{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,13]],"date-time":"2026-11-13T08:10:29Z","timestamp":1794557429381,"version":"4.9.1"},"reference-count":42,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,4,9]],"date-time":"2025-04-09T00:00:00Z","timestamp":1744156800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2025,4,9]],"date-time":"2025-04-09T00:00:00Z","timestamp":1744156800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arch Public Health"],"DOI":"10.1186\/s13690-025-01583-7","type":"journal-article","created":{"date-parts":[[2025,4,9]],"date-time":"2025-04-09T03:35:38Z","timestamp":1744169738000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Child immunization data quality in Rwanda: an assessment of routine health information system data"],"prefix":"10.1186","volume":"83","author":[{"given":"Thaoussi","family":"Uwera","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Frederik","family":"Fr\u00f8en","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleni","family":"Papadopoulou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enock","family":"Rukundo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hassan","family":"Sibomana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Muhire","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David K.","family":"Tumusiime","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahima","family":"Venkateswaran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,4,9]]},"reference":[{"key":"1583_CR1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12913-021-06652-5","volume":"21","author":"A Siyam","year":"2021","unstructured":"Siyam A, Ir P, York D, Antwi J, Amponsah F, Rambique O, et al. The burden of recording and reporting health data in primary health care facilities in five low- and lower-middle income countries. BMC Health Serv Res. 2021;21:1\u20139. https:\/\/doi.org\/10.1186\/s12913-021-06652-5.","journal-title":"BMC Health Serv Res"},{"key":"1583_CR2","doi-asserted-by":"publisher","DOI":"10.4103\/njcp.njcp","author":"DC Ogbuabor","year":"2019","unstructured":"Ogbuabor DC, Ghasi N, Okenwa UJ, Chukwunweike N, Nwangwu U, Ezenwaka OO. South-East Nigeria: A Cross-Sectional Study. Niger J Clin Pract. 2019;22:1070\u20137. https:\/\/doi.org\/10.4103\/njcp.njcp. Assessing the Quality of Immunization Data from Administrative Data in Enugu State,."},{"key":"1583_CR3","doi-asserted-by":"publisher","unstructured":"Peng RCY, Rose Khavari ND, Dominique C, Hinshaw1 LA. Shevde1 2. Current challenges and future possibilities for immunization information systems. Physiol Behav. 2017;176:139\u201348. https:\/\/doi.org\/10.1016\/j.acap.2020.11.008.Current.","DOI":"10.1016\/j.acap.2020.11.008.Current"},{"key":"1583_CR4","doi-asserted-by":"publisher","first-page":"e0000140","DOI":"10.1371\/journal.pgph.0000140","volume":"2","author":"C Rau","year":"2022","unstructured":"Rau C, L\u00fcdecke D, Dumolard LB, Grevendonk J, Wiernik BM, Kobbe R, et al. Data quality of reported child immunization coverage in 194 countries between 2000 and 2019. PLOS Glob Public Heal. 2022;2:e0000140. https:\/\/doi.org\/10.1371\/journal.pgph.0000140.","journal-title":"PLOS Glob Public Heal"},{"key":"1583_CR5","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12913-022-08449-6","volume":"22","author":"OU Lasim","year":"2022","unstructured":"Lasim OU, Ansah EW, Apaak D. Maternal and child health data quality in health care facilities at the cape Coast Metropolis, Ghana. BMC Health Serv Res. 2022;22:1\u201315. https:\/\/doi.org\/10.1186\/s12913-022-08449-6.","journal-title":"BMC Health Serv Res"},{"key":"1583_CR6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12889-019-6709-1","volume":"19","author":"P Bloland","year":"2019","unstructured":"Bloland P, MacNeil A. Defining & assessing the quality, usability, and utilization of immunization data. BMC Public Health. 2019;19:1\u20138. https:\/\/doi.org\/10.1186\/s12889-019-6709-1.","journal-title":"BMC Public Health"},{"key":"1583_CR7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.infoandorg.2018.12.002","volume":"29","author":"M Gebre-Mariam","year":"2019","unstructured":"Gebre-Mariam M, Bygstad B. Digitalization mechanisms of health management information systems in developing countries. Inf Organ. 2019;29:1\u201322. https:\/\/doi.org\/10.1016\/j.infoandorg.2018.12.002.","journal-title":"Inf Organ"},{"key":"1583_CR8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1371\/journal.pone.0211265","volume":"14","author":"AA Bhattacharya","year":"2019","unstructured":"Bhattacharya AA, Umar N, Audu A, Allen E, Schellenberg JRM, Marchant T. Quality of routine facility data for monitoring priority maternal and newborn indicators in DHIS2: A case study from Gombe State, Nigeria. PLoS ONE. 2019;14:1\u201321. https:\/\/doi.org\/10.1371\/journal.pone.0211265.","journal-title":"PLoS ONE"},{"key":"1583_CR9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12913-022-08598-8","volume":"22","author":"E Byrne","year":"2022","unstructured":"Byrne E, S\u00e6b\u00f8 JI. Routine use of DHIS2 data: a scoping review. BMC Health Serv Res. 2022;22:1\u201316. https:\/\/doi.org\/10.1186\/s12913-022-08598-8.","journal-title":"BMC Health Serv Res"},{"key":"1583_CR10","unstructured":"DHIS2 team. District Health Information System. District Health Information System (Version 2) Overview n.d. https:\/\/dhis2.org\/overview\/ (accessed March 5, 2024)."},{"key":"1583_CR11","doi-asserted-by":"publisher","first-page":"1463","DOI":"10.1109\/TBDATA.2021.3103458","volume":"8","author":"Z Fei","year":"2022","unstructured":"Fei Z, Ryeznik Y, Sverdlov O, Tan CW, Wong WK. An overview of healthcare data analytics with applications to the COVID-19 pandemic. IEEE Trans Big Data. 2022;8:1463\u201380. https:\/\/doi.org\/10.1109\/TBDATA.2021.3103458.","journal-title":"IEEE Trans Big Data"},{"key":"1583_CR12","doi-asserted-by":"crossref","unstructured":"Scott C, Clarke KEN, Grevendonk J, Dolan SB, Hussein;, Ahmed O, Morbidity and Mortality Weekly Report Country Immunization Information System Assessments-Kenya, 2015 and, Ghana et al. 2016 2015;66:2015\u20138. https:\/\/doi.org\/https:\/\/www.cdc.gov\/mmwr\/volumes\/66\/wr\/mm6644a5.htm","DOI":"10.15585\/mmwr.mm6644a5"},{"key":"1583_CR13","doi-asserted-by":"publisher","unstructured":"Syed R, Eden R, Makasi T, Chukwudi I, Mamudu A, Kamalpour M, et al. Digital health data quality issues: systematic review. J Med Internet Res. 2023;25. https:\/\/doi.org\/10.2196\/42615.","DOI":"10.2196\/42615"},{"key":"1583_CR14","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12913-023-10205-3","volume":"23","author":"HF Demirci","year":"2023","unstructured":"Demirci HF, Yardan ED. Data management in the digital health environment scale development study*. BMC Health Serv Res. 2023;23:1\u201317. https:\/\/doi.org\/10.1186\/s12913-023-10205-3.","journal-title":"BMC Health Serv Res"},{"key":"1583_CR15","doi-asserted-by":"publisher","unstructured":"Pascual-Ferr\u00e1 P, Alperstein N, Burleson J, Jamison AM, Bhaktaram A, Rath S, et al. Assessing message deployment during public health emergencies through social media: empirical test of optimizing content for effective dissemination. J Med Internet Res. 2024;26. https:\/\/doi.org\/10.2196\/50871.","DOI":"10.2196\/50871"},{"key":"1583_CR16","unstructured":"Mastercard Center for Inclusive Growth, Munk School of Global Affairs and Public Policy. Near-universal Child Vaccination Rates Rwanda 2019:1\u201325. https:\/\/doi.org\/https:\/\/reachalliance.org\/wp-content\/uploads\/2017\/03\/ReachProject-Rwanda3.pdf"},{"key":"1583_CR17","unstructured":"DHIS2 team. Improving National Immunization Program Impact with DHIS2. Impact stories: Countries using DHIS2 for immunization n.d. https:\/\/dhis2.org\/immunization\/ (accessed March 5, 2024)."},{"key":"1583_CR18","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1371\/journal.pone.0235823","volume":"15","author":"A Nshimyiryo","year":"2020","unstructured":"Nshimyiryo A, Kirk CM, Sauer SM, Ntawuyirusha E, Muhire A, Sayinzoga F, et al. Health management information system (HMIS) data verification: A case study in four districts in Rwanda. PLoS ONE. 2020;15:1\u201314. https:\/\/doi.org\/10.1371\/journal.pone.0235823.","journal-title":"PLoS ONE"},{"key":"1583_CR19","unstructured":"GAVI. Joint appraisal report 2019. 2019. https:\/\/www.gavi.org\/sites\/default\/files\/document\/2020\/Rwanda Joint Appraisal 2019.pdf."},{"key":"1583_CR20","unstructured":"CityPopulation.de. RWANDA: Administrative Division,Provinces and Districts n.d. https:\/\/www.citypopulation.de\/en\/rwanda\/admin\/ (accessed April 1, 2024)."},{"key":"1583_CR21","unstructured":"WHO (World Health Organization). Data quality review Module 3: Data verification and system assessment. n.d. https:\/\/doi.org\/https:\/\/iris.who.int\/bitstream\/handle\/10665\/259226\/9789241512749-eng.pdf?sequence=1%26;isAllowed=y"},{"key":"1583_CR22","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1136\/bmjgh-2019-001849","volume":"4","author":"A Ma\u00efga","year":"2019","unstructured":"Ma\u00efga A, Jiwani SS, Mutua MK, Porth TA, Taylor CM, Asiki G, et al. Generating statistics from health facility data: the state of routine health information systems in Eastern and Southern Africa. BMJ Glob Heal. 2019;4:1\u20139. https:\/\/doi.org\/10.1136\/bmjgh-2019-001849.","journal-title":"BMJ Glob Heal"},{"key":"1583_CR23","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12961-021-00694-1","volume":"19","author":"B Tilahun","year":"2021","unstructured":"Tilahun B, Teklu A, Mancuso A, Endehabtu BF, Gashu KD, Mekonnen ZA. Using health data for decision-making at each level of the health system to achieve universal health coverage in Ethiopia: the case of an immunization programme in a low-resource setting. Heal Res Policy Syst. 2021;19:1\u20138. https:\/\/doi.org\/10.1186\/s12961-021-00694-1.","journal-title":"Heal Res Policy Syst"},{"key":"1583_CR24","doi-asserted-by":"publisher","first-page":"470","DOI":"10.1197\/jamia.M1290.j","volume":"10","author":"Minist\u00e9rio da Sa\u00fade (Brasil)","year":"2003","unstructured":"Minist\u00e9rio da Sa\u00fade (Brasil). Instituto Nacional de c\u00e2ncer Jos\u00e9 de Alencar gomes Da Silva (INCA). Comparing Paper-based with electronic patient records: lessons learned during a study on diagnosis and procedure codes. J Am Med Inf Assoc. 2003;10:470\u20137. https:\/\/doi.org\/10.1197\/jamia.M1290.j.","journal-title":"J Am Med Inf Assoc"},{"key":"1583_CR25","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12884-016-0801-7","volume":"16","author":"JF Fr\u00f8en","year":"2016","unstructured":"Fr\u00f8en JF, Myhre SL, Frost MJ, Chou D, Mehl G, Say L, et al. eRegistries: electronic registries for maternal and child health. BMC Pregnancy Childbirth. 2016;16:1\u201315. https:\/\/doi.org\/10.1186\/s12884-016-0801-7.","journal-title":"BMC Pregnancy Childbirth"},{"key":"1583_CR26","doi-asserted-by":"publisher","first-page":"1","DOI":"10.11604\/pamj.2018.30.81.11951","volume":"30","author":"A Namageyo-Funa","year":"2018","unstructured":"Namageyo-Funa A, Samuel A, Bloland P, Macneil A. Considerations for the development and implementation of electronic immunization registries in Africa. Pan Afr Med J. 2018;30:1\u20136. https:\/\/doi.org\/10.11604\/pamj.2018.30.81.11951.","journal-title":"Pan Afr Med J"},{"key":"1583_CR27","doi-asserted-by":"publisher","first-page":"S30","DOI":"10.12968\/bjon.2015.24.Sup6.S30","volume":"24","author":"A Tubaishat","year":"2015","unstructured":"Tubaishat A, Tawalbeh LI, Azzam M, Al, Albashtawy M, Batiha AM. Electronic versus paper records: Documentation of pressure ulcer data. Br J Nurs. 2015;24:S30\u20137. https:\/\/doi.org\/10.12968\/bjon.2015.24.Sup6.S30.","journal-title":"Br J Nurs"},{"key":"1583_CR28","doi-asserted-by":"publisher","unstructured":"Wurster F, F\u00fctterer G, Beckmann M, Dittmer K, Jaschke J, K\u00f6berlein-Neu J, et al. The analyzation of change in Documentation due to the introduction of electronic patient records in Hospitals\u2014A systematic review. J Med Syst. 2022;46. https:\/\/doi.org\/10.1007\/s10916-022-01840-0.","DOI":"10.1007\/s10916-022-01840-0"},{"key":"1583_CR29","doi-asserted-by":"publisher","first-page":"4652","DOI":"10.1016\/j.vaccine.2020.02.091","volume":"38","author":"K Harrison","year":"2020","unstructured":"Harrison K, Rahimi N, Carolina Danovaro-Holliday M. Factors limiting data quality in the expanded programme on immunization in low and middle-income countries: A scoping review. Vaccine. 2020;38:4652\u201363. https:\/\/doi.org\/10.1016\/j.vaccine.2020.02.091.","journal-title":"Vaccine"},{"key":"1583_CR30","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-019-4188-9","author":"M Karami","year":"2019","unstructured":"Karami M, Khazaei S, Babaei A, Yaghini FA, Gouya MM, Zahraei SM. BMC Health Serv Res. 2019;19:1\u20139. https:\/\/doi.org\/10.1186\/s12913-019-4188-9. Accuracy and quality of immunization data in Iran: Findings from data quality self-assessment survey in 2017."},{"key":"1583_CR31","doi-asserted-by":"publisher","unstructured":"Hu Y, Zhang X, Li Q, Chen Y. Auditing the immunization data quality from routine reports in Shangyu district,east China. Int J Environ Res Public Health. 2016;13. https:\/\/doi.org\/10.3390\/ijerph13111158.","DOI":"10.3390\/ijerph13111158"},{"key":"1583_CR32","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12913-020-05865-4","volume":"20","author":"SA Ziema","year":"2020","unstructured":"Ziema SA, Asem L. Assessment of immunization data quality of routine reports in Ho municipality of Volta region, Ghana. BMC Health Serv Res. 2020;20:1\u20137. https:\/\/doi.org\/10.1186\/s12913-020-05865-4.","journal-title":"BMC Health Serv Res"},{"key":"1583_CR33","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1471-2458-5-108","volume":"5","author":"JC Mavimbe","year":"2005","unstructured":"Mavimbe JC, Braa J, Bjune G. Assessing immunization data quality from routine reports in Mozambique. BMC Public Health. 2005;5:1\u20138. https:\/\/doi.org\/10.1186\/1471-2458-5-108.","journal-title":"BMC Public Health"},{"key":"1583_CR34","doi-asserted-by":"publisher","first-page":"488","DOI":"10.9745\/GHSP-D-20-00134","volume":"8","author":"E Carnahan","year":"2020","unstructured":"Carnahan E, Ferriss E, Beylerian E, DienMwansa F, Bulula N, Lyimo D, et al. Determinants of facility-level use of electronic immunization registries in Tanzania and Zambia: an observational analysis. Glob Heal Sci Pract. 2020;8:488\u2013504. https:\/\/doi.org\/10.9745\/GHSP-D-20-00134.","journal-title":"Glob Heal Sci Pract"},{"key":"1583_CR35","doi-asserted-by":"publisher","first-page":"1","DOI":"10.2196\/53071","volume":"11","author":"T Uwera","year":"2024","unstructured":"Uwera T, Venkateswaran M, Bhutada K, Papadopoulou E, Rukundo E, Tumusiime DK, et al. Electronic immunization registry in Rwanda: qualitative study of health worker experiences. JMIR Hum Factors. 2024;11:1\u201313. https:\/\/doi.org\/10.2196\/53071.","journal-title":"JMIR Hum Factors"},{"key":"1583_CR36","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2020.07.074","author":"A Sowe","year":"2020","unstructured":"Sowe A, Gariboldi MI. Gambia Vaccine. 2020;38:6618\u201326. https:\/\/doi.org\/10.1016\/j.vaccine.2020.07.074. An assessment of the quality of vaccination data produced through smart paper technology in The."},{"key":"1583_CR37","doi-asserted-by":"publisher","first-page":"e12263","DOI":"10.1002\/ISD2.12263","volume":"89","author":"ET Lwoga","year":"2023","unstructured":"Lwoga ET, Musheiguza E. The quality of health data before and after the implementation of the electronic health management information system for the fistula program in Tanzania. Electron J Inf Syst Dev Ctries. 2023;89:e12263. https:\/\/doi.org\/10.1002\/ISD2.12263.","journal-title":"Electron J Inf Syst Dev Ctries"},{"key":"1583_CR38","doi-asserted-by":"publisher","first-page":"702","DOI":"10.1016\/j.ijmedinf.2013.04.004","volume":"82","author":"J Jang","year":"2013","unstructured":"Jang J, Yu SH, Kim CB, Moon Y, Kim S. The effects of an electronic medical record on the completeness of Documentation in the anesthesia record. Int J Med Inf. 2013;82:702\u20137. https:\/\/doi.org\/10.1016\/j.ijmedinf.2013.04.004.","journal-title":"Int J Med Inf"},{"key":"1583_CR39","doi-asserted-by":"publisher","unstructured":"Wurster F, Herrmann C, Beckmann M, Cecon-Stabel N, Dittmer K, Hansen T, et al. Differences in changes of data completeness after the implementation of an electronic medical record in three surgical departments of a German hospital\u2013a longitudinal comparative document analysis. BMC Med Inf Decis Mak. 2024;24. https:\/\/doi.org\/10.1186\/s12911-024-02667-0.","DOI":"10.1186\/s12911-024-02667-0"},{"key":"1583_CR40","unstructured":"WHO (World Health Organization). Data quality review Module 1: Framework and metrics. vol. NLM classi. 2017. https:\/\/doi.org\/https:\/\/iris.who.int\/bitstream\/handle\/10665\/259224\/9789241512725-eng.pdf?sequence=1%26;isAllowed=y"},{"key":"1583_CR41","doi-asserted-by":"publisher","first-page":"535","DOI":"10.2471\/BLT.08.053819","volume":"87","author":"A Burton","year":"2009","unstructured":"Burton A, Monasch R, Lautenbach B, Gacic-Dobo M, Neill M, Karimov R, et al. WHO and UNICEF estimates of National infant immunization coverage: methods and processes. Bull World Health Organ. 2009;87:535\u201341. https:\/\/doi.org\/10.2471\/BLT.08.053819.","journal-title":"Bull World Health Organ"},{"key":"1583_CR42","doi-asserted-by":"publisher","unstructured":"Wang M, Huang K, Li X, Zhao X, Downey L, Hassounah S, et al. Health workers\u2019 adoption of digital health technology in low- and middle-income countries: a systematic review and meta-analysis. Bull World Health Organ. 2025;103. https:\/\/doi.org\/10.2471\/BLT.24.292157.","DOI":"10.2471\/BLT.24.292157"}],"container-title":["Archives of Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13690-025-01583-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13690-025-01583-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13690-025-01583-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,27]],"date-time":"2025-04-27T03:41:39Z","timestamp":1745725299000},"score":1,"resource":{"primary":{"URL":"https:\/\/archpublichealth.biomedcentral.com\/articles\/10.1186\/s13690-025-01583-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,9]]},"references-count":42,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["1583"],"URL":"https:\/\/doi.org\/10.1186\/s13690-025-01583-7","relation":{"references":[{"id-type":"doi","id":"10.4103\/njcp.njcp","asserted-by":"subject"},{"id-type":"doi","id":"10.1186\/s12913-019-4188-9","asserted-by":"subject"},{"id-type":"doi","id":"10.1016\/j.vaccine.2020.07.074","asserted-by":"subject"}]},"ISSN":["2049-3258"],"issn-type":[{"value":"2049-3258","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,9]]},"assertion":[{"value":"4 January 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 March 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 April 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 April 2025","order":4,"name":"change_date","label":"Change Date","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Update","order":5,"name":"change_type","label":"Change Type","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The author David K. Tumusiime's affiliation has been corrected. Data availability section has been updated.","order":6,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"We obtained ethics approvals from the Regional Ethics Committee for Medical and Health Research, Norway (reference number: 251925), the Rwanda National Ethics Committee (reference number: 1011\/RNEC\/2020), and the National Health Research Committee (reference number: NHRC\/2021\/PROT\/002) of the Rwanda Ministry of Health. HMIS reports were obtained after formal requests to the relevant authorities (see study design and data collection).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"97"}}