Grant: Doctoral: Vanier Canada Graduate Scholarships

Newborn and child health remains one of the most significant health challenges in low-income countries (LICs). While knowledge on many interventions to improve newborn and child survival has advanced over the past few decades, healthcare systems in such settings remain unable to effectively deliver these life-saving interventions. A primary reason for this is that they have not been adapted to the contexts of LICs. For example, pediatric advanced life support management adapted for LICs has increasingly been advocated as a method to reduce under-five mortality. In response, Rwanda implemented ETAT+ (Emergency, Triage, Assessment and Treatment PLUS admission care), a locally adapted pediatric advanced life support management program to improve quality of hospital care for severely ill newborns and children. The program employs a multifaceted approach including evidence-based clinical practice guidelines, training, supervision and hospital audit. While my prior research assessed the baseline quality of hospital care for newborns and children in Rwanda and found great potential for impact from ETAT+, there has been no evaluation of the impact of the program in Rwanda. Therefore, this project will evaluate the impact of ETAT+ on the clinical practice of healthcare workers and, ultimately, on newborn and child health outcomes. I will use a very strong differences-in-differences approach to examine the change in the process of clinical care before and after ETAT+ implementation. I will use sophisticated time series methods to assess the impact of ETAT+ on health outcomes including hospital mortality. Further, I will perform an economic evaluation of ETAT+ to guide future resource allocation decisions and decisions about scaling-up ETAT+ nationwide. Lastly, I will evaluate the real-world experiences with implementation of ETAT+ to identify barriers and facilitators to its successful implementation in order to provide evidence to guide its adoption and scale-up over time.