Reliability of community health worker collected data for planning and policy in a peri-urban area of Kisumu, Kenya.

A general introduction of this article is as follows: Reliable and timely health information is an essential foundation of public health action and health systems strengthening, both nationally and internationally (Aqil et al. in Health Policy Plan 24(3): 217-228, 2009; Bradshaw et al. in initial burden of disease estimates for South Africa, 2000. South African Medical Research Council, Cape Town, 2003). The need for sound information is especially urgent in the case of emergent diseases and other acute health threats, where rapid awareness, investigation and response can save lives and prevent broader national outbreaks and even global pandemics (Aqil et al. in Health Policy Plan 24(3): 217-228, 2009). The government of Kenya, through the ministry of public health and sanitation has rolled out the community health strategy as a way of improving health care at the household level. This involves community health workers collecting health status data at the household level, which is then used for dialogue at all the levels to inform decisions and actions towards improvement in health status. A lot of health interventions have involved the community health workers in reaching out to the community, hence successfully implementing these health interventions. Large scale involvement of community health workers in government initiatives and most especially to collect health data for use in the health systems has been minimal due to the assumption that the data may not be useful to the government, because its quality is uncertain. It was therefore necessary that the validity and reliability of the data collected by community health workers be determined, and whether this kind of data can be used for planning and policy formulation for the communities from which it is collected. This would go a long way to settle speculation on whether the data collected by these workers is valid and reliable for use in determining the health status, its causes and distribution, of a community. Our general objective of this article is to investigate the validity and reliability of Community Based Information, and we deal with research question "What is the reliability of data collected at the Community level by Community health workers?". The methods which we use to find an reliable answer to this question is "Ten percent of all households visited by CHWs for data collection were recollected by a technically trained team. Test/retest method was applied to the data to establish reliability. The Kappa score, sensitivity, specificity and positive predictive values were also used to measure reliability". Finally our findings are as follows: Latrine availability and Antenatal care presented good correspondence between the two sets of data. This was also true for exclusive breast feeding indicator. Measles immunization coverage showed less consistency than the rest of the child health indicators. At last we conclude and recommend that CHWs can accurately and reliably collect household data which can be used for health decisions and actions especially in resource poor settings where other approaches to population based data are too expensive.

PERSPECTIVE ON OPPORTUNITIES FOR RESEARCH AND INTERVENTIONS PROVIDED BY COMMUNITY BASED HEALTH INFORMATION SYSTEM ILLUSTRATED BY THE POTENTIAL USE OF MOTIVATIONAL INTERVIEWING INTERVENTION.

BACKGROUND: With the growth of Community-Based Health Information (CBHIS) for decision making and service provision in the low income settings, innovative models of addressing Maternal and Newborn Health (MNH) morbidity and mortality are necessary. World Health Organization (WHO) estimates that five hundred thousand mothers and about three million newborns die each year in middle and low income countries. OBJECTIVES: To stimulate interest in utilisation CBHIS for research and interventions, with an illustration of potential using on Motivational Interviewing intervention. DATA SOURCE: Literature searched electronically, discussion with behavioural experts, health system researchers, and maternal and Newborn Health (MNH) experts, and book reviews. STUDY SELECTION: Broad selection criteria including all current literature relevantsubjects including CBHIS, behaviour change methods and Community MNH. DATA EXTRACTION: A checklist for relevance was used to identify the relevant behaviour change intervention to use in the illustration. DATA SYNTHESIS: A method that met the criteria was identified, and based on a discussion with behavioural experts, the decision to use it the illustration was reached. CONCLUSION: Motivational Interviewing Intervention (MII) should be considered for implementation and study on near-term Pregnant women in a setting where these mothers can be identified and a targeted intervention instituted.

Evidence-based dialogue with communities for district health systems' performance improvement.

Despite focused health policies and a reform agenda Kenya has not made a breakthrough in improving the situations of households entrapped in the vicious cycle of poverty and ill health. Consequently, Great Lakes University of Kisumu developed and tested a model for facilitating improvement in the performance of the District Health System (DHS) and, hence, the health status of poor households served. The model consisted of evidence-based dialogue between the communities and service providers, working with service consumers as partners in improving service delivery and outcomes. The study was undertaken in partnership with the Ministry of Health (MOH) and the Communities. The model was tested by introducing it in selected sites and carrying out health facility and household sample surveys at the beginning of the intervention and two years later in both intervention and control sites. Among the key improvements noted were: governance and management of the health system; service delivery and health outcomes in terms of immunisation coverage; usage of insecticide treated nets; and utilisation of skilled attendance at childbirth. Based on the results, the Kenyan MOH adopted the model as a strategy for the implementation of the Kenya Essential Package for Health countrywide. The University developed the implementation guidelines and training materials for rolling out the strategy countrywide.

Home Management of Diarrhea among Underfives in a Rural Community in Kenya: Household Perceptions and Practices

Introduction: Diarrheal disease is a major cause of morbidity and mortality among under-fives especially in rural and peri-urbancommunities in developing countries. Home management of diarrhea is one of the key household practices targeted for enhancement in the Community Integrated Management of Childhood Illness (C-IMCI) strategy. Objective: The aim of this study was to determine the perceptions of mothers/caregivers regarding the causes of diarrhea among under-fives and how it was managed in the home before seeking help from Community Health Workers or health facilities. Design: A household longitudinal study was conducted in Nyando district; Kenya in 2004-2006 adopting both qualitative and quantitative approaches. Subjects: A total of 927 mothers/caregivers of under-fives participated in the study. Main outcome measures: Perceived causes of childhood diarrhoea; action taken during diarrhea; fluid intake; recognition of signs of dehydration; feeding during convalescence; adherence to treatment and advice. Results: Majority of the respondents 807(87.1) reported that their children had suffered from diarrhea within the last 2 weeks before commencement of the study. Diarrhea was found to contribute to 48of child mortality in the study area. Perceived causes of diarrhea were: unclean water 524(55.6); contaminated food 508(54.9); bad eye 464 (50.0); false teeth 423(45.6) and breast milk 331(35.8). More than 70of mothers decreased fluid intake during diarrhea episodes. The mothers perceived wheat flour; rice water and selected herbs as anti-diarrheal agents. During illness; 239(27.8) of the children were reported not to have drunk any fluids at all; 487(52.5) drunk much less and only 93(10.0) were reported to have drunk more than usual. A significant 831(89.6) withheld milk including breast milk with the notion that it enhanced diarrhea. Conclusion: Based on these findings; there is need to develop and implement interactive communication strategies for the health workers and mothers to address perceptions and miscon- ceptions and facilitate positive change in the household practice on management of diarrhea among under-fives

New approaches, new activities and new outcomes in international conferences on HIV/AIDS in Africa--report of the 3rd African Conference on the Social Aspects of HIV/AIDS, Dakar, 10-14 October 2005.

Africa's HIV/AIDS situation remains cause for concern. The impact of HIV is considerable and threatens the survival and development of African societies. Although much has been attempted, the results still leave much to be desired. AIDS is an epidemic that needs to be addressed with much creativity and spirit of initiative. It is against this background that the 3rd African conference on the social aspects of HIV/AIDS brought innovations in the way international conferences are designed, activities implemented and results obtained. The innovations concerned the approach to international conferences and take into account reconceptualising HIV/AIDS so as to encourage holistic approaches and better visibility of vulnerable groups. The activities of the conference were organised in such a way as to get people living with HIV/AIDS (PLWHA), grassroots communities and marginalised groups to play a focal role. The conference offered an opportunity for developing cultural activities that would translate the African cultural concepts that had been identified as important in the HIV situation and response analysis. Interaction at the conference created an opportunity to analyse the various dimensions of the political, cultural and economic determinants. The conference offered food for thought around response construction while singling out the themes of urgency and acceleration of response, synergy construction, and coordination and conception of political responses.

New Approaches; New activities and New Outcomes in International Conferences on HIV/AIDS in Africa: Report of the 3rd African Conference on the Social Aspects of HIV/AIDS; Dakar; 10-14 October 2005

Africa's HIV/AIDS situation remains cause for concern. The impact of HIV is considerable and threatens the survival and development of African societies. Although much has been attempted; the results still leave much to be desired. AIDS is an epidemic that needs to be addressed with much creativity and spirit of initiative. It is against this background that the 3rd African conference on the social aspects of HIV/AIDS brought innovations in the way international conferences are designed; activities implemented and results obtained. The innovations concerned the approach to international conferences and take into account reconceptualising HIV/AIDS so as to encourage holistic approaches and better visibility of vulnerable groups.The activities of the conference were organised in such a way as to get people living with HIV/AIDS (PLWHA); grassroots communities and marginalised groups to play a focal role.The conference offered an opportunity for developing cultural activities that would translate the African cultural concepts that had been identified as important in the HIV situation and response analysis. Interaction at the conference created an opportunity to analyse the various dimensions of the political; cultural and economic determinants. The conference offered food for thought around response construction while singling out the themes of urgency and acceleration of response; synergy construction; and coordination and conception of political responses

Assessment of utilisation of PMTCT services at Nyanza Provincial Hospital, Kenya.

The main objective of the study was to assess the utilisation of prevention of mother-to-child transmission (PMTCT) services among mothers registered for services at Nyanza Provincial Hospital in Kenya. A crosssectional exploratory study was conducted, using both quantitative and qualitative approaches to collect primary and secondary data. The study population was 133 clients registered for PMTCT services. The study revealed that 52.4% of clients received PMTCT information at the health facility without prior knowledge about intervention, 96% waited for more than 90 minutes, and 89% took less than 10 minutes for post-test counselling. Knowledge of MTCT and PMTCT was inadequate even after counselling, as participants could not recall the information divulged during counselling. In addition, 80% of clients did not present for follow-up counselling irrespective of HIV status, and 95%, did not disclose positive HIV status to spouses/relatives for fear of stigma, discrimination and violence. Inadequate counselling services delivered to clients affected service utilisation, in that significant dropout occurred at the stages of HIV result (31.5%), enrollment (53.6%), and delivery (80.7%). Reasons for dropout included fear of positive HIV result, chronic illness, stigma and discrimination, unsupportive spouse and inability to pay for the services.

Assessment of utilisation of PMTCT services at Nyanza Provincial Hospital; Kenya

The main objective of the study was to assess the utilisation of prevention of mother-to-child transmission (PMTCT) services among mothers registered for services at Nyanza Provincial Hospital in Kenya. A cross-sectional exploratory study was conducted; using both quantitative and qualitative approaches to collect primary and secondary data. The study population was 133 clients registered for PMTCT services. The study revealed that 52.4 of clients received PMTCT information at the health facility without prior knowledge about intervention; 96 waited for more than 90 minutes; and 89 took less than 10 minutes for post-test counselling. Knowledge of MTCT and PMTCT was inadequate even after counselling; as participants could not recall the information divulged during counselling. In addition; 80 of clients did not present for follow-up counselling irrespective of HIV status; and 95 did not disclose positive HIV status to spouses/relatives for fear of stigma; discrimination and violence. Inadequate counselling services delivered to clients affected service utilisation; in that significant dropout occurred at the stages of HIV result (31.5); enrollment (53.6); and delivery (80.7). Reasons for dropout included fear of positive HIV result; chronic illness; stigma and discrimination; unsupportive spouse and inability to pay for the services

Joining together to combat poverty.

The International Poverty and Health Network (IPHN) was created in December 1997 following a series of conferences organized by the World Health Organization, with the aim of integrating health into plans to eradicate poverty. Around 1.3 billion people live on less than US$1 per day. Of the 4.4 billion people in developing countries nearly 60% lack access to sanitation, 30% do not have clean water, 20% have no health care, and 20% do not have enough dietary energy and protein. Even among rich nations there are gross socioeconomic inequalities. Many children are robbed of their physical and mental potential through poverty. Expressed in constant 1963 US dollars, an average Croatian family needed the annual income of US$894 to meet the poverty line in 1960 and US$9,027 in 1995. Accordingly, 9-25% of Croatian households were below the poverty line between 1960 and 1995. The increase in the poverty rate after 1991 was compounded by the war that destroyed almost a third of industrial capacity and infrastructure. Dissipation of the communist economy and inadequate privatization have contributed to the increase in unemployment rate, corruption, and other social ills. IPHN invited Croatian Medical Journal to publish this editorial to help push the issue of poverty up political and medical agendas on a global level. We argue that a factor contributing to the failure of most large-scale programs against poverty to date is the excessive emphasis on material and infrastructure assistance at the expense of spiritual, moral, and intellectual development.

Growth of civil society in developing countries: implications for health.

Owing to changes in political systems, the number of non-governmental organisations worldwide has increased substantially since 1980. The influence of civil society on health and health care depends on the recognition of its role as a partner in primary health care, on its success in the scaling up of activities, on its cooperation with the State and business sector, and on networking. In the event of health-sector reforms, civil society should focus on equity and justice, and advocate health as a public responsibility. The impact on health would increase if medical personnel joined forces with civil society and if medical schools added public speaking, networking, and lobbying to their agenda. The trend is that an increasing number of agents are getting involved in the promotion of health.

An integrated rural health project in Saradidi, Kenya.

In 1979 a community self help health development programme was initiated in Saradidi, Kenya, as the community's response to its problems. In line with the theoretical considerations made for the implementation of primary health care the community was involved in planning, organization, setting of priorities and objectives, implementation and evaluation of the programme. The Saradidi Health Development Project (SHDP) was initiated by people from the area with material assistance from within and outside Saradidi. Nearly 10 years since the beginning of the project, the SHDP still runs more or less on its own providing experiences for other projects and initiators.

Serological reactivity to the ring-infected erythrocyte surface antigen and circumsporozoite protein in gravid and nulligravid women infected with Plasmodium falciparum.

To investigate potential mechanisms for pregnancy-associated alterations in the immune response to malaria, we tested plasma samples from Plasmodium falciparum-infected nulligravida (42), primigravida (23) and multigravida (38) Kenyan women for reactivity to the ring-infected erythrocyte surface antigen (RESA) by a modified indirect fluorescent antibody assay and to synthetic peptides derived from amino acid sequences of RESA and the circumsporozoite (CS) protein of P. falciparum by an enzyme-linked immunosorbent assay. Reactivity to RESA showed the lowest titres in primigravid women, intermediate titres in nulligravid women and the highest titres in multigravid women (loge mean antibody = 3.28, 4.64, and 5.28, respectively, P less than 0.03), but was not associated with initial parasite density or response to chloroquine treatment. No relationship in antibody reactivity to the 3 synthetic peptides of the RESA molecule was observed by gravidity (0, 1, or greater than or equal to 2), age, initial parasite density or response to treatment. Levels of antibody to the synthetic peptides of the CS protein increased with age and were higher in gravid than in nulligravid women in the 15-19 year age group. The increased malaria prevalence and parasite density and the decreased response to antimalarial treatment in pregnant women is not explained by lower levels of antibody to RESA or CS protein during pregnancy.