"background": "Health systems strengthening in sub-Saharan Africa requires robust evidence on the adoption of new practices within district-level facilities. However, longitudinal data on the sustained uptake of interventions following initial implementation support is scarce. ", "purpose and objectives": "This study aimed to evaluate the long-term adoption rates of a standardised clinical documentation system introduced via a randomised field trial in district hospitals, and to identify institutional factors influencing sustained use. ", "methodology": "A longitudinal study was conducted following a cluster-randomised trial. Adoption was measured quarterly over a multi-year period via direct audit of patient records in 24 facilities. The primary analysis used a generalised estimating equations model: \ (P (Y{it=1) ) = \0 + \1 Ti + \2 t + \3 (Ti \ t) + \ Xit, where Y₈ₓ is adoption in hospital i at time t, T is treatment assignment, and X is a vector of time-varying covariates. Robust standard errors accounted for hospital-level clustering. ", "findings": "Adoption in intervention hospitals peaked at 78% (95% CI: 71, 84) post-implementation but declined to a stable plateau of 52% (95% CI: 45, 58) by the final measurement period. The decline was significantly associated with staff turnover rates (p<0. 01) and inadequate supervisory visits. ", "conclusion": "The intervention achieved moderate sustained adoption, but decay over time indicates that initial implementation success does not guarantee long-term integration without ongoing institutional support mechanisms. ", "recommendations": "Future health systems interventions should embed explicit, funded plans for continuous supervision and capacity building to mitigate the negative effects of staff turnover on adoption fidelity. ", "key words": "implementation science, health systems research, sustainability, cluster randomised trial, adoption fidelity, sub-Saharan Africa", "contribution statement": "This paper
Mwajuma Mwinyimvua (Sun,) studied this question.