. While ETAT+ focuses on improving the quality of hospital care for both newborns and children, we only found an impact on neonatal hospital mortality for ETAT+-targeted conditions that should be interpreted with caution given the relatively short pre-intervention period and potential regression to the mean.<\/jats:p>","DOI":"10.1093\/heapol\/czab109","type":"journal-article","created":{"date-parts":[[2021,8,30]],"date-time":"2021-08-30T13:21:45Z","timestamp":1630329705000},"page":"12-21","source":"Crossref","is-referenced-by-count":5,"title":["Impact of a multifaceted intervention to improve emergency care on newborn and child health outcomes in Rwanda"],"prefix":"10.1093","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7808-4652","authenticated-orcid":false,"given":"Celestin","family":"Hategeka","sequence":"first","affiliation":[{"name":"Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 655 Huntington Ave, Boston, MA 02115, USA"},{"name":"Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Larry D","family":"Lynd","sequence":"additional","affiliation":[{"name":"Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada"},{"name":"Centre for Health Evaluation and Outcome Sciences, Providence Health Research Institute, 588-1081 Burrard Street, Vancouver, BC V6Z IY6, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia","family":"Kenyon","sequence":"additional","affiliation":[{"name":"Division of Neonatal-Perinatal Medicine, Children\u2019s Hospital at London Health Sciences Centre, 800 Commissioners Rd E, London, ON N6A 5W9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisine","family":"Tuyisenge","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University Teaching Hospital of Kigali, KN 4 Ave, Kigali, Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael R","family":"Law","sequence":"additional","affiliation":[{"name":"Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,8,30]]},"reference":[{"key":"2022031617210974900_R1","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.worlddev.2016.11.013","article-title":"Learning from success: how Rwanda achieved the millennium development goals for 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