Disease Surveillance Networks Initiative Africa: Final Evaluation

The overall objective of the Foundation's Disease Surveillance Networks (DSN) Initiative is to strengthen technical capacity at the country level for disease surveillance and to bolster response to outbreaks through the sharing of technical information and expertise. It supports formalizing collaboration, information sharing and best practices among established networks as well as trans-national, interdisciplinary and multi-sectoral efforts, and is experienced in developing and fostering innovative partnerships. In order to more effectively address disease threats, the DSN has four key outcome areas:(1) forming and sustaining trans-boundary DSN;(2) strengthening and applying technical and communication skills by local experts and institutions;(3) increasing access and use of improved tools and methods on information sharing, reporting and monitoring; and(4) emphasizing One Health and transdisciplinary approaches to policy and practice at global, regional and local levels

Strengthening health system governance using health facility service charters: a mixed methods assessment of community experiences and perceptions in a district in Kenya.

BACKGROUND: Enhancing accountability in health systems is increasingly emphasised as crucial for improving the nature and quality of health service delivery worldwide and particularly in developing countries. Accountability mechanisms include, among others, health facilities committees, suggestion boxes, facility and patient charters. However, there is a dearth of information regarding the nature of and factors that influence the performance of accountability mechanisms, especially in developing countries. We examine community members' experiences of one such accountability mechanism, the health facility charter in Kericho District, Kenya. METHODS: A household survey was conducted in 2011 among 1,024 respondents (36% male, 64% female) aged 17 years and above stratified by health facility catchment area, situated in a division in Kericho District. In addition, sixteen focus group discussions were conducted with health facility users in the four health facility catchment areas. Quantitative data were analysed through frequency distributions and cross-tabulations. Qualitative data were transcribed and analysed using a thematic approach. RESULTS: The majority (65%) of household survey respondents had seen their local facility service charter, 84% of whom had read the information on the charter. Of these, 83% found the charter to be useful or very useful. According to the respondents, the charters provided useful information about the services offered and their costs, gave users a voice to curb potential overcharging and helped users plan their medical expenses before receiving the service. However, community members cited several challenges with using the charters: non-adherence to charter provisions by health workers; illegibility and language issues; lack of expenditure records; lack of time to read and understand them, often due to pressures around queuing; and socio-cultural limitations. CONCLUSION: Findings from this study suggest that improving the compliance of health facilities in districts across Kenya with regard to the implementation of the facility service charter is critical for accountability and community satisfaction with service delivery. To improve the compliance of health facilities, attention needs to be focused on mechanisms that help enforce official guidelines, address capacity gaps, and enhance public awareness of the charters and their use

Community perceptions of air pollution and related health risks in Nairobi Slums.

Abstract: Air pollution is among the leading global risks for mortality and responsible for increasing risk for chronic diseases. Community perceptions on exposure are critical in determining people's response and acceptance of related policies. Therefore, understanding people' perception is critical in informing the design of appropriate intervention measures. The aim of this paper was to establish levels and associations between perceived pollution and health risk perception among slum residents. A cross-sectional study of 5,317 individuals aged 35+ years was conducted in two slums of Nairobi. Association of perceived score and individual characteristics was assessed using linear regression. Spatial variation in the perceived levels was determined through hot spot analysis using ArcGIS. The average perceived air pollution level was higher among residents in Viwandani compared to those in Korogocho. Perceived air pollution level was positively associated with perceived health risks. The majority of respondents were exposed to air pollution in OPEN ACCESS Int. J. Environ. Res. Public Health 2013, 10 4852 their place of work with 66% exposed to at least two sources of air pollution. Less than 20% of the respondents in both areas mentioned sources related to indoor pollution. The perceived air pollution level and related health risks in the study community were low among the residents indicating the need for promoting awareness on air pollution sources and related health risks

A community-based intervention for primary prevention of cardiovascular diseases in the slums of Nairobi: the SCALE UP study protocol for a prospective quasi-experimental community-based trial

Abstract Background: The burden of cardiovascular disease is rising in sub-Saharan Africa with hypertension being the main risk factor. However, context-specific evidence on effective interventions for primary prevention of cardiovascular diseases in resource-poor settings is limited. This study aims to evaluate the feasibility and cost-effectiveness of one such intervention-the "Sustainable model for cardiovascular health by adjusting lifestyle and treatment with economic perspective in settings of urban poverty"

Physical access to health facilities and contraceptive use in Kenya: Evidence from the 2008-2009 Kenya Demographic and Health Survey

The objective of the study was to determine the spatial variation in modern contraceptive use and unmet need for family planning across the counties of Kenya and to examine whether the spatial patterns were associated with inequalities in physical access to health facilities. Data were obtained from the 2008-2009 Kenya Demographic and Health Survey and linked to the location of health facilities in the country. Multivariate logistic regression was used to examine the influence of distance to the nearest health facility and health facility density, in addition to other covariates, on modern contraceptive use and unmet need. Overall, the prevalence of modern contraceptive use and unmet need among women aged 15-49 in Kenya was 42.1% and 19.7% respectively. Among the respondents who lived more than 5 km from the nearest health facility modern contraceptive use was significantly less likely compared to women resident 5 km or less from the nearest health facility. Women from counties with higher health facility density were 53% more likely to use modern contraceptives compared to women in counties with low health facility density. Distance and health facility density in the county were not significantly associated with unmet need. Physical access to health facilities is an important determinant of modern contraceptive use and unmet need in Kenya. Strategies should be developed in underserved counties to mitigate the challenge of distance to health facilities, such as delivering services by outreach and mobile facilities. (Afr J Reprod Health 2012; 16[3]: 47-55).L'objectif de l'étude était de déterminer la variation spatiale dans l'utilisation des contraceptifs modernes et les besoins non satisfaits de la planification familiale à travers les comtés du Kenya et d'examiner si les structures spatiales ont été associées à des inégalités dans l'accès physique aux établissements de santé. Les données ont été obtenues à partir de l'Enquête Démographique et de Sante de 2008-2009 du Kenya et liées aux endroits où se situent les établissements de santé dans le pays. La régression logistique multi variée a été utilisée pour examiner l'influence de la distance au centre médical le plus proche et la densité de l'établissement de santé, y compris des autres coaxiales, sur l'utilisation de la contraception moderne et des besoins non satisfaits. Dans l'ensemble, la prévalence de l'utilisation de la contraception moderne et des besoins non satisfaits chez les femmes âgées de 15-49 ans au Kenya était de 42,1% et 19,7% respectivement. Parmi les répondants qui habitaient à plus de 5 km de l'établissement sanitaire le plus proche, l'utilisation des contraceptifs modernes était significativement moins susceptibles par rapport aux femmes qui habitent à 5 km ou moins de l'établissement sanitaire le plus proche. Les femmes dans les comtés ayant une densité d'établissement de sante plus élevée étaient de 53% plus susceptibles d'utiliser des contraceptifs modernes par rapport aux femmes dans les comtés à faible densité d'établissement de santé. La distance et la densitéétablissement de santédans le comtén'ont pas été significativementassociées àdes besoins non satisfaits.L'accès physique aux établissements de santé est un déterminant important de l'utilisation des contraceptifs modernes et les besoins non satisfaits au Kenya. Les stratégies devraient être élaborées dans les comtés défavorisés pour atténuer le défi de la distance aux centres de santé, tels que la prestation de services par la sensibilisation et les établissements mobiles (Afr J Reprod Health 2012; 16[3]: 47-55)