BackgroundDespite focused health policies and reform agenda, Kenya has challenges in improving households’ situation in poverty and ill health; interventions to address the Millennium Development Goals in maternal and child health, such as focused antenatal care and immunization of children, are yet to achieve success. Research has shown that addressing the demand side is critical in improving health outcomes. This paper presents a model for health systems performance improvement using a strategy that bridges the interface between the community and the health system.MethodsThe study employed quasi-experimental design, using pre- and post-intervention surveys in intervention and control sites. The intervention was the implementation of all components of the Kenyan Community Health Strategy, guided by policy. The two year intervention (2011 and 2012) saw the strategy introduced to selected district health management teams, service providers, and communities through a series of three-day training workshops that were held three times during the intervention period.Baseline and endline surveys were conducted in intervention and control sites where community unit assessment was undertaken to determine the status of health service utilization before and after the intervention. A community health unit consists of 1000 households, a population of about 5000, served by trained community health workers, each supporting about 20 to 50 households. Data was organized and analyzed using Excel, SPSS, Epi info, Stata Cal, and SAS.ResultsA number of health indicators, such as health facility delivery, antenatal care, water treatment, latrine use, and insecticide treated nets, improved in the intervention sites compared to non-interventions sites. The difference between intervention and control sites was statistically significant (p<0.0001) for antenatal care, health facility delivery, water treatment, latrine use, use of insecticide treated nets, presence of clinic card, and measles vaccination. Degree of improvement across the various indicators measured differed by socio-demographic contexts. The changes were greatest in the rural agrarian sites, compared to peri-urban and nomadic sites.ConclusionThe study showed that most of the components of the strategy were implemented and sustained in different socio-demographic contexts, while participatory community planning based on household information drives improvement of health indicators.

Background: Awareness of residual disabilities amongst people living in countries recovering from prolonged armed conflicts and their socio-economic consequences is increasing. Robust data on the prevalence of such disabilities are important for planning cost effective health services. This study outlines the first community-based prevalence study of Major Limb Loss (MLL) in the Acholi sub region of Northern Uganda. The generic lessons learnt are relevant to many other postconflict societies in Asia and Africa. Methods:A cross sectional survey using random cluster sampling was conducted across 8,000 households in eight districts, of which 7,864 were suitable for analysis. The households were sampled randomly using a high-resolution population model generated using a combination of census data and artificial intelligence. Data were collected using semi-structured questionnaires administered by trained staff, and results were statistically analysed to identify patterns.Results: Data obtained from 7,864 households demonstrated that 47.9% (3,763) of households contained people with disabilities, and 3.0%, (237) of households contained people living with MLL. Of those exhibiting disabilities, the most common types were physical disabilities affecting mobility and other conditions limiting vision or hearing. Our analysis suggests that MLL sufferers are disproportionately male, older and less well educated than the general population. Using the identified prevalence rate of MLL (0.6%) and an estimated population value for the Acholi Sub-Region of 1.9 million, we estimate that there are approximately 11,400 MLL sufferers in the region who require long-term rehabilitation services.Conclusions: This is the first large scale study on the prevalence of MLL following the Ugandan civil war -known for extreme forms of violence, cruelty and mutilation. Our study demonstrates the magnitude of the problem still faced by the affected people, almost 15 years after the end of large scale combat, and the relative paucity of rehabilitation services to meet their needs. Suitable alternative health policy frameworks are required to address these relatively invisible needs.

A261 model was implemented. Tally sheets were used to categorize referral recommendations. Satisfaction was defined as reported in survey response as, dissatisfied, neutral and satisfied. RESULTS: On patient satisfaction or dissatisfaction only two hundred and twenty eight respondents answered the questions of whom only 38% (37/117) reported that they were satisfied with the patient referral and counter referral process while 62% (80/117) were neutral. CONCLUSIONS: Two thirds of the respondents were undecided. They were neither satisfied nor dissatisfied with the referral process. This is a significant proportion which in the view of the authors, there is need for further investigation to establish factors that are likely to make patients remain neutral.

In this paper we discuss the experience of caregiving for children living with HIV in a resource poor environment in Gulu municipality in northern Uganda; the main research questions of the study were: what are the perceptions of caregivers on the care of children with HIV, and what barriers and enablers exist that undermine or promote better care for children respectively? The experience of caregivers and their perceptions on managing HIV in children is believed to shape the health seeking behaviour towards treatment and efforts to cope with its negative impact on the body. Women and children are the greatest bearer of the burden of the HIV scourge to date. While more and more children are undergoing treatment as a way of controlling HIV/AIDS, it is still crucial to understand the perceptions of their parents and/or caregivers on the AIDS pandemic and the impact of antiretroviral therapy on the quality of life of their children. In this paper the socio-medical views of these clients, based on an ethnographic study are discussed to give a holistic understanding of the 'crisis' of HIV/AIDS as well as their 'imagined' hopes, fears and expectations on antiretroviral therapy as HIV/AIDS become a chronic disease. Five themes emerged from analysing the experiences and perceptions of caregivers of children living with HIV: beliefs in the antiretroviral therapy, psychological counselling, family breakdown, positive living with HIV and social stigma. These were central in their perception of caring for the affected children and other family members.

much" to 4 "disagree/dissatisfied very much". Correlation analysis was performed to identify the relationship between working motivation and job satisfaction. Also, multivariate regression analysis with stepwise method was conducted between overall job satisfaction and various working motivation dimensions. Results: 141 out of 150 nurses filled out the questionnaire (RR 94%). The majority of the sample (68.8%) was female and belonged to the 21-30 years old group. Working motivation scoring was ranged from 2.54 to 2.04, meaning positive, except from working relationships (1.8 ±0.7). Also, the mean of overall job satisfaction was 2.3±0.6, meaning satisfied. Positive correlation was found between working motivation and job satisfaction (p≤ 0.01), with the exception of salary and working relationships. Personal development (β = 0.227), job interest (β = 0.254), responsibility (β = 0.149) and recognition (β = 0.154), were significant predictors of overall job satisfaction (p≤ 0.05). Reporting high motivation from work was positively and significantly associated with higher job satisfaction. ConClusions: Working motivation of health professionals contributes to the enhancement of their job satisfaction and consequently to the improvement of health services provision.