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Abstract
Background The Informed Health Choices (IHC) Key Concepts is a framework that provides a basis for developing educational resources and evaluating people's ability to think critically about health actions. We developed the original Key Concepts framework by reviewing texts and checklists for the public, journalists, and health professionals and collecting structured feedback from an international advisory group. We revised the original 2015 framework yearly from 2016 to 2018 based on feedback and experience using the framework. The objectives of this paper are to describe the development of the framework since 2018 and summarise their basis. Methods For the 2019 version, we responded to feedback on the 2018 version. For the current 2022 version, in addition to responding to feedback on the 2019 version, we reviewed the evidence base for each of the concepts. Whenever possible, we referenced systematic reviews that provide a basis for a concept. We screened all Cochrane methodology reviews and searched Epistemonikos, PubMed, and Google Scholar for methodology reviews and meta-epidemiological studies. Results The original framework included 32 concepts in six groups. The 2019 version and the current 2022 version include 49 concepts in the same three main groups that we have used since 2016. There are now 10 subgroups or higher-level concepts. For each concept, there is an explanation including one or more examples, the basis for the concept, and implications. Over 600 references are cited that support the concepts, and over half of the references are systematic reviews. Conclusions There is a large body of evidence that supports the IHC key concepts and we have received few suggestions for changes since 2019.
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Affiliation(s)
- Andrew D. Oxman
- Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, Oslo, Norway
| | - Iain Chalmers
- Centre for Evidence-Based Medicine, Department of Primary Care, University of Oxford, Oxford, UK
| | - Astrid Dahlgren
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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Mugisha M, Nyirazinyoye L, Simbi CMC, Chesire F, Senyonga R, Oxman M, Nsangi A, Semakula D, Rose CJ, Moberg J, Dahlgren A, Kaseje M, Lewin S, Sewankambo NK, Rosenbaum S, Oxman AD. Effects of the Informed Health Choices secondary school intervention on the ability of students in Rwanda to think critically about health choices: A cluster-randomized trial. J Evid Based Med 2023; 16:264-274. [PMID: 37735809 DOI: 10.1111/jebm.12551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 09/11/2023] [Indexed: 09/23/2023]
Abstract
AIM The aim of this trial was to evaluate the effects of the Informed Health Choices intervention on the ability of students in Rwandan to think critically and make Informed Health Choices. METHODS We conducted a two-arm cluster-randomized trial in 84 lower secondary schools from 10 districts representing five provinces of Rwanda. We used stratified randomization to allocate schools to the intervention or control. One class in each intervention school had ten 40-min lessons taught by a trained teacher in addition to the usual curriculum. Control schools followed the usual curriculum. The primary outcome was a passing score (≥ 9 out of 18 questions answered correctly) for students on the Critical Thinking about Health Test completed within 2 weeks after the intervention. We conducted an intention-to-treat analysis using generalized linear mixed models, accounting for the cluster design using random intercepts. RESULTS Between February 25 and March 29, 2022, we recruited 3,212 participants. We assigned 1,572 students and 42 teachers to the intervention arm and 1,556 students and 42 teachers to the control arm. The proportion of students who passed the test in the intervention arm was 915/1,572 (58.2%) compared to 302/1,556 (19.4%) in the control arm, adjusted odds ratio 10.6 (95% CI: 6.3-17.8), p < 0.0001, adjusted difference 37.2% (95% CI: 29.5%-45.0%). CONCLUSIONS The intervention is effective in helping students think critically about health choices. It was possible to improve students' ability to think critically about health in the context of a competence-based curriculum in Rwanda, despite challenging postpandemic conditions.
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Affiliation(s)
- Michael Mugisha
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Faculty of Medicine, Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Laetitia Nyirazinyoye
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | - Faith Chesire
- Faculty of Medicine, Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
- Tropical Institute of Community Health and Development, Kisumu, Kenya
| | - Ronald Senyonga
- Faculty of Medicine, Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Medicine, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Matt Oxman
- Centre for Epidemic Intervention Research, Norwegian Institute of Public Health, Oslo, Norway
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Allen Nsangi
- Department of Medicine, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Daniel Semakula
- Department of Medicine, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Christopher James Rose
- Centre for Epidemic Intervention Research, Norwegian Institute of Public Health, Oslo, Norway
| | - Jenny Moberg
- Centre for Epidemic Intervention Research, Norwegian Institute of Public Health, Oslo, Norway
| | - Astrid Dahlgren
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Margaret Kaseje
- Tropical Institute of Community Health and Development, Kisumu, Kenya
| | - Simon Lewin
- Centre for Epidemic Intervention Research, Norwegian Institute of Public Health, Oslo, Norway
- Department of Health Sciences Ålesund, Norwegian University of Science and Technology (NTNU), Ålesund, Norway
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Nelson K Sewankambo
- Department of Medicine, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Sarah Rosenbaum
- Centre for Epidemic Intervention Research, Norwegian Institute of Public Health, Oslo, Norway
| | - Andrew D Oxman
- Centre for Epidemic Intervention Research, Norwegian Institute of Public Health, Oslo, Norway
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Ssenyonga R, Oxman AD, Nakyejwe E, Chesire F, Mugisha M, Nsangi A, Semakula D, Oxman M, Rose CJ, Rosenbaum SE, Moberg J, Kaseje M, Nyirazinyoye L, Dahlgren A, Lewin S, Sewankambo NK. Use of the informed health choices educational intervention to improve secondary students' ability to think critically about health interventions in Uganda: A cluster-randomized trial. J Evid Based Med 2023; 16:285-293. [PMID: 37725488 DOI: 10.1111/jebm.12553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 09/11/2023] [Indexed: 09/21/2023]
Abstract
AIM The aim was to evaluate the effect of the Informed Health Choices (IHC) educational intervention on secondary students' ability to assess health-related claims and make informed choices. METHODS In a cluster-randomized trial, we randomized 80 secondary schools (students aged 13-17 years) in Uganda to the intervention or control (usual curriculum). The intervention included a 2-day teacher training workshop, 10 lessons accessed online by teachers and delivered in one school term. The lesson plans were developed for classrooms equipped with a blackboard or a blackboard and projector. The lessons addressed nine prioritized concepts. We used two multiple-choice questions for each concept to evaluate the students' ability to assess claims and make informed choices. The primary outcome was the proportion of students with a passing score (≥9 of 18 questions answered correctly). RESULTS Eighty schools consented and were randomly allocated. A total of 2477 students in the 40 intervention schools and 2376 students in the 40 control schools participated in this trial. In the intervention schools, 1364 (55%) of students that completed the test had a passing score compared with 586 (25%) of students in the control schools (adjusted difference 33%, 95% CI 26%-39%). CONCLUSIONS The IHC secondary school intervention improved students' ability to think critically and make informed choices. Well-designed digital resources may improve access to educational material, even in schools without computers or other information and communication technology (ICT). This could facilitate scaling-up use of the resources and help to address inequities associated with limited ICT access.
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Affiliation(s)
- Ronald Ssenyonga
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
- Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Andrew D Oxman
- Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, Oslo, Norway
| | - Esther Nakyejwe
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Faith Chesire
- Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
- Tropical Institute of Community Health and Development in Africa, Kisumu, Kenya
| | - Michael Mugisha
- Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Allen Nsangi
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Daniel Semakula
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Matt Oxman
- Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, Oslo, Norway
| | - Christopher James Rose
- Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, Oslo, Norway
| | - Sarah E Rosenbaum
- Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, Oslo, Norway
| | - Jenny Moberg
- Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, Oslo, Norway
| | - Margaret Kaseje
- Tropical Institute of Community Health and Development in Africa, Kisumu, Kenya
| | - Laetitia Nyirazinyoye
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Astrid Dahlgren
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Simon Lewin
- Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, Oslo, Norway
- Department of Health Sciences, Norwegian University of Science and Technology, Ålesund, Norway
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Nelson K Sewankambo
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
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Chesire F, Mugisha M, Ssenyonga R, Rose CJ, Nsangi A, Kaseje M, Sewankambo NK, Oxman M, Rosenbaum SE, Moberg J, Dahlgren A, Lewin S, Oxman AD. Effects of the Informed Health Choices secondary school intervention: A prospective meta-analysis. J Evid Based Med 2023; 16:321-331. [PMID: 37735807 DOI: 10.1111/jebm.12552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 09/06/2023] [Indexed: 09/23/2023]
Abstract
AIM The aim of this prospective meta-analysis was to synthesize the results of three cluster-randomized trials of an intervention designed to teach lower-secondary school students (age 14-16) to think critically about health choices. METHODS We conducted the trials in Kenya, Rwanda, and Uganda. The intervention included a 2- to 3-day teacher training workshop, digital resources, and ten 40-min lessons. The lessons focused on nine key concepts. We did not intervene in control schools. The primary outcome was a passing score on a test (≥9 of 18 multiple-choice questions answered correctly). We performed random effects meta-analyses to estimate the overall adjusted odds ratios. Secondary outcomes included effects of the intervention on teachers. RESULTS Altogether, 244 schools (11,344 students) took part in the three trials. The overall adjusted odds ratio was 5.5 (95% CI: 3.0-10.2; p < 0.0001) in favor of the intervention (high certainty evidence). This corresponds to 33% (95% CI: 25-40%) more students in the intervention schools passing the test. Overall, 3397 (58%) of 5846 students in intervention schools had a passing score. The overall adjusted odds ratio for teachers was 13.7(95% CI: 4.6-40.4; p < 0.0001), corresponding to 32% (95% CI: 6%-57%) more teachers in the intervention schools passing the test (moderate certainty evidence). Overall, 118 (97%) of 122 teachers in intervention schools had a passing score. CONCLUSIONS The intervention led to a large improvement in the ability of students and teachers to think critically about health choices, but 42% of students in the intervention schools did not achieve a passing score.
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Affiliation(s)
- Faith Chesire
- Tropical Institute of Community Health and Development, Kisumu, Kenya
- Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Michael Mugisha
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Ronald Ssenyonga
- College of Health Sciences, Makerere University, Kampala, Uganda
- Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Christopher J Rose
- Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, Oslo, Norway
| | - Allen Nsangi
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Margaret Kaseje
- Tropical Institute of Community Health and Development, Kisumu, Kenya
| | | | - Matt Oxman
- Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, Oslo, Norway
| | - Sarah E Rosenbaum
- Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, Oslo, Norway
| | - Jenny Moberg
- Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, Oslo, Norway
| | - Astrid Dahlgren
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Simon Lewin
- Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, Oslo, Norway
- Faculty of Medicine and Health Sciences, Department of Health Sciences Ålesund, Norwegian University of Science and Technology (NTNU), Ålesund, Norway
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Andrew D Oxman
- Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, Oslo, Norway
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Chesire F, Kaseje M, Ochieng M, Ngatia B, Mugisha M, Ssenyonga R, Oxman M, Nsangi A, Semakula D, Rose CJ, Nyirazinyoye L, Dahlgren A, Lewin S, Sewankambo NK, Rosenbaum S, Oxman AD. Effects of the informed health choices secondary school intervention on the ability of students in Kenya to think critically about health choices: A cluster-randomized trial. J Evid Based Med 2023; 16:275-284. [PMID: 37735827 DOI: 10.1111/jebm.12556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 09/13/2023] [Indexed: 09/23/2023]
Abstract
AIM There is an overabundance of claims about the advantages and disadvantages of health interventions. People need to be able to appraise the reliability of these claims. The aim of this two-arm cluster-randomized trial was to evaluate the Informed Health Choices secondary school intervention designed to teach students to assess claims about the effects of health actions and make informed decisions. METHODS We conducted the trial among students from 80 secondary schools in five subcounties in Kenya. We used stratified randomization to allocate schools to the intervention or control arm. The intervention included a 2-day teacher training workshop and 10 lessons that addressed nine prioritized key concepts for assessing claims about treatment effects. We did not intervene in the control schools. The primary outcome was the proportion of students with a passing score (≥ 9/18 correct answers) on the Critical Thinking about Health test, which included two multiple-choice questions for each concept. RESULTS Between May 11, 2022, and July 8, 2022, we recruited 3362 students and 80 teachers. We allocated 1863 students and 40 teachers to the intervention and 1499 students and 40 teachers to the control arm. In the intervention schools, 1149/1863 (61.7%) of students achieved a passing score compared to 511/1499 (34.1%) in the control schools (odds ratio 3.6 (95% CI 2.5-5.2), p < 0.0001). CONCLUSIONS The intervention had a large effect on students' ability to think critically about health interventions. It is possible to integrate the learning of critical thinking about health within Kenya secondary school curriculum.
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Affiliation(s)
- Faith Chesire
- Department of Community Health and Development, Tropical Institute of Community Health and Development, Kisumu, Kenya
- Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Margaret Kaseje
- Department of Community Health and Development, Tropical Institute of Community Health and Development, Kisumu, Kenya
| | - Marlyn Ochieng
- Department of Community Health and Development, Tropical Institute of Community Health and Development, Kisumu, Kenya
| | - Benson Ngatia
- Department of Community Health and Development, Tropical Institute of Community Health and Development, Kisumu, Kenya
| | - Michael Mugisha
- Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Ronald Ssenyonga
- Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Matt Oxman
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Allen Nsangi
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Daniel Semakula
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Christopher James Rose
- Centre for Epidemic Interventions Research, (CEIR), Norwegian Institute of Public Health, Oslo, Norway
| | - Laetitia Nyirazinyoye
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Astrid Dahlgren
- Centre for Epidemic Interventions Research, (CEIR), Norwegian Institute of Public Health, Oslo, Norway
| | - Simon Lewin
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | | | - Sarah Rosenbaum
- Centre for Epidemic Interventions Research, (CEIR), Norwegian Institute of Public Health, Oslo, Norway
| | - Andrew D Oxman
- Centre for Epidemic Interventions Research, (CEIR), Norwegian Institute of Public Health, Oslo, Norway
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Chesire F, Ochieng M, Mugisha M, Ssenyonga R, Oxman M, Nsangi A, Semakula D, Nyirazinyoye L, Lewin S, Sewankambo NK, Kaseje M, Oxman AD, Rosenbaum S. Contextualizing critical thinking about health using digital technology in secondary schools in Kenya: a qualitative analysis. Pilot Feasibility Stud 2022; 8:227. [PMID: 36203201 PMCID: PMC9535840 DOI: 10.1186/s40814-022-01183-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 09/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background Good health decisions depend on one’s ability to think critically about health claims and make informed health choices. Young people can learn these skills through school-based interventions, but learning resources need to be low-cost and built around lessons that can fit into existing curricula. As a first step to developing and evaluating digital learning resources that are feasible to use in Kenyan secondary schools, we conducted a context analysis to explore interest in critical thinking for health, map where critical thinking about health best fits in the curriculum, explore conditions for introducing new learning resources, and describe the information and communication technology (ICT) infrastructure available for teaching and learning. Methods We employed a qualitative descriptive approach. We interviewed 15 key informants, carried out two focus group discussions, observed ICT conditions in five secondary schools, reviewed seven documents, and conducted an online catalog of ICT infrastructure in all schools (n=250) in Kisumu County. Participants included national curriculum developers, national ICT officers, teachers, and national examiners. We used a framework analysis approach to analyze data and report findings. Findings Although critical thinking is a core competence in the curriculum, critical thinking about health is not currently taught in Kenyan secondary schools. Teachers, health officials, and curriculum developers recognized the importance of teaching critical thinking about health in secondary schools. Stakeholders agreed that Informed Health Choices learning resources could be embedded in nine subjects. The National Institute of Curriculum Development regulates resources for learning; the development of new resources requires collaboration and approval from this body. Most schools do not use ICT for teaching, and for those few that do, the use is limited. Implementation of Kenya’s ICT policy framework for schools faces several challenges which include inadequate ICT infrastructure, poor internet connectivity, and teachers’ lack of training and experience. Conclusion Teaching critical thinking about health is possible within the current Kenyan lower secondary school curriculum, but the learning resources will need to be designed for inclusion in and across existing subjects. The National ICT Plan and Vision for 2030 provides an opportunity for scale-up and integration of technology in teaching and learning environments, which can enable future use of digital resources in schools. However, given the current ICT condition in schools in the country, digital learning resources should be designed to function with limited ICT infrastructure, unstable Internet access, and for use by teachers with low levels of experience using digital technology. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01183-0.
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Affiliation(s)
- Faith Chesire
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway. .,Tropical Institute of Community Health and Development, Kisumu, Kenya.
| | - Marlyn Ochieng
- Tropical Institute of Community Health and Development, Kisumu, Kenya
| | - Michael Mugisha
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.,School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Ronald Ssenyonga
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Medicine, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Matt Oxman
- Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, Oslo, Norway.,Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Allen Nsangi
- Department of Medicine, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Daniel Semakula
- Department of Medicine, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Laetitia Nyirazinyoye
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Simon Lewin
- Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, Oslo, Norway.,Department of Health Sciences Ålesund, Norwegian University of Science and Technology (NTNU), Ålesund, Norway.,Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Nelson K Sewankambo
- Department of Medicine, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Margaret Kaseje
- Tropical Institute of Community Health and Development, Kisumu, Kenya
| | - Andrew D Oxman
- Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, Oslo, Norway
| | - Sarah Rosenbaum
- Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, Oslo, Norway.
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