AHAIC 2017 ABSTRACT BOOK by onesmus okwogo

THEME:TOWARDS A HEALTHIER AFRICA,PEOPLE, SYSTEMS & INNOVATIONS Nairobi, Kenya

Radisson Blu Hotel, Nairobi

2017

Book of Abstracts

March 7-9, 2017

www.ahaic.org

Compiling Team Josephat Nyagero Desta Lakew Emma Gituku Harriet Mirieri

Layout and Design Team: Betty Muriuki JoeNancy Mararo Onesmus Okwogo 2

Table of Contents Word from the chair..................................................................................................Page 4 Objectives of Conference........................................................................................Page 5 Organizing Committee.............................................................................................Page 7 Scientific Committee................................................................................................Page 8 Abstract track directors and reviewers.................................................................Page 9 Description of plenary sessions .............................................................................Page 12 Abstract and Poster Sessions Day 1.......................................................................Page 20 Abstract and Poster Sessions Day 2.......................................................................Page 150 Abstract and Poster Sessions Day 3.......................................................................Page 298

Welcome

to the Africa Health Agenda InternationalConference (AHAIC 2017), which takes place at the Radisson Blu Hotel i n Nairobi, Kenya, from March 7-9, 2017. This conference is built on the successes of the 1st AHAIC, which was held in November 1517, 2014 at the Safari Park Hotel in Nairobi, and was jointly organised by Amref Health Africa and the World Health Organization. Close to 800 delegates will converge in Nairobi for this exciting event which facilitates exchange of scientific knowledge and research findings and stimulates debate on strategies, ideas and innovations. It promotes the application of knowledge to inform health care financing, human resources for health, community health systems strengthening, and evidence-based advocacy for policy and practice change in line with the SDG health agenda. Africaâ&#x20AC;&#x2122;s health agenda is a significant and unique part of the global health agenda, and must be treated as distinctive and special. One element of this unique agenda is the predominant role that preventable diseases play in the morbidity and mortalityofAfricaâ&#x20AC;&#x2122;s people and the gap that exists between communities and the health system. Arising from this is the need for formalisation of Community Health Workers in national civil service schemes as a strategy to increase access to health care for all and thus achieve universal health care on the continent. And so at the Opening Ceremony of the conference, we shall be launching the Workers not Volunteers campaign to bring attention to this issue and encourage governments to make CHWs a paid health worker cadre. AHAIC 2017 unveils the key role played by scientific research and its contributions to the achievement of the SDGs. It also provides an

Africa Health Agenda International Conference 2017

opportunityforresearchers, scholars and industry leaders to assess and come to an understanding of what universal actions are needed to reverse the health status of vulnerable populations and ensure vibrant and healthy communities across the continent. Eachcountryfacesspecificchallengestoachieving sustainable development. The commitment to strengthen international cooperation to address these persistent challenges and to ensure promotionofsocialequityisatthecoreoftheSDGs. In addition, achievement of the SDGs depends on global partnerships for sustainable development with active engagement of governments, civil society, the private sector, the United Nations system and other partners. During the initial period of implementation of the SDG framework, research inputs are critical to address major questions facing governments as they adopt the SDGs into country plans and strategies. AHAIC 2017 brings together health development professionals and researchers to share and evaluate evidence that can contribute to generating home-grown solutions to the health problems faced by the African continent. It also articulates the role and contributions of private sector in the achievement of the SDGs and transformation of the African continent. AHAIC 2017 has two exciting parallel events: a Youth Pre-Conference from March 5-6 opened officially by the First Lady of Malawi, Dr Gertrude Mutharika and the First Lady of Kenya Margaret Kenyatta, and a 48-hour hackathon to create innovative solutions to the issues that lead to maternal and child death. The Organising Committee has been working hard for the past one year to bring you a successful conference and I hope that you will find plenty to learn, share and discuss, and that at the end of it all, we will successfully define Africaâ&#x20AC;&#x2122;s health agenda.

Dr Githinji Gitahi Chairman, AHAIC Organising Committee

Objectives of the conference 1. To bring together researchers, policy makers, practitioners, the private sector, advocates for health and civil society together to reflect on home-grown solutions to achieving the Sustainable Development Goals across the continent 2. To share scientific research findings and best practices addressing health and health systems in Africa 3. To identify and discuss gaps and challenges in implementing the Sustainable Development Goals in Africa

7-9 March 2017 Nairobi, Kenya

Organizing Partners World Health Organization Ministry of Health Kenya Nairobi City County Government GSK Amref Health Africa

Organizing Committee Name

Organisation

Responsibility

Dr Githinji Gitahi

Amref Health Africa, HQ

Chair

Dr Festus Ilako

Amref Health Africa, HQ

Vice Chair

Dr Josephat Nyagero

Amref Health Africa, AMIU

Member

Desta Lakew

Amref Health Africa, AMIU

Member

Betty Muriuki

Amref Health Africa, HQ

Member

Susan Gitau

GlaxoSmithKline

Member

Dr Meshack Ndirangu

Amref Health Africa, Kenya

Member

Dr Joachim Osur

Amref Health Africa, Regional

Member

Charles Nzioka

Ministry of Health

Member

Hillary Kipchumba

World Health Organisation

Member

Victoria Kimotho

Amref Health Africa, Regional

Member

Rose Mungai

Amref Health Africa, HQ

Member

Kevin Oneill

Amref Health Africa, Canada

Member

Stella Kiguta Ng’ang’a

GlaxoSmithKline

Member

Emma Gituku

Amref Health Africa, HQ

Member

7-9 March 2017 Nairobi, Kenya

Scientific Committee Name

Organisation

Responsibility

Dr Josephat Nyagero

Amref Health Africa AMIU

Chair

Dr Joachim Osur

Amref Health Africa, Regional

Vice Chair

Dr Shiphrah Kuria

Amref Health Africa, Regional

Member

Dr Jane Carter

Amref Health Africa, AMIU

Member

Dr Nzomo Mwita

Amref Health Africa, HQ

Member

Dr Alice Lakati

Amref Health Africa, AMIU

Member

Dr George Kimathi

Amref Health Africa, HQ

Member

Dr Moses Alobo

GlaxoSmithKline

Member

Victoria Kimotho

Amref Health Africa, Regional

Member

Maarten Kuijpers

Amref Health Africa Netherlands

Member

Eddine Sarroukh

Philips

Member

Dr. Peter Cherutich

Ministry of Health, Kenya

Member

Cosmas Leonard

World Health Organisation

Abstract Manager

Harriet Mirieri

Amref Health Africa, HQ

Secretariat

Emma Gituku

Amref Health Africa, HQ

Coordinator

Africa Health Agenda International Conference 2017

Abstract Track Directors and Reviewers Name

Role Organization

Prof Mabel Nangami

mnnangami@gmail.com

Moi University

Prof Ellen Chirwa

embweza@kcn.unima.mw

Kamuzu University, Malawi

Prof Colin Binns

C.Binns@curtin.edu.au

Curtin University, Australia

Prof Fred Wabwire

fwabwire@musph.ac.ug

Makerere University

Prof Margaret Keraka Dr Moses Alobo

mnyajokah@gmail.com moses.s.alobo@gsk.com

TD TD

Kenyatta University GSK

Dr Josephat Nyagero

josephat.nyagero@amref.org

Amref Health Africa - AMIU

Dr Joachim Osur

joachim.osur@amref.org

Amref Health Africa - HOs

Dr Ryan Wiley

rwiley@shifthealth.com

Amref Health Africa – CA

Dr Jane Carter

jcarter@iconnect.co.ke

Amref Health Africa - AMIU

Dr Hillary Kipruto

kiprutohi@who.int

WHO

Dr Chris Paton

chris.paton@ndm.ox.ac.uk

Oxford University, Britain

Dr Bob Bortoluss

Bob.Bortolussi@iwk.nshealth.ca

Dalhousie Med, Canada

Dr Rita Noronha

Rita.Noronha@amref.org

Amref Health Africa – TZ

Prof. Mohamed Karama

mkarama@umma.ac.ke

Umma University

Prof Joyce Olenja

jolenja@gmail.com

University of Nairobi

Prof Duncan Saunders

duncans@ualberta.ca

University of Alberta

Pius Chaya

Pius.Chaya@amref.org

Amref Health Africa – TZ

Micah Matia’ngi

Micah.Matiangi@amref.org

Amref Health Africa - AMIU

Dr. Nzomo Mwita

Nzomo.Mwita@amref.org

Amref Health Africa - HQs

Dr. George Kimathi

George.Kimathi@amref.org

Amref Health Africa - HQs

Dr Tom Arunga

Arungatom65@gmail.com

MoH-Kenya

Dr Sophie Ochola

ocholasa55@gmail.com

Kenyatta University

Dr Shiprah Kuria

Shiphrah.kuria@amref.org

Amref Health Africa – HQs

Dr Sarah Masyuko

smasyuko@uw.edu

NASCOP

Dr Peninah Masibo

pmasibo@aphrc.org

APHRC

Dr Nyawira Gitahi Kamau nyawira.n.gitahi-kamau@gsk.com

GSK

Dr Nekoye N Otsyula

nekoye.n.otsyula@gsk.com

GSK

Dr Maurice Odindo

modindo@communityinitiative.org R

Community Initiative

Dr Mark Mudenyo

Mudenyo@yahoo.com

Kenyatta National Hospital

7-9 March 2017 Nairobi, Kenya

Dr Margaret Makumi

margaretmakumi@gmail.com

HFECD, Global Fund

Dr Margaret Mungai

Margaret.mungai@amref.org

Amref Health Africa – KE

Dr Koki Kinagwi Dr Janet Muriuki Dr Florence Temu

Koki.kinagwi@amref.org jmuriuki@intrahealth.org Florence.temu@amref.org

R R R

Amref Health Africa – KE IntraHealth Amref Health Africa – TZ

Dr Eric Mugambi

ericmugambi@gmail.com

GSK

Dr Caroline Kabiru

ckabiru@aphrc.org

APHRC

Dr Beatrice Gatumia

Beatrice.w.gatumia@gsk.com

GSK

Dr Anne Geniets

Anne.geniets@education.ox.ac.uk

Oxford University

Dr Alison Morgan

apmorgan@unimelb.edu.au

Melbourne University

Dr Alice Lakati

Alice.lakati@amref.org

Amref Health Africa - AMIU

Samuel Muhula

Samuel.muhula@amref.org

Amref Health Africa – KE

David Ngilangwa

david.ngilangwa@amref.org

Amref Health Africa – TZ

KEY TR-Track Director R-Reviewer Description of Plenary Sessions

Africa Health Agenda International Conference 2017

Session Coding for AHAIC 2017 Week Day TU – Tuesday WE – Wednesday TH – Thursday

Session Type ABO – Abstract Oral PE – Poster Exhibition PS – Plenary Session Order -1, 2, 3… Speaker Order – 01, 02, 03…

7-9 March 2017 Nairobi, Kenya

Description of Plenary Sessions

DAY ONE, Tuesday March 7, 2017 TIME: 0830-1000 Plenary 1 Addressing bottlenecks affecting health systems in communities of Africa: Strategies, achievements, challenges and the way forward Venue Kilimanjaro Ballroom Welcome Dr Festus Ilako - Looking Forward, AHAIC 2017 Moderator Prof Fred Wabwire Mangen, Makerere University and Regional Centre for Quality of Health Care (RCQHC) Keynote Speakers Dr Delanyo Dovlo, Director, Health Systems Strengthening Cluster, World Health Organization, Regional Office for Africa Dr Marc-Alain Widdowson, Deputy Director, Centres for Disease Control and Protection (CDC) Kenya Panelists Prof Richard Muga, Uzima University, Kenya Prof Francis Omaswa, Executive Director, African Centre for Global Health and Social Transformation (ACHEST) Dr Davide Mosca, Director of Health Division, International Organisation for Migration (IOM) Description This first plenary of the AHAIC 2017 aims at examining the bottlenecks that are hindering the attainment of Universal Health Coverage (UHC) in sub-Saharan Africa, achievements to date and strategies for attaining UHC and the Sustainable Development Goal Number 3 targets. After the keynote address, there will be a panel discussion with contributions from experts and delegates to come up with five actions to accelerate the implementation of health-related Sustainable Development Goals in Africa. The session will discuss high-impact priorities and policy issues that should be addressed to unlock health systems bottlenecks such as empowering communities, devolution, replacing verticalisation with integration, proactive strategic planning and investment in current and future health threats and events, and improving access to and quality of health services. Others are addressing health systems barriers such as shortage of health professionals, inadequate healthcare financing, low adoption of technology and innovation, low research outputs on the continent, poor data quality and inadequate use of evidence for decision-making, and how to ensure better policies and governance.

7-9 March 2017 Nairobi, Kenya

DAY ONE, Tuesday March 7, 2017

Time 1030 – 1130

Plenary 2A AHAIC 2017 Official Opening Ceremony Venue Kilimanjaro Ballroom Master of Ceremonies Caroline Mutoko Speakers Dr Githinji Gitahi, Group Chief Executive Officer, Amref Health Africa Mr David Pritchard, Vice-President, GlaxoSmithKline (GSK) Youth Preconference Representative Dr Matshidiso Moeti, Regional Director, World Health Organization, Africa Regional Office Chief Guest Dr Cleopa Kilonzo Mailu, Cabinet Secretary, Ministry of Health,Kenya Time1130 - 1245 Plenary 2B Health Ministerial Panel: Response to and preparedness for health threats in Africa Venue Kilimanjaro Ballroom Moderator Dr Githinji Gitahi, Group Chief Executive Officer, Amref Health Africa Lead Discussant Amb Dr Mustapha Sidiki Kaloko, Commissioner for Social Affairs, African Union Commission Panelists Dr Cleopa K Mailu, Cabinet Secretary, Ministry of Health, Kenya Dr Jane Ruth Aceng, Minister for Health, Uganda Hon Mahmoud Thabit Kombo, Minister for Health and Social Welfare, Revolutionary Government of Zanzibar Dr Hamisi Kigwangalla, Deputy Minister for Health and Social Welfare, Community Development, Gender Services and Children, United Republic of Tanzania Dr Raymonde Goudou-Coffie, Ministre de la Santè et de l’Hygiene Publique, Cote d’Ivoire

Africa Health Agenda International Conference 2017

Description Immediately following the official opening ceremony of the AHAIC 2017, a health ministerial panel will discuss threats to global health security in Africa with the objective of shedding light on their respective countriesâ&#x20AC;&#x2122; and Africaâ&#x20AC;&#x2122;s preparedness for emerging and re-emergent health events and threats, and on the role of governments, the African Union, Regional Economic Commissions and non-state actors. The session will culminate in the launch of a Community Health Worker campaign, highlighting partner commitments to implementation of national community health strategies to tackle health threats and health systems weaknesses. The campaign also emphasizes the important role, community health workers play in addressing health systems gaps like shortage of health professionals, poor uptake of health promotion and disease prevention interventions, poor data quality and inadequate use of data and evidence for decision-making at household, community and sub-national levels. DAY TWO, Wednesday March 8, 2017 TIME 0830-1000 Plenary 3 Impacting health in Africa through public-private partnerships: Lessons, challenges and future actions Venue Kilimanjaro Ballroom Moderator Prof Bitange Ndemo, University of Nairobi Keynote Speaker Dr Marijke Wijnrok, Chief of Staff, The Global Fund Panelists Bruno Witvoet, Executive Vice-President, Unilever Africa Isabel Torres, Senior Director, Access to Medicines Emerging Markets, Takeda Pharmaceuticals Ian Walker, Corporate Citizenship Director, Johnson&Johnson Prof Khama Rogo, Health Sector Specialist and Head, World Bank Group Health in Africa Initiative Ashling Mulvaney, Senior Director, Healthy Heart Africa, AstraZeneca PLC Description Mixed public and private healthcare systems characterise developing countries, Africa included. There are inadequate policies and broad frameworks on how public and private sectors can better collaborate to address the problems of health financing, access and quality. The overall investment in health systems strengthening in sub-Saharan Africa remain low, thereby impacting negatively on the health of the population. Countries that have robust private sector involvement and investment in health have stronger and more responsive healthcare systems. This plenary session will stimulate discussion and debate on the priorities of private sector investment on the continent and the role of multi-sectoral funding mechanisms to loop in private sector funding and investments. The keynote speaker will share experiences and lessons from the Global Fund against AIDS, Tuberculosis and Malaria, and how this multi-stakeholder funding model has impacted the lives of millions women and child across the developing world. The keynote presentation will be followed by a panel discussion on the role of private sector on health outcomes in Africa. 7-9 March 2017 Nairobi, Kenya

DAY TWO, Wednesday March 8, 2017 TIME 1030-1130 Plenary 4 Implementation of the health Sustainable Development Goals in Africa: Strategies, lessons and next steps Venue Kilimanjaro Ballroom Moderator Edwin Macharia, Partner and Regional Director for Africa, Dalberg East Africa Keynote Speaker Mr Siddharth Chatterjee, UN Resident Coordinator and UNDP Resident Representative Panelists Neren Rau, Director, External Affairs and Communications, MSD (Pty) Ltd South Africa H E Mrs Toyin Saraki, Founder, Wellbeing Foundation, Nigeria Dr Marc-Alain Widdowson, Deputy Director, Centres for Disease Control and Protection (CDC), Kenya Diarietou Gaye, Country Director for Kenya, Rwanda, Eritrea, Uganda, Africa, The World Bank Description This plenary will explore the status of the implementation of health-related SDGs in Africa. The keynote speaker will share experiences in the past 12 months of the implementation of the SDGs from a multilateral funding institution perspective. He will also share insights on strategies that work, lessons learnt and steps needed to galvanise the international community and the Africa to accelerate achievement of the SDGs.

DAY THREE, Thursday March 9, 2017 TIME 8.30-10.00 Plenary 5 The role of innovations and technology in improving health services in Africa Venue Kilimanjaro Ballroom Moderator Prof Melba Wasunna, Strathmore University Keynote Speaker Robert Collymore, Chief Executive Officer, Safaricom Ltd

Africa Health Agenda International Conference 2017

Award of Winners of the Innovate4Life Hackathon Desta Lakew, Fundraising and Partnerships Director, Amref Health in Africa Panelists Roelof Assies, General Manager, Philips East Africa Nicole Spieker, Director of Quality, PharmAccess Foundation, Amsterdam Rita Owino, Market Development Manager, Primary and Referral Care, GE Healthcare Description Disruptive innovations buoyed by recent advances in mobile and other technologies have the potential to democratise health care, and improve access to and quality and affordability of critical health services. However, for this to have any impact, governments, civil society, private sector and communities should work collaboratively to develop and scale up technological and non-technology-based innovations and business models. This plenary session will focus of the role of technology and innovations in attaining the health SDGs, the importance of public-private collaborations, and investments necessary for this to happen. A keynote presentation will be followed by panel discussions and commentaries, and awarding of the winner of the Innovate4Life hackathon on maternal health.

DAY THREE, Thursday March 9, 2017 TIME 1030-1130 Plenary 6 Antimicrobial resistance Venue Kilimanjaro Ballroom Moderator Dr Zonke Mlokoti-Fikeni, GSK Area Medical Lead, Africa & Asia DC Keynote Speakers Prof Charles Feldman, University of Witwatersrand, SA Prof Gunturu Revathi, Consultant Clinical Microbiologist, Aga Khan University Hospital, Nairobi Description Antimicrobial resistance is an emergent global health crisis and threat. AMR impacts on the health of populations, governments and communities in terms of increased cost of care, morbidity and mortality. The threat of AMR calls for action by governments, health managers and professionals, and the private sector aimed at prevention. The penultimate plenary is dedicated to discussing the problem of superbugs and the emerging global problem of microbial resistance. There will be a keynote address, panel discussion and commentaries by global experts in the field on AMR. The presenters will cover the burden of the problem, some lessons learnt and strategies to reduce the impact of microbial resistance on the continent. 7-9 March 2017 Nairobi, Kenya

DAY THREE, Thursday March 9, 2017 TIME 1430-1530 Plenary 7 Moving towards Universal Health Coverage: The critical role of effective stewardship of mixed health systems Sponsored by The Rockefeller Foundation Venue Kilimanjaro Ballroom Moderator Mr Nathaniel Otoo, Chief Executive Officer, Ghana National Health Insurance Authority Keynote Speaker Mr Nathaniel Otoo, Chief Executive Officer, Ghana National Health Insurance Authority Panelists Prof Stella Anyangwe, Global Health Expert, Honorary Professor of Epidemiology, University of Pretoria School of Health Sciences and Public Health, and former WHO Country Representative Dr Francis Ukwuije, Senior Health Economist and Head of HealthCare Financing, Equity and Investment, Federal Ministry of Health, Nigeria Dr Amit Thakker, Chairman, Africa Healthcare Federation Mrs Sinit Mehtsun, Joint Learning Network Coordinator Description This session will highlight how countries in the Joint Learning Network (JLN) are moving towards Universal Health Coverage (UHC) and strengthening stewardship of their mixed health systems. Session speakers from Ghana, Kenya, and/or Nigeria will highlight their key challenges and practical solutions in building public sector stewardship capacity and harnessing the private sector to achieve UHC. The format of the session will include a keynote address on UHC and an interactive, Davosstyle discussion among speakers and the audience members. Proposed speakers will provide a mix of perspectives, including policymakers, private actors and international development partners.

Africa Health Agenda International Conference 2017

DAY THREE, Thursday March 9, 2017 TIME 1530-1630 Plenary 8 Closing Ceremony Venue Kilimanjaro Ballroom Master of Ceremony Ms Caroline Mutoko Keynote Speakers Dr Githinji Gitahi, Group Chief Executive Officer, Amref Health Africa Mr Omari Issa, Chair, Amref Health Africa International Board Dr Nicholas Muraguri, Principal Secretary, Ministry of Health, Kenya Dr Evans Kidero, Governor of Nairobi City County, Republic of Kenya Chief Guest H E Dr J M Kikwete, immediate former President of the United Republic of Tanzania Vote of Thanks Anne Marie Kamanye, Amref Health Africa in Canada

7-9 March 2017 Nairobi, Kenya

Abstracts and Poster Sessions Day 1

Tuesday TUABO01 Combined demand and supply side strategies: community based distribution approach for improving family planning/reproductive health services uptake in Western Kenya. Sherine Athero , Michael Mutua , Richard Muga 1 2 African Population and Health Research Center, Kenya, Uzima University 1

Issues 8 Unmet need for family Planning (FP) is high in many parts of the world particularly in rural, poor populations. Access and use ofcontraceptives reduces unwanted pregnancies, unsafe abortion hence improving maternal and child health. Western counties in Kenya, which are largely rural consistently, recorded high unmet need for FP. The high transportation cost,myths and misconceptions are common barriers. Description Between 2009 and 2017, APHRC led a consortium of partners to implement FP community-based distribution (CBD) project to increase supply and demand for FP services in Siaya and Busia Counties. The project targeted women of reproductive age and men as secondary target. The activities involved training of health workers, demand creation, service provision, data collection, dissemination and advocacy for investments and change of attitude to FP/RH. Lessons The combined demand and supply intervention through CBD works best in poor access areas. The increased distribution outlets by 600 CHVs and 4 mobile outreaches increased number of FP users by 46,353 new clients. It influenced positive FP switching behavior from short to long acting methods; from 1,634 clients served with BTL, 56% formerly used pills and injectable, 26% new users. Of the 19,745 clients served with implants, 46% formerly used pills and injectable, 46% new users. Of 2240 clients served with IUCD, 46% formerly used pills and injectable, 41% new users. The consortium approach is best in maximizing achievements within limited resources and avoiding duplication of efforts. Recommendations There is need for intensive advocacy activities to mobilize county government and implementing partners to adopt the strategy in other counties with high TFR and low CPR. For sustainability, there is need for continues resource allocation to FP/RH to cater for stipend to CHVâ&#x20AC;&#x2122;s activities. It is therefore essential to work towards institutionalization of successful project activities into the existing government structures for sustainability.

7-9 March 2017 Nairobi, Kenya

TUABO02 Political economy analysis of family planning. Maureen Olyaro Christian Aid Background While contraceptive prevalence rate and other family planning (FP) indicators in Kenya are improving steadily, there still exist vast regional disparities, which call for a deeper understanding of the underlying power and governance context within which FP service delivery takes place. Kenya is among the 69 countries under the FP2020 global movement that have signed commitments to address the barriers to women accessing contraceptive information, services and supplies. Methods This is a qualitative study using the Political Economy Analysis (PEA) Framework. In addition to a desk review, 6 focus group discussions and 9 in-depth interviews were used to collect information from women of reproductive age, men and youth. The participants were purposively sampled. Qualitative methods were used to explore the context and institutional issues as well as motivations, incentives and behaviors that drive FP uptake in the community. Discussions and interviews were recorded and analyzed manually. Results Communities are willing to join the spaces nominally created by devolution, claim and open up new spaces for engagement, including scrutiny mechanisms and joint for dialogue. Analysis revealed gaps in accountability around commodity security that can be plugged by establishing civil society/citizen participation in tracking commodities. Lack of accountability for funding for FP is evident through a largely donor funded FP commodity budget. This undermines the Government's ability to feel responsible and answerable to resourcing FP and the community's ability to hold the government accountable. Collective and individual action weakness has led to apathy towards FP service delivery and has resulted in communities' reluctance to hold service providers accountable. Conclusions and Recommendations Need to establish, increase and improve the engagement between communities and national/ county governments in FP service delivery. Further, there is need to address the power imbalances that hinder women and youth from claiming their right to access FP.

Africa Health Agenda International Conference 2017

TUABO03 Improved access and utilisation of maternal health services: Women’s group approach in Gulu and Amuru districts in Northern Uganda. Margaret Mugisa , Patrick Kagurusi , Paul Gabula , Aweno N. 1

Amref Health Africa in Uganda

Issue Women group (WG) approach has contributed to notable health outcomes as demonstrated in many countries in the world and contributes towards SDG 3and 5. Women through the participatory learning action cycle (PLAC) have shown that maternal and newborn health strategies improves the capacity of families and communities to reduce maternal and infant deaths; provides appropriate care to pregnant women, mothers and newborns and improve care seeking behaviour. Despite the benefits, little is documented about the women group approach in improving access and utlisation of maternal health services in Gulu and Amuru districts. Intervention Using the PLAC approach, Women groups are taken through a four phase process facilitated by a trained Woman Group facilitator, in which women’s groups collectively decide priorityactions, and organize activities accordingly. Amref Health Africa through its three year (2014-2017) project in Northern Uganda has used the PLAC approach to establish 150 women groups, facilitate health Assistants to monitor WGs; facilitate district support supervision exercises; link WGs to partners and engage stakeholders in advocacy. WGs have used strategies inclusive of group laws; use of Village Saving and Loans Association; health education; communal farming to improve access and utilisation of maternal health services. The year three results against baseline indicate improvement in PNC within 24 hours increase from 9 % to 10%; male partners accompanying women for ANC from 68.7 to71. %; pregnant women referred by VHTs from 0% to 28 %. Four or more ANC visits from 32.82% to 38 % and women in reproductive age reporting facilities to be highly accessible from 43% to 59%. Lessons learnt Women group approach empowers women make informed decisions to access and utilise health care services. Men involved in WGs are more supportive of their spouses’ access and utilise health services Collaborative engagement with WGs contribute to better utlisation of health services. Key words Women Groups; Participatory learning action cycle.

7-9 March 2017 Nairobi, Kenya

TUABO04 Factors associated with recruitment and retention of Community Health Workers in Maternal, Newborn and Child Health Programme in Simiyu Region, Tanzania. David Paul Ngilangwa , Benatus Sambili , Godfrey Matumu , Rita Noronha 1

Amref Health Africa in Tanzania

Background Effectiveness of Community Health Workers (CHWs) in delivery of Maternal and Child Health (MNCH) programmes has been widely documented. However, their attrition continues to be a serious threat to the sustainability of such programmes. From 2011 to 2014, Amref Health Africa recruited and trained 3,924 CHWs to work in MNCH programme in North-western, Tanzania aiming at improving MNCH services by strengthening formal and community health systems. We conducted this study to understand factors associated with CHWs recruitment and their retention. Methods In this cross-sectional study design conducted in October 2014 in Simiyu region, we randomly selected 341 CHWs who were working with the programme. Structured questionnaires were administered to solicit factors for recruitment, retention and attrition. Data were descriptively and inferentially analyzed SPSS version 20. Results 341 current CHWs participated in this study. Majority of them were below 35 years (58%), women (54%) and with primary education (53%). Motivation factors for being CHW were aspiration to serve the community, desire for further training to become qualified medical practitioner, use of free time productively and financial gain. Attrition rate of CHWs over three years was 12.7%. The main reason given was relocation (p<0.001). While community recognition, and financial incentives were among the key retention reasons for the CHWs. However, being married (Odds Ratio (OR) 5.9, 95% Confidence Interval (CI) 1.7-20.1), having prior-volunteer experience (OR 10.5 95% CI 12.740.5) and prior-employment were positively associated with retention of CHWs. Besides, married women were less likely as compared to the men counterparts to remain as CHWs. Conclusions Our study found that, both financial and non-financial incentives were critical in contributing to the retention of CHWs. We recommend that CHWs programmes to carefully select its CHWs by understanding their motives beforehand; provide incentives; and regular supportive supervision to facilitate their retention.

Africa Health Agenda International Conference 2017

TUABO05 A decade of progress providing safe abortion services in Ethiopia: results of national assessments in 2008 and 2014. Yohannes Wado , Sally Dijkerman , Tamara Fetters 1

Ipas

Background Ethiopia has one of the highest maternal mortality ratios in the world (420 per 100,000 live births in 2013) and unsafe abortion continues to be one of the major causes. To reduce deaths and disabilities from unsafe abortion, Ethiopia liberalized its abortion law in 2005 to allow safe abortion under certain conditions. This study aimed to measure how availability and utilization of safe abortion services has changed in the last decade in Ethiopia. Methods This paper draws on results from nationally representative health facility studies conducted in Ethiopia in 2008 and 2014. The data came from three sources at two points in time: Interviews with 335 health providers in 2008 and 822 health care providers in 2014, review of facility logbooks, and prospective data on 3,092 women in 2008 and 5,604 women in 2014 seeking treatment for abortion complications or induced abortion over a one month period. The Safe Abortion Care Model was used as a framework of analysis. Results There has been a rapid expansion of health facilities eligible to provide legal abortion services in Ethiopia. Between 2008 and 2014, the number of facilities reporting basic and comprehensive signal functions for abortion care increased. Access to basic abortion care services has exceeded the recommended level of available facilities providing the service, increasing from 25% to 117%, with more than half of regions meeting the recommended level. Comprehensive abortion services increased from 20% of the recommended level in 2008 to 38% in 2014. Smaller regions and city administrations achieved or exceeded the recommended level of comprehensive service facilities, yet larger regions fall short. The use of appropriate technology for conducting first and second trimester abortion and the provision of post abortion family planning has increased at the same time abortion-related obstetric complications have decreased. Conclusion Ten years after the change in abortion law, service availability and quality has increased, but access to lifesaving comprehensive care still falls short of recommended levels.

7-9 March 2017 Nairobi, Kenya

TUABO06 District health team-led supervision of community based family planning services: what do findings suggest to strengthen the community based service delivery system? Evarine Nampewo , Ramadhan Kirunda , Joshua Thembo , Fred Mubiru 1

Busia District Local Government, FHI 360, Uganda 2

Issues Advancing Partners & Communities (APC) project in support of Ugandaâ&#x20AC;&#x2122;s Ministry of Health (MOH) advances community programs that seek to improve the overall health of communities, especially in relation to family planning (FP) provided by community Health workers (CHWs) across 16 districts. CBFP services are expected to continue beyond APC project and CHWs are expected to carry forward CBFP service delivery with support from District Health teams (DHTs) which are mandated to provide logistical and technical support to Health facilities and CHWs. Description Thirteen (13) districts were purposively selected to use this approach, and from these, 52 health facilities were randomly selected and assessed by the DHTs. Results indicated that 87% (45) of the health facilities had received District level supervision in the previous three months of which 56% (25) had integrated CBFP in the supervision, (33%, n=17) had enough FP supplies to sustain CBFP services, 94% (49) of the available midwives had been trained on CBFP and held at least 2 CBFP meetings with the CHWs in the previous three months, 67% (35) and 71% (37) of the health facility incharges and records assistants respectively are involved in CHW CBFP services and 83% (43) health centers had reported CBFP data in the Health Management information system (HMIS105) in the last two months. Lessons Learnt DHT involvement has potential for increased ownership and support to Community Based Health service delivery system at facility and district level, better system responsiveness, upward and downward accountability plus continued access to health services at community level. Recommendations Development programs directly working with CHWs should focus on linking them to the District level/main stream health system. Many approaches can be used, one of them being district led supervision of community based services delivery which brings in the aspects of accountability, responsiveness, better relations and responsibility in healthcare.

Africa Health Agenda International Conference 2017

TUABO07 Integrating revenue mobilization in maternal health projects at the local level Ernest Okyere Christian Aid, Ghana Issue Despite some improvements in Ghanaâ&#x20AC;&#x2122;s healthcare since 2000, there are still enormous fiscal challenges within the health sector. Government allocation for health consistently falls below the Abuja Declaration target of 15%. In spite of some donor grants supplementing the government budget, there are still stark logistical inadequacies in the health system. In view of the need for sustainable health financing, particularly for maternal health services, there is a need to integrate local revenue mobilization in development projects. Description This project integrated tax education into a maternal health project to boost internally generated revenue as a means to better health service provision. Lessons learnt An increase in citizen knowledge on taxation led to increased civic responsibility towards tax obligations, increased citizen demand fortransparencyin the collection oflocal taxes and expenditure, increased local authority oversight of revenue mobilisation mechanisms, and increased allocations to health and increased accountability. Leveraging same platform to discuss maternal health issues, particularly challenges juxtaposed against local revenue generation practices brought to the fore the urgency for local authorities and the citizenry to work together to improve revenue generation and this has significantly increased local government trust and respect for the citizenry and enhanced citizen participation in local government processes. Recommendations It is imperative that local revenue generation, accountability and their links to sustainable health financing be mainstreamed in health projects as much as possible. Citizensâ&#x20AC;&#x2122; understanding of the different types of taxes/levies they pay, the rights they have to hold duty bearers accountable and their responsibility as citizens should be continuously discussed by development partners as a priority intervention area.

7-9 March 2017 Nairobi, Kenya

TUABO08 Exploring the impact of devolution on health equity in Kenya. Rosalind McCollum , Lilian Otiso , Robinson Karuga , Sally Theobald , Tim Martineau , Miriam 1 Taegtmeyer 1

Liverpool School of Tropical Medicine, Great Britain, LVCT Health Kenya,

Background Devolution of services (including health) to 47 new locally elected governments in Kenya has been described as a means to address inequities, but will not necessarily do so without the expressed commitment of county level health planners and service providers to address and monitor access, use and quality of health services for all. Objective We sought to understand perceptions of equity, the implications of devolution for health equity and solicit recommendations for more equitable and responsive approaches across the health system. Methods We collected qualitative data through 14 national level key informant interviews, 117 in-depth interviews with county level decision makers across ten counties, 136 interviews with health workers and community stakeholders from sub-county to community level and 14 focus group discussions with community members from three counties. Qualitative data were digitally recorded, transcribed and coded before thematic framework analysis. Results Health infrastructure, health worker recruitment and equipment were priorities for many counties. Respondents at community and health facility levels described mixed felt impact of devolution. Geographic access has improved through infrastructure investment, but this has not been consistently complemented by commitment to quality with lack of equipment, staff, drugs and commodities in some counties. Financial access has been promoted through free maternal health care and elimination of user fees at dispensaries and health centers. However lower, irregular drug supply and payment of funds (including compensation for skilled deliveries) to health facilities in some counties, has compromised the ability of health workers to provide outreach services and/or comprehensive quality services to all patients. Conclusion and recommendations Three years following devolution, a mixed picture is emerging of its influence on equity of health services. The counties studied have taken steps to increase availability of services, but must adequately address coverage and quality of those services for the most vulnerable.

Africa Health Agenda International Conference 2017

TUABO09 Creating sustainable Community Health Insurance Schemes by leveraging from National Social schemes. Heri Marwa , Prosper Msuya 1

PharmAccess, Tanzania

Issues Recently, there has been renewed interest on Community Health Insurance in Africa as a means to steer the countries towards Universal Health Coverage. However, most of the established CBHF fail to sustain due to small risk pool and management challenges. PharmAccess (PAI), a Dutch NGO has supported National Health Insurance Fund (NHIF) in Tanzania to pilot CHBF scheme, which leverage on experience and NHIF management with Community based advantages of CBHF to create a sustainable scheme which is considered to be future model for creating sustainable Community schemes in Africa. Description Following health sector reforms, Tanzania government introduced NHIF which is mandatory for government employees and voluntary scheme, Community Health Fund (CHF) for informal sector. All districts in Tanzania are required by law to establish voluntary CHF. Despite 50% premium subsidy offered by Tanzania Government for every enrolled household, CHF have failed to prosper, with national average of less than 7% since its establishment in 2001.To turn around CHF into sustainable scheme, PAI signed agreement with NHIF to support piloting of new model of CHF in Kilimanjaro region. With the new model, NHIF takes over management of the scheme; hence capitalizing on infrastructure and management experience on insurance. Risk pooling is shifted from district level to regional level. Enrollment is done by trained volunteers at household level and Council health service body, made by community member oversees operations of CHF. All private and public facilities are contracted to provide services. Lesson learnt After only 18 months, average of 7% enrollment has been reached, with re-enrollment rate of 31%. Scheme is becoming more sustainable and actuarial calculations shows scale will be reached when 30% of community is enrolled. From this ongoing pilot, we learnt that Community schemes can be sustained by capitalizing on advantage of having National Health Insurance Schemes. Next steps Following the success, NHIF have prepared a document to roll out improved CHF in 7 new regions of the country.

7-9 March 2017 Nairobi, Kenya

TUABO10 Influencing access to reproductive health services through incentivizing of community health volunteers (CHVS) in Bumula Sub-County. Lawrence Auma , Oliver Furechi 1

Save the Children International, Kenya

Issues A key challenge in health care service delivery at community level is how to ensure sustainable motivation for CHV (Community Health Volunteers). Due to economic constrains, most of the CHVs stop their services to the households and focus on their households’ livelihoods. CHVs don’t meet regularly due to their focus on their livelihoods and thus do not benefit from the peer to peer support, accountability and mentorship that regular meetings provide. Description: Village Savings and Loaning Associations (VSLA) is a livelihoods’ participatory approach intervention that unites the group members to solve theireconomic challenges as theydiscuss and solve community health-related issues. Save the Children supported the VSLA initiation within 33 community health unit (CHU) in Bungoma County since 2015. Out of the 775 members implementing VSLA, 765 (98.7%) have been retained.The group members meet weekly to discuss community health issues and buy shares and take/repay loans. Lessons learnt Participating in the VSLA has strengthened groups cohesion thus improved health care services at the household. Wetoto (a sub county public health focal person in one of the sub counties in Bungoma County) says, “Since CHU members embraced the VSLA, almost no CHV misses meetings”. Monicah, his counterpart in another sub county affirms that; “Nowadays the households’ visits are done with quality because the CHVs are interested in their work and they meet regularly to share their work experiences among themselves”. She continues, “even the number of the CHV’s drop out has gone down to about 2%.” On the other hand, Emily a CHV, says, “I am very happy that VSLA has helped me as a widow to pay for my children’s school fee as well as putting up a semi-permanent house for myself”. Recommendations Since there is an improved CHVs motivation, the VSLA methodology should be adopted to improve community health strategy. The intervention has addressed CHU’s health care sustainability, reduce attrition rate of the CU members and improve groups’ cohesiveness.

Africa Health Agenda International Conference 2017

TUABO11 The policy context and health service delivery to key and vulnerable populations at cross border sites: Experience from CB-HIPP project, Kenya. Dorothy Muroki , Boniface Kitungulu, Joyce Olenja, Missie Oindo, Leanne Kamau, Denise Juma, Fridah Muinde, Martin Sirengo and Helgar Musyoki. 1

FHI 360, Kenya

Background The Cross-Border Health Integrated Partnership Project (CB-HIPP) is designed to extend quality, integrated health services to mobile key and vulnerable populations in strategic border areas in East, Central and Southern Africa focusing on Burundi, Kenya, Rwanda, Tanzania and Uganda. Objectives One of the focal areas for CB-HIPP is to improve the policy environment for seamless service delivery to mobile cross border key populations including female sex workers (FSW); men who have sex with men (MSM); and people who inject drugs (PWID) and vulnerable populations including Long distance truck drivers (LDTDs) and Clearing and Forwarding Agents (CFA). Methods The assessment included: three cross-border sites (Busia, Malaba, and Taveta) and 2 fishing/wet border sites (Muhuru Bay and Sio Port/Port Victoria). The study utilized qualitative methods including 30 Key informants, 33 Focus group discussions and 120 In-depth interviews that were subjected to content analysis. Results The current guidelines are general and do not specifically address the needs of key populations. Gaps in policy include lack of specific guidelines on how to treat patients from neighbouring countries as well as lack of uniformity in service delivery for PLHIVs. The key concern was about treatment regimen for HIV which is different for Kenya, Tanzania and Uganda, posing a challenge to clients who cannot get refills when stuck in a foreign country. Current policies have not been helpful in addressing issues of discrimination against MSM and PWID, resulting in poor health seeking behaviour. This is exacerbated by minimal familiarity of key populations among county health management and service providers. Conclusions and Recommendations There are Policy gaps in the provision of services to mobile key populations. There is need to review health policy, harmonization treatment regimens at regional level, sensitization and training health service providers for provision of quality services to key and vulnerable populations at cross border sites. .

7-9 March 2017 Nairobi, Kenya

TUABO12 The policy context and health service delivery to key and vulnerable populations at cross border sites: Experience from CB-HIPP project, Kenya. Thu Vu , Katalin Buzasi 1

Amsterdam Institute of International Development (AIID), Netherlands

Background It is recognized that economic growth does not always bring equal benefit for all. This gives rise to the concept of “inclusive growth”, which concerns how improvement in income and other wellbeing dimensions is distributed across society. For Kenya, how have differently groups in the society benefited differently in terms of health and other non-income dimensions in the last decade? Is the “growth” inclusive? Methods We first investigate and compare the existing concepts and measurements of inclusive growth used by various international organizations and scholars. Secondly, we overview the empirical literature which identifies the channels through which health influences income and other aspects of development, and correspondingly, how do social protection programs play a role in making growth more equitable. Third, using data from the Kenya Demographic and Health Surveys (20089, 2014) we analyze if changes in Kenya in terms of health and other non-income dimensions can be considered as inclusive according to the existing concepts and measures. Results Inclusiveness of the change in health differs remarkably across different well-being indicators and divisions of groups in the society, as well as across different measurements of inclusive growth at hand. For example, even in one geographic area different ethnicities show contrasting trends in health improvement. Moreover, groups that benefit very poorly in one health indicator tend to have the same trend in several other indicators (both income and non-income), which suggests the impoverishment effect of health. Conclusions and Recommendations The striking disparity of health change across different groups in the society provides valuable insights into the dynamic of the existing socio-economic and cultural determinants of growth.The awareness of left-behind groups in the course of growth helps policy makers and social workers identify appropriate interventions. Key words Inclusive growth, health, social protection, development

Africa Health Agenda International Conference 2017

TUABO13 Kangaroo mother care: A cost effective strategy in reducing neonatal deaths due to low birth weight and preterm birth complications. Linvell Chirwa Ministry of Health, Malawi Background Every year 4 million babies die in the first four weeks of life and almost all the neonatal deaths arise in low-income and middle-income countries, Malawi inclusive. Objectives The study aimed at improving the effectiveness of Kangaroo Mother Care services at Mitundu Community Hospital through mobilization of supplies and equipment, increasing the number of babies benefiting from KMC services, ensuring family involvement, strengthening referral system and capacity building in the provision of Kangaroo care services. Methods Baseline analysis on the causes of neonatal deaths for the six month preceding the project at the facility was done and main causes of neonatal deaths were identified. The Kangaroo care room was improved by putting in place an electric heater, incubator, wall clock, stationery and feeding cups. A daily monitoring sheet was developed, a register and Kangaroo mother care guidelines were put in place. More babies less than 2500g birth weight were enrolled and monitored regardless of their gestational age. Targets and indicators were also set. After six month of the project implementation, evaluation was done by finding the proportion of premature babies that died against the total preterm babies registered within the same period. Results Within the six months preceding the project, the facility registered 37 premature babies of which 17 ended in neonatal deaths within the facility representing a 45.9% death rate. Fifteen (41%) of them were enrolled in KMC services. In addition, out of the fifteen babies enrolled in KMC, nine (60%) were referred to a Central Hospital, four (26.7%) died while on KMC due to inadequate monitoring and two (13.3%) were discharged home on KMC follow up. During the six months period of the quality improvement project, 134 babies were enrolled and out of them 26 died representing a 19.4% death rate. Conclusion and Recommendation Kangaroo mother care is a cheap and safe strategy, if widely adopted can really help preterm and low birth weight babies to survive and thrive, hence contributing to the achievement of the Sustainable Development Goal 3.

7-9 March 2017 Nairobi, Kenya

TUABO14 ECOLOO: A Sustainable Toilet Solution for Urban & Rural Areas Imad Agi United Nations Non-Governmental Liaison Service (UNNGLS) & UN Foundation, Senegal Issues 2.5 billion people worldwide have no access to toilet. Open spaces, riverbanks, road and street side and the open field are some of the common places to defecate. It is also seen that the water sources are badly affected by both pit/ring and modern flush toilets. The sewage from the flush toilet badly affected the fragile environment. These practices not only pollute the environment but also contaminate the land and water resources leading to disease and death. Description ECOLOO is a stand-alone, decentralized toilet system that is affordable, ergonomic, biological, comfortable, ecological, hygienic, multi-functional and practical. ECOLOO is odor-free, sewagefree, water-free and energy-free on-site waste treatment toilet system that employs biologic processes to create a natural fertilizer. Water can still be used for hygiene purposes only. ECOLOO comes in various designs and shapes (squatting, sitting, handicapped friendly) to fit all purposes and is functional in both hot and cold climates and can be located indoor, outdoor, inside houses or buildings in rural or urban areas. Our project in Jordan together with UNDP for the UNESCO World Heritage Site “PETRA” rescued the site from losing its “Heritage Title” after receiving yellow card from UNESCO for being unsustainable where thousands of tourists practiced open defecation polluting the protected historical area. Lessons Learnt Jordan is the 2nd in the World in water scarcity. ECOLOO didn’t only help them solving sanitation issue and reducing pollution but also in preserving their precious water from being flushed away and polluted. Next Steps “Prevention instead of Curing!” We have to protect our water resources by preventing water to be flushed/mixed with waste. Flush toilet is the worst invention of all times according to WASH experts, creating diseases killing people.

Africa Health Agenda International Conference 2017

TUABO15 Closing the loop: Designing a mobile referrals platform for Community Health Volunteers to improve access to reproductive health care in Western Kenya Erick Yegon , Rebecca Braun , Leonard Mulase , Stephen Sitati , Sarah Packer , Barbara Burke , Niki 1 Ndebele 1

Ipas Africa Alliance

Background Community Health Volunteers (CHVs) provide vital links between the community and the healthcare system, including reproductive health (RH) counseling, services, and facility referrals. Given widespread mobile phone use and high unmet need for RH care, designing a mobile-phone based referral platform (mReferrals) for CHVs may be a promising approach to improve healthcare at the community level. Methods The study is being conducted at five public healthcare facilities in Busia County, Kenya. Study populations include women seeking RH referrals, 25 CHVs (five per facility) and 10 providers (two per facility). The mReferrals platform uses a mobile application and text-messaging, and was designed with input from women, CHVs and providers. Data collection includes background surveys, referral and service data collected through mReferrals, and user experience surveys and in-depth interviews. Analyses are conducted using STATA (quantitative) and Dedoose (qualitative). Results CHVs are female (60%), have partially/fully completed secondary school (80%), and own a mobile phone (96%). On average, they are 43 years old with 12 years of experience. Providers are female (70%), community health nurses/officers (80%), and own a mobile phone (100%). On average, they are 36 years old with 10 years of experience. In the first two months, CHVs made 1143 RH referrals, mainly for contraception (69%). Among those referrals, 68% were completed, 13% are open, 16% required follow-up and 3% went unused. Among unused referrals, most clients went to a different facility (83%); few did not go to any facility (17%). The majority of clients reported good services (79%). All data collection and analysis will be completed by March 2017. Conclusions Preliminary results suggest a mobile-phone based referrals platform is a promising approach to improve healthcare at the community level, enabling CHVs to support their clientsâ&#x20AC;&#x2122; RH needs. Endline evaluation data will provide valuable information on acceptability and feasibility for scale-up.

7-9 March 2017 Nairobi, Kenya

TUABO16 Leveraging smart mobile tools to motivate and strengthen community health worker programs Caroline Mbindyo , Regina Mutuku 1

Living Goods Kenya, Medic Mobile 2

Issue Community health workers (CHWs) play a critical role in supporting resilient health systems by connecting families to life-saving health services and education - especially in areas where health resources are scarce. Unfortunately, performance management and motivation of CHWs has been a major hurdle for implementers, resulting in limited efficiency and impact. Mobile technology provides an unprecedented opportunity to strengthen community health systems by empowering CHWs with effective, intuitive tools and expanding supervisorsâ&#x20AC;&#x2122; access to performance data. Description In 2014, Living Goods and Medic Mobile teamed up to develop, launch, and scale a new mobile application with a goal of providing 7,000 Living Goods CHWs with innovative mobile tools, reaching over one million households across Uganda and Kenya within two years. The App has been an invaluable driver for: 1) Expanding CHWsâ&#x20AC;&#x2122; ability to accurately assess, diagnose, and treat childhood illnesses providing high-value support to pregnant women, and timely follow-up with clients 2) Providing CHW supervisors and sub-county supervisors with real-time data from the field, enabling them to tailor support, monitor quality, and drive performance 3) Enabling CHWs to self-manage their workload through tracking targets and prioritizing tasks. Lessons Learnt Mobile tools can be a critical cornerstone of a community health strategy, driving high-quality performance management, impact, and accountability while bridging the support gap that can exist between CHWs and their supervisors. Recommendations Drive health impact by incorporating mobile tools that increase CHWsâ&#x20AC;&#x2122; ability to efficiently and accurately diagnose, treat or refer patients, and collect client information and secondly give supervisors access to real-time data to drive on-going performance management, Build adaptive and responsive mobile tools that support a larger organizational culture of performance and impact, Leverage flexible design to accommodate new contexts, devices, content, and logic, open sourcing both technology and lessons can promote advancement within the larger CHW ecosystem.

Africa Health Agenda International Conference 2017

TUABO17 Evaluating adherence to testing and treatment procedures by community health volunteers in community case management of malaria, Bungoma County, Kenya Mable Jerop Amref Health Africa in Kenya Background For prompt diagnosis and treatment of malaria cases, World Health Organization recommended Community Case Management of Malaria (CCMM). In CCMM, community health volunteers (CHVs) are trained in management of uncomplicated malaria at household level while referring severe malaria cases or other ailments to health facility. We evaluated adherence to testing and treatment procedures using rapid diagnostic test kits (RDTs) and artemether lumefantrine (AL). Method A cross sectional study was conducted among 147 CHVs in Bungoma County who were randomly selected from the CHVs trained on CCMM. An observational checklist and structured questionnaire was used to evaluate the testing and treatment procedures, where a series of steps were systematically evaluated as they carried out testing and treatment. CHVs scoring an average of 80% and more were considered to adhere to testing while an average score of 100% was considered adherence to treatment. Data was analyzed using both descriptive and bivariate analysis. Results Of the 147 CHVs, the mean age was 40 and 39% were female. Majority of CHVs (89%) had attained a post primary education. A total of 452 clients were tested for malaria at the household level and the malaria positivity rate was 24%. 65% of CHVs were considered to adhere to testing procedures while 85% of CHVs with a positive malaria test managed treatment correctly. Gloves use frequency and RDT availability were significantly associated to adherence to testing (UAOR 2.02 (95% CI 0.785.25)) and (UAOR 6.08 (95% CI 1.12- 33.1)) respectively. 67% CHVs who had received supportive supervision (131) adhered to testing. Conclusion A considerable number of CHVs tested and treated clients correctly according to the required guidelines for CCMM. Managing level one health services is therefore considered a positive approach to curb Malaria.

7-9 March 2017 Nairobi, Kenya

TUABO18 Improving healthcare at community level through innovation by the private sector Maarten van Herpen Philips (Africa Innovation Hub) Issue An underlying cause for the high maternal and child mortality in Africa is that there is currently a large group of vulnerable people for which there is no equitable access to quality health care services. Innovation can help to improve this situation, but the problem is that these people also have no equitable access to innovations that are specifically addressing their problems. The reason for this is that these innovations are simply not there, because established companies are having difficulties scaling them, especially due to internal barriers. Description In order for the SDGs to make a meaningful impact, nobody should be left behind. This is why we need established companies to create inclusive innovation strategies that advance the SDGs. Philips is successfully doing this by structuring autonomous teams within the company that have a dedicated focus on the vulnerable group of people that other colleagues may not even consider as potential customers. This is how Philips, and other companies, can integrate support of the SDGs into their core business strategies. Lessons learnt Through the Philips Africa Innovation Hub, Philips has demonstrated that this is an approach that works. Within two years, we are already launching several inclusive healthcare innovations in the market with an enormous potential for impact. Some examples are (1) the Philips Childrenâ&#x20AC;&#x2122;s Automated Respiratory Rate Monitor (ChARM) to aid in the diagnosis of childhood pneumonia, (2) the Philips Wind-up Doppler-ultrasound fetal heart rate monitor, and (3) the Philips Community Life Centers â&#x20AC;&#x201C; a community driven and integrated approach to strengthening primary healthcare. Next steps There is great value for companies to integrate support for SDG-3 into their core business strategies, and to create locally relevant solutions for unmet needs of people who are excluded today. To achieve this, the companies need to focus their attention towards the underserved customer, and they need to change the approaches or business models that are customary. Companies can structure themselves to achieve this, by creating local ventures with autonomyto break away from existing conventions, while leveraging assets. Keywords Innovation, private sector, primary healthcare, community healthcare, community health workers.

Africa Health Agenda International Conference 2017

TUABO19 Partnering with other international NGOs to deliver health services in hard to reach communities - Christian Aid Nigeria ‘fruit bowl’ approach experience. Kazeem Balogun , Nanlop Ogbureke 1

Christian Aid UK, Nigeria

Issues Nigeria despite being the largest economy in Africa is plagued by a weak health system as a result of inadequate funding- average of 5% budgetary allocation to health in the last 5 years as against the Abuja declaration of 15%. Consequently, health facilities are poorly equipped and not responding to the health needs of the people. Description Christian Aid (CA) Nigeria uses a “fruit bowl” approach to integrate community healthinterventions. In response to communities’ health needs, CA partnered with other international NGOs – Water Aid, Marie Stopes and Vitamin Angels to deliver family planning (FP), sanitation and hygiene, and vitamin A supplement and deworming (VAS-D) services in hard to reach communities that would ordinarily not reached. CA partners facilitated community dialogue prior to FP services, mobilized communities using volunteers and faith leaders for children under 5 VAS-D during MNCH Week and facilitated community led total sanitation (CLTS). Lesson Learnt Improved health seeking behaviour by communities. Partnership with others eliminates duplication of resources. Addressing social norms helps in driving uptake of services. Partnership with others resulted in 6,600 women and men accessing FP services, access to VAS-D services for 32,556 children under 5 years and access of 12,464 community members to improved sanitation and hygiene services. Next Steps Partnership with other organizations should never be a replacement of health providers’ responsibilities but an attempt to meet immediate needs while engaging government to become more responsive to health needs of the people. Key Words ‘fruit bowl approch'.

7-9 March 2017 Nairobi, Kenya

TUABO20 Assessing the demand for community health workers social support: Perspectives of mothers in rural Rwanda. Purity Mwendwa University College Dublin Background Pregnancy and childbirth are often joyful events, but may be associated with health risks and complications. CHWs can be instrumental in advising, encouraging and empowering families to seek antenatal care and deliver at health facilities, and they may also help the family to prepare for delivery by ensuring they know where to go and helping them overcome barriers concerning money, transportation, and other necessary family logistics. Such supportive relationships may enhance feelings of well-being, personal control, and can lead to positive pregnancy outcomes. But too often there is less demand for CHW services, particularly if such services are considered inappropriate or even ineffective. Objectives The objectives of this study were to investigate the demand for CHW services in rural Rwanda, identify services most valued by pregnant women and to identify what services pregnant women would want in addition. Methods Data were collected from two rural districts of Rwanda using 5 focus group interviews. The groups comprised a total of 64 mothers aged 19-42 who had delivered within the previous year preceding the study. The focus group interview guide was structured according to three broad support categories a) emotional, b) informational and c) instrumental support. Results Informational support, information on prenatal care, delivery care and nutritional advice, was by far the most valued support by mothers. Mothers expressed a need for more emotional support from CHWs (counseling husbands/ partners about pregnancy and childbirth) and instrumental support (helping mothers to build houses, collaborating with mothers to set up kitchen gardens). Conclusion The findings reiterate the key role that CHWs play in offering social support to mothers during and after pregnancy. The demand for additional CHWs support underscores the value that pregnant women attach to services provided but also underlines the gap in access to care. The findings also point to the multiple roles that CHWs may have to play to meet the demands of community members. These findings have implications for the scale-up of CHW national programs and stress the importance of investing more in CHW programs to sustain service delivery in these settings.

Africa Health Agenda International Conference 2017

TUABO21 Setting up a Community HIV Testing Lab for Men who have Sex with Men in Yaounde. Jean Paul Ossomba Humanity First Cameroon Background The fight against HIV within the community of Men who have Sex with Men (MSM) is fraught with many obstacles, including stigma that prevents them from using medical services such as the HIV test, which remains a medical procedure in Cameroon. We must develop other strategies if we want to cover the needs in terms of HIV testing. It is in this light that Humanity First Cameroon has set up a HIV testing lab inside his Drop In Center for this target. This strategy has allowed us to reach the indicators that have been assigned to us in the second year of the CHAMP project for the period from October to September 2016. Method For the establishment of this laboratory, the intervention included: 1) Drafting standard operational procedures (SOP) for the two rapid HIV tests used: the kit ALERE DETERMINE TM HIVÂ˝ in first line and OraQuick HIV Â˝ in second-line; 2) Identified and ordered all equipment and material required; 3) Participated in training of Quality assurance of HIV test with the support of the Center for Disease Control and prevention (CDC) 4) Writing the Biosafety Manual. Result Through this laboratory, we have tested 647 MSMs in this period, 199 of them were tested positive and have been enrolled for the antiretroviral treatment. We are working to maintain their viral load undetectable. Conclusion This Community lab for HIV testing has allowed us to screen a large number of our beneficiaries and to offer them a friendly service. We are currently enrolled for the CDC's accreditation program through the Global Health Systems Solution supervision missions.

7-9 March 2017 Nairobi, Kenya

TUABO22 Role of community health workers monetary incentives on retention and health service delivery in Kibwezi district, Kenya Ruth Mbugua Mount Kenya University, Kenya Background The global policy of providing primary level care was initiated with the declaration of Alma-Ata in 1978.The second National Health Sector Strategic Plan defined a new approach to the delivery of Health Care Services to Kenyans, the Kenya Essential Package of Health. Community Health Workers (CHWs) are the key agents in the implementation of the community strategy. In Kibwezi District CHWs trained by MOPHS do not receive monetary incentives while their counter parts trained by other partners receive monetary incentives. Objectives The aim of the study was to assess the role of monetary incentives on retention and performance of Community Health Workers in Kibwezi District in Kenya. Methods A Cross-Sectional Comparative study design was used where both quantitative and qualitative data was collected. Multi stage, purposive and simple random sampling were used to select 4 Community Units (CUs) receiving incentives and 4 Community Units not receiving monetary incentives. A total of 282 CHWs were interviewed. Data was analysed using Stata version 11. Association between the variables was analyzed using chi-square tests and logistic regression modeling cross tabulations. Significance level was P < 0.05 at 95% CI. Results Results of this study show that there was a significant difference in the number of women referred for antenatal care (P =0.022), number of women counseled on exclusive breastfeeding (P =0.043) and participation of CHWs in community dialogue days (P=0.005) between the two groups. CUs receiving monetary incentives had better key health indicators. There was a significant difference in the proportion of children below 5 years who were fully immunized (P= <0.0001), proportion of women who had attended 4 ANC visits (P=0.028) and the proportion of pregnant women delivering with a skilled birth attendant (P=0.003).CUs not receiving monetary incentives had higher attrition rates of CHWs (13%) than CUs receiving monetary incentives (4%).(P=0.013). Conclusion: The study findings indicate that monetary incentives enhance performance and retention of CHWs. Recommendations There is a need for government and partners to explore sustainable performance based financial incentives which will ensure all the CHWs receive monetary incentives.

Africa Health Agenda International Conference 2017

TUABO23 The ICT Device, a major innovation initiated by Amref Health Africa in the health system Senegal? Mouhamed El Bachir Amref Health Africa West Africa, Senegal Introduction In the Southern part of Senegal (Kolda region), maternal, newborn and child mortality is still high due to low skilled birth attendance (25%) and low access to health care. Amref Health Africa developed an integrated technology based solution aiming to improve demand and supply for MNCH services. Methodology The technology involves 3 components: mHealth, e-learning and telemedicine integrated alongside the health system. CHWs use smart phones to register, and follow up pregnant women and children under five. They are linked to the peripheral health workers who receive and store information on tablets and computers and provide care and services to women and children. In addition, health personnel capacity on MNCH is regularly reinforced through E-learning. Finally, a telemedicine platform connected to the M- health application allows referral and case management in hospital. Furthermore, a mobile telemedicine pack connected to the platform is used for outreach interventions in remote communities. Results This integrated system enables us to connect and support remote health workers. The involvement of CHWs for monitoring pregnancies and the survival of children, full and uninterrupted health system chain fosters the continuity of care and an efficient referral system.Actually, 9201 pregnant women, 41019 children under five are registered and monitored through the platform and 75 CHWs have a mobile connected to the telemedicine server. Conclusion The ICT platform appears as a revolution in the heart of the health system. From mother to child health, this device remains a very dynamic and interactive tool for monitoring patients.

7-9 March 2017 Nairobi, Kenya

TUABO24 Use of social audits to enhance community participation in the improvement of quality maternal health service delivery Seminie Nyirenda , Shiphrah Kuria , Charles Suya , Madalitso Tolani , 1 Patrick Ngalawango 1 2 Amref Health Africa in Malawi, Amref Health Africa HQ 1

Introduction Amref Health Africa Malawi implemented Staying Alive project in Mangochi district. The project aimed at contributing towards reduction in maternal mortality (MDG 5a). One of the key components of the project was advocacy, which aimed at enhancing community engagement in the development and monitoring of the District Implementation Plan (DIP), but also improving access to maternal health service delivery in health facilities. One of the strategies which was used was social auditing. This case study presents results from social audits conducted in Namwera and Katuli health centre, Mangochi district. Methodology Community Based Organizations (CBOs) were trained in social auditing and they conducted community sensitization meetings on importance of holding duty bearers accountable and also community participation in decision making. Purposive sampling was used to select health facilities and CBOs to participate in social audits. In communities surrounding the sampled health facilities, problems affecting access to maternal services were identified and interface meetings were conducted at facility level. Interview guide was used to collect data during focus group discussion at community level while at facility level data was collected from interface meeting reports. Data was analyzed using content analysis. Results The audits revealed pilferage of drugs in the health facilities. They also revealed women delivering on their own at Katuli health center because of poor attitude of staff. At Namwera health centre, many obstetric complications were reported because Traditional Birth Attendants were still conducting deliveries. Action plans were developed and followed which saw drug culprits charged with fines, facility staff being replaced, and TBAs stopping the malpractice. Conclusion Social audits empowered community members to hold duty bearers accountable but also assist them to participate in decision making process in order to improve their own health. Key Words Social Audits, Community Based Organizations, Millennium Development Goals, District Implementation Plan

Africa Health Agenda International Conference 2017

TUABO25 Social media listening: Using new technologies to address gaps on adolescence sexual and reproductive health (ASRH) Nyasha Sithole 1, 2, Tikhala Ithaye1, Tinotenda Kabai3, Onward Chironda2 1AfriYAN, 2My Age Zimbabwe Trust Zimbabwe, 3YPNSRHHA Issues Social media is booming across Africa – it has become the fastest growing region for mobile connections over the past five years and young people across Eastern and Southern Africa (ESA) recognize the power of these platforms and use them for advocacy. The programme of action of the International Conference on Population and Development Beyond 2014, requires states to remove legal, regulatory and policy barriers to ASRH services. Age of consent to access ASRH services in ESA in most cases is not clear. Henceforth, need to address the policy gaps and this was done through a social media campaign, named #90DaysofConsent in Botswana, Zimbabwe, Malawi and Zambia in 2016. Description #90DaysOfConsent campaign looked at age of consent to sex, HIV Testing and Counseling, access to contraception, to marriage and to participating in medical research. Using the relatively new science of ‘social listening’, YPNSRHHA and My Age Zimbabwe collected data and data collected through social media was used to draft in country advocacy briefs. The findings have been used to influence the formulation of the National ASRH Strategy for 2016-2020 and Right Here Right Now in Zimbabwe. Lessons Learnt Youth leadership and engagement is effective in addressing ASRH gaps, New and innovative technologies, are to bridge the ASRH gaps, Improved research and learning for advocacy by young people and youth led institutions and a method mix approach in using new technologies that is social media and texts for those with and without internet respectively. Recommendations Presentation of the findings in the form of case studies at national decision making platforms like the National ASRH Forum and advocate for investment in youth leadership to improve ASRH programming.

7-9 March 2017 Nairobi, Kenya

TUABO26 Increasing modern contraceptives uptake among adolescents with a particular focus on the uptake of long-acting reversible contraceptives (LARCS) through voucher and referral strategy Kidi Moses , Stephen Sitati , Caroline Tatua , Leonard Mulase , Erick Yegon 1

Ipas Africa Alliance

Background According to the Kenya National Bureau of Statistics 2010, only 19.6% of currently married adolescents aged 15 - 19 years use a modern contraceptive while merely 5% of all adolescents in Kenya aged 15 - 19 years currently use any modern method. Our analysis focused on the average effect of exposure to the voucher program (by living in voucher catchment areas) on net change in the use of modern contraceptives. We hypothesize that it might improve the uptake of LARCs by reducing cost and service delivery barriers. Methodology The comparative study measured association of exposure to FP voucher with uptake of contraceptive between respondents living in areas where the voucher program operated and respondents living in the non -voucher program. The baseline data generated from three months before intervention and results analyzed after three months of intervention in 46 non-intervention facilities as well as 14 comparison intervention facilities in western Kenya. Results Proportion of women below 25 years who received modern contraceptive method increased significantly (p<0.01) from 30% (n=3,124) at baseline to 34% (n=4,325) three months after intervention. Conversely, non-intervention sites marked decline (at p<0.001) in modern contraception from 70% (n=7,171) at baseline to 66% (n=8,559) after three months. A similar trend was noted when categorized by FP method: LARC [for intervention facilities, increased from 38%; n=1,017 at baseline to 41% with n=2,577 post intervention versus non-intervention facilities which decreased from 62%; n=1,664 at baseline to 59%; n=2,543 after] and short-term [for intervention facilities, increase from 28%; n=2,107 at baseline to 30% n=2,577 at post intervention versus nonintervention facilities which decreased from 72%; n=5,507 at baseline and 70%; n=6,016 later]. Conclusion Evidence from all counties included in this review indicates that referral voucher schemes can increase the uptake of contraceptive services and can be a highly effective tool to increase access especially for special populations including the youth.

Africa Health Agenda International Conference 2017

TUABO27 Increase safe and informed decision making on sexual and reproductive health (SRH) by young people in North Shoa Zone of Amhara Region, Ethiopia Hussein Abdulla Amref Health Africa in Ethiopia Background Needs in the area of SRH are very high in Ethiopia. The maternal mortality ratio remains as high as 676 per 100,000 live births. The lifetime risk of a woman dying during pregnancy or childbirth is high. This study was assessed the level of SRH knowledge, attitude and practices among the young people in North Shoa, Amhara, Ethiopia. Methods Cross-sectional study design, which followed a combination of both qualitative and quantitative approaches was used .The survey, was conducted from December 2015 to January 2016 in twelve district of North Shoa zone. A total sample size of 1665 young people aged 10-29 participated quantitative data collection. Furthermore, interviews, focus group discussions (FGDs), observations as well as health facility assessments were used to capture data pertinent to Survey. Quantitative data entry, cleaning and analysis was done using SPSS version 20 while qualitative data analysis was carried out through a thematic analysis of transcribed interviews and FGDs. Results Unwanted pregnancy (53.3%) followed by early and unplanned sex (47.4%) and early marriage (46%) were the most frequently mentioned SRH problems that adolescents and youth in the study district commonly face. Survey also found that 89.7% of the respondents have ever heard about STIs and HIV. Only 33.0% of the participants ever visited health institutions for SRH services. Conclusions and Recommendations SRH information and services were also not easily available, accessible and friendly. In orderto increase knowledge of available SRH services for youth, available community based opportunities need to be utilized and culturally appropriate information education and behavior change communication activities need to be implemented.

7-9 March 2017 Nairobi, Kenya

TUABO28 Using education as a tool to end FGM in Trans Mara, Narok County Meshack Acholla , Moses Dapash 1

Kakenya Center for Excellence, Kenya

Issues Female Genital Mutilation is one of the biggest sexual and reproductive health challenges facing many adolescent girls in Africa. In Kenya, FGM is at 21% nationally from available data but the practice is still done with a lot of secrecy. The practice is dominant among the Maasai community with 78% of women and girls aged 15-49 having undergone the cut . FGM makes adolescent girls vulnerable to child marriage which leads to teenage pregnancy and increasing cases of maternal mortality due to birth related complications particularly for young adolescent girls aged 15-19 years. This abstract seeks to highlight our approaches in addressing gaps in adolescent SRHR. Description Kakenya Center for Excellence (KCE)â&#x20AC;&#x2122;s approach is to use education as a tool to eliminate destructive barriers to girls. We have established a girls' boarding school, for girls vulnerable to FGM. In the school the girls are given SRHR knowledge including the effects of FGM to women and girls, the legal environment in Kenya to protect them against forceful practice of FGM and how to be champions against FGM in their communities. The health education is done through a well structured curriculum. Lessons Learnt There are still many myths that promote the practice of FGM among the Maasai community. There is need to address them by providing facts on the effects of FGM to women and girls.100% of girls in our school have so far avoided FGM and excel in education. These girls set a good example and great anti-FGM champions in the fight to end FGM. Next Steps We plan to up-scale our intervention by building a big school for girls in the area.We plan to construct a Youth Friendly health facility to offer SRHR services.

Africa Health Agenda International Conference 2017

TUABO29 Empowering Young People to advocate for Implementation of policies in Kenya Sharon Barasa Center for the Study of Adolescents, Kenya Background Though Kenya has a vibrant sexual reproductive health policy framework, awareness and investment in these policies remains low. The commitment to these policies aim to ensure thatyoung people are protected from harmful practices, are allowed to enjoy their sexuality and receive information to make informed choices as well as have access to contraceptives and youth friendly services. This aim is however not realized as many policy makers, young people and key stakeholders are not aware of these policies, and there is little or no monetary and human resource allocated for their implementation and awareness. This has slowed down the progress in implementation of these policies in all levels, thus stagnating and even accelerating of SRHR (Sexual reproductive health & rights) problems they were to resolve. Description Using an innovative youth adult partnership, several approaches were instituted to accelerate awareness on these policies among young people, policy makers and the public. 20 youth who had previously undertaken a 4 year SRH course were capacity built on: advocacy, national, regional and international policies, and budgeting. More awareness was created to policy makers, other young people and the general public on existing policies. There was an increase in youth participation in national dialogues on sexual reproductive health and rights. Young people conducted forums with parliamentarians and had an impact on budget allocation in Kisumu County. They were also recognized as strong advocates of their rights by policy makers. Lessons Learned If young peopleâ&#x20AC;&#x2122;s capacity is built, they can work with adults to create a larger impact in the implementation of existing policies, and thus a progression to solving SRHR needs of young people. Next Steps Young people need to be involved to advocate for change and create accountability tools to ensure progressive implementation of these policies. Keywords SRHR, youth, policy

7-9 March 2017 Nairobi, Kenya

TUABO30 Motivational Intervention for Young Males In Siaya. Results of an Intervention Study Anke van der Kwaak , Peter Ofware , Paul Kiage, Pam Baatsen 1

Royal Tropical Institute, Netherlands, Amref Health Africa in Kenya

Background A consortium consisting of The Royal Tropical Institute (KIT), GGD Amsterdam, Amref Kenya witnessed that male youth were often absent from SRH services. The limited existing evidence shows that male youth face considerable unmet needs and reduced access to SRH services. Health care service providers face challenges with addressing young peopleâ&#x20AC;&#x2122;s sexuality, and sessions often end up providing information and advice in a moralizing way. In 2013 an intervention study was launched focusing on the SRH roles and responsibilities of male youth; the intervention was called motivational intervention (MI+). It aimed to change the way in which peer educators, counsellors and health professionals engage male youth in Kenya. Objectives Is MI+ is an effective approach to improve the SRHR of male adolescents in Kenya in terms of improved access to and uptake of services and SRHR practices? Are those who have never usedservices now taking them up, and are those using them getting better-quality services that respond to their needs and rights? Methods A double difference mixed methods before and after study was implemented in Siaya county applying a survey among 1167 young males, focus groups discussions, in-depth interviews, key informant interviews and a qualitative midline. Results The study shows an improved interaction between health providers and male youth leading to higher increase in uptake of counselling in the intervention sites compared to control sites.The intervention strengthened referral by jointly training a mixture of nurses, counsellors, teachers and peer educators at each site. Conclusions and recommendations There is a significant potential for introducing and upscaling quality improvement measures in SRH services by training not only staff but also male youth, teachers and peer educators in MI+.

Africa Health Agenda International Conference 2017

TUABO31 Regional response to the challenge of health worker migration in Africa Joachim Osur Amref Health Africa Issue With a 12% of world population, Sub-Saharan Africa bears the greatest burden of disease at 27% globally. Despite this, only 3.5% of global health workforce is found in Sub-Saharan Africa. Against this backdrop, an average 30% of all newly trained health workers leave the health workforce in Sub-Saharan Africa. Out of these 22% migrate out of the continent, 5.5% migrate to other African countries, 1.6% abandon medical practice and the rest face other forms of attrition. The net effect is a weakened health system that is unable to meet its health challenges leading to inability to achieve universal health coverage and the resilience required to achieve the right to health and sustainable development in Africa. Description Through its Health Systems Advocacy for Africa (HSA) project, Amref Health Africa and its partners have done a situational analysis in its focus countries. Results show that countries generally lack a database for monitoring health worker migration; there are no policies to ensure mutual gain for recipient countries and Sub-Saharan African countries where health workers emigrate from; Sub-Saharan African Countries generally do not report on the WHO Code of Ethical Practice on the International Recruitment of Health Workers; and the countries lack interventions that will help them manage health worker migration. HSA has gone ahead to convene the Association of Medical Councils of Africa (AMCOA) to deliberate solutions to the migration problem. AMCOA has as a result developed a Protocol on Health Worker Migration in Africa to be implemented by member countries. Among others, the protocol mandates member countries to develop and use a harmonized data collection tool on emigrating health workers; maintain and share a register on health worker migration; set up and manage a database on health workers migrating within the AMCOA region; exchange information on migration; and advise host governments on how to manage the migration to limit harm to the health system. Lesson Learnt While the issue of health worker migration has drawn global concern leading to WHO developing the International Code on Ethical Recruitment of Health Workers, Governments in Sub-Saharan Africa have not prioritized it with only 8 governments reporting on implementation of the Code to date. Following sensitization on the prevailing evidence however, the countries have shown renewed commitment and are ready to tackle the problem of health worker migration as evidenced by their move to develop Health Worker Migration Protocol. A total of 15 out of the 17 AMCOA focus countries have signed the Protocol and committed to implementing it. Next Steps Amref Health Africa will support countries to implement the Protocol on Health Worker Migration. Further, countries will be supported to develop laws and policies that ensure mutual benefit between countries contributing and those receiving emigrant health workers while strengthening the human resources to improve attraction and retention of health workers within the Sub-Saharan Africa. 7-9 March 2017 Nairobi, Kenya

TUABO32 Sub-County Health Management Teams Leadership Development Program for Improved Maternal and Child Health Service Delivery in Makueni County Deborah Kioko , Evalin Karijo , Mutisya F , Patrick Igunza , Peter Ofware 1

Kenya Nutrition and Dietetic Institution (KNDI), Amref Health Africa in Kenya 2

Issues Leadership development program (LDP) is an important strategy to achieve better health service delivery. According to the Makueni County strategic plan, leadership and management contribute to maternal and child mortality rates. The Mama na Mtoto wa Afrika Maternal, Newborn and Child Health (MNCH) project midterm evaluation, one of the recommendations was to build capacity of the Sub-County Health Management Teams (SCHMTs) and health care providers (HCPs) on leadership, management and governance to enable sustainability and continuity of the projectâ&#x20AC;&#x2122;s gains. Description LDP begun January to June 2015 in four Sub Counties where SCHMTs focused in three MNCH indicators: attendance of the 4th ANC visit, skilled delivery and child growth monitoring flagged as of great challenge as they had not shown improvement. The SCHMTs worked in five teams with bi-monthly six months of coaching which exposed teams to leadership and management skills. SCHMTs utilized different interventions to improve MNCH indicators in eight health facilities. Tawa and Sultan Hamud Hospitals assessed skilled delivery; Kaia, Kisau and Kyusini Hospitals assessed 4th ANC visit; while Kathonzweni, Matiliku and Makueni Hospitals assessed Child growth monitoring. Pre-intervention period data, January to June 2014 used as a baseline to measure achievement of indicators for intervention period. Lessons learnt End of intervention period: Skilled delivery improved from 116 to 175 at Tawa and from 267 to 448 at Sultan Hamud Hospitals. 4th ANC visit I mproved from 86 to 156 at Kisau, from 4 to7 at Kaia and from 26 to 40 at Kyuasini hospitals. Child growth monitoring done in three health facilities (Kathonzweni, Makueni and Matiliku) improved from 1901 to 3790. Next steps Support SCHMTs to cascade LDP to rural health facility managers to improve provision and utilization of services. Carry out further scientific analysis and share lessons learned to County MNCH stakeholders and partners to replicate. Key words Leadership, Management and Intervention

Africa Health Agenda International Conference 2017

TUABO33 Early removal of the prepex device for male circumcision Vincent Aloo Maseno University, Kenya Issue The second National Strategy on Male Circumcision advocates for adoption of devices to scale up male circumcision services. Prepex is an innovative non-surgical method for male circumcision. There are no injections, bleeding, suturing and one can resume work immediately after placement. The device is recommended to be removed on day 7 after placement but this leads to pain and client dissatisfaction with this method. Description It involves placement and removal after 7 days followed by healing for 6 weeks. After placement, the device should be removed on the seventh day. This method works by progressively stopping blood supply to the foreskin which eventually dies and dries off. The dry foreskin embeds in the device and results into pain during removal which makes clients get dissatisfied with this method. Lessons learnt Early removal of the device on day 5 has been found to be less painful and safe: no bleeding. This was tested using a pain scale rated from 0 (no pain) to 10 (extreme pain). All clients reported a rating of 1 to 5 (mild to moderate pain). Clients reported satisfaction with day 5 removal. Recommendations Early removal is strongly recommended to enhance client satisfaction with this innovative method. The national guidelines on Prepex procedure should be revised to provide for early removal of the device which can increase uptake of this method.

7-9 March 2017 Nairobi, Kenya

TUABO34 Implementing HRIS to track health workforce training through a peer-to-peer model Robert M. Nguni , Robert M Nguni1, Bernard O. Ajwang , Martin Kinyua , Paul Wakhungu , 1 1 1 1 David Juma , Ann Mungai , Janet Muriuki , Pius Wassuna Owino 1

Intrahealth International Kenya,

Issues To address imbalanced skills mix among healthcare workers (HCWs), Kenya has embarked on a number of interventions to strengthen health workforce development. However, with more than 60,000 public-sector HCWs countrywide, and dozens of in-service training (IST) courses, it has been challenging to track HCW training. Some HCWs take the same course more than once at the expense of others, hence the need for a system to schedule, track and report on IST. Description Through technical cooperation with the Ministry of Health (MOH), the USAID-funded Human Resources forHealth (HRH) CapacityBridge and FUNZO Kenya projects, led byIntraHealth Intenational, implemented two integrated human resources information systems (HRIS)- iHRIS Manage and iHRIS Train. With iHRIS Train, training institutions and partners schedule IST courses for HCWs. Following completion of trainings, results, certificates and other documents are updated into iHRIS Train for each HCW and added to their e-files, which are accessible in iHRIS Manage. This allows national and county HRH leaders to determine which HCWs should be selected for each course. Lessons learnt Devolvement of Kenyaâ&#x20AC;&#x2122;s health sector in 2013 presented a challenge in extending implementation and use of iHRIS beyond the national level to include 47 county governments. The projects conducted basic and advanced iHRIS training for counties, and adopted a peer-to-peer model through identification of iHRIS champions. These champions cascaded iHRIS implementation to more counties. As a result, 35 counties are consistently using iHRIS; 589 HRH officers from national and county levels, facilities, training institutions and partners have been trained. iHRIS now supports 57,373 records for HCWs and more than 20,000 training records. Next steps iHRIS should be integrated with regulatory HRIS (rHRIS) to ensure data sharing across systems thus allowing for seamless awarding of continuing professional development (CPD) points and subsequent re-licensure of HCWs, eliminating the need for manual CPD log books.

Africa Health Agenda International Conference 2017

TUABO35 Barriers to increasing numbers & skills of Health Workers in Uganda through eLearning Andrew Wabwire , Patrick Bigirwa 1

Amref Health Africa, Uganda

Background The Nursing Council in Uganda adopted the distance education learning programme after realizing that by using only the existing capacity for residential training it would take about 20 years to upgrade 1,000 midwives to a diploma level. Objectives This study aimed at establishing why there is low enrolment of midwives under the eLearning project in Uganda. Methods The study population comprised of 6,226 enrolled midwives working in selected public and private health facilities in Uganda identified through the 5 districts or regional referral hospitals. The study protocol considered 150 midwives who have not enrolled for upgrading in any professional development courses. Stratified sampling technique was used to select 5 district hospitals and 91 catchment health facilities from which 150 enrolled midwives were identified to participate in the study. To select respondents, we used simple random sampling technique. Each District hospital served as a primary sampling unit and was placed in a logical geographic order to provide the element of implicit stratification, each was randomly selected. Standard questionnaires were administered to 98 respondents and in depth key informant interviews to 45 respondents in the study population. Results Results ofthis study showed that there are factors that influence enrolment to eLearning programmes with the major one(56%) being limited information about eLearning programmes, others (34%) indicated limited basic computer skills and high training costs associated with upgrading. Conclusion Considering the limitations mentioned there is urgent need to review the programme strategy to consider increased awareness creation, basic computer training sessions and increasing subsidies on training to attract more enrolled midwives. Recommendations There is need to actively and widely advertise the program, conduct continuous ICT skills training and offer subsidies on scholarship level to attract more enrolled midwives.

7-9 March 2017 Nairobi, Kenya

TUABO36 Automated-feedback generated in smart phone for supportive supervision enhanced performance of TB Facilities and community health workers in Nigeria Kehinde Jimoh , Olanrewaju Oladimeji 1

Abt Associates, Nigeria, Zankili Medical Research

Background Nigeria is tenth among high TB burden countries with weak program supervision which was paper based, bulky, it could tear, wet or get lost (no back-up), time consuming and feedback was not provided immediately to ensure plan of actions to resolve issues. We objectively carried out an assessment of how the color-coded on the spot automated-feedback smart phone with data backup has improved in supportive supervision of TB facilities and community health workers. Method We recently conducted key informant interviews in three zones in the country among the smart phone users at the Health facility, Local government, State and Federal levels. To have their feedback concerning the key differences between the paper based checklist and on the sport automatedfeedback smart phone users were trained to use smart phone for supervision in TB facilities. So an assessment was conducted to determine the effectiveness of this technology. Results The median time to receive objective feedbacks was 24 (range 12-36) hours before the intervention with the smart phone. We were informed by the users that the phones automatically calculate TB indicators at the facility-level and then analyze them against national standards. This rapid automated feedback is further utilized to deliberate on issues and look in to remedial options to solve them. This is also documented in the Action Plan booklet for follow-up. Conclusion This method has reduced the delay in the timing of feedback, the smart phone is very easy for the supervisors to use, faster to conduct supervision and the final supervisory feedback is backedup in the cloud for data backing. This also provides a platform for clinical supervisors to devise immediate feedbackbased on the data-driven qualityimprovement plans during routine monitoring/ supervision. We recommend scaling up by the National Tuberculosis Program.

Africa Health Agenda International Conference 2017

TUPE01 Assessing the Service Availability and Readiness to Provide Basic Health Care Package towards Universal Health Coverage In Zambia: A Survey in Kalomo District. Hideki Higashi , Gocho Kapoba , Kalaluka Mutemwa , Shinobu Ashinda , Mwansa Bowa , 2 1 1 Mainza Makunga , Takanori Hirayama , Yuta Yokobori 1

Japan International Cooperation Agency, Kalomo District Medical Office, Zambia

Background The Government of Zambia has spent decades in developing the basic health care (BHC) package as a guiding principle towards universal health coverage. The launch of the National Health Care Package (NHCP) in 2016 was a key milestone that merged the concepts of BHC and essential health care services into one package. Objectives This study aims to assess the service availability and readiness to provide BHC services in a rural district of Zambia. Methods A facility survey was conducted in Kalomo District, Southern Province, in January 2016. The District Hospital and 12 health centres were sampled for the survey. Standardised questionnaire forms were devised for each level of facility based on information from the NHCP, Standard Treatment Guideline of Zambia and the Service Availability and Readiness Assessment tool from the World Health Organization. Two survey teams were formed to obtain data. The teams collated and analysed data by means of spreadsheet. Results The crude average availability of BHC services was 66% for health centers and 89% for the District Hospital. Availability of services for non-communicable diseases (NCDs) were generally insufficient (<50%) compared to those for communicable diseases and maternal and child health conditions (>80%). While preventive outreach activities for malaria and immunisation were sufficient, few activities were conducted for other conditions, especially for NCDs. Lack of in-service trainings, transport means and specific drugs and medical supplies were the major impediments for providing BHC services. Conclusions Outreach activities and NCD services need to be strengthened by addressing the identified impediments.

7-9 March 2017 Nairobi, Kenya

TUPE02 Strengthening Health Systems and Management Towards Universal Health Coverage: Data-Informed Activity Planning In Kalomo District, Zambia. Hideki Higashi , Gocho M. Kapoba , Yuta Yokobori , Kalaluka Mutemwa , Shinobu Ashida , Irene 2 2 2 2 2 2 Chinyama , Brian Halale ,Vincent Chipeta , PeterKampamba , Mainza Makunga , Florence Mhango , 2 1 2 Kelvin Mupemo , Takanori Hirayama , Kenneth Chibwe 1

Japan International Cooperation Agency, Kalomo District Medical Office, Zambia

Issues In 2016 the Government of Zambia launched the National Health Care Package (NHCP) that sets standards for health services provided at each level of health care. In relation to this, a survey was conducted in a rural district of Kalomo, Southern Province, to assess the service availability and readiness to provide basic health care (BHC); a subset of NHCP covering the first level and below. Description Based on the survey findings, the Kalomo District Medical Office (DMO) has taken the initiative to develop an activity plan that aims to expand the provision of health services towards universal coverage of BHC in the district. A workshop was organised to analyse data from the survey, identify potential bottlenecks and develop concrete activities to address those bottlenecks. Lessons learnt From the data analysis, it was recognised that a limited number of areas in the health system were commonly impeding on effective deliveries of different health services: human resource development, transport maintenance, drug supply, and equipment maintenance. The developed activity plan therefore targets these areas with an additional element that focuses on strengthening the zonal network and supporting system. This extra element plays a pivotal role for all activities whereby zonal health centres are designated as hubs, bringing together 4-6 satellite clinics each to provide health services (e.g., diagnostic services) and to extend supportive activities (e.g., training, mentorship) in an integrated and cost-effective manner. Recommendations Strengthening health systems and management has the potential to expand BHC service coverage effectively and efficiently

Africa Health Agenda International Conference 2017

TUPE03 Task Sharing using Community Health Volunteers to Deliver Maternal and Neonatal Care Services in Rural North Rift, Kenya Martin Omedo , Thomas Kâ&#x20AC;&#x2122;Ouma1, Diana Menya , Vandana Tripathi1, Theresa Castillo , 4 PT Le 1

HealthRight International Kenya, Moi University, School of Public Health, HealthRight 4 International USA New York University, School of Global Health 1

Background There is limited evidence to guide the development of task sharing interventions to improve maternal health outcomes in low-resource settings. This study reports the results of task sharing between community health volunteers (CHVs) and health care extension workers (CHEWs) to improve the knowledge, practices and coverage (KPC) of maternal and neonatal care (MNC) in a geographically and socio-economically isolated population in Kenya. Methods Structured surveys collected data on KPC indicators (based on USAID core indicators) at baseline (2012) and at midline (2014). We conducted difference-in-difference analysis, and assessed these quantitative results with qualitative findings gathered from CHVs and CHEWs regarding their perspectives on the delivery of the task sharing intervention. Results The proportion of pregnant women visited by the CHVs to offer basic MNC services significantly improved in both the intervention and comparison arms. Out of the 10 core indicators evaluated, statistically significant positive changes were noted in four indicators (skilled birth delivery;antenatal care; knowledge of danger signs-during pregnancy and at delivery and of the newborn- and family planning), negative in one (iron supplementation), and no significant changes in the remaining indicators. Qualitative data revealed that CHVs defined their primary responsibilities as referring expectant mothers for antenatal care and conducting at least four household visits for expectant mothers. CHVs also highlighted the need for adequate support and monitoring as well as administrative supervision and basic work-related supplies. Conclusion This analysis indicates that task sharing can have a positive impact on the delivery of maternal and neonatal care services in rural, hard-to-reach populations. However, substantial improvements in supervision and collaboration must be made in order to deliver the intervention more effectively. Furtherresearch, especiallythose employing multiple methods, is needed to guide future interventions to improve maternal and child health in similar low-resource settings.

7-9 March 2017 Nairobi, Kenya

TUPE04 Recreational Use of Phosphodiesterase 5 Inhibitors and Its Associated Factors among undergraduate male students in an Ethiopian University: A Cross-Sectional Study Eyob Gebreyohannes University of Gondar, Ethiopia Background Mounting evidence indicates that the recreational use of PDE5 inhibitors drugs in combination with illicit drugs for sexual enhancement aid was dramatically increased in younger population. In Ethiopia, substance such as Khat, cigarette and alcohol were widely abused among university students. Thus, we hypothesized to assess the prevalence of PDE5 inhibitors use and associated factors among Gondar university undergraduate students. Methods An institutional-based cross-sectional study, using a 52-item survey-questionnaire was conducted from October to December 2015 to assess the PDE5 inhibitors use and associated factors among male students in University of Gondar (UOG), Ethiopia. Self-esteem and sexual relationship (SEAR) questionnaire (14 items), International index of erectile function (IIEF) questionnaire (15 items) and PDE5 inhibitors use (14 items) were included in the questionnaire. Results Across all the respondents, more than half (55.7%, n=233) had heard about PDE5 inhibitors, but only twenty-three (5.5%) men recorded trying PDE5 inhibitors drugs at least once. Older students were more likely to use PDE5 inhibitors compared to junior students [AOR: 1.40, 95% CI: (1.109, 1.768)]. Those students who were smokers are 5.15 times more likely to use PDE5 inhibitors as compared to their counterpart [AOR: 5.15, 95% CI: (2.096, 12.687)]. Further, multivariate logistic regression showed that students who are in relationship, alcohol use, more number of cigarettes smoking per day and students with more sexual partners were found to be significant associated with PDE5 inhibitors use. Conclusion The prevalence of PDE5 inhibitors use among undergraduate students was 5.5%. Cigarette smoking and other substance use, older age, and higher number of sexual partners were significantly associated factors for PDE5 inhibitors use. These findings suggests that restricting to access PDE5 inhibitors drugs is essential to curtail misuse among university students. Further studies focusing on psychosocial determinants of ED and PDE5 inhibitors use among younger populated are warranted.

Africa Health Agenda International Conference 2017

TUPE05 Effect of Active Management of Third Stage of Labour (AMSTL) Training on incidences of Postpartum Hemorrhage Cases in Siaya County 1 1 1 1 Emmaculate Otieno , Brenda Achieng , Liddy Dulo , Monica Oguttu Kisumu Medical and Education Trust, Kenya

Issues Post-partum hemorrhage (PPH) is the leading cause of maternal mortality worldwide. In low-income countries it accounts for nearly one quarter of all maternal deaths. In Kenya 25% of all the deaths are due to PPH. Active management of the third stage of labour (AMSTL) is one of the highly effective procedures which has been shown to reduce blood loss and risk of severe postpartum hemorrhage among facility-based deliveries. However little thought or teaching seems to be devoted to the third stage of labor compared with that given to the first and second stages. Description Through the Sub county RH coordinators, providers from health facilities with maternity services, high burden of PPH cases and with good linkage with the community were selected. 21 TOTs were trained, and 483 providers from 81 health facilities trained on AMSTL, correct diagnosis and management of PPH by cause e.g Trauma, Tone, Tissue and Thrombin.Key emphasis was done on; storage and dosage of uterotonics, use of a uterine balloon tamponade (UBT) for atonic uterus. Joint MOH/KMET support supervision was done to providers post training. A maternal health taskforce was established to help review all the maternal health issues including PPH near misses and come up with solutions to reduce future incidences. Lessons learnt Data collected 6 months post training showed a 5 % increase in maternal health complications due to PPH. 5 mothers were managed using UBT. No maternal death was reported. This is attributed to the knowledge of timely diagnosis and management of PPH gained during the training. In conclusion, adopting a whole county through capacity building collectively improves patient management, documentation, reduces/improves transfer of patients and improves maternal health outcomes. Recommendation More emphasis should be done on simple innovative techniques to reduce maternal mortalities in Kenya. Key words Postpartum hemorrhage, Active management of third stage of labour, uterine balloon tamponade

7-9 March 2017 Nairobi, Kenya

TUPE06 Community Health Services: The Missing Link in the Provision of RMNCAH in the Private Health Sector Beatrice Grace Akinyi , Amos Onderi , Monica Oguttu 1

Kisumu Medical & Education Trust, Kenya

Issue Maternal mortality ratio and neonatal mortality rate trends in Kenya have remained unacceptably high in a decade. In 2007, Kenya adopted a community health strategy to reverse the trend of poor health indicators including indicators in reproductive, maternal, neonatal, child and adolescent health. More efforts were however put in supporting community health services in public health sector facilities not realizing an equal role the private health sector would play in reversing the poor indicators. KMET through Huduma Poa social franchise innovatively bridges this gap in the private sector. Community health volunteers (CHVs) are utilized in the private health sector to increase access and demand for integrated health services, strengthen health facility-community linkages; and raise community's awareness of their rights to health services. Description Huduma Poa builds capacity of CHVs in community health healthy strategy and key messages in integrated reproductive and child health. Two CHVs are attached to each Huduma Poa facility. CHVs are equipped with demand creation kits including IEC materials. CHVs generate demand through diverse community forums; and refer clients to the clinics. The CHVs are incentivized based on their performance which is reviewed monthly and quarterly. Lessons learnt Community health services through the Huduma Poa strategy has demonstrated an accelerated access to integrated services in the private health sector, demystified myths and misconceptions that hinder the utilization of services. The number of referrals to the facilities increased by 130% (2015) compared to 3% (2012). Male involvement in reproductive health has improved (42%) in the private sector compared to 1.3% in 2012. Key Words Community health strategy, community health volunteers, Huduma Poa

Africa Health Agenda International Conference 2017

TUPE07 Improving Attrition and Retention Of Health Workers in Rural Areas: Perceptions Of Staff Housing Conditions; The Case of Sacred Heart Mission Hospital Katondwe, Luangwa District, Zambia Klaus Andreas Thieme, Martina Zambia Weber

SolidarMed - The Swiss Organization for Health in Africa, Zambia

Background Push and pull factors like working conditions, salary levels, understaffing and especially rural housing conditions contribute to a low rate of attrition and retention of health workers in rural Zambia. Objectives The study researched the health workers’ perceived staff housing conditions by the example of the Sacred Heart Hospital Katondwe, found in a very rural setup in Luangwa District, Zambia. Methods The study used the qualitative method of photo elicitation to explore the health workers’ perception of their housing conditions and its impact on their own job satisfaction. The main characteristics of the existing staff houses were collected and tabled. Results The findings of the study show an ambivalent perception of the housing conditions by the study participants. Although most houses show modern standard features, they are not adapted to the hot climate in the Luangwa valley in sense of roofing, insulation and ventilation. Houses are perceived as too small to accommodate the nuclear and often times additionally the extended family. The rural setup is perceived being conducive because of fresh air, green surroundings and the lack of congestion in terms of population density, traffic and pollution. Mostly the hot climate and the insect infestation contribute to negative feelings. Having to share the houses with co-workers is perceived as a particular hardship. Conclusions The health workers’ views on housing contribute to a deeper understanding of rural housing. While the tranquility of rural housing seems to be perceived positively, fundamental house features are impacting on the living conditions and hence on the retention heavily. Recommendations Rural staff houses should be well adapted to the climate and need to consider the need for adequate space to accommodate nuclear and extended family. Basic power supply for lighting, access to fresh water and protection from mosquitoes needs to be offered for improved housing quality.

7-9 March 2017 Nairobi, Kenya

TUPE08 Traditional Birth Attendant Reorientation and Motherpacks Incentives Effect on Health Facility Delivery Uptake in Narok County, Kenya: An Impact Analysis John E. Kitui Christian Aid, Kenya Background A community health programme in Narok County Kenya aimed to improve skilled birth assistance (SBAs) during childbirth through two demand side interventions. First, traditional birth attendants (TBAs) were co-opted into using their influence to promote delivery at health facilities and to accompany mothers in labour to health facilities in return for Ksh500 (US$5). Secondly, a free Motherpack consisting of a range of baby care items was given to each mother after delivery at the facilities. Objectives This impact analysis estimates the effect of TBA reorientation and motherpacks on trends of health facility delivery numbers. Methods Dependency or inferred causality was estimated between reorientation of TBAs and provision of Motherpacks with changes in monthly facility delivery data from 28 health facilities between January 2013 and December 2015 as obtained from the District Health Information Systems. The intervention data consisted of the starting month for each of the two interventions at each facility. A negative binomial generalized linear model framework is applied to model the relationship as all variables were measured as count data and were over dispersed. All analyses were conducted using R software. Results During the 35 months considered, 9095 facility deliveries took place, 408 TBAs reached, and 2181 Motherpacks distributed. The introduction of Motherpacks had the greatest effect on the outcome at 0.2 (p=.009), followed by TBA intervention at 0.15 (p=.001). Months since study start had a much lower effect at 0.05 (p=0.033). Conclusion Collaborating with TBAs and offering basic commodities important to mothers and babies immediately after delivery at health facilities can improve uptake of SBAs in rural communities with high home deliveries. Recommendations Reorientation of TBAs and incentives for couples and for alternative service providers should be incorporated into policies and strategies aimed at improving SBAs during child birth in similar contexts.

Africa Health Agenda International Conference 2017

TUPE09 Making Safe Motherhood a reality: The Issue of Financing Bashiru Jumah1, Ernest Okyere2 1SEND-Ghana, 2Christian Aid, Ghana Background Ghanaâ&#x20AC;&#x2122;s progress at meeting MDG 5 targets has been slow although a number of pro-poor interventions have been implemented in the health sector since 2000. In 2013, maternal mortality rate in Ghana was projected at 380 per 100,000 births far above MDG 5 target of 185/100,000 births by 2015. The 3 regions of the North with the highest incidence of poverty even lag behind the rest of the country. In 2013, institutional MMR in the Northern and Upper West Regions exceeded the national average of 154 per 100,000, standing at 174 and 193 per 100,000 respectively. Poor public financial management was targeted for understanding the slow progress on MDG 5. Objectives To assess government funding sources for maternal health and to track government expenditure on maternal health services Methods Using both quantitative and qualitative approaches, questionnaires were administered to 30 DHMTs, 23 hospitals, and seven (7) health centres. Key informant interviews were conducted with District Directors of Health and Sector policies, plans and reports were also reviewed for analysis. Results The study observed a marginal growth of health sector budget from 2011 to 2013 which were largely spent on compensations. There was poor flow of donor resources to address family planning, ante-natal care, skilled delivery and Emergency Obstetric and Newborn Care (EmOC). For instance only 19% of a European Commission grant was for MDG 5 Acceleration framework was released for such interventions. Erratic financial flows and low investments in health infrastructure, supplies were also identified as key constraints to achieving quality maternal health. Conclusion A critical contributor to the slow pace of achieving MDG 5 target in Ghana is inadequate financial support to lower level health facilities, inadequate funding sources as well as inadequate manpower for the health sector Recommendations In order for the Government to meet the Abuja Declaration targets, there is a need for Government to timely and consistently release funds to health administrations and ensure adequate supply of human and materials resources to health facilities

7-9 March 2017 Nairobi, Kenya

TUPE10 Challenges to Menstrual Hygiene Management in Secondary Schools in Addis Ababa Deborah Regasa, Wlelegne Yallew Ethiopia Background Millions of women and girls continue to be denied their rights to Water, Sanitation and Hygiene (WASH), health, education, dignity and gender equity. Especially menstrual hygiene has been largely neglected by WASH. If the situation does not change, it may not be possible for development programmes to achieve their goals. This study was aimed to identify challenges to menstrual hygiene management in secondary schools of Addis Ababa. Objective To explore menstrual hygiene management related challenges for school girls in secondary schools of Addis Ababa, Ethiopia, 2016. Methods Exploratory qualitative research was conducted from January to March 2016. Six focus group discussions eight in depth interviews and five key informant interviews were conducted among youth girls in five schools. Level of saturation was used to determine the number of interviews and thematic content analysis was used to analysis the data. Results According this research the major challenges identified by school girls were fear of leakage and staining, fear of teasing from boys, pain and failure to manage menstrual flow at school. As a result girls preferred to stay at home especially on the first day of their menses. Conclusion and recommendation Menstrual hygiene management related challenges are negatively affecting girlsâ&#x20AC;&#x2122; participation in school. Most of the challenges were the results of environmental, biological and interpersonal factors. The first two factors can be reduced by provision of clean, private latrine with water, dust bin and absorbents and involving boys in trainings. Provision of pain killers is also the other solution to pain during menstrual flow.

Africa Health Agenda International Conference 2017

TUPE11 Womenâ&#x20AC;&#x2122;s persistent utilization of unskilled birth attendance: a study of mothers in Kakamega County, Kenya Lucy Natecho Namusonge Background Sub-Saharan Africa has the highest maternal mortality rate (MMR) due to lack of skilled supervision at birth. Utilization of skilled birth attendants (SBAs) may lower MMR. In Kenya 95.5% of pregnant women receive antenatal care while 39% in rural areas deliver at home. Kakamega County has facility deliveries at 48.6% compared to the national average which challenges improvement of maternal survival. Women prefer home deliveries conducted by unskilled birth attendants (UBA) to health facilities. Objectives To assess the level of knowledge in pregnancy, labour and delivery among women who utilized unskilled birth attendants; to assess socio-cultural factors leading to uptake of unskilled birth attendance; to assess health system factors leading to uptake of UBA and to establish strategies for scaling up uptake of SBA. Methodology It was a descriptive cross-sectional study utilizing quantitative and qualitative approachestargeting postnatal mothers with children aged less than six months who delivered without SBA.Quantitative data was collected through interview using structured questionnaires andqualitative data using FGDs. Analysis was done using SPSS v. 20.0 and presented in figures, tables, frequencies and numerations. Results Multiple logistic regression was used to test association between research variables and odds ratio for the strength of association between study variables. Results showed antenatal attendance 92.7% and SBA at 48.6%. Factors found to influence uptake of UBAs in the study were: age (X2=8.65, df=3, P= 0.013), occupation (X2=10.04, df=3, P=0.006), religion (X2=19.73, df=5, P=0.0001), monthly income (X2=7.59, df=2, P=0.002), marital status (X2=10.10424, df=2, P=0.005) and education level (X2=9.472, df=4, P=0.002). Conclusion Health providersâ&#x20AC;&#x2122; negative attitude, socio cultural practices and insecurity led to uptake of UBA. Recommendations The study recommends equipping women with knowledge, empowerment, streamlining community-health facility referral systems; health providers to be kind and culturally sensitive to clientsâ&#x20AC;&#x2122; needs to scale up SBA uptake and advocating for birth preparedness.

7-9 March 2017 Nairobi, Kenya

TUPE12 Factors Influencing Health Facility Delivery among Rural Maasai Communities in Magadi Subcounty, Kenya Sarah Karanja , Richard Gichuki , Patrick Igunza , Samuel Muhula , Lepantas Leshore , 1 1 2 2 3 Peter Ofware , Josephine Lesiamon , Lennie Kyomuhangi , Josephat Nyagero , Danielle Charlet , 4 1 Nancy Binkin , David Ojakaa 1

Amref Health Africa in Kenya, Amref Health Africa, University Research Co., LLC, University of California San Diego

Background Among the Maasai community most childbirth occurs at home and is not assisted by skilled birth attendance. We launched the “Boma” model in Magadi Sub-county to promote health facility delivery (HFD) by establishing community health units and training community health volunteers (CHVs) and traditional birth attendants (TBAs) as safe motherhood promoters. The project’s endterm evaluation revealed that HFD increased from 14% to 24% which is still considerably below the national average (61%). We therefore conducted this study to determine factors influencing HFD and describe barriers and motivators to the same. Methodology This was a mixed methods cross-sectional study involving women who had delivered in the last 24 months, focus group discussions with health providers, chiefs and CHVs and in-depth interviews with mothers, key decision influencers and TBAs. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) using logistic regression were calculated to identify predictive factors for HFD and thematic analysis done to describe barriers and motivators to HFD. Results Of the 200 women interviewed, 39% had delivered in a health facility. Factors associated with HFD included not married [AOR 2.4 (95% CI 1.1-5.4)], low parity [AOR 0.7 (95% CI 0.5-0.9)], living near the health facility [AOR 2.2 (95% CI 1.1-4.4)] and belonging to the highest wealth quintiles [AOR 4.9 (95% CI 1.5-16.5)]. Barriers to health facility delivery included women not being the final decision makers on place of birth, lack of birth plan, unfamiliar birthing position, disrespect and/or abuse, distance and lack of essential drugs and supplies. Motivators included proximity to health facility, mother’s health condition, integration of TBAs into the health system, and health education/advice received. Conclusion Community based interventions such as the “Boma model” is one way of improving HFD. Health facilities need to be functional, transport mechanisms established and intensive health education provided to increase awareness of skilled birth care.

Africa Health Agenda International Conference 2017

TUPE13 Peer Communication on Sex and Sexual Health among Youths: A case of Debre Berhan University, Ethiopia Muluken Dessalegn , Takele Gezahegn , Josephat Nyagero 1

Amref Health Africa in Ethiopia, Debre Berhan University, Amref Health Africa HQ

Background Friends are considered an important source of advice and information about sex. Conversations about sex among young people tend to generate norms that influence positive or negative pressure on individuals to conform to group standards. The aim of the study was to explore peer communication on sex and sexual health. Methods Grounded theory qualitative study design was employed using focus group discussions and participant observation. Participants were selected using criterion purposive sampling. Semistructured guides and checklists were used as data collection tools. Information was audio-recorded and transcribed verbatim and uploaded to ATLAS.ti 7 software for coding. Data collection and analysis were undertaken simultaneously using constant comparative analysis. Results Students talked with peers and sexual partners about sex more than sexual health issues. Common places of talk included dormitory, begtera (near dorm where students meet), and space (reading rooms). Whereas, time of talk, either in a group or with just their close friends or sex partners, included during training, evening and weekend time, during walking together, and break time. Students used verbal and non-verbal and formal and informal communication styles. Conclusion The content, place, and time for discussions about sex were influenced by gender, social-cultural norms (e.g. religion), rural vs urban living, and the occurrence of sexual healthissues (e.g sexuallytransmitted infections or unwanted pregnancies). Priority should be given to designing audiencespecific strategies and messages to promote discussions about sex and toencourage safe sexual practices. Primary target groups should include female and rural students, who are predisposed to risky sexual behavior.

7-9 March 2017 Nairobi, Kenya

TUPE14 Reproductive health service utilization and associated factors: The case of North Shewa Zone Youth, Amhara Region, Ethiopia Muluken Dessalegn Amref Health Africa, Ethiopia Background Many youth are less informed, less experienced, and less comfortable in utilizing reproductive health services. In the Sub-Saharan region the adolescents account for a higher proportion of new HIV infections and unmet need for reproductive health (RH) services. This study assessed reproductive health service utilization and associated factors among the youth in Amhara Region, Ethiopia. Methods A community based cross-sectional study was conducted from June 15-July 30, 2014. Three hundred ninety one youth were selected by systematic random sampling technique and interviewed using structured questionnaire. Data were analyzed using SPSS windows version 20. Multiple logistic regression was done to control potential confounding variables. P values < 0.05 were considered statistically significant. Results Three hundred and ninety one in-school and out-of-school youth were interviewed; 256 (65.5%) participants were in school and 209 (53.5%) were males. Almost all respondents (93.9%) had heard about reproductive health services and a third 129 (33%) had ever practiced sexual intercourse and 54.7% of them had utilized at least one reproductive health services. Never had sexual intercourse (AOR=3.693, 95%CI: 1.266, 10.775), families that asked their children about friends (parental monitoring) (AOR=1.892, 95%CI: 1.026, 3.491), knew where service was provided (AOR=3.273, 95%CI: 1.158, 9.247), youths who read newspaper (AOR=3.787, 95%CI: 1.849) were independent predictors of youth reproductive service utilization at 95 % CI and p-value <0.05. Conclusions Even though the youth have information about reproductive health services, youth reproductive health services utilization is very low. Therefore, building life skills, facilitating parent to child communication, establishing and strengthening of youth centres and increasing awareness for youth about those services are important steps to improve adolescents' reproductive health (RH) service utilization.

Africa Health Agenda International Conference 2017

TUPE15 Education and Postnatal Health Care Utilization of young girls In Cameroon Cedric Stephane Mbella Ministry of Economy, Planning and Regional Development, Cameroon Objective The aim of this study is to assess and analyze the influence of level of education of the young girl on her postnatal care seeking behavior. Methods Data was from the DHS-MICS (2011), a national cross-sectional survey of 15,426 women aged between 15-49 years old, but our study focused on 2873 young girls aged from 15 to 24 years old whose last delivery took place 5 years before the survey. The specification used in this study to achieve our objective was the probit model. Results This study revealed that education (formal education) had a strong influence on postnatal care utilization of Cameroonian young girls in the 42 days after delivery. The following results were obtained: (a) compared with an uneducated young girl a young girl who completed primary school increased her likelihood to use postnatal health services by 10%; (b) for a young girl with secondary or more education level, her likelihood to use postnatal services increased by 9%. Conclusion In order to strengthen maternal care demand in Cameroon, public policy should focus on measures which encourage and keep young girls in the education system with the intention that these girls complete at least secondary school.

7-9 March 2017 Nairobi, Kenya

TUPE16 Pastoralism and Antenatal Care Service Utilization In Dubti District; Afar, Ethiopia, 2015; Cross-Sectional Study Nejimu Zepro Samara University, Ethiopia Background Health service utilization among pastoralists in Ethiopia is not well documented. Available data are very few and institution-based. Health services are particularly inadequate and poorly equipped, being scarce, inaccessible and donâ&#x20AC;&#x2122;t fit to pastoralist way of life. Effective antenatal care (ANC) use has been shown to influence womenâ&#x20AC;&#x2122;s use of maternal health services, probably the most effective intervention in reducing maternal mortality in the developing world. Despite many studies done on ANC service utilization among agrarian women, the studies done on pastoralist women are almost negligible. Method A community cross-sectional study was carried out from 5th January to 5th February, 2015. The data was collected by interviews through a questionnaire. Statistical analyses were done to describe pertinent findings. Result Of 788 women, 42.4% (334) made at least one antenatal care visit, while 19.5% (65) had adequately utilized antenatal care (i.e., made four or more antenatal care visits). Only 9.7% of women visited an antenatal care center during the first trimester (12 weeks). Institutional delivery service utilization of the district was extremely low 7.4% (58). Educational status of the mother had a significant association with institutional delivery. Mothers who attended college/university were five times more likely to utilize delivery service than those mothers who are illiterate. ANC utilization in peri-urban area was two times more than ANC utilization in rural areas with CI of (1.376, 3.595). Multivariate analyses, being in peri-urban residence (AOR=2.224, 95% CI: 1.38, 3.60), possessing radio/TV (AOR=3.134, 95% CI: 2.204, 4.457), were positively associated with ANC service utilization. Conclusion Every pregnant woman should receive at least four ANC visits but only 20% of the respondents were able to fulfill the recommendation. Pastoralist lifestyles, access, demographic and socio-cultural barriers affect proper utilization of maternal health services. Increasing service coverage and promotion of available services in the community, accessible health services, transportation and improving information, education and communication on maternal health services must be intensified to reach women in pastoralist communities of the country. Rigorous efforts are needed to reach disadvantaged groups, so as to overcome health inequities between agrarian and disadvantaged pastoralist women. Key words Pastoralism, Antenatal care utilization

Africa Health Agenda International Conference 2017

TUPE17 Performance Contract and Internal Efficiency of a Country’s Health System towards Reproductive and Maternal Health Care Services: Experience from Rwanda Ntacyabukura Blaise University of Rwanda Background From 2005 to 2015, Rwanda Government has reduced by half the maternal mortality and Birth rate through different interventions, guided by Performance contracts, to ensure a rapid development growth. In 2005, Service delivery in health facilities was poor, lacking commitment, competition and easy public health surveillance until 2006, when the government took the IMIHIGO (performance contract) exercise to achieve micro and macro efficiency of the country health system. Objective The aim of this study was to highlight potential stages of this program which guided success of all interventions applied so far. Methods Field observation, scientific literature review, report review and informal interviews to health workers were conducted. Results Binding agreements between health personnel, per level and per institution and the President of the Republic took place. They were based on real facts for real achievement, practicable, and clearly easy to evaluate. Everyone wrote his/her objectives with measurable indicators, taking into account national priorities, as highlighted in Sustainable Development Goals (SDG), for a one-year period. At the district level, monitoring is the responsibility of the hospital staff and the Policy making Committee, together with the Governor of the respective Province. Reporting is done on a quarterly basis and in every semester there is an evaluation by a team consisting of a representative from the Prime Minister’s office, Ministry of health and Ministry of Finance. It scores on a scale of 0-10 depending on the percentage of completed activities. This leads to a “traffic light” rating of Green (90-100% of activities implemented), Yellow (50-89%) and Red (0-49%). Health institution’s directors are held to account on their performance twice a year in public sessions, which are chaired by the President. There is a Question-Answer session, with phone-ins from the public on the how and why. The one with repeatedly low score can get fired. Conclusion Based on this experience, any health system can respond to people’s expectations and give potential of equitable and efficient service to go along with the technological advances in medicine for effective health service delivery. Success can be achieved in Community health services deeply rooted in every remote and urban center. Key words Women health, health system, performance contract, SDGs and government 7-9 March 2017 Nairobi, Kenya

TUPE18 Playing House and Sex Ed; Using listening and creation of safe spaces as a way to address gaps in Adolescent Sexual and Reproductive Health Rights Mageda Esolyo Trust For Indigenous Culture and health, Kenya Issues As young children we would play house- this game in Kenya in (Swahili) is called “cha mama cha baba”. During this game, we would play pretend. A boy would pretend to be husband, a girl a wife and some of us would pretend to be their children. We would pretend to cook; clean, go to school actually emulate a real life family. During this game the husband and wife would pretend to typically do what “married couples do”. Have sex. Sleeping next to each other represented it and the game would be played on weekends. That being said, Adolescent gaps in sexual and reproductive health are present. This is because we aren’t acknowledging that young adolescents are exposed to different factors in their young lives. We tend to cluster all of them in one category be it those that are in school, out of school, in marginalized communities, have difficult childhood backgrounds, homeless etc. So we tend to try and hide information from the adolescent some which by the time they are “playing house” depending on their exposure they already know. Description Meeting adolescent youth in their spaces. Assisting young girls and boys create forums where they can speak about their sexual and reproductive experiences and learn from one another and learn from them. Thus at this spaces we go to disseminate information of the sexual and reproductive health with a particular focus on positive sexuality and sexual practices, agency, autonomy and consent. We listen to them and understand them. We give them information to that will equip them to make decisions in their various diverse environments. Lessons learnt Adolescent have their own way of speaking and learning from each other. They are clustered some times by their experiences thus an adolescent exposure to her /his sexual health varies by experience and environment. Adolescent are at a stage of life when a lot of body changes take place, thus creating space where they can talk to each other (as was with the age set in African culture) and acknowledge these changes and thus they acknowledge that they have sexual health issue and rights. The fact that Sexual lives are taboo conversation in African setting it makes it difficult to approach as a situation where that’s the key focus, it can be in a school club or an after curriculum activity. Recommendation Enacting the comprehensive sexuality curriculum in schools not as a class session but as a compulsory extra curriculum activity. Service providers should treat the adolescents whom are mature minors as any other human beings inquiring for a service and collection of these stories for qualitative data and to develop policy and solutions.

Africa Health Agenda International Conference 2017

TUPE19 The Role of Maternal, Psychosocial and Social Cultural Factors in HIV- Exposed Infants Service Uptake; Nakuru Provincial General Hospital, Kenya Eliza Wambui , Margaret Keraka , Purity Nguhiu , Mutugi Muriithi 1

Kenyatta University, Kenya

Centre for Health Policy, Episolutions and Analytics, Kenya

Background The purpose of the study was determine the factors that lead to low uptake of HIV- Exposed Infants services despite the services being readily available and provided free of charge in public health facilities in Kenya. Objectives The specific objectives of the study were to identify the maternal determinants, psycho-social and social-cultural factors which determine HIV-Exposed Infant’s service uptake. Methods The study was carried out at Nakuru General Hospital, PMTCT clinic among 329 HIV positive mothers and their HIV exposed-infants. Data was collected from mother-baby pairs using structured questionnaires and Key Informant Interviews to mentor mothers, service providers and community health workers attached to the facility. Descriptive statistics was used for analysis of continuous variables. Pearson’s Chi-square test was used to compare association between categorical variables. Hypothesis testing was done using chi-square test. All the results were considered at a significance level of 0.05. Results The study findings indicated that maternal factors including marital status and timeliness of uptake of immunization services had significant statistical association (X2 =7.67, df=1, P=0.001). Psycho-social factors showed significant association with timeliness in immunization (X2 =8.87, df= 1, P=0.03) and timeliness in uptake of Early Infant Diagnosis (EID) as (X2 =28.9, df=1, P=˂0.001). Further findings showed women’s disclosure of their HIV status to their male partners had significant statistical association to HEI service uptake (X2 =6.88, P=0.009). Conclusions and Recommendations The study concluded that maternal characteristics, psychosocial and social-cultural factors influenced service uptake and recommended for promotion of PMTCT psychosocial support groups among all HIV positive women and inclusion of mentor mothers as champions in demand creation, campaigns and interpersonal communication to improve the timely uptake of early infant diagnosis (EID) and immunization services Key words HIV-Exposed infants, Early Infant Diagnosis, psychosocial, social-cultural

7-9 March 2017 Nairobi, Kenya

TUPE20 Quality of Community Based Reproductive Health Particularly Family Planning Services in Jimma and East Wollega Zones, Ormiya Regional State, Ethiopia Anley Haile Abate Amref Health Africa, Ethiopia Introduction Quality of care in Family Planning (FP) encompasses a wide range of issues including technical competence, compliance of service provider with standard guidelines, availability of choice of methods, information/counseling given to clients, interpersonal relationships, the setup in which the service is being rendered and accessibility of the service. Providing quality family planning services is an important task for health care providers so as to increase service utilization and coverage. Objective To assess the quality of community based family planning services as benchmark in intervention and non-intervention health post of Jimma and East Wollega Zones. Methods Quasi-experimental (matched intervention and comparison) study design was employed. In which comparison group was selected from two adjacent districts of Jimma and East Wollega Zones which will not be the intervention areas. Exit interview with FP clients, in-depth interview with health workers, and observation of FP service provision, facility inventory and focus group discussion with health development armies were conducted. Qualitative data were analyzed using content and thematic analysis techniques, while quantitative data were analyzed using SPSS version 16. Results From the total Health extension workers (HEWs) working in the intervention districts 57(89.0%) received training on FP, and similarly 41(89.1%) of HEWs in the control districts were trained. Regarding training status of health workers working in Health centers supervising the HPs 44(38.9%) were trained on FP, while only 21(16.5%) of health workers in the control HC received training. Infrastructure that help to enhance the service delivery to FP clients was unavailable in a significant number of health facilities of intervention and non- intervention health facilities. Most of the contraceptives were out of stock with stock out dates ranging from a day up to 90 days in the last three months of the study. Conclusion and recommendations Even though, the overall client satisfaction with FP service they received from health providers was lower; a relatively higher proportion of clients were willing to use the service and recommend their friends or family to use FP service from the same health provider they have currently used. It is recommended all actors working in the area to support in building the capacity of HEWs, improving infrastructure, equipment and supplies for all health providers in the project area. Job-aids, implementation manuals and standard operating procedures should be developed and availed in all health facilities.

Africa Health Agenda International Conference 2017

TUPE21 Improving Maternal and Newborn Care through Routine Sharing of Service Uptake and Outcomes Data with Health Stewards in Rural Uganda Patrick Kagurusi Amref Health Africa, Uganda Issue In Uganda 17 women and 106 newborns die daily due to pregnancy and child birth conditions. To prevent these deaths, evidence based decisions need to be made by health stewards on the health system. In 2013, Amref Health Africa in Uganda implementing the Saving Lives at birth program targeted 100 rural Health Clinics in 4 districts of South-western Uganda to deliver 52,000 safe births attended by skilled birth attendants in 3 years. A baseline survey prior to project commencement revealed that the 4 target districts had only 7 out of the 24 required medical doctors, 35 out of the required 69 midwives and just 2 out 8 functional operating theatres. Also, health stewards were aware of the staffing gaps but were not clear about the impact gaps were having on serviced delivery especially skilled birth attendance. Intervention A quarterly graphic dissemination of comparative service uptake and outcome data on Antenatal Care and skilled birth attendance to district health teams (DHTs) comprising of health workers and the district leadership i.e. health stewards was implementation. The stewards used the data to define the root causes of poor uptake of services. Within 18 months of the practice, 18 doctors and 42 midwives were hired through a budget realignment mechanism and 6 operating theatres were operationalized. Overall, important system decisions were implemented to improve human resource numbers, discipline, motivation, the medicines situation and to improve health infrastructure. Lessons learnt Routine presentation of service uptake and outcome data can influence positive actions from health stewards leading to responsive health systems. We recommend routine engagement of health stewards with evidence as an approach to systems health strengthening. Key words Health System Maternal Newborn

7-9 March 2017 Nairobi, Kenya

TUPE22 Assessing Alternative Menstrual Hygiene Management Practices amongst adolescent girls in selected schools in Gulu and Kitgum and Pader in Northern Uganda Teo Namata Amref Health Africa, Uganda Background Menstruation is still clouded with poor menstrual hygiene management resulting in adolescent girls experiencing adverse health outcomes. For young girls in poor, rural settings who often receive minimal instruction on what menstruation is and how it can be managed, the experience has been described as frightening and shame-inducing. The associated effects of menstruation, hygienic requirements among others have implications for young girls school attendance and self-esteem. Objective We assessed alternative Menstrual Hygiene Management (MHM) practices amongst adolescent girls in selected schools with a focus on understanding the level of knowledge on MHM, alternative hygiene management practices, effects of MHM practices amongst school going adolescent girls. Methodology A pre-designed structured questionnaire was administered to a total of 320 (10 girls aged between 9-16 in each of the 32 targeted schools). In addition, 14 focus group discussions each consisting between 11-13 members were also conducted. Quantitative data was analyzed using SPSS while content analysis was employed for qualitative data. Findings 75.1% of adolescent girls in these schools use sanitary pads followed by old pieces of clothes 23%. However, the pads and clothes are used for long hours (7-10) a day which leads to leakages, smell, burns and swelling. The effects of abdominal pain 79.41%, backache, general body weakness combined lead to girls missing school. Lack of proper disposal of used menstrual material, poor access to water and soap to bathe or wash are contributing factors to improper menstrual hygiene in targeted schools. Conclusions Menstrual hygiene management practices are a key aspect in keeping girls in schools and for effective menstrual hygiene management, reliable WASH practices and facilities must be in place. Key words Menstruation Menstrual Hygiene Management Practices Adolescent girls

Africa Health Agenda International Conference 2017

TUPE23 Experiences of Water User Committees using Village Savings and Loans Association for Sustainable O&M of their water facility Teo Namata , Morrish Ojok 1

Amref Health Africa, Uganda

Introduction Olam Kara village is located in Pader District in Northern Uganda with a population of 415 people. The village had a shared unprotected well that was used by both community and their animals. Diarrhea was a common problem especially among children. Families had to frequently visit health units and spend money on treatment; there was loss of production time due to sickness and frequent visits to the health facilities. In such a situation, Amref Health Africa with support from the Dutch Ministry initiated a 5-year water and sanitation project with the main goal of improving peopleâ&#x20AC;&#x2122;s access to safe drinking water. Olam Kara Village was among the selected villages to benefit from this project. Integration of VSLA into Water User Committees Critical to the project success were innovations and participatory approaches. The project integrated an innovative financial inclusion approach- the Village Saving and Loan Association (VSLA) concept into the training of Water User Committees (WUCs). The introduction of the VSLA concept was to test and pilot a model for sustainable Operation and Maintenance (O&M) of the water facility. Financial Analysis Thirty-three (33) members comprised of Olam Kara VSLA. Each member contributed 1000 (USD 0.3) monthly for O&M and individual saving that ranged from a minimum of 1000-5000 (0.3-1.44) per week. A total of USD 97 was collected for O&M of the water facility. Out of this, 62 were spent on O&M during 2015. There was available balance of USD 52 for O&M of water facility. In addition, members accessed loans at a reduced and affordable interest rate of 5%. Possibility for scaling up the intervention The idea of integrating VSLA with WUC is scalable due to the fact that VSLA have widely spread across all districts and community members are already benefiting from it. Key words Water User Committees, Village Savings and Loans Association, Operation and Maintenance

7-9 March 2017 Nairobi, Kenya

TUPE24 Smart Technologies for urban and peri-urban communities: Amref Health Africaâ&#x20AC;&#x2122;s Experience in promoting Water Borne/Pour Flush Toilets in Northern Uganda Teo Namata Amref Health Africa, Uganda Issue Safe water supplies, sanitation and hygiene promotion remains vital for good health, environmental protection and poverty alleviation. Although there has been great improvement in achieving the national targets with sanitation coverage standing at 74.8% in Uganda, the quality of the sanitation facilities has always been compromised. Pit latrines are commonly used both in rural and peri urban communities. However, these get filled up and abandoned and with limited land in the urban communities and poor drainage, smart technologies like waterborne toilets remain the best option. Description Amref Health Africa in Uganda acquired funds from European Union to implement a five year â&#x20AC;&#x153;Basic sanitation program in urban and peri-urban communities-Gulu, Kitgum and Pader districts. The project is aimed at increasing access to basic sanitation services through improved sanitation infrastructures and strengthening sanitation chain. Water Borne/Pour Flush toilet is one of the technologies Amref has adopted. How Pour Flush toilet works: One needs a container of water placed around the toilet. Scoop water from the container using a small bucket and pour in the toilet every after use. Once you pour water, the fecal matter will be pushed to the septic tank. The septic tank can be emptied by the cesspool emptier once filled up and re-used again. Conclusion Pit latrines are used by majority of the people not withstanding that their disadvantages far outweigh the advantages in a long run. The adoption of the pour flush toilet that uses less water and can be emptied for reuse without the construction of another facility is the best option.

Africa Health Agenda International Conference 2017

TUPE25 Barriers to accessing post-fistula repair services at two Engender Health supported sites in Uganda (Hoima and Kitovu hospitals) Hassan Kanakulya , Molly Tumusiime , Rose Mukisa 1

Engender Health, Uganda

Background EngenderHealth is a global womenâ&#x20AC;&#x2122;s health organization committed to ensuring that every pregnancy is planned, every child is wanted, and every mother has the best chance at survival. EngenderHealth is currently implementing the Fistula Care Plus project (FC+) that supports the Uganda Ministry of Health to strengthen health system capacity for fistula detection, prevention, treatment and re-integration. Kitovu Hospital and Hoima Hospital are some of the hospitals being supported by EngenderHealth to provide free fistula treatment services under the Fistula Care + project. Objectives To assess barriers to post-operative care for women repaired with fistula in order to sustain positive outcomes after discharge. Methodology This was a retrospective a review of fistula client forms from January 2013 to February 2016 at two fistula repair sites in Uganda supported by the Fistula Care Plus (FC+) Project implemented by EngenderHealth with support from USAID. A counselor was recruited to conduct client follow-up through telephone calls following validation exercise that which had a total of 212 clients entered into the database and later analyzed using SPSS version 20. Results Out of 212 clients, only 144(68%) had complete telephone contacts and were considered for follow-up. 130(90%) clients were reached, 13(9%) were not reachable through the availed telephone contacts, 1(1%) client had died. 78(60%) had followed appointment, 52(40%) had not returned for follow-up. Of the 52 who did not return, 34(65%) said they lacked transport, 8(15%) were not aware that they had to go back for follow up. 5(10%) said they had no reason to return because they were still leaking, 3(6%) had relocated and 1(2%) had a sick child and 1(2%) had died. Conclusion In order to improve fistula treatment outcome, it is important that interventions that will address barriers to access to post fistula repair services should be put in place these may include linking repaired clients to nearby health facilities; support from village health teams; use of valid telephone contacts, adequate provision of counselling services. Once these barriers are addressed, there shall be evidence that a change has happened in the lives of these women who had lost hope while living with fistula.

7-9 March 2017 Nairobi, Kenya

TUPE26 Social Accountability in Health System Strengthening in Acholi Sub Region Teo Namata Amref Health Africa, Uganda Introduction Accountability is being answerable meaning that someone has an obligation to meet certain commitments/standards and if it is found that these have not been met, there are consequences to face. Without accountability, putting resources into a system is like pouring water into a pipe with a crack â&#x20AC;&#x201C; they may leak out. With limited funds for Uganda health staff and facilities, there is need to ensure proper accountability and value for money. However, with the limited funds available sometimes wastage through loss of drugs and absence of staff surface. This loss is estimated at 13% by (World Bank Assessment report 2010). Absenteeism remains the largest source of wastage in the health sector costing about 25.7 billion shillings per year. In Gulu alone, the level of absenteeism is at 19%. Suggested Intervention Socio accountability through active engagement of local communities in the assessment and planning of health services can help in strengthening health systems in Acholi Sub Region. Social accountability creates a space for citizen voice and participation in planning and monitoring of health services. Socio accountability can improve health outcomes; reviewing the health outcomes in Acholi and Uganda as a whole, a number of short comings relate to accountability challenges, power dynamics and also poor health-seeking behaviors. For example, many women in Acholi are not empowered in their own homes/families, with 40% reporting that their husbands make decisions about their healthcare. Conclusion and Recommendations Social accountability works with communities and local health service providers to discuss local health issues. Creating space and facilitating dialogues improves responsibility, responsiveness and relationships. Key words Social Accountability, Health System Strengthening

Africa Health Agenda International Conference 2017

TUPE27 Increasing access to Maternal and Newborn Health through a Transport Subsidy Scheme in Bungoma County in Western Kenya Boniface W Mbuthia , George Wafula, Felistus Naliaka, Martin Simiyu, Paul Munyao 1

Options Kenya

Background Positive progress on Maternal and Newborn Health (MNH) in Kenya include: reduction in maternal death to 360 from 488/100,000 livebirths; increase in skilled birth attendance (SBA) from 44% to 62%. 41% of births in Bungoma are conducted by a skilled attendant, compared to a national average of 62%. The County was ranked 43rd out of 47 counties in Kenya for SBA. Hence the need for additional collaborative interventions by the Maternal and Newborn Improvement (MANI) project through DFID support 2013-2017 on Reducing Maternal and Newborn Deaths in Kenya. Issues Some of the contributing factors include: socio- economic and cultural barriers when accessing MNH services, transport cost, low income mothers living beyond the 5km radius and weak linkages between community and facility. Description MANI project is implementing health system strengthening (HSS) interventions in Bungoma County aimed at reducing maternal and neonatal deaths from 2013- 2017, covering 6 of 10 sub-counties. Transport subsidy is one of the interventions. It includes a voucher, CHVs, HCWs, boda-boda riders and health facilities. Results so far The results so far include - 69 health facilities, 1,840 CHVs, 349 riders. Number of deliveries October to November 2014 were 25, 308 while number of deliveries October 2015 to November 2015 were 29,631. 4323 additional deliveries were reported during the period in the 69 health facilities included in DSF. Lessons learnt Use of existing structures to strengthen community referrals for MNH services, Use of mobile-phone for communication and funds transfer, It addresses financial barriers for the low income mothers and involving multi-sectoral approach in addressing MNH gaps in meeting SDGs Next steps Optimize the intervention for better results and increase utilization rate on vouchers distributed

7-9 March 2017 Nairobi, Kenya

TUPE28 Influence of PHASE on WASH Financing Priorities of Private and Public Schools Mtwalib Walude1, Isa Sematimba1 1Amref Health Africa, Uganda Background Kawempe Division of Kampala, the capital of Uganda has a population of 300,000 people and has the largest number of slums in the city. Communities in the division are located within low-lying poorly drained land and are prone to flooding during the rainy season. Overcrowded neighborhoods and poor sanitary conditions expose school children to WASH diseases i.e. malaria, diarrhea and typhoid. In 2007, the Personal Hygiene and Sanitation Education (PHASE) Model was introduced to change poor personal hygiene and sanitation behavior among pupils and their families. Methodology In 2016 a descriptive comparative study to assess the influence of PHASE on investments by different actors in WASH was conducted in 40 primary schools (20 intervention-PHASE and 20 non-intervention â&#x20AC;&#x201C; non-PHASE). Qualitative data was collected to explain quantitative data. Data was analyzed using the Epi Info 6.0 statistical software while quantitative data was analysed by content and themes. Results NGOâ&#x20AC;&#x2122;s financed (62.2%) while schools financed 37.6% of the interventions. The bulk of school WASH budgets went to operation and maintenance (95% in PHASE and 100% for NON-PHASE schools). Comparing PHASE and non-PHASE schools; 95% versus 47.4% had WASH committees, 68.4% versus 26.3% had costed sanitation plans, 75% vs 44.4% held regular meetings on WASH respectively. Furthermore, 85% phase vs 50% non-phase schools spent on Menstrual Hygiene management, 95% vs 75% spent on washing with soap. There was no difference in expenditure on water bills, latrine cleaning and emptying Conclusions and Recommendations Schools implementing PHASE have better management and allocate more resources for priority hygiene interventions. PHASE should be scaled up in all schools. Key words PHASE, Public and Private Schools, Financing Priorities

Africa Health Agenda International Conference 2017

TUPE29 Determinants of Modern Contraceptives Utilization among Married Women in Pastoralist District of South Omo Alemu Debiso Arba Minch University, Ethiopia Introduction Ethiopia is among one of sub-Saharan country with high fertility rate and low contraceptive rate which accounts approximately 5 and 28.3 percent respectively, while contraceptive prevalence rate (CPR) among urban married women is 53 percent and 23 percent among rural women. Objective The objective of this study was to assess the determinants of modern contraceptives utilization among married women in reproductive age group in Bena Tsemay district of southern Ethiopia. Methods and materials A community based un-matched case-control design was used. One semi urban and seven rural kebeles were randomly selected. One hundred and seventy seven users (cases) and three hundred and seventy five non-users (controls) were taken by systematic sampling. The target population was all married women in the reproductive age group (15-49 years). The data was collected using structured questionnaire and analyzed using SPSS 20.0 version. To ascertain the association between dependent and independent variables, odds ratio with 95% confidence interval was calculated. Results A total of 567 women of reproductive age group were interviewed, which makes response rate of 97.3%. The majority of respondents 501(90 .8%) were semi-urban dwellers and the rest 51(9. 2 %) were rural residents. Majority of the participants were illiterate and housewives. Mothers with education level of secondary and above (AOR=4.04; 95% CI=1.12-14.56), age 15-24 and 25-34 years (AOR=0.13; 95%; CI=0.06-0.30), (AOR=0.30; 95% CI=0.16-0.53) and spousal communication (AOR=9.35; 95%CI= 5.24-16.68) respectively, were statistically significant association with modern contraceptive utilization. Conclusions It is concluded from this study that modern contraceptive utilization is associated with some socio-demographic and socio-cultural factors like age, educational status and spousal communication. So, respective organizations should work on IEC approach of information delivery to increase utilization of FP among pastoralist districts. Key Words Case control Study, Modern Contraceptives Use, Pastoralist Community, South Ethiopia

7-9 March 2017 Nairobi, Kenya

TUPE30 Implications of Devolution for Community Health Services In Kenya Rosalind McCollum , Lilian Otiso , Robinson Karuga , Sally Theobald , Tim Martineau 1

Liverpool School of Tropical Medicine, Great Britain, LVCT Health 2

Background Devolution in Kenya presents county governments with a unique opportunity to expand and innovate context-appropriate community health services for their entire population. Community health volunteers (CHVs) deliver these services and are uniquely placed to link communities with the health system, advancing towards universal health coverage by bringing health services closer to hard-to-reach groups. Objective We sought to understand the implications of devolution for community health by identifying opportunities and challenges for equitable community health implementation. Methods We collected qualitative data through 14 national level key informant interviews, 117 in-depth interviews with county level decision makers across ten counties, 136 interviews with health workers and community stakeholders from sub-county to community level and 14 focus group discussions with community members from three counties. Qualitative data were digitally recorded, transcribed and coded before thematic framework analysis. Results Respondents across counties and health systems levels demonstrated differing levels of understanding for the community health strategy and approach. Post-devolution some counties have prioritised visible health interventions such as infrastructure, neglecting community health activities. However as time passes following devolution, more counties are recognising the value of community health strategy for expanding health coverage resulting in some counties having prioritised and budgeted for context-specific community health related activities such as providing regular CHV stipend, training CHVs to identify common local diseases such as non-communicable diseases, and varied CHV to household ratio (depending on terrain and household density). However, functionality of community units remains a common challenge to service quality. Conclusion and recommendations In Kenya CHVs can, and do, promote equity in extending health services. However, varied levels of understanding have resulted in differing investment and planning for community health by county decision makers. We recommend county level advocacy for politicians and technical decision makers and quality focus for community health service planning and monitoring.

Africa Health Agenda International Conference 2017

TUPE31 Prevalence and Severity of Menopause Symptoms among Perimenopausal and Postmenopausal Women Aged 30-49 Years in Gulele Sub-City of Addis Ababa, Ethiopia Engida Yisma , Natnael Eshetu , Stephanie Ly , Berhanu Dessalegn 1

Addis Ababa University, Ethiopia, University of California, Los Angeles, Los Angeles, CA, USA , Mizan-Tepi University, Mizan, Ethiopia

Background Menopause begins after a woman completes her last menstrual cycle, typically occurring later in life. Due to an aging population combined with longer life expectancy, Sub-Saharan African women will spend a majority of their lives in postmenopause. Menopausal symptom research has been primarily conducted in Caucasian women from high-income countries. Understanding menopause symptom prevalence and perceptions among diverse women in Ethiopia will better inform reproductive health care. Objective To assess the prevalence and severity of menopause symptoms among perimenopausal and postmenopausal women aged 30-49 years in Gulele sub-city of Addis Ababa, Ethiopia Methods We did a cross-sectional study on a sample of 226 perimenopausal and postmenopausal women aged 30-49 years in Gulele sub-city of Addis Ababa Ethiopia. Data on sociodemographic characteristics, menopausal status and an 11-item Menopause Rating Scale (MRS) were collected using interviewer-administered questionnaire.Results: The participants were 40.41 ± 5.93 years on average, the majority of them were married, received some education and consisted of different ethnicities and wealth quintiles. The most prevalent types of symptoms reported were from somatic subscale (65.9%) while psychological (46.0%) and urogenital subscale symptoms (30.5%) were less prevalent. The most commonly individual symptoms reported were: hot flushes (65.9% (95% confidence interval [CI]: 59.4%â€“72.1%), difficulty of falling asleep (49.6% (95% CI: 42.9%-56.3%), depressive mood (46.0% (95% CI: 39.4%-52.8%), irritability (45.1% (95% CI: 38.5%-51.9%) and anxiety (39.8% (95% CI: 33.4%-46.5%). Postmenopausal women experienced higher proportions of urogenital symptoms compared to perimenopausal women while perimenopausal women experienced a higher prevalence of psychological symptoms compared to postmenopausal women. Women presented severe scores in 8.4%, 1.3%, 10.6% and 8.4% for total MRS, somatic, psychological and urogenital subscales menopause symptoms respectively. Conclusions The study showed a high proportion of menopausal symptoms among perimenopausal and postmenopausal women aged 30-49 in Gulele sub-city of Addis Ababa, Ethiopia although a small frequency of women presented severe menopause score according to MRS. The findings reflect menopausal symptoms are common among women in the study area and findings were also consistent with previous research conducted internationally. Future research with larger cross-sectional studies and different Ethiopian female subpopulations is needed to address unmet health needs.

7-9 March 2017 Nairobi, Kenya

TUPE32 Mlearning Technical Artefacts for Improved Efficiency Of Enrolled Midwives Charles Mungai Amref Health Africa in Uganda Background Ubiquitous ICTs such as mobile devices are now known to be effective channels for information dissemination, translation and application. In this paper, we identify technical knowledge artefacts possed by different health care providers that could be harnessed through mobile devices to improve the efficiency of enrolled midwives as they undertake patient diagonosis, therapy and treatment. The intent of this paper is to explore the place of mobile devices in eliciting increased ability of enrolled midwives to access and apply current and relevant technical knowledge in a timely fashion. Methods The methods chosen for this research support a qualitative and quantitative methodology for the purpose of answering the research questions on use of mobile devices to establish; i) the technical knowledge artefacts obtainable from different health care providers for the benefit of enrolled midwives; ii) technical knowledge artefacts deliverable to enrolled midwives using mLearning and; iii) the perception of enrolled midwives to receiving technical training through mLearning. Preliminary findings & Implications The JIBU project baseline survey 2014 attests that about 80% of the nurses and midwives contacted their tutors/supervisors for real-time solutions whenever they were faced with first aid or challenging circumstances. Some of the technical knowledge artefacts nurses and midwives seek from their superiors included, among others: dosage administration, different condition management, performing some surgical procedures, disease diagnosis, etc. Conclusion Innovations in learning using mobile devices (mLearning) come in handy in disseminating technical skills needed for nurses and midwives practice because they are ubiquitous. The exact health care knowledge artefacts that nurses and midwives are willing to embrace on their mobile devices becomes a critical research problem as we seek for innovative approaches of improving their efficiency.

Africa Health Agenda International Conference 2017

TUPE33 Cost-Benefit Implications for Mlearning Technical Knowledge Artefacts for Enrolled Midwives Charles Mungai Amref Health Africa, Uganda Background A radical transformation of how we access and/or share information from knowledge sources is now phenomenal, with mLearning taking center stage World over, lifelong learning for skills improvement is taking center stage, thanks to the emergence of various educational technologies. This paper reports on a cost-benefit analysis undertaken on our candidate mLearning technical knowledge artefacts identified in our earlier study undertaken through the JIBU mLearning project. Methods For effective mLearning, learners choose the content, integrate artefacts/objects/real experiences, and move around with devices. Learning extends beyond classroom walls through collaborative and cooperative learning. Data was enlisted from enrolled midwives through quantitative and qualitative approaches. The costs and benefits of delivering technical skills to enrolled midwives through mLearning was thus deduced. Preliminary findings & Implications The mobile phone was the most commonly owned/used mobile device. Almost all (96%) enrolled midwives had a mobile phone and only 17% either owned or used a flash disk. Whereas 34% indicated that they owned/used a notebook (kindle), this was mistaken to be the paper-based handwriting notebook. Majority (85%) of the mobile phones owned/used by enrolled midwives were first generation or low end mobile phones. First generation or low end mobile phones are dominantly used for voice calls and text communication with limited support for effective mLearning. Conclusion It has been established that some costs of mLearning are easily quantified and a monetary value established. Benefits of mLearning are not easily quantified. Human life as a non-market good finds support in a utilitarian foundation, where costs and benefits are best evaluated in terms of making society better-off. As such itâ&#x20AC;&#x2122;s difficult to quantitatively establish mLearning cost benefit ratios.

7-9 March 2017 Nairobi, Kenya

TUPE34 Exploring the factors hindering girls and women accessing health care facilities In Morogoro, Tanzania Halima Lila International Development Research Centre (IDRC), Tanzania & Dalhousie University, Tanzania Description and issues Tanzania is committed to reducing maternal and neonatal mortality rates in the country, currently maternal mortality rate (MMR) is 432/100,000 while neonatal mortality rates (NMR) is 26/1000. Lack of access to Comprehensive Emergency Obstetric and Newborn Care (CEMONC) and shortage of qualified human resources for health is a major challenge especially in rural settings. That can be one of the barriers for girls and women to access care at the health facilities. To address that, there is a need to increase coverage of CEMONC services by ensuring the availability of infrastructure and qualified human resource. An implementation research was established in five health facilities in Morogoro to address the shortage of qualified personnel using a task shifting approach, whereby tasks normally performed by medical doctors can be performed by skilled non-medical doctors. While at the same time exploring the best practices for scaling up CEMONC in Tanzania. Lesson learned Majority of girls and women interviewed mentioned that, the challenges to access health centres during antenatal, natal and postnatal are shortage of skilled personnel, non-friendly services, shortage of medical supplies, laboratory services and equipment for safe delivery. Other factors include geographical barriers eg. Distance, poor road infrastructure, safe, transport, customs and believes, influence of traditional birth attendants and inadequate involvement of men. Recommendations This study highlights the factors that hinder girls and women accessing health care facilities for antenatal, natal and postnatal care. Availability of adequate skilled personnel, infrastructure and friendly health services are necessary. Furthermore, community advocacy, comprehensive education on reproductive health during adolescents and active engagement of boys and men in reproductive services is crucial much so in pastoralist tribes.

Africa Health Agenda International Conference 2017

TUPE35 Sexual and Reproductive Health Experiences among Youth with Disability in select special schools, Thika West Sub-County, Kiambu, Kenya Doris Nyakundi Amref Health Africa, Kenya, Moi University, Kenya Background Worldwide, there are 180 to 220 million youths (15-24 years) living with disability. 4.6% of Kenyans live with some form of disability, 3.6% of whom are youth aged between 15-24 years. Youths with disability (YWD) are generally marginalized; to date little is known about their reproductive health needs and sexuality. This study aims to establish the Sexual and Reproductive Health (SRH) experiences among youth with disability in special schools. Methods A mixed methods cross-sectional survey of youths with disabilities from two special schools was conducted in May 2015. Systematic random sampling was used to select participants who completed structured questionnaires while purposive sampling was used to select participants for the key informant interviews and focused group discussions. Quantitative data was analyzed using univariate and bivariate statistics including proportions, chi square, and t-test. Qualitative data was transcribed verbatim and coded to establish patterns of emerging themes. Results 150 YWD were surveyed, 82(54.7%) male and 68(45.3%) female. Mean age was 17.3 years. Main preference for SRH information was teachers (52%), friends (54%) and parents (58%), Health care workers were least preferred (17%). 22(14.7%) of the participants have ever had sexual intercourse, 17(77.2%) male and 5(22.8%) female. Risky sexual practices were non-condom use (77.7%), multiple sexual partners (9%). Gender (P-0.021) was found to be significantly associated with premarital sexual practices. Type of disability (P-0.032) and gender (P-0.021) were also found to be associated with having ever had an HIV test .There was perceived lack of confidentiality among health care workers, lack of skilled teachers to handle SRH issues and lack of disability friendly materials on SRH. Conclusions Gender and type of disability are significant variables in premarital sexual practices among YWD. Recommendations: Policy makers need to consider gender and type of disability when developing SRH policies and implementing programs targeting YWD.

7-9 March 2017 Nairobi, Kenya

TUPE36 Assessment of Bacteriological Ground Water Quality of the shallow boreholes of Sogomo Area, Eldoret-Kenya Faith Lutomia KEMRI/CDC, Kenya Introduction Increasing population in developing countries is becoming a major challenge bringing with it sanitation problems and challenges related to accessibility and quality of water. Assessment of water quality has therefore become important to ensure safety. Methods In this study, the bacteriological quality of water from eight Boreholes (BHs) in Sogomo area was analyzed for three months and results compared to WHO standards. Bacteriological analyses were by spread plate technique on Nutrient Agar (NA) for Total bacterial counts (TBC) and Most Probable Number (MPN) for Total Coliforms (TC). Results The mean TBC ranged between 6.33 x 100 - 7.43 x 102 CFUs/ml with only two BHs (BH4 with 1.11 x 102 CFUs/ml and BH6 with 7.43 x102 CFUs/ml) having TBC greater than the recommended WHO limits. However, the mean TC levels in BHs ranged between 9.66 and 1753.33 MPN/100ml for all BHs hence did not comply with the WHO requirements of NIL coliforms per 100 ml of drinking water. Conclusion The study concluded that although the TBC levels were low in the BHS, TC which reveal faecal contamination were present and BH water was not safe for use. Key words Bacteriological quality, Borehole water, Total coliforms, Total bacterial

Africa Health Agenda International Conference 2017

TUPE37 Determinants of Repeated Abortion among Women of Reproductive Age attending health facilities in Northern Ethiopia: A Case-control study Mussie Alemayehu , Muluken Dessalegn 1

Mekele University, Ethiopia Amref Health Africa in Ethiopia

Background Every year, an estimated 19–20 million unsafe abortions take place, almost all in developing countries, leading to 68,000 deaths and millions more injured many permanently. Many women throughout the world, experience more than one abortion in their lifetimes. Repeat abortion is an indicator of the larger problem of unintended pregnancy. This study aimed to identify determinants of repeat abortion in Tigray Region, Ethiopia. Methods Unmatched case-control study was conducted in hospitals in Tigray Region, northern Ethiopia, in 2015. The sample included 105 cases and 204 controls, recruited from among women seeking abortion care at public hospitals. Clients having two or more abortions (“repeat abortion”) were taken as cases and those who had a total of one abortion were taken as controls (“single abortion”). Cases were selected consecutive based on proportional to size allocation while systematic sampling was employed for controls. Data were analyzed using SPSS version 20.0. Binary and multiple variable logistic regression analyses were calculated with 95% CI. Results Mean age of cases was 24 years (±6.85) and 22 years (±6.25) for controls. Study participants who did not understand their fertility cycle and when they were most likely to conceive after menstruation (AOR=2.0, CI: 1.1-3.7), having a previous abortion using medication(AOR=3.3, CI: 1.83, 6.11), having multiple sexual partners in the preceding 12 months (AOR=4.4, CI: 2.39,8.45), perceiving that the abortion procedure is not painful (AOR=2.3, CI: 1.31,4.26), initiating sexual intercourse before the age of 18 years (AOR=2.7, CI: 1.49, 5.23) and disclosure to a third-party about terminating the pregnancy (AOR=2.1, CI: 1.2,3.83) were independent predictors of repeat abortion. Conclusion and Recommendations This study identified several factors correlated with women having repeat abortions. It may be helpful for the Government of Ethiopia to encourage women to delay sexual debut and decrease their number of sexual partners, including by promoting discussion within families about sexuality, to decrease the occurrence of repeated abortion.

7-9 March 2017 Nairobi, Kenya

TUPE38 Implementing Paperless Nutrition Programming using Mhealth Samuel Kemboi Biwott , Regina Mbochi, Ibrahim Osman, Angela M, Hassan O, Bill A, Poore K, Duncan H 1

Save the Children, Kenya

Background: Mhealth is part of the health informatics revolution to improve on accurate diagnosis, treatment, reporting and monitoring of acute malnutrition. Implementation of I ntegrated Management of Acute Malnutrition in 40 Health facilities 20 Case and 20 controls distributed in 3 sub counties from January 2015-December 2016. Methods The mHealth funded by OFDA/USAID through world vision using Dimagi Commcare piloted in 4 counties. Pilot was informed by poor indicators in service availability and readiness mapping. System strengthening Stepwedge approach used in design and implementation focused in capacity, system and process. Joint programme implementation focused on strengthening demand and supply and building hardware and software. Programmes execution linked to participatory accountability by all stakeholders. Why mHealth Case Management-Accurate screening, diagnosis and treatment, -Clinical Mentorship-Clinical decision support and adherence of IMAM protocol, -Defaulter Tracing-Absentee list, Defaulter list, -Referral- When, Why and Where to refer, -Reporting-Accurate, Timely, -Recording and Documentation- Legible and Continuity of care, Duplication of case records, -Stock Management- Dosage, Stock outs reason why less or more supplementation. Results Skill transfer to 100% of health workers and health managers 54 (35M, 19F), 13SCHMT (9M, 4 F) 3CHMT (1F, 2 M) and 41CHWs (31M,10F). Facilitated 24 documented monthly targeted supervision. Provision of monthly airtime for the 20 pilot facilities for data submission. Compliance and acceptability improved from 40% in July 2015 to 100% September 2016.Data quality Audit revealed 95% accuracy rate from tablet â&#x20AC;&#x201C;MOH 713 â&#x20AC;&#x201C; DHIS2.Issuance of access right to MoH key staff observed improved data use for action by health managers using analyzed crystal reports and dashboard summaries. Conclusions Remote monitoring and technical assistance of the facilities and systems, creation of social media group (whatsup) to exchange ideas and experience, Sector wide accountability strategies improved results at scale, Cross learning within implementing partners from different contexts, and target beneficiaries, Beneficial to work with locally mHealth service for cost effective skill transfer and continuity of technical assistance beyond design to implementation, Need to document and generate evidence for learning to determine success, failure and inform scalability and replicability in resource limited set up.

Africa Health Agenda International Conference 2017

TUPE39 Accessibility to Sexual And Reproductive Health and Rights Education among Marginalized Youth in selected districts of Tanzania Mercy Kawala , David Ngilangwa , Benatus Sambili , Serafina Mkuwa , Rita Noronha 1

Amref Health Africa, Tanzania

Background Access to information, education and services is central in the promotion of sexual and reproductive health and rights (SRHR) among young people. It enables young people to make informed choices on sexuality matters, hence reduce teenage pregnancies and sexually transmitted infections (STIs). This study assessed accessibility of SRH rights information among marginalized young people in three municipalities of Iringa, Ilala and Kinondoni in Tanzania. Methods A cross-sectional study design using mixed methods was conducted in 2013 in three selected districts of Tanzania, randomly and purposely selected a total 398 young people including those with disabilities, food vendors, school truants, housemaids and those living with HIV/AIDS to partake in study. Quantitative data analysis was done using Statistical Package for Social Science (SPSS) version 20, while qualitative data was thematically analyzed. Results A total of 396 (99%) participants (144 Males and 251 females), with a mean age of 20.1 years participated. The majority of them were; female, out of school youths, cohabiting and had completed secondary education. Overall, (317) 79.6% of interviewed young people had SRH rights knowledge. The leading sources of SRH rights information reported were peer educators (36.7%) and radio (22.8%). Awareness regarding laws and policies related to SRH right was 55.1%. However, young people living with HIV and school truants had more access to SRHR education and services than the other youth groups(X2 30.69, p< 0.0001). Conclusion Generally, access to SRH rights information is high; however it decreases when it is disaggregated across different age groups. There is a need for the diversified approaches for reaching specific groups of youth depending on their needs and circumstances.

7-9 March 2017 Nairobi, Kenya

TUPE40 Unskilled but Competent: Results from an HIV Rapid Test Competence Assessment among Non-Medical Non-Laboratory Staff In Tanzania Lusungu Ngailo , David Ngilangwa1, David Ocheng , Sagamo Mattaro , Mwanakombo Khama , Rita 1 1 Noronha , Florence Temu 1

Amref Health Africa, Tanzania

Background Tanzania suffers from a human resource for health crisis in the area of HIV laboratory diagnostic and testing. Task sharing has been recommended by the World Health Organization and is taking place unsystematically across the country, where non-laboratory certified personnel working in health facilities perform HIV rapid testing (HRT), due to staff shortage. To understand this phenomenon and to devise proper response, Amref Health Africa assessed the competence non-laboratory personnel, who regularly conduct HRT in health facilities. Method This was a nationwide assessment targeting 8,656 testers from 1,482 health facilities. Testers were provided with blood samples and asked to perform the HRT. They were scored on the accuracy of the procedure by a team of 3 qualified laboratory personnel. Data were analysed using Stata 10. Results Majority of participants were medical personnel 22.1% (1,913) and non-medical working in standalone and rural health facilities. Their professions ranged from social workers, lay counsellors and pastors. Of all non-medical 85.8% were competent in conducting rapid HIV test. Conclusion The study found that a large number of unskilled health service providers are performing HRT in health facilities and proven to be competent. We recommend them for further training and accreditation, and especially to those in the lower cadres, who form the bulk of the healthcare workforce, to fully integrate them into laboratory diagnostic services.

Africa Health Agenda International Conference 2017

TUPE41 Majibu Platform-The Power of Mobile Phones Applications in Increasing Access to Sexual and Reproductive Health Education in Tanzania Pius Chaya , David Ngilangwa , Anna-Grace Katemb , Joseph Pilot 1

Amref Health Africa in Tanzania

Issue Use of mhealth or mLearning innovations has received significant momentum due to the booming and penetration of mobile phones usage in the world including Tanzania. While countries strive to bridge the Human Resource for Health (HRH) gaps and in particular related to knowledge and skills on addressing Sexual, Reproductive Health and rights (SRHR) needs, the use of mLearning for health workers from hard to reach areas is of paramount importance. The phased out Millennium Development Goals attempted to address the health systems caveats, including HRH skills, retention and supply, yet utilization of mhealth for increasing the knowledge and skills on SRHR information and education of providers remain critical. Description The m-Learning project, dubbed Jibu, was implemented by Amref Health Africa in collaboration with Amref Flying Doctors in the Netherlands in 2014-2015. The project aimed to improve the quality of care, increase access of SRHR knowledge and increase opportunities for peer learning among 3,000 nurses-midwives across Tanzania. The project used a platform called Majibu platform (a Swahili word meaning solutions). Lessons learnt Using mobile applications in forms of mLearning has proved to be potential to improve Healthcare provider knowledge and skills and to support decision-making. The Jibu m-Learning project has observed the feasibility of mobile applications for nurses and midwives to increase access to health information, on SRHR topics and to improve health service delivery. Also, mLearning has improved collaboration and relationships among users, and has increased access and convenience to learning materials and clinical policy guidelines. Majority of nurses are motivated to buy smartphones as a tool for updating their knowledge and skills related to clinical knowledge. Recommendations The adoption of mLearning for HRH is supplemented by the boom of the mobile phones usage in Tanzania. This calls for stakeholders to invest more on the area.

7-9 March 2017 Nairobi, Kenya

TUPE42 Would Moran Marry Uncircumcised Woman? Assessment Of Alternative Rite of Passage Intervention in Kilindi District, Tanzania Jane Sempeho , David Ngilangwa , George Saiteu , Jeremiah Kidola 1

Amref Health Africa, Tanzania, National Institute of Medical Research, Mwanza, Tanzania 2

Introduction Over the years Tanzania has experienced significant decline of Female Genital Mutilation prevalence. However, majority of uncircumcised women are turned down in marriage proposals particularly those in rural areas. Amref Health Africa in Tanzania implemented a three-year community-led Alternative Rite of Passage (ARP) project to eradicate FGM among the Maasai community. In this approach, as transition from girlhood to womanhood, girls would go through all rituals for four days without cut of their genitals. Methods This was a cross-sectional study comprising of a parallel mixed method approach which was designed to measure the behavior of the girls after their graduation to ARP intervention in Kilindi District, Tanzania. The study randomly selected and interviewed 210 girls who passed through ARP. Data collection using semi-structured questionnaire was done between June-July 2016. Data were descriptively and inferentially analysed using Stata 12. Results Majority of interviewed ARP graduates were students 109 (52%) with median age of 13 years (Interquartile range [IQR] 11-15). Of those 210 interviewed girls, only 25% (n=54) reported to be circumcised. Of those circumcised, 35 (69%) of them reported to be circumcised after ARP graduation. Majority of circumcised girls 32 (60%) cited fear of not being married was the reason for their option. About 63 (30%) of the girls knew at least another uncircumcised girl who went through ARP and got married to a moran (young Maasai warrior). There was a significant differences between the uncircumcised (40%) and circumcised (11%) who reported that morans would opt to marry them (P=Ă&#x2039;â&#x20AC;&#x161;0.001). Conclusions The prevalence of circumcised girls after ARP graduation in this population is high. In addition, preference of being married with a moran is positively associated with FGM, this suggests that more interventions targeting the community and morans in particular are needed.

Africa Health Agenda International Conference 2017

TUPE43 Breaking the Taboo: Menstrual Hygiene Management within Community Led Total Sanitation; Insights from Kenya Sanitation and Hygiene Improvement Program (KSHIP). Geoffrey Ikiara , Kurao D, Kimathi G, Kioko K, Lengewa M, Vincent O 1

Kenyatta University, Kenya

Introduction Significant barriers to good menstrual hygiene management persist across Kenya and remain a challenge for low-income women and girls. Kenya sanitation and hygiene Improvement program is expanding Community-Led Total Sanitation (CLTS) to address Menstrual Hygiene Management (MHM) in schools and communities and break the silence on menstruation. Methodology We conducted a baseline survey in July-2015 in eleven counties (Wajir, Kwale, Tharaka-Nithi, Embu, Muranga, Nakuru, Narok, Kisii, Migori, Busia and Uasin Gishu) in Kenya. A total of 4396 randomly selected household heads were interviewed. Structured observations of school water, sanitation and hygiene facilities were performed at 175 schools. Focus group discussions were done with girls and key informant interviews with teachers and school administrators. Descriptive and thematic analysis was used for quantitative and qualitative data respectively. Results 46% (2186) of the respondents treat menstruation as a secret thing while others (17%) as socially shameful and something dirty, while 22% (1045) do not know about menstruation. Only 3% of the respondents treat menstruation as a normal physiological process. None of the schools (175) surveyed met the recommended pupil: latrine ratio of 25:1 (girls) and 30:1 (boys). 10.6% (502) of mothers reported that they provided MHM information to girls and boys while 3.6% (173) helped in breaking the myths on Menstruation.11.2% (533) of girls reported to have access to affordable Menstrual Hygiene material. 46% of teachers interviewed reported not having adequate facilities in their schools for MHM. Conclusion These findings have identified key barriers to good MHM in schools and community such as low levels of knowledge about menstruation and its management, structural designs gaps and inadequate facilities. Mainstreaming MHM in CLTS triggering provides the best opportunity to break the silence on menstruation thus improving the health status of the community and alleviating additional stress placed on women and girls. Keywords Menstrual hygiene; appropriate hygiene practices; barriers to good MHM practices; break the silence on menstruation.

7-9 March 2017 Nairobi, Kenya

TUPE44 Use of Mobile Phone Short Messaging Service as tool for Health Education and Awareness to Accelerate TB Case-Finding: Mombasa, Kenya Joshua Limo Kenya Association for Prevention of Tuberculosis & Lung Disease, Kenya Abstract to be accessed from author Email: limojn@gmail.com

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TUPE45 Familyconnect - A Collaborative Mhealth Approach to Optimize Health Service Delivery in Uganda Alex Muhereza1, Melissa Cederqvisit2 1UNICEF Uganda, 2Plan International Abstract to be accessed from author Email: amuhereza@unicef.org

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TUPE46 Menstrual Hygiene Management Practices and its Associated Factors among adolescent high school girls in Slum Areas of Addis Ababa Wosen Mariam Amref Health Africa, Ethiopia Background The practice of Menstrual Hygiene Management varies from society to society depending on the culture, literacy and economic status of the society. In most developing countries menstruation is considered a taboo. Young girls donâ&#x20AC;&#x2122;t get appropriate information from parents and instructors at school level. Objectives To assess menstrual hygiene management practices and associated factors among adolescent high school girls in Gulelle sub city, Addis Ababa Methods A school-based cross-sectional study was conducted in December 2014 among 912 adolescent school girls in Gullele sub city. Adolescent girls were obtained by systematic random sampling and purposive sampling methods. Self-administered structured and pretested questionnaire s used as the data collecting instrument for quantitative part of the survey. Data was coded, entered, using Epi Info 3.5.4 and analyzed by SPSS version 20. For qualitative part, semi-structured questionnaires and structured checklist was used to collect FGD and observational data. Results Seven hundred and fifty two adolescent girls (82.5%; 95% CI: 79.8-84.9) practiced good menstrual hygiene. The practice of good menstrual hygiene was higher among girls who were informed about menstrual hygiene before menarche (AOR 1.82: 95% CI: 1.17-2.83), girls who had a high level of knowledge (AOR 2.04: 95%CI:-1.08-3.83), and girls whose mother was literate (AOR 1.78: 95% CI: 1.15-2.75).Similarly, the qualitative results add on lack of adequate information, lack of access to menstrual pads and sanitation facility with adequate water supply in schools were the major challenges. Conclusions and Recommendations Majority of the girls had good menstrual hygiene management. Information on menstrual hygiene before menarche, knowledge of menstrual hygiene and motherâ&#x20AC;&#x2122;s education status are the factors associated with the level of expected practice. Stakeholders should work in an integrated manner to address the aforementioned problem to promote good menstrual hygiene management practice.

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TUPE47 Self-Reported Sexual Behaviour among In and Out of School Adolescents in Handeni District, Tanzania: An Implication for the future interventions Aisha Byanaku , David Ngilangwa 1

Amref Health Africa, Tanzania

Introduction Young people in Tanzania face many problems that affect their access to Sexual and Reproductive Health Rights (SRHR). While there are many efforts both from government and the non-governmental organizations in addressing SRHR and promote their rights, currently many youth especially in the rural remote areas do not access these services. Amref Health Africa conducted a baseline survey to understand different SRHR indicators before implementation of intervention project in Handeni district, Tanzania. Methods This was cross-sectional study from February to April 2016. A multistage sampling whereby 1) one village from each ward was purposefully selected; 2) 30 in and out of school adolescents were randomly selected. A total of 365 respondents were interviewed using semi-structured questionnaire. Data were descriptively and inferentially analysed using Stata 12. Results The median age of study respondents was 19.1 years. The majority of respondents were out of school adolescents, single, had primary education level 219 (59%) and Muslim255 (70%). The reported median age of starting sexual intercourse was 15.9 years, while the age of marriage was 19.9 years. The average number of life sexual partners was 5.7. Males reported to have more than doubled the number of lifetime partners than their female counterparts. In school adolescents reported having fewer life time partners as compared to the out of school respondents (3.0 and 6.6, respectively). Additional, majority of them reported Inconsistent condom use during sexual intercourse. Most of adolescents knew the symptoms of Sexually Transmitted Infections (STIs) as discharge from penis/vagina (43%), pain during urination (20%) and ulcers/sores in genital area (9%). The majority of respondents also knew the place to seek medical attention when one contracts STIs and majority of respondents depend on government health facilities. Conclusions Findings show that there is high risk sexual practices among adolescents in this population which suggest for immediate intervention to address such challenges.

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TUPE48 Urban Water, Sanitation And Hygiene Implementation Challenges and Factors Associated with its Effectiveness in Slum Areas of Addis Ababa, Ethiopia Abdissa Fufa Aga Amref Health Africa, Ethiopia Background Access to improved drinking water sources and improved sanitation facilities in Ethiopia is among the lowest in Sub-Saharan Africa with only 49% and 4.5% national coverage respectively. Objectives To assess challenges of urban WASH program implementation and factors determining its effectiveness in slum areas of Addis Ababa, Ethiopia. Methods Community based cross-sectional study was employed from January- February 2015. Quantitative data was collected through household survey from 576 respondents. A total of 24 Key Informants Interviews and 9 Focus Group Discussions were conducted to collect qualitative data. Results Piped water is main source of drinking water for 66.8% households. Only 23.6% households practice treating drinking water. Respondents who didn’t have formal education have lower knowledge on water treatment compared to those with educational level of secondary school and above [AOR=0.45; 95%CI: (0.24-0.84)]. About 47.4% of surveyed households have latrine. But, only 12.5% have improved facilities. Availability of latrine is low in households whose main source of income is from employment compared to those source of income is from private business [AOR=0.47; 95%CI: (0.24-0.92)] and labor work [AOR=0.29; 95%CI: (0.13-0.63)]. It’s also low among household owners who didn’t have formal education [AOR=0.45; 95%CI: (0.26-0.81)] and who attended primary school [AOR=0.52; 95%CI: (0.30-0.90)] compared to respondents whose educational background is secondary school and above. Only 14.9% respondents wash their hands at critical times, and it gets lower among respondents who didn’t have formal education compared to those with educational status of secondary school and above [AOR 0.35=; 95%CI: (0.19-0.64)]. Conclusions and Recommendations Access to improved drinking water sources and sanitation facilities is low. Low socio-economic status and knowledge of the community are the major challenges. Developing WASH projects that not only focus on improving WASH status of the community but also address the basic root causes of the problem is necessary.

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TUPE49 Increasing Access of Comprehensive Sexuality Education for Young People Alvin Irungu Centre Study for the Adolescents, Kenya Background Despite the presence of aspects of Sex Education in the curriculum in schools in Kenya, Adolescent involvement in sexual immorality is still rampant. This paper is a response to this situation. Less than 20% of young people aged between 10-14 years have comprehensive knowledge of HIV. Itâ&#x20AC;&#x2122;s main concern is to assess how Comprehensive Sex Education (CSE) is disseminated, and how adolescents are benefiting from it, with a view to determining the way forward. The WSWM (World Start with Me) is an ICT, school based programme which has been implemented in Kenya since 2006. The programme aims at improving the capacity of young people to respond to the challenges associated with transition from adolescence to adulthood. It uses innovative approaches that facilitate youth participation and promote responsible behaviour. As an advocacy network, WAYAN advocates for at policy and community level for enhanced access to comprehensive SRH information and services for young people. WAYAN uses this approach to meaningfully engage young people in implementing its programs. The programs aim at creating awareness on sexuality education and SRHR in general. Objective The objective of this paper is to show how to improve access of CSE by using young people with age appropriate knowledge, on a broad set of topics related to sexuality including reproductive health. Methods Use of Youth Advocates to disseminate CSE knowledge, as a peer to peer approach and also use of social media platforms, to create awareness. Results From the Facebook page with over 8,000 likes gives a lot of sexual information and discussions to young people. Also, CSA Youth Advocates has been able to reach out to over 2,000,000 young people with SRH/HIV knowledge and skills, through having member advocates in different counties, who empower in and out of school young people with CSE and SRHR programs, thus showing how using young people is effective in information sharing. By involving young people in implementation of CSE and SRHR programs, we increase the knowledge of young people on CSE, thus increase access of CSE. Conclusions and Next steps To implement adequate CSE for adolescents in Kenya, a multilevel system of approach is required. Change must first occur at the individual and interpersonal levels. Thereafter, the community level where the community realizes the benefit of this reproductive health education. Lastly, change is needed at the organizational and policy level. Government policy should mandate adolescentsâ&#x20AC;&#x2122; rights of CSE.

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TUPE50 The ICT Device, a major innovation initiated by Amref Health Africa in the Health System Senegal Mouhamed EL Bachir Amref Health Africa, Senegal Introduction In the Southern part of Senegal (Kolda region), maternal, newborn and child mortality is still high due to low skilled birth attendance (25%)and low access to health care. Amref Health Africa developed an integrated technology based solution aiming to improve demand and supply for MNCH services. Methodology The technology involves 3 components: mHealth, e-learning and telemedicine integrated alongside the health system. CHWs use smart phones to register, and follow up pregnant women and children under five. They are linked to the peripheral health workers who receive and store information on tablets and computers and provide care and services to women and children. In addition, health personnel capacity on MNCH is regularly reinforced through E-learning. Finally, a telemedicine platform connected to the M- health application allows referral and case management in hospital. Furthermore, a mobile telemedicine pack connected to the platform is used for outreach interventions in remote communities. Results This integrated system enables us to connect and support remote health workers. The involvement of CHWS for monitoring pregnancies and the survival of children, ,full and uninterrupted health system chain fosters the continuity of care and an efficient referral system. Actually, 9201 pregnant women, 41019 children under five are registered and monitored through the platform and 75 CHWs have a mobile connected to the telemedicine server. Conclusion The ICT platform appears as a revolution in the heart of the health system. From mother to child, this device remains a very dynamic and interactive tool for monitoring patients.

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TUPE51 Family Role in reducing smoking behavior in urban adolescents in Nepal Babita Adhikari Kathmandu University, Nepal Background: This research assesses adolescents' and family's perspectives on the role of family in reducing health risk taking behaviour. It also explains adolescents' attitude towards family and how it shapes their health risk taking behaviour. Among other risk taking behaviours, this research explores the sharply increasing uptake of smoking by adolescents in the context of Nepal's growing urban societies. Methods: Several in-depth interviews with parents and high school students have been taken and focus group discussions are ongoing. Results: Initial findings suggest that adolescents in Nepal are at high risk for a number of negative health outcomes such as accidents, early pregnancy, sexually transmitted infections and HIV/AIDS due to their propensity to take health risk behaviour. Health risk behaviour such as smoking, alcohol consumption, substance abuse and unsafe sexual activities are common and sharply increasing among adolescents. Adolescents get information on protective factors from parents, teachers, peers and media but despite such information, many urban adolescents are increasingly taking up smoking. The major reason behind such risk taking attitude is believed to be due to ineffective role played by family in changing themselves according to the fast changing societal contexts in urban environments. As adolescents find more comforts in seeking support over virtual social media, their ability and skills to practically interact with realtime friends, parents and family is almost non-existent. This problem is further compounded by the fact that support system available for urban adolescents are minimum and most of communication to adolescents are done through mass media or street level poster awareness which the adolescents find least interesting. Conclusion: The findings are expected to help learn the extent of smoking problem in adolescents in urban areas, the reason for such risk taking behaviour and its relationship with nature of available family and peer support system. The research will be useful for public and private sector health communication centres for designing well targeted adolescents counselling programmes and support system.

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TUPE52 Perceptions of Populations on the Integration of Youth Friendly Services in Peripheral Health Facilities 1Mouhamed El Bachir Lo, Khaltoume Camara, Babacar Dia, Babacar Diallo, Bara Ndiaye, Sylla Thiam 1Amref Health Africa West Africa, Senegal Introduction : In a context marked by an active sexuality and the adoption of risky behaviors of adolescents / youth, Amref Health Africa, through the ASK program, supported the State of Senegal in sexual and reproductive health (SRH) in landscaping 6 areas teen/ young people spaces in six health posts in the health districts of Mbour and Thiadiaye. The present work aims to study the perception of communities in regard to the teenagers / youth spaces integrated into health care services. Methodology: The study is based on a qualitative approach to assess the perception of communities about teenager/youth spaces. Through a collective maintenance guide and individual care guide, 98 actors were interviewed. Participants were grouped into five broad categories: community leaders; health care workers; teens / school youth, the aides-Ados / Young, other people. Results: Overall the perception is positive among different actors. Religious guides found that EA is a very good initiative, as they seek to support young people in the prosecution of knowledge and protection against premature or unwanted pregnancies. For teachers, a structure like the EA is a necessity for the villages because of the precariousness of life that parents do not have time to care for their children. Many young people have given a positive assessment of teenagers /youth spaces. Health staff are unanimous in affirming that the teenagers/youth spaces has reduced the number of teenage pregnancies. The geographical location of teenagers/youth spaces, in health posts was well appreciated as to bring together the youth of the same care even if some actors consider this may stunt the attendance of young people. Conclusion: Teenager/youth spaces significantly contribute to facilitate access to information and SRH services. There is a generally positive assessment of all categories included the establishment of teenagers spaces to mainly fight against early or unplanned pregnancies.

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TUPE53 The Positive Effects of using Edutainment in Adolescent Sexual and Reproductive Health Education: Impact Study in Tanzania MaqC Eric Gitau , Yulia Koval-Molodtsova , Jorik van Enck 1

UNICEF & dance4life Liaison Kenya , Dance4life International, Netherlands 1

Issues The results of impact research in Tanzania released in 2015 focusing on the application of the dance4life model using youth engagement and personal leadership approaches to tackle Sexual and Reproductive Health (SRH) Issues for Young People. Description The dance4life model includes four consecutive steps, which enable active learning and stimulate intrinsic motivation to take leadership. Marketed at the grassroots level, dance4life engages teens through edutainment, interactive experiences, tapping into youth culture and including dance, music, role-playing and storytelling. This helps to create awareness of threats to their sexual health and offers tools to build self-esteem and autonomy. dance4life peer leaders enable discussion through shared learning around basic facts and knowledge. They bust locally known myths, break taboos and create a safe, youth-friendly space for participants to share their personal stories, and serve as knowledge managers referring young people to the trusted resources and services. In 2015 the dance4life Program in Tanzania was externally evaluated and compared to the conventional Governmental SRH Program, and the Results demonstrate the Impact of dance4lifeâ&#x20AC;&#x2122;s Edutainment and Empowerment Elements in improving the Knowledge, Attitudes, Confidence and Intentions of Young People. Broadly the Methodology integrated: a. Conceptual Analysis, b. Analytical Framework and c. Methodological Framework. Lessons learnt The evaluation demonstrated comparative increases in teaching values and life skills versus the traditional government sexuality education program. For example, dance4life participants reported a dramatically greater ability to make informed choices (67% vs. 9%), have higher self-esteem (70% vs. 9%), confidence (73% vs. 10%) and improved communication (72% vs. 8%). These life skills further translate into sexual behaviour change: dance4life participants reported significant gains in consistent condom use (85% dance4life vs. 76% traditional school program), access to condoms (63% vs. 44%), and convincing partners to use condoms (79% vs. 65%). Next steps Building on the results of this evaluation and other studies on the dance4life model impact, a further rigorous evaluation is foreseen as a Prospective Longitudinal Study (at least 3 years long) to get data on how the model leads to improved health outcomes for the young people. Key words impact, adolescent sexual health youth empowerment, personal leadership, edutainment.

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TUPE54 Approaches to Enhancing Amref Health Africaâ&#x20AC;&#x2122;s Visibility through Social Media Carolyne Khamala Amref Health Africa in Kenya Issue Years after the emergence of new technology, a number of non-governmental organisations are yet to adopt the use of new media despite the growth in mobile phone penetration especially in Africa and the fact that the continent is still lagging behind the rest of the world in terms of internet users. Description The Communications unit builds into Strategic Objective 5 (Institutional Strengthening) in the organisationâ&#x20AC;&#x2122;s Transitional Business Plan II working with other departments and countries to disseminate information using appropriate messaging and channels. Amref Health Africa operates a number of social media platforms including Facebook, Twitter, Instagram, You Tube and WhatsApp to promote and disseminate health messages, engage with our stakeholders and showcase our impact in the community with engaging success stories. We use a variety of mediums including text, images, short videos, animations and infographics, which help to present complex health data in simple visuals. Lessons Learnt Social media provides a cheaper way of sharing information both to the local and global audience. It is also important to provide feedback to our online audiences. In addition, sharing social media content with the global team unifies the organisation. Video content has had the highest viewership of all social media content posted, enabling us to tell simple stories of empowered communities who had no access to basic health care, and how our interventions have changed millions of lives in Africa. As a result of our digital media campaigns our Facebook audience increased from more than 11,000 to over 50,000, while the number of Twitter followers rose from about 7000 to above 15,000. We currently have more than 1,500 followers on Instagram. Next steps Implement the social media guidelines to reflect the global brand, ensure adequate preparation and inclusion of the Communications unit in key organisation activities, train staff on the use of social media and provide quick and timely response to our online users. Key words Social media, Infographics, NGO.

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TUPE55 Knowledge and Source of Sexual and Reproductive Health Rights Information among Adolescents in Handeni District, Tanzania Serafina Mkuwa , David Ngilangwa , Aisha Byanaku 1

Amref Health Africa, Tanzania

Introduction In Sub-Saharan Africa, adolescents accounts for 30% of the population. Majority of them lack education and have poor access to services related to Sexual and Reproductive Health Rights (SRHR). Poor access has been associated with adolescentsâ&#x20AC;&#x2122; vulnerability to sexual health risks including early pregnancies and sexually transmitted diseases. Amref Health Africa conducted survey to understand SRHR indicators before implementation of intervention project in Handeni district, Tanzania. Methods This was cross-sectional study from February to April 2016. Multistage sampling whereby 1) one village from each ward was purposefully selected; 2) 30 in and out of school adolescents were randomly selected. A total of 365 respondents were interviewed using semi-structured questionnaire. Data were descriptively and inferentially analysed using Stata 12. Results The median age of study respondents was 19.1 years. The majority of respondents were out of school adolescents, single, with primary education and Muslims. Most of respondents 302 (83%) have heard information related to SRHR. Most reported source of SRHR information were radio 233 (64%) and television 116 (32%). However, when asked about the reliable sources of information about SRHR, school teachers ranked highest (29%) followed by media and health care providers by 22% and 17%, respectively. The least popular source of information were community volunteers, peer educators and brothers and sisters. There was a clear difference on preferred access to SRH information for example while healthcare providers ranked third in importance they scored very high among out of school adolescents as compared to those in school. Conclusions Our findings show that SRHR knowledge among this population is high and again parents and teachers are most trusted when it comes to consultation on SRHR information. This implies that, there is a need to plan for different interventions for different groups of adolescents.

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TUPE56 Increasing Routine Immunization using Community Structures Nancy Mwangi , Anne Musuva , Samson Thuo 1

Population Services Kenya, Unit of Vaccines and immunisation, Kenya

Background Basic vaccination has decreased from 77% to 71% (KDHS 2014). To reverse this trend an immunization campaign aimed at increasing uptake of immunization in 10 Counties was implemented using radio, in Kericho, more community structures i.e. outreaches, household visits were incorporated. Community Health Volunteers (CHVs) used session guides, referral vouchers and Mother Child booklets to educate and refer the Households. Objectives Measure the proportion of caregivers: 1) Who were aware of the recommended vaccines, 2) Could recall 4 diseases protected by immunization, 3) Knew when to go to Health Facilities to complete the immunization Schedule. Methodology A baseline and endline cross sectional household survey was conducted to assess progress. In 1) Kericho to assess the Interpersonal Communication and 2) in 4 counties (Nairobi, Kakamega, Garissa and Kericho) to assess impact of radio activities. In Kericho, 424 Caregivers at Baseline and 435 at endline were surveyed. Questionnaires were administered by trained CHVs and observations made from the mother child booklet. In the 4 counties, 425 caregivers were purposively sampled using computer aided telephonic interviews. Data analyzed through Excel & Stata. Results 98.6% of respondents had heard Immunization messages compared to 89.9% at baseline. Availability of mother child booklets increased from 89% to 95%. There was an increase of 8% of caregivers who believed the community completed the immunization schedule with awareness on all vaccines increasing by at least 12%. More respondents at endline are aware of 4 or more vaccines for children as compared to the baseline. Conclusions/recommendations The mother to child booklet was a great resource in data collection and behaviour change. Community structures remain a great resource for behavior change and project learning avail opportunities for scale up. There remains a need to understand the â&#x20AC;&#x153;Whyâ&#x20AC;? in counties with low coverage and immunization decline.

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TUPE57 Youth Corners and Staff Training: High Impact Interventions to Increase Uptake of Youth Friendly Services Gulu, Kitgum and Pader Gloria Ndagire Amref Health Africa, Uganda Background In Uganda approximately 52.7% of the population is under 15 years of age. One in every four Ugandans (23.3%) is an adolescent and one in every three (37.4%) is a young person. Most adolescents are unable to access age appropriate and relevant preventive and curative health services. Access is limited by long waiting times and poor service quality. In post conflict northern Uganda high numbers of orphans fuels teenage pregnancies and STIs. Intervention Between 2013 and 2015, Amref Health Africa through the ASK project worked with 40 health facilities to set up youth corners and trained personnel in youth friendly service provision. By December 2014, 28 of the 40 facilities had allocated time (at least four hours a week) and or space for youth friendly service provision and 117 health workers had been trained on youth friendly services. 26 of the 40 project facilities had at least one health worker trained. The main mode of service delivery was integrated outreaches conducted by 33 of the 40 facilities. The 28 facilities with allocated space and or time provided onsite youth friendly services. Results Analysis was done of the ASK project reports for 2013 and 2014. In 2013 a total of 15,634 young people aged 10-24 received services. This increased to 24,534 in 2014 a percentage increase of 56.9%. In 2014, 67% were female while 33% were male. 92% and 93.4% of those who received services where aged 15-24 years in 2013 and 2014 respectively. Only 8% and 6.6% respectively were aged between 10-14 years. Conclusion Making health services friendlier to young people increases service uptake. Majority of young people who seek these services are female and or aged 15-24.

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TUPE58 Bridging the Gap between Teachers and Pupils in Nomadic Pastoral Communities through Comprehensive Sexuality Education in Schools In Kilindi District, Tanzania George Saiteu , David Ngilangwa , Serafina Mkuwa , Rita Noronha , Florence Temu 1

Amref Health Africa, Tanzania

Issue In Tanzania young people below 24 years constitute 32% of the population. However, they face several Sexual and Reproductive Health Rights (SRHR) challenges including teenage pregnancies which results to high rates of deaths. This mainly of cultural barriers that hinder d iscussion around sexuality issues among students and teachers. Comprehensive Sexuality Education (CSE) for both teachers and students is important to address the problem. Description In 2011, Amref Health Africa through PAMOJA TUNAWEZA SRHR Project introduced CSE training to equip teachers and students with more knowledge and skills to discuss sexuality issues in more confident ways. Previously there was some shyness of students and teachers who lacked this information to discuss together. The project trained 82 teachers, 256 peer educators (128 male and 128 female) and 2 district officers. Every week peer educators had sessions with their peers in case they faced with difficult questions they consulted trained teachers for more support. Lessons learnt Teachers and students knowledge on CSE has increased by 80%. They have had confidence to talk about sexuality with their students; this was not possible before due to cultural barriers and lack of knowledge. In school peer educators have gained confidence to face their teachers and discuss about sexuality, they have been a channel to transform this knowledge to their peers in schools and out of schools. Reduction of early pregnancies has been noted, in 2010 before the introduction of the program early pregnancies were 19 students 2011 were 9 and 2012 were 3, this shows that there is an improvement on knowledge gained, this makes students make informed decisions about their sexuality. Next steps CSE curriculum should be introduced in primary and secondary schools to equip teachers and students with this knowledge so that they will be able to give make informed decisions on sexuality issues. Key words Comprehensive sexuality education nomadic community Tanzania

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TUPE59 Appropriate Technologies in Mhealth Technology to Enhance Access to Antenatal Care 1Mercy Simiyu, 1Christine Wanjiru 1Medic Mobile Inc, Kenya Issue Death from childbirth is one of the greatest challenges facing rural African women today. Women delivering outside of a health care institution are most at risk, with no access to life-saving medications or skilled birth attendants. An estimated 454 women per 100,000 (2010) in Tanzania die in childbirth, compared to 8.2 per 100,000 in the United Kingdom (2013). Almost 7,900 Tanzanian women die annually due to complications of pregnancy and childbirth. Description In 2015, with Bruyere Research Institute and Shirati Hospital, Medic Mobile designed an mHealth system for use by Community Health Workers (CHWs) on antenatal care (ANC), and stock monitoring tools for the dispensary nurses (DNs) in Mara, Tanzania. The platform helps ensure continuous availability of Clean Delivery Kits (CDKs) in district dispensaries. 196 CHWs and 64 DNs attended system training in September 2015. The tool provides timely reminders and real-time communication between CHWs and health facilities, and helps CHWs educate women on the importance of ANC. CHWs register pregnant women via SMS messages, even in areas with intermittent connectivity. When CHWs text â&#x20AC;&#x153;P 3 Janeâ&#x20AC;? (P for Pregnancy, 3 for gestation period in weeks, with the pregnant womanâ&#x20AC;&#x2122;s name) to a gateway number, Medic Mobile registers the pregnancy, creates a patient ID, calculates the expected delivery date, and schedules automated reminder messages to the CHW on ANC appointments for each pregnant woman. Lessons Learned Use of familiar technology for mHealth at the community level encourages CHW adoption. When the core technology is managed by the ground partner, the phones tend to be regularly charged and loaded with air-time ensuring project continuity. Recommendations Design mHealth tools with the end-user, mindful of their workflow and tech ecosystem. Empower ground partners to manage the core technology; encourage regular communication between them and the end user to assist with faster troubleshooting.

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TUPE60 Acceptability, usability and views on Deployment of PEEK, a Smartphone Mhealth Intervention For Eye Care In Kenya Sarah Karanja , Vaishali Lodhia , Shelley Lees , Andrew Bastawrous 1

Amref Health Africa in Kenya, London School of Hygiene and Tropical Medicine 2

Background The Portable Eye Examination Kit (PEEK) is a smartphone based ophthalmic testing system that has been developed to perform comprehensive eye examinations. PEEK offers a solution to overcoming barriers to limited access to traditional ophthalmic testing methods and has been piloted on adults in Nakuru, Kenya and compared with traditional eye examination tools. Shortages in ophthalmic personnel, high cost and difficulty to transport equipment have made it difficult to offer services particularly in rural areas. This qualitative study evaluated the acceptability and usability of PEEK in addition to views regarding the adoption and nationwide deployment. Methods A qualitative analysis of semi-structured interviews conducted with 20 patients, 8 Healthcare Care Providers (HCPs) involved in the pilot study and 4 key decision makers in ophthalmic service provision, who had been purposively sampled. A framework analysis approach using pre-defined themes was used to analyse the data. Emerging themes relating to the objectives were also explored from the data. Results Patients found PEEK to be acceptable due to its benefits in overcoming the barriers to access ophthalmic services. Most thought it to be fast, convenient, and able to reach a large population. All patients expressed satisfaction with PEEK. HCPs perceived PEEK to satisfy the criteria for usability and found it acceptable based on the technology acceptance model. PEEK was also found to have features required for strengthening ophthalmic delivery as a capabilities enhancer, opportunity creator, social enabler and knowledge generator. Some of the deployment related issues included; need for government and community involvement, communication and awareness creation, data protection, infrastructure development including capacity creation, training and maintenance support. Conclusion PEEK was deemed as an acceptable eye care solution as it provides a beneficial service, supports patientsâ&#x20AC;&#x2122; needs, and fulfils HCPs roles and overall contributes to strengthening eye health.

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TUPE61 The Influence of the Turkana Traditional Leaders (Nguimurok) on Acceptability of Sexual Reproductive Health Services and Rights (SRHR) in Turkana North, Kenya David Kawai , Bernard Mbogo , Anthony Arasio , Peter Ofware 1

Amref Health Africa, Kenya

Background Sub-Saharan Africa has had a health crisis in uptake of services for several decades. This has been attributed to underfunding, understaffing, unavailability and inaccessibility of health services to the majority of the population. Despite many interventions by government and development agencies in Turkana, uptake of SRHR services has been low. Turkana traditional leaders, called Nguimurok have immense influence and yet they have not been involved in making decisions on access and utilization of SRHR services. Objectives The study objective was to describe the influence of Nguimurok on access to and utilization of SRHR services. Methods This was a cross sectional study conducted in Turkana west and North sub counties using qualitative exploratory research design. The respondents were purposively sampled. Structured discussion guides were used to collect qualitative data that was transcribed and translated from Ngâ&#x20AC;&#x2122;aturkana into English and analyzed using manual thematic categorization and content analysis. Results Nguimurok are revered by the community and appreciate superiority of modern health care system. They consider themselves as health practitioners and are not opposed to service delivery through the modern healthcare system. They acknowledge that family size should be commensurate with wealth and that there are traditional ways to space children. They prefer the natural child spacing methods. They accept early, teenage and planned marriages as a cultural practice but recognize that there are attendant complications that result from these marriages. Their authority is unquestioned and they do not beat their wives. Conclusion Cognizant of the superiority and complementarity of modern healthcare system the Nguimurokâ&#x20AC;&#x2122;s influence can be tapped to increase access and utilization of SRHR services in rural Turkana. Their sphere of influence is an untapped potential in catalyzing health system strengthening processes that development partners have always ignored.

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TUPE62 A Cost-Benefit Analysis of Manual, Semi-Automated and Mobile-Based Fully Automated Community Health Management Information System in Makueni County, Kenya Evalin Karijo , David Ojakaa , Anne Gitimu , Meshack Mbinda , Happiness Oruko , 1

FidelinaNdunge , RachelAmbalu , Deborah Kioko 1

Amref Health africa in Kenya, Brim Consultancy, Amref Health Africa

Background Effective and efficient Health Management Information Systems (HMIS) contribute to achievement of the Kenya Vision 2030. However, HMIS at community level is majorly managed through manual systems, marred with erratic reporting, and inefficient transmission of data to the National District Health Information System (DHIS). Concurrently, there is rapid growth in mhealth technology, hence the need to ascertain which methods of HMIS are most beneficial. Methods Amref Health Africa carried out cost-benefit analysis of three alternative community-based HMIS - manual, semi-automated, and mobile fully automated system linked to the National (DHIS) test site. Each alternative was implemented in one separate Community Health Unit, in Makueni County, Kenya. Quantitative and qualitative data on costs of operations and cost of benefits gained & lost was collected through interviews with Community Health Volunteers (CHVs), Community Health Assistants (CHAs) and the Sub-County and County Management. One year data was projected to up-to five years and cost-benefit ratios computed. Results The costs of operating the manual, semi-automated, and fully-automated HMIS was Kshs. 2.2 million, Ksh. 2.6 million, and Ksh. 4.9 million respectively. The cost of benefits monetary man-hours (effort) taken to perform tasks, costs of incomplete and inaccurate data, and cost of delays to refer patients was Kshs. 3.4 million, Kshs. 3.0 million and Kshs. 1.1 million for the manual, semi-automated, and fully-automated HMIS alternatives respectively. The benefit-cost ratio for migrating from the manual system to the fully automated linked system was 1:1.15. Conclusion At community level, benefits in man-hours (effort) of using fully-automated linked system contribute positively on volunteerism of CHVs, CHAs, and referrals. The fully automated linked system is a wise investment and should be scaled up for greater economies of scale which lower operation costs, improve information management at community level, and improvement in evidence-based decision making in the health sector.

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TUPE63 How risky are the innovative strategies that involve Community Health Volunteers in Sputum Sample Collection, Packaging and Transportation? Mombasa, Kenya Benson Ulo , Cyprian Kamau , Titus Kiptai , Jane Kitonga , Margaret Mungai , Zilpha Samoe , 3 3 CosmasMwamburi , FaithNgari 1

Amref Health Africa in Kenya, Christian Health Association of Kenya, Ministry of Health 2

Background Kenya notified 89,211 TB cases in 2014, 80% of World Health Organization estiamtes. Mombasa County notified 4,726 TB cases with TB case notification rate of 469 per 100,000 population compared to the national average of 208/100,000. With Global Fund support Amref Health Africa implemented active TB case finding in Mombasa through Christian Health Association of Kenya according to Kenyaâ&#x20AC;&#x2122;s Strategy for Community Health. Methods Community Health Volunteers (CHVs) were trained and mentored on community education, TB screening, referral of presumptive TB cases, sputum collection and transportation, and infection prevention. They instructed clients on sputum collection in poly pots and placement in safety containers. CHVs transported the samples to laboratories in carrier boxes. A structured questionnaire to assess the risk of CHVs contaminating themselves with sputum was administered to 37 CHVs at 14 months of implementation. This was a representative sample of 114 active CHVs from July 2014 to September 2015. Risk based on frequency of negative practice occurring was classified as: None (never); low (1 in â&#x2030;Ľ 10), High (1 in 3 to 9); Very high (1 in 1 to 2 times). Data was analyzed descriptively. Results Of the 16,226 sputum samples analyzed, 5% (870) were positive for TB. Only 73% of CHVS applied hand sanitizer despite 94% wearing gloves all the time when handling sputum. Client contaminating poly pots had the highest risk with 35% of CHV reporting no risk compared to 62.2% and 59.5% for spillage during transportation and contamination of containers during packaging respectively. Laboratory personnel never assisted 45.9% of CHVs to disinfect their containers and 48.6% of CHVs used only the safety container to transport sputum due to stigma. Conclusions and recommendations With training, mentorship and safety commodities CHVs can adopt personal safety practices. Significant risks of contamination still exist and more safety interventions and technical assistance from laboratory personnel are required.

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TUPE64 Increasing access of Comprehensive Sexuality Education for young people Alvin Irungu Centre Study for the Adolescents, Kenya Issue World Start with Me (WSWM) is an innovative and interactive ICT based Sexual Reproductive health and rights (CSE) curriculum that uses a youth centered approach to encourage young people to learn by doing. Designed for 12-19 year old young people, WSWM combines three approaches; school based; facility based; and community based to reach young people in 129 schools nationally with comprehensive sexuality education. The WSWM program was initiated in 1996 by Centre for the Study of Adolescence (CSA) in collaboration with Rutgers WPF. Description The program seeks to promote appropriate attitudes, healthy and responsible behaviour and life skills for young people, increase young peopleâ&#x20AC;&#x2122;s knowledge on SRHR, as well as access to reproductive health services. Teachers and peer educators are trained on the WSWM curriculum to act as facilitators. Installed on computers using CD-rom, students are assisted by virtual peer educators, who give detailed information on fifteen lessons covering: body changes, relationships, sexuality etc. In addition,. Each topic/lesson has assignments and games that enable students apply and internalize the information, explore opinions and exercise skills through discussion. This also serves to link young people to services at selected health facilities offering young friendly services. Through trained community health workers and youth groups, a supportive environment for providing CSE is enabled among parents and the wider community. Results Evaluation results show increased knowledge and skills among young people to make safe and informed decisions and access SRHR services. The program has also led to increased support for CSE by relevant ministries and .at the micro level among participating school, communities and health facilities. Conclusion & Next steps Providing CSE to young people through innovative ICT approaches helps achieve positive SRH outcomes and sustain their interest in learning/ completion of schooling. Connecting the school to the health facility and the community consolidates support for CSE. Programs for young people should use a youth centered approach to encourage young people to freely and openly discuss SRHR and access relevant services.

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TUPE65 Involving young people improves access to HIV/AIDS Information and Services Alvin Irungu YAS! Network, Kenya Issues Young people between the ages of 15-24 are the group most affected by AIDS, accounting for 40% of all adult HIV infections globally. Young people remain at the centre of the epidemic and they have the power, through their leadership, to definitively change the course of the AIDS epidemic. Objective The objective of this paper is to show how meaningful involvement of young people contributes towards the fight against HIV/AIDS. Description YAS! Network works with young peopleâ&#x20AC;&#x2122;s creativity and energy as a platform for SRHR advocacy. Members are between ages 18 and 27. The network is aimed at creating a unique platform for young people where they can meaningfully participate in the fight against HIV/AIDS. The network designs and implements programs on SRHR, the programs aim at creating awareness about SRH issues and advocating for implementation of policies on reproductive health. Young people are trained on SRHR and HIV to be able to effectively implement programs. Lessons learned YAS! Network and partners have been able to reach out to over 50,000 young people with SRH/HIV information and also advocate for their reproductive health rights. YAS has participated in campaigns that aim to scale up the fight against HIV/AIDS among adolescents. By involving young people in the decision-making process, we increased the knowledge on what exactly needs to be done to improve the SRH of young people which as a result contributes to the fight against HIV/AIDS. Conclusion & Next steps Young people should be given opportunities, tools and incentives to adopt safe behaviors and to consistently demonstrate the capability to make responsible choices, and encourage others to do the same. Organizations implementing programs on SRH/HIV specifically should formulate sustainable strategies and activities in which young people can meaningfully participate in without forgetting about gender equity and regional balance. The results of the interventions will be used to inform policy makers and other stakeholders, the importance of involving young people in SRHR programs and in the fight against HIV.

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TUPE66 Advocating for County Governments Resource Allocation to Community Units: The case of Makueni County In Kenya Rachael Ambalu , Evalin Karijo , Happiness Oruko , Peter Ofware , Fidelina Ndunge , 1 Deborah Kioko 1

Amref Health Africa in Kenya

Issue Community Health Units (CUs) have contributed to significant changes in health indicators where they have been established. In Kenya, Amref Health Africaâ&#x20AC;&#x2122;s mama na mtoto wa Afrika project in Makueni county conducted a study on factors influencing CU functionality and sustainability in 2014. The study identified inadequate resource allocation to Community Health services (CHS) by government as a major barrier to the sustainability of community units. Description Evidence generated from research on Functionality and Sustainability of Community Units provided an advocacy framework for a policy brief whose focus was on financial sustainability of community units. The framework addressed three dimensions of CU progression including; strengthening CU functionality status, orienting CUs to Organizational Development and Systems Strengthening (ODSS) and funding CUs to conduct Income Generating Activities. Lessons learnt The advocacy framework has contributed to development of the Kenya National CHS Policy on sustainability of CUs. In the financial year 2016/2017 Makueni county government allocated Ksh. 5.5 million for the first time to support community health services, other than relying on development partners. The county has taken up the printing and provision of reporting tools for CUs, and also 15 CUs have been provided with motorbikes to boost CU income generation for sustainability and also improve referrals for health services. Next steps The CU sustainability model is a worth investment in strengthening health systems in Africa. Evidence generated from this model will be used in lobbying for county governments to be in the forefront in strengthening CHS implementation. Scaling the CU sustainability model to the national level can ensure sustainable financing for the CU workforce, and contribute to the achievement of the Sustainable Development Goals (SDGs). Key Words Advocacy, Resource allocation, Sustainability

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TUPE67 Integrated HIV/AIDS, TB and Malaria Control Programming at Community Level: A catalyst in steering the health agenda in Lungalunga Sub-County in Kenya Magdalen Mangut , Christine Mwamsidu 1

Amref Health Africa in Kenya

Issues Community health systems complements efforts towards increasing and sustaining access to health services while providing for the missing link between the community and health service delivery platforms. The World Health Organization (WHO) recommends an integrated approach to HIV/AIDS, TB and Malaria control programming, which has been largely disease specific with no integration to address other deserving individual, family or community health needs. Kenyaâ&#x20AC;&#x2122;s community health strategy defines the role of Community Health Volunteers (CHVs) in basic healthcare with emphasis on integrated model of preventive and promotive health service delivery. In Kenya, Community Health Services have been defined in a community system strengthening (CSS) framework and is coordinated by the CSS technical working group (CSS TWG). Description An integrated approach to HIV/AIDS, TB and Malaria control programming at community level was initiated in October 2015 and will be piloted up to December 2017 at community level in Lungalunga Sub County in Kwale County and is expected to provide valuable lessons. This was informed by: Lungalunga Sub County not having functional community units, weak coordination mechanisms and linkages between different community actors consequently affecting referral and overall service provision. There were also weak mobilization processes, limiting demand creation/ utilization of key HIV/ AIDS, TB and malaria prevention interventions. Comparison of performance of HIV, TB and malaria related indicators was done for the period January- June 2016 versus January- June 2015 when community level integration of HIV/AIDS, TB and Malaria control programming had not been initiated. Lessons learnt According to the Kenya Health Information System (DHIS 2), Lungalunga sub county reporting rate improved from 41% to 47%. The number of households not using Long Lasting Insecticide Treated Nets (LLITNs) reduced from 428 to 154, the number of persons not knowing their HIV status reduced from 18783 to 7241, while the number of community members referred for being presumed to have TB increased from 98 to 6689. 51 community dialogue days were held in January- June 2016 compared to 35 in January- June 2015. Integrated approaches to delivering health services have been a catalyst in steering the health agenda in Lungalunga Sub County unlike vertical/ disease specific approaches. Next steps Operational integration of HIV/AIDS, TB and Malaria control programming at community level that emphasizes the users of services rather than the disease should be scaled up to other Sub Counties in Kenya.

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TUPE68 Assessment of Household Economic Strengthening as a sustainable model in care and support for Orphans And Vulnerable Children in Kitui County, Kenya Sarah Karanja , Rachel Ambalu , Rudia Ikamati , Evalin Karijo , MargaretMungai 1

Amref Health Africa in Kenya

Background The Population of Orphans and Vulnerable Children (OVC) in Kenya who face a multitude of obstacles to achieving sustainable food and economic security is estimated to be 2.6 million. USAIDâ&#x20AC;&#x2122;s APHIAPLUS KAMILI project (2011-2015) supported the implementation of Household Economic Strengthening (HES) to strengthen the capacity of OVC households in implementing livelihood and food security interventions. A study was conducted to assess HES as a sustainable model in care and support of OVC in Kitui county with the following objectives; to gauge the role of socio-demographic determinants for HES outcomes, and secondly to assess the effect of HES on improving the economic status of OVC households. Methods A before and after quantitative study was conducted in six months between January and July 2014 in Kitui county of Kenya. 267 households were purposively sampled from four sub-counties in Kitui using the Household Vulnerability Assessment (HVA) tool. Households were disaggregated on the basis of the gender of the caregiver, sub-county and the number of the OVC per household. A correlation test of the variables was then done using chi-square in view of the outcome of the HES intervention. Results 88.6% of households headed by male caregivers had increased income while those headed by their female counterparts was at 86.2%. Households with four or more children had better outcomes than those that had three or less children). Mutomo Sub-county had the highest level of increased income of 95.9 % while Kitui West had the least increment (51.1%). 51% (219 HHs) of the households with 714 OVC were able to meet their basic priority needs. As a result, the households graduated from the programme and in effect, the project was able to efficiently reach more beneficiaries. Conclusion and recommendations The HES model empirically demonstrated meaningful transitioning of the OVC households from dependency to self-reliance in meeting the priority needs of the OVC across the six domains of OVC care. This is an effective model in addressing sustainability among the vulnerable populations. Key words Household Economic Strengthening, Vulnerable populations, sustainability.

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TUPE69 Redirecting focus on SRHR Policies in East Africa- Youth Perspectives on Implementation Sheenan Mbau Center for the Study of Adolescents, Kenya Introduction Globally, there is an increasing concern on sexual activity and its outcomes among adolescents. In East Africa for instance, early pregnancy, unsafe abortion and sexually transmitted infections including HIV are some of the adverse reproductive health outcomes emanating from sexual activity among school going youth. Kenya Tanzania and Uganda have been rated as some of the nations with progressive SRH (Sexual Reproductive Health) Policies. However, these countries continue to manifest poor SRH outcomes amongst its young people. Methods Although Kenyaâ&#x20AC;&#x2122;s HIV Prevalence has reduced almost by half in the last decade to the current 6.5% Uganda and Tanzania have 7.3% and 5.3% respectively which is still a big and looming problem for the three countries. Teenage pregnancy and child marriage remain national problems in all the countries while SRH service delivery remains weak. A Desk review analysis and feedback sessions was conducted by youth in the three East African countries assessing the number of policies with regard to SRH existing in each of the select East African countries, Assessment of Budgetary allocation to the policies, Involvement of youth and adolescents in those countries, and levels of awareness among youth of the policies. Additionally the youth Network reviewed feedback from 3 partner youth Networks in those countries regarding religious and political leadership commitment on implementation of the SRH policies in those countries. Results Key Outcomes included evidence on Low Government commitment, Low Resource allocation and limited space for youth to contribute to realization of the policy aspirations. Young people observed that religious institutions have increasingly become intolerant to sexuality education and were unwilling to support youth access to SRH information and services.

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TUPE70 The Collaboration/Integration of Traditional Health Practitioners (THPS) into the Formal Health System through THP Mentorship Maurice Ntuli , Bonface Hlabano 1

Amref Health Africa, South Africa

Issues During the THP project implementation an innovative idea was to appoint Mentors who are traditional health practitioners (THPs) to mentor other THPs. This abstract is based on the contribution that mentors did in strengthening formal health system effectiveness between July and December 2013. Description Twenty nine mentors were identified among 610 THPs involved in the THP project, to mentor other THPs on health issues they were trained on and were implementing. Mentors used the checklist which had questions that were linked to the 5 project objectives. The questionnaire had 14 questions to test if the THPs were implementing the project deliverables. The second part of the questionnaire was qualitative. It was for the THP mentors to observe what could be the gaps by the THPs in delivering the project deliverables. Lessons learnt 130 out of 610 THPs were visited by the THP mentors and the following were discovered: The number of THPs who: were complying with project deliverables increased from 47% to 79%, worked with clinics increased from 51% to 89%, referred clients to the clinic increased from 15% to 67%, referred OVC clients to department of Social Development went up from 48% to 72%, worked with civil society went up from 32% to 71%, cleaned their yards increased from 5% to 66%, built pit latrines increased from 49% to 69%, started gardens increases from 47% to 68%, received back referral from the clinics increased from 0% to 6%, stored their medicines safely increased from 7% to 9%. Next steps The South Africa government to employ appropriate mentors who are THPs for successful integration/collaboration of formal and information health care system.

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TUPE71 Implementation of PHASE Project in Rustenburg, South Africa to Reduce Water Borne Diseases among 3000 Learners Alvina Matamela , Maurice Vusi Ntuli , Boniface Hlabano 1

Amref Health Africa, South Africa

Issues Children (3000) in 7 schools of rural areas of the Rustenburg Local Municipality in the North West province (SA) were at risk of preventable health conditions such as malnutrition, HIV & AIDS, diarrhoea, cholera, other water and sanitation born diseases. This was as a result of schools with little or no hygiene education. There was also a high prevalence of diarrhoea which was the main cause of paediatric hospitalization in the province. These diseases have a negative impact on school attendance patterns amongst learners and yet can be prevented. Description The project had employed 3 strategies in order to reduce incidences and prevalence of water, sanitation and hygiene related illnesses among the learners: Capacity Development: To improve community/learner/educator involvement, knowledge and behaviour. Mentoring and Support: To increase the knowledge and promote behavioural change among school children Monitoring and Evaluation: To generate and document evidence, share lessons learnt and advocate for PHASE to form part of standard teacher training programme. Lessons learnt The following were trained mentored and supported: 31 Life Orientation Educators, 13 school governing members, 40 community health workers, 7 health concern clubs, 3000 learners, 15 learners from health clubs, one inter- school competitions (Dramas, Play, Poems and designing of story cards). With regards to PHASE, all the schools now have action plans, active participation by parents, communities and critical stakeholders , are prioritizing menstrual hygiene management, conduct regular personal hygiene sessions using the PHASE toolkits, safe and portable water, proper and adequate hand washing facilities, and proper waste management. Next steps The submissions made for PHASE to be integrated within teacher training programmes as well as to lobby for the PHASE toolkits to be adopted in the whole province of Northwest and beyond.

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TUPE72 Reproductive Health Commodity Security System: A Synergistic Model Bongs Lainjo Cybermatic International Background Maternal and infant morbidity and mortality remain a global challenge and based on latest reports, mitigation efforts have not been encouraging. Unsustainable fertility rates continue to rise unabated in low and middle-income countries (LMICs). Significant gaps in reproductive health and rights continue unabated. According to a recent United Nations Population Fund (UNFPA) report, 225 million women do not have access to contraceptives. This short fall is universal and only acerbates an already dire situation. Inability to address these challenges has many implications including ubiquitous poor quality of health for both mother and child. Reasons for these dismal performances include limited access to quality services, qualified staff, poor logistics management and lack of commodities. These poor outcomes prompted the author to develop the model: RH Analysis and Planning System (RAPSYS). Methodology The participatory model is based on pilot-tested results. It is defined by key determinants â&#x20AC;&#x201C; utilization, demand, access, supply and procurement; cross cutting components â&#x20AC;&#x201C; coordination, supervision, funding, advocacy, capacity building M and E; and all driven by an enabling environment. The systems use expert experience to develop effective strategies including: qualitative assessment, Delphi ranking, action plan, commodity projection and monitoring framework. Results There is adequate evidence that the conventional approach in program design and implementation continues to show different levels of understanding of the expected outcomes. This model has helped vulnerable countries in streamlining their interventions, making them more result-based, efficient, effective, sustainable and accountable. It has been successfully implemented in ten Asian countries. Conclusion There is convincing evidence that the complications involved in designing development interventions have become more convoluted, unstructured, and poorly coordinated. This outlook has resulted in many cases producing inadequate and dismal outcomes. The relevant tasks are daunting with resources becoming more and more limited. This framework is part of an initiative to help refine current processes and procedures.

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TUPE73 Increasing access to Comprehensive Sexuality Education (CSE) for Young People Alvin Irungu Centre Study for the Adolescence, Kenya Background The Kenyan population pyramid is wide-based, with those below 25 years constituting 18.8 million, which represents about 66 per cent of the total population. In Kenya as in other parts of Africa, young people face severe threats to their health and general well-being. The main SRHR (Sexual Reproductive Health and Rights) problems facing the youth include sexual assault and prostitution, early pregnancy and childbearing, unsafe abortion, malnutrition, female genital cutting, infertility, and reproductive tract infections (RTIs) including STIs and HIV/AIDS. Description The WSWM (World Start with Me) is an ICT, school based program which has been implemented in Kenya since 2006. The program aims at improving the capacity of young people to respond to the challenges associated with transition from adolescence to adulthood. It uses innovative approaches that facilitate youth participation and promote responsible behavior. One approach involves the use of Youth Advocates to disseminate CSE information to young people, as a peer to peer approach and also uses social media platforms and ICT to create awareness. Results The Youth Advocates have been able to reach out to over 20,000 young people yearly with SRHR information by having member advocates in different counties, who empower in and out of school young people with CSE and SRHR programs and over 8,000 people with information on SRHR via social media Lesson Learned By involving young people in implementation of CSE and SRHR programs, we increase the knowledge of young people on CSE, thus increase access of CSE. Conclusions and Next steps To implement age appropriate CSE for adolescents in school, a multilevel system of approach is required. Change must first occur at the individual and interpersonal levels. Thereafter, the community level where the community realizes the benefit of this reproductive health education.

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TUPE74 Addressing sexual and reproductive health and rights challenges among young people in Nairobi County through community organizing Julia Kosgei Kenya Medical Association, Kenya Issues: A study conducted by Kenya Medical Association (KMA) on knowledge attitude and perceptions on contraceptive and safe abortion among healthcare providers and girls and women of reproductive age noted inadequate knowledge on reproductive health law in Kenya as well as unavailability of quality reproductive health services including contraceptive and safe abortion services which contributed to unintended pregnancies and unsafe abortion. KMA aimed at creating awareness on sexual and reproductive health and rights (SRHR); and increasing referrals for contraceptive, safe abortion and post abortion care services among young people living in peri-urban settlements in Nairobi County through community organizing. Description: 68 young people from 34 villages in three informal settlements in Nairobi were trained on SRHR and community organizing. They thereafter established 34 teams referred to as community advocacy groups (CAGs) with community leaders and community health volunteers and developed work plans aimed at creating SRHR awareness among young people and making referrals for contraceptive, safe abortion and post abortion care services to healthcare providers trained by KMA on provision of these services. KMA also engaged County and sub county health managers operating within these areas to increase access to reproductive health care service provision for young people in public healthcare facilities. Results: In 12 months, members of the 34 CAGs were able to sensitize over 5,897 young people on SRHR, referred 49 girls of ages (15-25yrs) for safe abortion services, 1,500 for contraceptive services and 56 for post abortion care services. Access to trained healthcare providers has deterred women from procuring unsafe abortions from quacks. Linkage with the county health management teams has seen improved access to contraceptives in public healthcare facilities operating within these settlements thereby reducing unintended pregnancies. Lessons learnt: Engaging young people through participatory techniques including community organizing contributes to effectively addressing SRHR challenges at the community level. Recommendations: Young people need information and options to make informed decisions. By combining efforts through engaging the County health managers, training healthcare providers, ensuring provision youth friendly services including safe abortion services and empowering young people so as to increase reproductive health and rights knowledge and awareness as well as strengthen referrals and linkages to public healthcare facilities will help address challenges faced by young people in accessing reproductive health information and services.

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TUPE75 Improving Treatment Success Rate and Case Notification of Smear Positive Tuberculosis Patients through Household Health Education in Kenya Titus Kiptai Amref Health Africa, Kenya Background Tuberculosis (TB) remains a public health challenge post 2015 in developing countries. Kenya notified TB cases dropped from 99,159 in 2012 to 89,760 in 2013 (9.48% decline) with a treatment success rate of 85% and positivity rate of 43.6%. In 2014, Kenya registered 34,997 (39%) pulmonary bacteriologically confirmed TB cases against a total 89,294 notified cases lower than 45.4% (N=8190) registered in Kakamega, Kisumu and Machakos counties. These patients are known to be infectious and treatment and investigation of their contacts is key. In response to this, Kenyan government has involved the public, private and Civil Society Organizations (CSOs) in implementing TB control activities. Amref health Africa in Kenya, a non-state Principal recipient, implemented the Global Fund TB Grant through 16 CSOs three of which implemented in the above 3 counties. Intervention Between October 2014 and December 2014, three CSOs trained and engaged 140 community Heath Volunteers (CHVs) in Kakamega, Kisumu and Machakos. CHVs visited household of notified bacteriologically confirmed TB cases and emphasized on drug adherence, and health education on TB (and MDR TB) transmission, diagnosis, management and prevention, stigma and discrimination, HIV testing and nutrition management. TIBU data for the three counties was extracted and treatment outcomes analysed. Contacts were screened and identified presumptive TB clients referred to diagnostic facilities. CHVs were reimbursed transport per household. Results Of the 940 pulmonary bacteriologically confirmed patients, 386 were visited. 1,740 contacts were given health education and screened, 177 presumptive clients were referred and 14 (8%) diagnosed with TB. Evaluated treatment outcomes for 386 patients were: cured (73%), Treatment complete (17%) (90% treatment success rate), died (4%) (Which 3% were TB/HIV co-infected), lost to follow up (3%), transfer out (2%) and failure (1%). This contributed to treatment success rate of 86.4% in the three counties. Lessons learnt CSOs through CHVs plays a role in contributing to treatment success rate of the pulmonary bacteriologically confirmed TB cases. Conclusion and Recommendation Health education at the household level for all the TB patients undergoing treatment and the family members is key in increasing treatment success rates and identification of the missing TB cases.

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TUPE76 Access, utilization and Impact of out of pocket (OOP) spending on maternal and child health services in Kenya: Evidence from Kenya Household Health Expenditure and Utilization survey (KHHUES) data of 2003, 2007 and 2013 Estelle Sidze , Thomas Maina , Stephen K Mulupi , Djesika Amendah , Martin Mutua , 4 4 Christine Fenenga , ChrisElbers 1

African Population and Health Research Center (APHRC), Kenya, The Palladium Group 4 AIDSPAN, Amsterdam Institute for Global Health and Development (AIGHD) 2

Background Despite Kenya recording impressive gains in reducing maternal, neonatal and child mortality rates in recent times, the burden of poor access to maternal, neonatal and child health services (MNCH) varies across counties with some counties reporting maternal and child mortality rates that are higher than the national average. In addition, disparities still exist with regard to MNCH outcomes across counties, with the outcomes more substantially worse in poor and households living in rural and slum areas. Methods To shed light on the barriers to access and utilization of maternal and child health services and the impact of out of pocket payments, we analyzed data from the three rounds of Kenya Household Health Expenditure and Utilization Surveys (KHHUES) undertaken in 2003, 2007 and 2013. Results In 2003, 27.3% of children below 5 years were reported to have been sick. The proportion of children below 5 years who were reported to be sick however increased marginally to 27.4% in 2013. The proportion of children below 5 years who were reported to be ill increased with income. Illness reporting is more likely for children in the richest quintile (31.1% in 2003, 21.6% in 2007 and 34.1 % in 2013) than for those in the poorest quintile (26.8% in 2003, 15.4% in 2007 and 23.1%). Access to health services by children under 5 years generally improved over the same period with the total number of visits made during the 4-week recall period to all providers (in millions) increasing from 1.2 in 2003 to 3.6 in 2013. The proportion of children under 5 years with some sickness reported but did not seek healthcare reduced from 17.9% in 2003 to 8.1% in 2013. The illness reporting however differed more significantly between urban and rural households and between income groups. Use of health services among children under 5 years however varied between urban and rural residents and by income group. In 2013, OOP spending by children below 5 years was estimated at about Kshs. 25 (US$ 0.25) in public hospitals, Kshs. 10 (US$ 0.10) in health centres and dispensaries. During the same period, the average OOP spending by children below 5 years in private for profit facilities was â&#x20AC;&#x201C; Kshs. 1,119(US$11.9) in private hospitals, private clinics Kshs. 590 (US$5.9), Kshs. 600 (US$) in FBO hospitals and Kshs. 200 (US$ 20 in mission health centres and dispensaries. The average OOP spending for a delivery in a public hospital was estimated at about Kshs, 4,000 (US$ 50), Kshs. 27,300 (US$320) in private hospitals and an average OOP spending of Kshs. 14,000 (US$.200) in FBO hospitals.

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Conclusion and policy recommendations The analysis of the KHHUES data of 2003, 2007 and 2013 reveals inequalities in use and access to maternal and child services with cost being the most significant barrier. Reducing the incidence of catastrophic health expenditure can be achieved by focusing on increasing financial protection offered to the poor and vulnerable through expansion of coverage through the National Hospital Insurance Scheme (NHIF) and better targeting the pro-poor initiatives like abolition of user fees and free maternal health policy.

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TUPE77 Increasing Accessibility of People Who Use Drugs to Medically Assisted Therapy through Community Health Strategy Anthony Makenga Malindi MAT clinic, Kenya Background Medically Assisted Therapy (MAT) was initiated in Malindi Sub-County February 2015. To date, 510 clients have been enrolled and 58 default cases recorded. A local Civil Society Organization is the referral Centre for clients to the MAT clinic. The CSO has 10 outreach workers covering a population of 217,117 people. Community Health Strategy (CHS) is a community-based approach that bridges the gap between households and the formal health system, enabling communities take an active role in determining their own health. Setting- Malindi town and Shella wards have a population of 115,665 people, with more than 592 PWUDs (0.5% of the population). This area has three 3 community health units (CUs)with 150 trained Community Health Volunteers (CHVs). CHVs link households to the health care system by educating communities on health issues, organizing community dialogue days, distributing IEC materials, referral of clients for health services, tracing health service defaulters among other roles. Methods A Sample of 10 CHVs were interviewed on their perceptions, willingness to support MAT. 10 community members were also interviewed to understand communityâ&#x20AC;&#x2122;s perceptions of the MAT program. Results The need for further capacity building on drugs use was stressed. Community members identified drug abuse as a problem, but had limited exposure in health messages about drug use. There is good opportunity to integrate MAT with CHS in creating awareness about the MAT program, establishing a link between households and harm reduction services, continuity of care through follow ups and defaulter tracing, treatment adherence for ARVs and Anti-TB. Conclusion Through integration of CHS with MAT, number of clients available for MAT enrollment will increase, retention and treatment adherence rates will increase, Community re-integration clients enhanced, while stigma against PWUD will be reduced.

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TUPE78 Defining the Participatory Space(s) for SRHR Dialogue and Descent in the Africa Region Patrick Kadama African Centre for Global Health and Social Transformation, ACHEST, Uganda Background This paper describes a study conducted by the Regional Context Team of the partnership for Health System Advocacy for Africa (HSA), led by ACHEST to inform interventions planned interventions. Methods The study aims to identify the policy participatory space(s) and to characterize the participation of African Civil Society Organizations (CSOs) as well as other actors within regional health governance arena for health system strengthening (HSS), using the lens of arrangements for and, progress made towards attainment of Sexual Reproductive Health and Rights in the Africa Region. Special focus is placed upon better definition and understanding of the spaces and places within which participation can occur, and particularly the ways in which Regional Government Actors and inter-Government actors (such as African Union and Regional Development Banks), as well as Global actors (such as UN agencies, World Bank and Global Health Initiatives) provide such opportunities for African CSO to participate. Results The findings are expected to inform strategic action and advocacy work by the HSA regional context team as well as others. This will facilitate effective engagement for conducting evidence based advocacy for HSS to support better health outcomes and the attainment of SRHR.

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TUPE79 Menstrual cycle awareness in prevention of unwanted pregnancies: Experience From Ecole Secondaire Du Saint Esprit De Nyanza, Rwanda Eric Twizeyimana University of Rwanda Background 15.7% of girls aged 15-19 in Rwanda have begun bearing children, mostly out of unwanted pregnancies. In 2015, 735 respondents out of 1902 homes surveyed, reported to have unintended pregnancy and birth in last four years, and 78% of them were under 20 years. The knowledge about menstrual cycle can be very helpful to reduce unwanted pregnancy mainly in the youth. The aim of this study was to assess the level of knowledge about the menstrual cycle in high school students. Methods 80 students aged from 15 to 25 were interviewed and 60 were girls while 20 were boys. The interview was given in groups for some and individually for others as some felt comfortable when they in a group while others prefered an individual. Each response was recorded and the analysis of collected data was done using Microsoft Excel. Results 18.33% of girls knew their menstrual cycle and 81.66% of girls did not know how to calculate different days of their menstrual cycle. 20% of boys responded that they knew how to calculate different days of menstrual cycle and 80% of boys did not know how to calculate different days of the menstrual cycle. Conclusion and Recommendations The rate of unwanted pregnancies in young ladies is increasing while they do not have relevant knowledge about everything concerning the menstrual cycle and boys who could help their sisters, also do not have that knowledge. We should do campaigns or develop projects focusing on reproductive health teaching in high schools to tackle this problem.

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TUPE80 Strengthening Multi-Stakeholder Platforms for Evidence Based Advocacy Happiness Oruko Amref Health Africa, Kenya Background The Health Systems Advocacy Partnership (HSA Partnership) is a five year project implemented at three levels: Global and Regional and Country level in Kenya, Uganda and Zambia. In Kenya, the project is at the national level and in four counties: Narok, Kajiado, Homabay and Siaya. The four counties were selected due to poor performing HRH indicators in Human Resources for Health (HRH) and Sexual Reproductive Health (SRH).It is being implemented by four non-government partners, Amref Health Africa, the African Center for Global Health and Social Transformation (ACHEST), Health Action International (HAI), Wemos Foundation, and is funded by the Dutch Ministry for Foreign Trade and Development Cooperation. The overall goal is to enable communities realize their right to the highest attainable sexual and reproductive health. The project aims to contribute to achieving Sexual and Reproductive Health and Rights (SRHR) by creating space for a strong civil society to engage effectively with governments, the private sector and other stakeholders accountable for health systems, to deliver equitable, accessible and high-quality SRHR services. Description Different multi-stakeholder platforms exist, but in some cases they are not functional, effective and sustainable. At the community level platforms include: local community structures such as community units, public participation and social accountability forums and CSOs networks. At the county level, the platforms are: existing coalitions and CSOs networks, Health stakeholder forums, the Technical Working groups (TWGs) on Human Resources for Health (HRH) and Sexual Reproductive Health (SRH), County Health Committees as well as the Court Users committee for the Judiciary. At the national level, CSO coalitions, the Technical Working groups (TWGs) and the Inter Agency Coordination Committee (ICCS) on HRH and SRH, the parliamentary health committee and committee of health at the senate. In order to ensure effective multi-stakeholder space for dialogue and dissent, the project will: sensitize and build the capacity of members in the networks on evidence based advocacy, assist in planning and coordination of the forums at the various levels as well as leverage on already existing structures and platforms. The community will be empowered to demand for their health rights through policy dialogues on health and rights. To ensure sustainability, the team will also advocate to the national and county governments to finance and budget for the respective platforms in their annual work plans. Lessons Learnt Among the key lessons learnt are the platforms need to be engaged differently at all levels. The successes of the platforms depend on political and social factors and require buy-in and commitment from all parties. By leveraging on the strengths and varied approaches of different stakeholder and partners, multi-stakeholder platforms can eliminate policy implementation barriers, facilitate scale-up, and increase the impact that one stakeholder or partner might have had alone.

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Recommendations: Continuous analysis of the multi-stakeholder platforms in HRH and SRH If successfully implemented, there will be a sustainable dialogue space for continuous evidence based advocacy.

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TUPE81 DREAMS: Community Partnership to accelerate Sexual and Reproductive Health Services for Adolescent Girls and Young Women Christopher Obongo PATH Kenya Issue Adolescent girls and young women (AGYW) in Kenya bear a disproportionate burden of HIV and other sexual and reproductive health (SRH) problems. For instance, despite accounting for <10% of the national population, 21% of HIV incidence occurred in young women aged 15-24 in 2014. Similarly, health problems related to childbearing are common among AGYW; 15% of women give birth by age 18 and half by age 20. Moreover, while public health interventions seem to have had positive effects at changing general SRH knowledge and attitudes, there is limited evidence of changes in sexual risk behavior in this group. In 2014, 15% of young women reported initiating sex before age 15 and half had their first sex before completing high school. A significant proportion of these first and early sex experiences are unprotected and coerced. Despite this disparate burden among AGYW, persistent legal, policy, social and cultural barriers limit their access to essential and high impact HIV and SRH services. Consequently, innovative strategies are needed for an effective and sustainable response to AGYWâ&#x20AC;&#x2122;s SRH needs in Kenya. This presentation describes PATH Kenyaâ&#x20AC;&#x2122;s DREAMS initiative and how it uniquely responds to the above needs in Kisumu and Homabay counties. Description DREAMS project aims to reduce HIV incidence among AGYW by 40% through a comprehensive intervention strategy that incorporates empowerment of individual AGYW, provision of adolescent-friendly services and, a girl-centered approach. In addition, services are targeted at male sexual partners, families, and communities in which AGYW live. A girl roster mapping exercise was first conducted to establish the universe of girls within the project area. Second, we collaborated with local CSO to develop vulnerability criteria for identification and enrolment of eligible girls. Third, we developed structures to facilitate implementation of project activities; we established safe spaces, identified well-equipped link facilities, and developed implementation tools and SOPs. Fourth, we initiated provision of various service packages to empower AGYW and their families such as parenting skills for caregivers, social assets for AGYW, educational support, and social economic strengthening (for girls and caregivers). Over 30,000 girls and their families have been reached by project activities. Lessons Learnt Community participation and ownership is crucial in a number of ways: (1) for enrollment of AGYW through community participation, enrollment increased from 273 to 26,204 in one quarter; (2) establishing safe spaces for AGYW; all safe spaces are donated by community and located within existing community resource centers; (3) partnership with other SRH service organizations facilitates delivery of biomedical services and; (4) monthly meetings with implementing partners facilitate review of progress and lesson sharing.

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Next Steps We continue to strategize ways of increasing enrollment among 20-24 year olds; we will strengthen spouse engagement to reach married AGYW in this age group. We will also work closely with various government ministries and departments to integrate services for AGYW for sustainability.

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TUPE82 Improving Under-Reporting of Risky Sexual Behaviours among Adolescent Clients Presenting for HIV Testing Service at Mildmay Uganda using Modern Information and Communication Technology Dorothy Nakkazi , Grace Kabunga, David Kavuma, Eunice Namujjehe, Harriet Chemusto, Yvonne Karamagi and Barbara Mukasa 1

Mildmay Uganda

Background Risky sexual behaviour is usually under-reported by adolescent patients because of various reasons ranging from stigma to lack of confidentiality, low risk perception, criminalisation of risk and poor provider attitude. It has been proved that modern ICT facilitates confidentiality and helps get more valid results on sensitive topics from this patient category. Mildmay Uganda (MUg), through their ICT program has made positive strides in dealing with under-reporting of risky behaviour. Procedure MUg uses Audio Computer-Assisted Self Interview (ACASI) in Patient care including HTC, through a program called questionnaire development system 2.6. It is a self-interview, currently, ACASI has been mainstreamed and all adolescents (10- 19) who come to MUg to access HIV Testing Services undergo this interview before they receive their HIV test results. A 12 months review (April 2015-March 2016) was done to evaluate the adolescent respondents in relation to preference to computer usage; privacy; reasons for computer preference; possibilities of lying and computer accessibility. Results Sixty two percent (62%) of the adolescent respondents preferred interacting with a computer to people.; 52% preferred a computer because of privacy; 57% had no reason against the computer interview; 45% admitted that they would lie if some of the interview questions were asked by people; and 76% had used a computer before this interview. Risky sexual behaviour issues regarding sexual orientation, transactional sex, number of sexual partners, knowledge of partnerâ&#x20AC;&#x2122;s HIV status, condom use and substance abuse, among others, were reported on. Lessons Learnt ICT tailored self-interviews are helpful in reporting sensitive issues among adolescent populations. It is a feasible approach in resource limited settings considering 76% of the adolescents had used a computer before this interview. Cascading this and other new ICT innovations in Adolescent Reproductive Health programs is very essential in meeting the special needs of this population. Conclusion Innovative ICT programs for behavioral interventions are a feasible approach to identification of risky sexual behaviors among adolescents in a bid to contribute to HIV epidemic control.

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TUPE83 Cervical Cancer Screening and Pre-Cancer Treatment for Adolescents and Young Females Living with HIV at Mildmay Uganda Elizabeth Najjuko Mildmay Uganda Introduction Cervical cancer is the 2nd most common cancer in women with more than 500,000 new cases occurring annually and nearly 85% in sub-Saharan Africa. In Uganda it is the leading cause of cancer among women accounting for 40% of all cancers. HIV infection has also been associated with advanced as well as early stage cervical neoplasia. Cervical cancer is preventable with screening, HPV vaccination and treatment of precancerous lesions. Description Mildmay Uganda commenced cervical cancer screening using Pap smear in 2008 and VIA (Visual Inspection with Acetic Acid) in 2009. The Strategic Plan for Cervical Cancer Prevention and Control 2010-2014 for Uganda recommends cervical cancer screening using visual inspection for women 25 to 49 years however Mildmay Uganda does screen sexually active adolescents and young people aged 15-24 years as well. Results Review of programme data of the HIV positive adolescents and young persons who visited the Sexual and Reproductive Health (SRH) clinic at Mildmay Uganda in the period July 2015 to June 2016 showed that; 1046 adolescents and young persons visited the clinic and received information on cervical cancer screening, prevention and pre cancer treatment. One ninety one (18%) of these were screened for cervical cancer using Visual Inspection with Acetic Acid (VIA). Of those screened185 (97%) and 6 (3%) had negative and positive results respectively. Five (5) of the 6 with positive results had lesions that occupied less than 75% of the cervix. These were successfully managed using cryotherapy. One had a lesion that was suspicious for cancer for which she was referred to Mulago hospital for a cervical biopsy and further management. Conclusion Screening sexually active HIV positive adolescents and young people for cervical cancer has the potential to contribute to reduction of the burden of cervical cancer.

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TUPE84 Lessons from the HOPE Model: Key Findings from the End of Kenya’s HOPE Program Evaluation Betty Adera Global Communities (formerly CHF International), Kenya Background Healthy Outcomes through Prevention Education (HOPE) is a USAID funded program that uses peer, school and community-based interventions to educate adolescents about HIV and AIDS and encourage healthy behaviours. Global Communities implemented this program in partnership with National Organization of Peer Educators (NOPE), Kenya Girl Guide Association (KGGA), St. John’s Community Center (SJCC) and Support for Addiction Prevention and Treatment in Africa (SAPTA) in Nairobi and Kiambu Counties with a focus on schools and communities in the informal urban settlements. The goal of the HOPE Program was to increase students’ Knowledge, Attitudes and Practices (KAP) related to HIV. HOPE Program used Peer Education as the main vehicle for delivering HIV prevention messages. Methods The evaluation design was quasi-experimental with one group pre and post-test without control group applying mixed method of data collection. Clustered -Stratified random sampling was used in selection of schools and classes to be surveyed and purposive sampling for qualitative respondents. A sample size of 681 respondents was surveyed for quantitative respondents out of the planned 662 giving a response rate of 105%. Qualitative data was collected from 128 respondents out of the planned 152 giving a response rate of 84.2%. Results On the extent to which the HOPE Program achieved its goal and objectives: 68933 students out of a planned 64000 were reached; students’ knowledge on HIV and STIs increased by over 100%; percentage of students aged 15-24 years who had ever had sex reduced from 65% at baseline to 59% and stigma against people living with HIV reduced significantly. The HOPE Program model which is a hybrid of Peer Education, parental empowerment and teacher support was effective at addressing varied needs of at-risk youth urban slums of Nairobi and Kiambu Counties. Conclusions and Recommendations While positive outcomes are observed following implementation of the HOPE Model, it is important to note that enhanced engagement of students, parents, teachers, communities, line government ministries and program partners contributed significantly towards the success of the program. Core parts of the HOPE Model, especially the work with students, parents and community leaders can be applied in many settings (urban/rural) and used to address a number of problems confronting at risk youth.

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TUPE85 Lessons on Adolescent Girls Male Sexual Partners Characterization in Kamukunji Sub-County, Nairobi City County Betty Adera Global Communities (formerly CHF International), Kenya Issues If girls are given a chance to stay in school, get access to health services, delay marriage and childbirth, it's not only them who benefit - so do their children, families, communities, and countries. The issues that girls face will be specific to their age, where they live, their culture and other life circumstances. Programs have to use different, intentional strategies to identify those girls who are most off-track and design programs in such a way that will enable them to participate. Description The DREAMS Program seeks to support the most vulnerable Adolescent Girls and Young Women (AGYW) to live Determined, Resilient, Empowered, AIDS-Free, Mentored and Safe (DREAMS) lives. Through conducting a rapid household assessment in Kamukunji Sub-county, the program enumerated the entire universe of Adolescent Girls and Young Women and identify those who are off-track and most at risk. Respondents were asked to mention some of the major shocks that were affecting households in their settlement. The exercise was conducted using a mobile phone platform where a set of 7 non-sensitive questions were administered to collect demographic information on AGYW. Results The exercise confirmed that out of 24,917 interviewed households, 10,513 members were AGYW aged 10-24 years old. Further disaggregated data showed 3,790 AGYW age 10 to 14; 3,345 AGYW age 15 to 19; and 3,378 AGYW age 20-24. Results showed AGYW living with neither parents nor those married with children as the most off-track. In general, 42% of the AGYW had children and 48% were living without parents. Despite the high number of children who are of school going age, 58% were out of school out of which 18% of them were married with children. Of the 42% who are in school, 22% were in school living with neither parent while 2% were married with children. Lessons Learnt In designing an evidence based program, it is important to understand your beneficiary population. AGYW are not a homogenous group hence understanding their differences helps design programs that meet their different needs It is important to segment AGYW based on age cohorts and similar characteristics to be able to reach them with age-appropriate and interventions and services The most off-track AGYW might not be obvious to identify hence the need to employ a targeted approach.

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Key Recommendations: Conducting a rapid household assessment helps to determine all the AGYW beneficiaries in target communities Gathering data on AGYW in terms of their education and marital status including who they live with can help determine which of them are most off-track and most at risk.Use of mobile phone platforms to conduct rapid household assessment is a cost effective strategy.

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TUPE86 Power of Peer Education: Key Unintended Outcomes of Kenya’s HOPE Program Betty Adera Global Communities (formerly CHF International), Kenya Background Healthy Outcomes through Prevention Education (HOPE) is a USAID funded program that uses peer, school and community-based interventions to educate adolescents about HIV and AIDS and encourage healthy behaviours. Global Communities implemented this program in partnership with National Organization of Peer Educators (NOPE), Kenya Girl Guide Association (KGGA), St. John’s Community Center (SJCC) and Support for Addiction Prevention and Treatment in Africa (SAPTA) in Nairobi and Kiambu Counties with a focus on schools and communities in the informal urban settlements. The goal of the HOPE Program was to increase students’ Knowledge, Attitudes and Practices (KAP) related to HIV. HOPE Program used Peer Education as the main vehicle for delivering HIV prevention messages. Methods The evaluation design was quasi-experimental with one group pre and post-test without control group applying mixed method of data collection. Clustered Stratified random sampling was used in selection of schools and classes to be surveyed and purposive sampling for qualitative respondents. A sample size of 681 respondents was surveyed for quantitative respondents out of the planned 662 giving a response rate of 105%. Qualitative data was collected from 128 respondents out of the planned 152 giving a response rate of 84.2%. Results On student’s perception of changes in high risk behaviour: 77% of primary and 76% of secondary school students mentioned there is less conflict in schools; 66% of primary and 74% of secondary school students reported more awareness of Gender Based Violence (GBV); and 60% of primary and 51% of secondary school students reported less pressure on girls to have sex. On students perception of changes in communication: 80% of primary and 92 % of secondary school students reported improved communication between students of different religious groups; 87% of primary and 77% of secondary school students reported improved communication between them and their teachers as well as parents. On students’ perception of change in academic performance: 84% of primary and 70% of secondary school students reported improved academic outcomes. On parents’ perceptions of interpersonal and parental skills after parental empowerment training, 99% of parents reported positively reinforcing desired behaviour in their children; 97% reported managing conflicts in and outside the family; and 100% reported listening effectively to their children.

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Conclusions and Recommendations: Positive changes reported in perceptions of both students and parents regarding communication, reduction in high risk behaviours, academic performance following the Peer Education strategy are laudable. Programs implementing HIV prevention among young people need to place emphasis on assessing unintended outcomes on a continuous basis and integrate findings into program implementation strategies for more sustained impact.

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TUPE87 Improving Knowledge on Emergency Contraception among Students of the University of Buea: A Comparison of Health Talk Versus Educational Leaflet Misrak Beyene , Atashili Julius , Nde Fon Peter 1

Ethiopian Public Health Institute, Ethiopia, University of Buea, Cameroon 2

Background Unintended pregnancy is a major public health concern in the world. Emergency Contraception (EC) is one of the modern contraceptive methods which is being used to prevent unintended pregnancy after unprotected sexual intercourse. But it is relatively unknown in the community and knowledge remains the major barrier for its use. Objective The objectives of the study were to assess the knowledge, attitude and practice (KAP) of EC, the effect of health talk versus educational leaflet on EC and the relationship between socio-demographic characteristics with knowledge on EC. Methods The study was carried out at the University of Buea, Cameroon. The study design was randomized control trial. The interventions for the study were health talk versus educational leaflets. And data was collected using self-interviewed questionnaires before and after the interventions. The study targeted students of the University of Buea. Students taking French,102 were chosen randomly among the other compulsory courses (English, Sport and Civics and Ethics) taken by all of the students in the University. Data was analysed using Epi info version 3.5.4. Results One hundred and fifty nine (48.9%) of the participants responded that they had heard of EC. Knowledge about what constitutes EC was low (11.4%). One hundred and sixty three (50.2%) had positive attitude towards EC. However, only 7.7% responded that they or their partners had previously used EC. At the end of the study, health talk was found to improve knowledge more than educational leaflet. The difference in increased knowledge was 33.0% (P<0.001). Moreover, previous use of EC was associated with knowledge on EC. Conclusions There was inadequate knowledge, positive attitude and low use of EC and a month after the intervention, health talk was found to improve knowledge. Recommendations As a recommendation, health talk method should be used to ameliorate studentsâ&#x20AC;&#x2122; knowledge on EC, health professionals should give adequate education on EC and further studies should be conducted on a larger scale and in a different educational settings to assess the association of the rest of the predictors.

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TUPE88 Replicating successful modeling gains into health care financing: a case of selected counties in Kenya Masime Angwa Ruth , Bijay Kumar , Lucy Ojiambo , Michura Samson 1

Action Aid International Kenya

Issue Financial protection is at the core of Universal Health Care. Improving financial protection is therefore central to health financing policy. Most of the resources for universal health coverage should come from public budgets to maximize financial protection. Optimum usage, management and flow of public funds is crucial. Currently the health sector in Kenya is struggling with stagnant or declining budgets, system inefficiencies, persistently poor service quality and lack of equity that calls for increased public allocation, consistent and effective utilization of available funds. Description Action Aid International Kenya (AAK) implemented a Public Financing for Agriculture project in 2012 - 2015 in 4 counties – Migori, Kakamega, West Pokot, and Baringo – focusing on Agriculture financing with remarkable success. The project’s objectives were formation of strong citizens’ movements, increased public financing for agriculture, increased citizen participation in decisionmaking forums, increased accountability for the utilization of public funds, and increased donor funding for the sector. Employed methodologies ranged from awareness creation to development, signing and follow-up of citizen service delivery charters by small-holder farmers and the general public. As a result, on average (during the project period alone) the counties realized an increase in public financing for agriculture of more than 12%. Subsequently, in relation to the other counties, service delivery for small-holder farmers has greatly improved as well as the health care seeking behaviour in the four counties. Lessons Learned This model can be used to improve the status of various health indicators including maternal mortality; new-born and under five mortality as the citizenry become active participants in the delivery of health services. Next steps AAK intent to model the same for health care, show how such success can be achieved for the vulnerable populations, and consequently attain universal health coverage.

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Abstracts and Poster Sessions Day 2

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Wednesday WEABO01 Perception on teaching learning practice among upgrading Health Extension Workers in Shashemane Health Science College, Oromia Region Belayneh Lemma Amref Health Africa Ethiopia Background Ethiopia Federal Ministry of Health launched a new accelerated expansion of primary health care through health extension programme in 2003. The health extension programme introduced a new cadre of health extension workers (HEWs) who received a year course of institutional and field training and provides 16 packages of essential interventions. Considering practical challenges, MOH launched upgrading training programme of HEWs from level III to level IV. Objective This study aimed to assess the perception of level IV health extension workers on teaching learning practice of Shashemane Health Science College. Methods A qualitative phenomenological study design was used to collect information from all students found in Shashemane Health Science College. Data was collected from eighteen participants by personal face to face in-depth interview and five FGDs with taking notes and audio record using semi-structured interview guides. Note that institutions grouped their students in one to five network to facilitate the teaching learning process. Hence we purposely selected 18 one to two five network group leaders and did 5 FGDs. The thematic analysis was done using detailed interview notes and transcribed audio records using open code software. Results Study respondents perceived that their upgrading training programme can fill gaps of the health HEWs to address the major community health problems. The participants appreciated the presence of qualified trainers, equipped skill labs, methodologies used and learning modules/reference they had as important elements of the teaching learning process. However they were dissatisfied by duration of the training, imbalance between theory & practice and student-classroom ratio. Conclusion & Recommendations The upgrading training programme addresses major training gaps of HEWs to improve community health needs. While the challenges related to duration of the training, practical sessions and student -classroom ratio needs to be improved.

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WEABO02 A comparison of clinicians' knowledge of Sexually Transmitted Infections (STIs) and AntiRetroviral Treatment at cross-border areas in East Africa Agnes Gatome Abt Associates Inc, Kenya Background HIV prevalence in the East African Community (EAC) varies from 1.1-7.3% among adults age 15-49. Significant resources are invested in the training of healthcare workers in HIV prevention, care and treatment. STIs are a risk factor for HIV transmission and training curricula include management of STIs as a prevention measure against HIV transmission. Objectives The USAID-funded Cross-Border Health Integrated Partnerships Project assessed clinician knowledge on treatment of four STIs (Syphilis, Gonorrhea, Herpes and Chlamydia) and adult ART and compared this with national guidelines for STI and ART management. Methods Data was collected through interviews with clinicians offering ART and STI treatment at 46 public and private facilities in seven EAC cross-border areas. Results At private and public facilities assessed offering ART, health worker knowledge was accurate. For STI management, there was a wide variation in treatment of STIs often with inappropriate or incorrect treatment given for STIs as compared to national guidelines. There were few diagnostic facilities to distinguish STIs and majority of clinicians at primary care facilities treated them broadly as pelvic inflammatory disease and genital ulcer disease. Treatment cited was more accurate at public rather than private facilities. Conclusions and recommendations Cross-border towns are hotspots for STI and HIV infections due to the mobility facilitated by the EAC common market protocol. Appropriate treatment of STIs is important to reduce STI and HIV transmission. It is recognized that clinician knowledge may not translate to good clinical practice but it is an important prerequisite to accurate treatment and management. In-service and postservice training programs should also focus on treatment of STIs and support clinicians with job aides for use in day-to-day work. Finally, private facilities should be included in post-service trainings to improve clinical knowledge and ensure appropriate treatment is provided to all regardless of their choice of provider.

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WEABO03 Leveraging incentives to deliver better health outcomes: Results of a randomized controlled study Alfred Wise Living Goods, Uganda Background Despite improvements in under-five child mortality, an estimated 6.9 million children die from preventable diseases every year. Community health workers (CHW) play a critical role in delivering health impact to underserved areas, and saving lives. However, community health systems - often comprised of unpaid, volunteer workers-have been largely ineffective at reducing child mortality. Weak incentives and performance management have been cited as major limiting factors. Living Goods and BRAC strengthen community health systems by training, equipping, and managing CHWs who provide iCCM and MNCH services, and earn a small income from performance-based incentives and sales of impactful products. The model leverages both monetary and non-monetary incentives to motivate CHWs, improve performance, and deliver better health outcomes. From 2011-2013, external researchers conducted a randomized controlled study (RCT) to evaluate the impact of the model in Uganda. Objectives Evaluate the impact of an incentives-based community health delivery model on reducing underfive child mortality. Methods A randomized controlled trial of 214 rural villages across 10 districts in Uganda was carried out, involving a total sample size of over 8,000 households. In treatment villages, Living Goods and partner BRACâ&#x20AC;&#x2122;s CHWs conducted home visits educating households on essential health behaviors and selling impactful products. Results: The study found a 27 percent reduction in under-five mortality, 27 percent reduction in neonatal mortality, and 33 percent reduction in infant mortality in Living Goods and BRAC treatment areas compared to control areas. The effects are supported by changes in health knowledge, preventive behavior, community case management, and follow-up visits. Conclusions and Recommendations Integrated, well-managed, and incentive-driven models of community health delivery can drive significant reductions in newborn and under-five child mortality. Both monetary and non-monetary incentives such as recognition and awards, status, and regular supervision and coaching can be leveraged to help drive performance and health impact. Country governments and funders can support scale-up of these kind of effective community health models to improve health outcomes.

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WEABO04 Evaluation of Clinical Nurse Educators' Program in Moi Teaching Referral Hospital, Kenya Linnet Sang Moi Teaching and Referral Hospital, Kenya Background The purpose of this study was to evaluate the implementation of Clinical Nurse Educators’ (CNEs) program in Moi Teaching and Referral Hospital, Kenya. Nurses constitute an important element of the medical team. The variables, gender, professional qualification, years of nursing experience, work station, role and function of CNEs, Nursing process, Continuous Medical Education (CME) attendance and challenges faced by CNEs were evaluated and how these variables related with the implementation of CNEs program. Methods The study which used descriptive research design employing quantitative and qualitative methods was conducted in Moi Teaching and Referral Hospital in June, 2016. A questionnaire and an interview schedule were used for data collection from 224 nurses and 13 Clinical Nurse Educators’ in Moi Teaching and Referral Hospital. Descriptive statistics and thematic analysis were used to analyze data. Results The results showed majority 213 (90%) of the respondents with an overall mean of 3.30 out of 4.00, showing that most nurses ‘Somewhat Agree’ that the CNEs carry out their roles and functions as stipulated on their job descriptions and all the respondents had a positive attitude towards the nursing process, as shown by improved findings on the after analysis of the nursing process evaluation. Majority (75%) of the respondents said that the nurse to patient ratio was not optimal to apply the nursing process. The Clinical Nurse Educators’ program is not yet fully implemented in all of the five divisions of the hospital. The findings revealed that the knowledge of nurses on the nursing process has improved. However, its full application on patient management is not adequate because of high patient nurse ratio. Conclusion The studied hospital should consider addressing the challenges that impede the full implementation of the program

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WEABO05 Intrahealth’s experience on best practices and models for training health HR managers in Kenya Matthew Thuku , Nyapada L , Malubi A¹, Wanyoike I¹, Kiema J¹, Cheboi B¹, Muriuki J¹, Wassuna O¹ 1

IntraHealth International, Kenya

Issue Following the Constitution promulgation, Kenya adopted a devolved structure with 47 county governments. On average, 50-80% of county workers are in the health sector. Managing over 57,000 workforce has brought challenges, with county health departments lacking professional HR officers. Description The IntraHealth International-led, USAID-funded Human Resources forHealth (HRH) CapacityBridge Project trained health managers through face-to-face (f2f) training, eLearning and mentorship. In partnership with the Institute of Human Resource Management, IntraHealth developed basic and advanced HRM curricula to build HR skills and inculcate best practices among managers, incorporating an HRM e-course with 11 modules for continued learning. Training was coupled with a weekly, 7-week mentorship program to build competencies beyond just knowledge. Twenty HRM mentors were drawn from private, public and faith-based institutions in targeted counties and paired with mentees based on identified needs and mentors’ skills and availability. Lessons Learnt Effective county management of health workers is taking root. A total of 449 officers underwent f2f training, 146 undertook the e-course while 57 were mentored. The program achieved results in three areas: counties strengthened HRM systems; mentors expressed professional satisfaction and earned continuing professional development (CPD) points; and mentees developed requisite HR skills and earned CPD points for re-licensure. Some mentees developed HRH policy guidelines/structures for their counties -job descriptions, performance appraisal guidelines, staff exit questionnaire to inform appropriate retention strategies, HRH strategic plans, re-establishing disciplinary advisory committees. A public-sector HRM mentorship user guide and tools has since been developed. The mentorship program demonstrated how public service can be improved through collaborative learning with private and faith-based institutions. Recommendations Standardization and sustainability must be anchored in sound policies and guidelines. Going forward it is critical to target top county leadership, many of whom make critical HR decisions yet lack HR skills as well as leadership, management and governance training.

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WEABO06 Secret sauce to training frontline health workers effectively for improved health service delivery Authors: Jackline Kiarie , Martin Kiandiko , Frasia Karua 1

Amref Health Africa

Corresponding Author: Jackline Njeri Kiarie of Amref Health Africa P.O Box 27691 – 00506, Nairobi and Email address: Jackline.Kiarie@Amref.org Issue Developing countries are facing a severe shortage of health workers. Community Health Workers (CHWs) are essential to fill this gap. Building their capacity strengthens the health system from the ground up. However, there is high attrition of those trained (30-40%) and missed opportunities for continuous training. Description A cross-sectoral partnership comprising Amref Health Africa, Mezzanine, Accenture, M-PESA Foundation, Safaricom and the Kenya Ministry of Health built the Leap mLearning Solution. Leap is a leading solution which delivers training through SMS and Audio across all geographies. It has been used to offer continuous support to CHWs by enabling access to peer collaboration, tools to support practice, continuous and refresher training and strengthened supervision. In the last 4 years, over 15,000,000 SMS’s and 80,000 minutes of audio messages of training content have been delivered to over 5,000 CHWs reaching over 500,000 community members with health education, first aid services and referrals. 91% of those on mLearning complete on time with a performance of 90% in the inbuilt evaluations. Anecdotal evidence shows that those CHVs in the mLearning program have 15% higher knowledge levels than those undergoing the traditional face to face training approach with less than 1% attrition. There’s also increased confidence by the community and supervisors on the ability of the CHWs to deliver health service. Lessons Learnt The mLearning solution has transitioned into a social enterprise to enable scale to otherimplementing partners in Africa. We have learnt that different capacities are required in design and deployment of the solution, strong partnerships are therefore critical; it must be designed with scale in mind; a good understanding of the end user, technology infrastructure and general mHealth environment ensures that the solution is responsive with flexibility to support advancing technology and environments. Ownership of the solution by the stakeholder’s is critical for scale. Key Words Mobile learning, Frontline Health workers, health service delivery

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WEABO07 mproving Attrition and Retention of Rural Health Workers: Building up a Sustainable and Cost-Effective Housing Cooperative in Zambia Klaus Thieme , Martina Weber 1

SolidarMed- The Swiss Organization for Health in Africa, Zambia Background: Push and pull factors like working conditions, salary levels, understaffing and especially rural housing conditions contribute to a low rate of attrition and retention of health workers in rural Zambia.

Objectives The study researched the health workers’ perceived staff housing conditions by the example of the Sacred Heart Hospital Katondwe, found in a very rural setup in Luangwa District, Zambia. Methods: The study used the qualitative method of photo elicitation to explore the health workers’ perception of their housing conditions and its impact on their own job satisfaction. The main characteristics of the existing staff houses were collected and tabled. Results The findings of the study show an ambivalent perception of the housing conditions by the study participants. Although most houses showmodern standard features, theyoftentimes are not adapted to the hot climate in the Luangwa valley in sense of roofing, insulation and ventilation. Houses are perceived as too small to accommodate the nuclear and oftentimes additionally the extended family. The rural setup is perceived being conducive because of fresh air, green surroundings and the lack of congestion in terms of population density, traffic and pollution. Mostly the hot climate and the insect infestation contribute to negative feelings. Having to share the houses with co-workers is perceived as a particular hardship. Conclusions The health workers’ views on housing contribute to a deeper understanding of rural housing. While the tranquility of rural housing seems to be perceived positively, fundamental house features are impacting the living conditions and therefore the retention heavily. Recommendations: Rural staff houses should be well adapted to the climate and need to consider the need for adequate space to accommodate nuclear and extended family. Basic power supply for lighting, access to fresh water and protection from mosquitoes needs to be offered for improved housing quality.

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WEABO08 Performance Based Financing Intervention in Public and FBO Primary Healthcare Facilities in Bungoma County in Western Kenya Boniface Mbuthia Options Kenya Background Positive progress on MNH in Kenya includes: reduction in maternal death to 360 from 488/100,000 live births; increase in SBA from 44% to 62%. 41% of births in Bungoma are conducted by a skilled attendant, compared to a national average of 62%. The County was ranked 43rd out of 47 counties in Kenya for SBA (KDHS, 2014/15). Hence the need for additional collaborative interventions by the Maternal and Newborn Improvement (MANI) project through DFIDâ&#x20AC;&#x2122;s support 2013-2017 on Reducing Maternal and Newborn Deaths in Kenya. Issues Contributing factors to low utilization MNH/RH services: poor motivation, poor team work and planning, low quality of care and lack of essential inputs. Description MANI implements health system strengthening (HSS) interventions in Bungoma aimed at reducing maternal and neonatal deaths from 2013- 2017, covering 6 sub-counties. PBF is a system approach with an orientation on results defined as quantity and quality of service outputs and inclusion of vulnerable persons.PBF reimbursements are disbursed and shared between the health workers (60%) and facility improvement (40%) on attainment of selected indicators. Progress so far is that 35 health facilities are participating, the County team has been trained, 7 underperforming indicators in MNH-RH selected and MANI supports development of quality, quantity evaluation criteria and indices tool for staff sharing bonuses. Lessons learnt PBF promotes staff motivation, separation of functions strengths implementation, PBF indices promote fairness and transparency, facility improvement fund bridges the gaps in quality of care, business plans promotes innovation and quality evaluations strengthen service delivery Next steps Optimize the PBF intervention and motivate health facilities to attain the EmONC status.

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WEABO09 Engaging young people for better health and development MaqC Eric Gitau , Yulia Koval-Molodtsova 1

UNICEF & dance4life Liaison Kenya , Dance4life International, Netherlands 1

Background Everyone these days does youth consultations, but young people are not always meaningfully involved. We acknowledge that young people know their reality best. Therefore we involve and engage them in everything we do. In this presentation dance4ilfe and Philips will show how youth can be meaningfully engaged and we will present a case of how the private sector can play a role in engaging with youth and collaborating with NGOs, such as dance4life. Methods Both dance4life and Philips use a human-centered approach to design which includes a creative approach to problem-solving. We use a co-creation process with the young people who we are designing for, resulting in new solutions that are tailor made to suit their needs. We involve a diverse cross-section of young people throughout the whole process - from strategizing to concept creation to solution development. We create safe spaces and facilitate participation so that young people feel at ease and comfortable to talk about their issues, needs and dreams. Following this innovative approach, it is possible to gain empathy and deep insights about young people within a relatively short timeframe. Moreover, we have learned to listen to young people. We inspire them and allow them to inspire us. Philips is developing a health and well-being strategy for adolescents in Kenya recognizing that adolescents have not been served by most health initiatives and services. Therefore, togetherwith dance4life peer educators, we have undertaken an initial study (following the approach described above) to gain trust and insights and develop effective intervention strategies for health and wellbeing that will be appealing and deeply engaging for young people and form the basis for the deployment of youth-friendly services. Results Philips interviewed experts from the University, NGOs, Government and Health Sectors, parents and teachers in March 2016. In August we interacted directly with young people (boys and girls) to listen, learn and engage with them in selected topics for discussion. Interactive sessions have been organized and facilitated by Kenyan young experienced dance4life facilitators. In this presentation dance4life and Philips will share experiences about working with the human-centered design approach and present the results and outcomes of the youth consultations and expert interviews for the adolescent strategy in Kenya of Philips.

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WEABO10 Can the Kenyan government afford rotavirus vaccination after GAVI graduation? Christophe Sauboin , Vincent Kioi , Baudouin Standaert 1

GlaxoSmithKline, Kenya

Background Rotavirus vaccination has been introduced in Kenya since 2014. The Global Alliance for Vaccines and Immunization (GAVI) supported the introduction with a co-financing of Kenya government. GAVI policy leads countries with growing economies to increase the co-financing until self-finance is achieved. Kenya is expected to move to the accelerated transition phase by 2021 bearing full vaccine cost by 2026. Objectives The study analyses the capacity of Kenya to self-finance the rotavirus vaccine by projecting the budget impact over the long run. Methods With a static multi-cohort model we estimated the number of rotavirus-related episodes, hospitalisations and deaths averted following rotavirus vaccination over 2016-2036. Demographic increase, gross domestic product growth and GAVI requirements in function of gross national income are included to estimate long-term vaccine contribution and cost-offset. All costs are from government perspective, excluding GAVIâ&#x20AC;&#x2122;s part. Disease incidence, mortality, costs and vaccine effects are retrieved from literature. Productivity gains due to mortality reduction are estimated and lead to government budget increase when children enter the labour market. GAVI vaccine price is considered after graduation. No discount is applied. Results Rotavirus vaccination is estimated to provide budget savings during preparatory phase and the first three years of accelerated transition phase until 2023, annual savings reaching USD 3 million in 2020. In 2025 extra budget is required reaching USD 1.5 million (0.04% of government health expenditures). The needed budget thereafter would decrease and savings may appear from 2029. Total cost estimates for disease management over the evaluation period was USD 224.6 and 174.7 million without and with vaccination respectively. Conclusions Rotavirus vaccination may provide savings over the long term for Kenya government with selffinancing post-GAVI graduation. Savings occurred from productivity gains, treatment and hospitalisations cost-offsets. Recommendations Temporary extra budget requirement shouldnâ&#x20AC;&#x2122;t deter vaccination efforts in the perspective of long term savings.

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WEABO11 Strengthening Community Health through Public/Private Partnerships Maurice Siminyu , Ruth Ngechu 1

Busia County, Kenya, Living Goods Kenya

Issue Community health workers have tremendous potential to deliver health impact. However, the public sector has historically struggled to drive and maintain the performance of these mostly volunteer teams. Innovative public/private partnerships can provide integrative solutions that strengthen community health and increase access to maternal, newborn, and child health services. Description In 2015, Living Goods partnered with Busia County to leverage the organizationâ&#x20AC;&#x2122;s integrated CHW model which demonstrated a 27 percent decrease in under-five child mortality in Uganda. Under the public/private-like partnership, Living Goods works alongside the Western Kenya county to support community health volunteers (CHVs), bringing them into the organizationâ&#x20AC;&#x2122;s incentivesbased performance management system. Through proactive training, use of smart mobile tools and assured health commodities, Living Goods trains and manages CHVs who support pregnant women and newborns and conduct community case management of childhood illnesses, while earning an income by selling impactful products. Results The results so far have been impressive: reduced facility workload, 226 active CHVs serving over 24,300 households across Busia County. By the end of 2017, Living Goods in partnership with Busia County strives to cover at least 70 percent of the county improving access to health services across the county, particularly for moms and babies. Lessons Learned Strong and on-going collaboration in the design of the program was critical to the success of the partnership from recruitment and training practices to data and performance management. Additionally, strong support and buy-in from senior leadership, both political and technical, further reinforced this foundation of trust and transparency, paving the way for an impactful partnership. Recommendations There is significant opportunity for the public sector to leverage and integrate the strengths of private partners to deliver community health helping them reach vulnerable populations and increasing access to maternal, newborn, and child health services.

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WEABO12 The Afya Elimu Fund: Increasing student access to training fees through a sustainable Revolving Loans Fund Stephen Karuntimi1, Milo P¹, Karutu C¹, Nashipae F¹, Munene I¹, Muriuki J¹, Wassuna O¹, Karen D¹ IntraHealth International, Kenya

Issue Unaffordable education fees, especially for students from poor backgrounds, are a key factor hindering training of new health workers in Kenya. At 1.5 health workers per 1,000 populations, Kenya is far below the World Health Organization’s recommended ratio of 2.3 health workers per 1,000 population. Description In 2013, the Government of Kenya (GOK) and U.S. Agency for International Development (USAID) through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) provided seed funds to start the Afya Elimu Fund (AEF), a public-private partnership which aims to increase access to fees for poor students in mid-level medical training colleges. The loan fund was conceptualised in 2011 from a scholarship program initiated under the USAID-funded Capacity Kenya Project led by IntraHealth International. AEF loans are provided at low interest rates (4%) to cover tuition fees. The fund is managed by GOK Higher Education Loans Board (HELB) with an oversight board drawn from the health and private sectors chaired by the Principal Secretary, Ministry of Health (MOH). The main contributors to AEF are the Ministry of Education through HELB, USAID, MOH, IntraHealth, Family Group Foundation, Standard Chartered Group, I&M Bank, and Rattansi Educational Trust. Lessons Learnt The fund has lent to more than 9,000 students with a loan value of KES 523 million (USD 5.23 million). As of September 30, 2016, about 14.5% (n=1,354) of AEF beneficiaries had completed studies. It is projected that an average of 18,000 loans will be issued each year and about 5,000 new graduates produced annually to help bridge the gap in adequate supply of qualified health workers. Conclusion/Next steps Affordable loans targeted at the poor (rather than scholarships) constitute the best instrument for achieving the desired outcome. More needs to be done to diversify AEF’s contributor portfolio to include additional private sector companies and foundations as well as county governments. Key words student, loans, health, fund, graduates

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WEABO13 Improving access to medical care in Africa via telemedicine: a Case Study of Cape Verde Yaya Mbaoua GlobalMed Africa & The Mbaoua Group The nation of Cape Verde is home to 500 thousand people who live on nine islands. Travel to the two large hospitals in the main island of Santiago is expensive and limited to one or two flights or fairy rides each day. Faced with the inconvenience and cost of transportation, residents delay travelling to the main hospitals until health problems became serious. At the request of the government, the International Virtual eHospital Foundation designed and implemented a telemedicine program for Cape Verde. Now GlobalMed's mobile telemedicine stations are placed at each of the nine islands, where patients can see a physician in Santiago, without actually going there. What this means is that if a doctor faces a complicated case in Praia, they can consult a specialist at the main hospital in Santiago for a second opinion. In one case, a pregnant woman was able to see her baby the first time, using an ultrasound device. Another patient found out he had a tooth abscess when a doctor in Santiago remotely conducted an oral exam."Few places demonstrate the promise of Africa better than Cape Verde" US Secretary of State Hillary Clinton said during her visit in 2013. "Some places have certain aspects that can be comparable. But few places have put it all together, with good governance, transparency, accountability, the rule of law that is delivering for its people."

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WEABO14 Patients’ perspectives on use of mobile phones in HIV Patient-Care Support: A descriptive study at Kibera and Baba Dogo Health Centers, Nairobi Patrick Igunza , Bonface Abunah , Richard Gichuki , Edward Omondi , Everlyn Kabia , 1 Samuel Muhula 1

Amref Heath Africa in Kenya

Background Mobile phone interventions have been found to have beneficial effects in healthcare service delivery. Use of short text message service (SMS) in HIV care has been shown to improve adherence to ART, and consequently clinical outcomes. Factors associated with effective and consistent use of phones by patients have not however been adequately evaluated. This study assesses HIV patient’s perspectives on mobile phone use for care support in resource limited settings. Methods A longitudinal study involving HIV-positive patients presenting for care for the first time and with regular cell phone access was conducted. They were sent weekly SMSs assessing their wellbeing and were expected to respond within 48 hours to indicate whether (‘Sawa’) or (‘Shida’) if they needed help from a healthcare provider. Those responding with “shida” were triaged by phone. Non-responders were called to establish reasons for non-response. An exit questionnaire inquiring participant’s perspectives on the SMS service was administered after one year. Descriptive statistics were used to analyze the responses. Results Of 350 (42.3% male; 57.7% female) participants recruited, 215(61.4%) were interviewed after one year. 48(22.3%) reported ever losing access to a cell phone. Most participants did not have any difficulty receiving (87%) or sending (79.1%) weekly SMS. Weekly SMSes were perceived to be helpful by 93.9% of participants while 90.7% felt they could also help patients with other disease conditions. Only 0.5% felt the SMSes were a nuisance and 2.3% felt SMSes could expose their HIV status. Main benefit of weekly SMSes reported was getting assistance when sick (33%). Main reason for non-response was SMS not being received or delivered (33%). Conclusion: SMS service is acceptable for care support by HIV patients who perceive it as beneficial to even patients with other health conditions. Cell phone use should be included among healthcare service delivery strategies.

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WEABO15 How an app is improving quality of care during childbirth in Kenya and Ethiopia Tara Talvacchia , Ruth Maithya , Diana Mukami 1

Maternity Foundation, United States, Amref Health Africa HQ 2

Maternity Foundationâ&#x20AC;&#x2122;s Safe Delivery App is a smart phone application that provides skilled birth attendants with direct and instant access to evidence-based and up-to-date clinical guidelines on Basic Emergency Obstetric and Neonatal Care. The App leverages the growing ubiquity of mobile phones to provide life-saving information and guidance through easy-to-understand animated instruction videos, action cards and drug lists. It can serve as a training tool both in pre- and inservice training, and equips birth attendants even in the most remote areas with a powerful onthe-job reference tool. The App was created in 2012 with support from MSD for Mothers, and in collaboration with the University of Copenhagen and the University of Southern Denmark. The App is also currently supported by the Bill & Melinda Gates Foundation. As a leader in innovation for health in Sub-Saharan Africa, Amref has been innovating in capacity building for nearly 60 years. Since 2000, Amref has worked to leverage technology supported learning including telemedicine, eLearning and mLearning. Together, Maternity Foundation and Amref in Kenya are working to integrate the Safe Delivery App into pre-service BEmONC education for skilled birth attendants, and as a job aid that they can continue to use in practice. Our collaborative presentation will explore how the Safe Delivery App can improve BEmONC training, by providing strong visual guidance of critical life-saving skills; and enhancing transfer of knowledge and skills to their clinical sites after trainings.

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WEABO16 Reducing perinatal mortality by over 15% in Northern Uganda; Focusing on using improvement methods to scale up simple high impact lifesaving interventions Isabirye Paul University Research CO., LLC USAID-ASSIST Project, Uganda Background About 8500 pregnant women develop complications each year in six Northern districts of Uganda, where approximately 4800 pregnant women live with HIV, and based on the countryâ&#x20AC;&#x2122;s mortality rate, more than 200 women lose their lives due to pregnancy-related conditions. In an effort to reduce the number of maternal and newborn deaths in Uganda and Zambia, the Saving Mothers, Giving Life (SMGL) initiative was launched in 2012 and designed to address three major gaps in health service delivery: a) delays in seeking appropriate care, b) inability to access the most appropriate care in a timely manner, and c) inconsistencies in the quality of care provided at health facilities. Four districts of western Uganda (Kyenjojo, Kabarole, Kamwenge and Kibale) were covered during the first phase of the SMGL initiative which resulted in 30% reduction of maternal mortality. In February 2015, the initiative was expanded to 6 northern districts of Uganda (Apac, Lira, Dokolo, Pader, Nwoya and Gulu). Twenty high-volume sites were chosen at the beginning of the scale-up, covering about 64% of deliveries in the six supported districts in FY 2013/2014. Methods The major causes of neonatal deaths in these facilities included: birth asphyxia, prematurity and neonatal sepsis. These formed the focus of USAID Applying Science to Strengthen and Improve Systems (ASSIST) Projectâ&#x20AC;&#x2122;s interventions which included establishment of MNCH work improvement teams who were trained in Helping Babies Breathe plus (HBB+) and followed up through monthly onsite building of skills and coaching to improve the processes of care. This was coupled with maternal interventions like active monitoring of the labor process using a partograph and review of every death of a mother or baby to understand the causes and factors associated with each death and draw recommendations to prevent similar causes of deaths. Results Analysis of routine data showed a significant reduction in perinatal mortality from 6.4% (January 2015) to 2.8% in September 2015. To validate these results, a second study of data was carried out by external assessors. The external assessment found a reduction of more than 15% reduction in perinatal mortality in five high-volume delivery health facilities over the nine-month period (14,120 deliveries). Conclusion Improvement methods can be used to scale up simple, high-impact, lifesaving interventions for newborns in limited resource settings.

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WEABO17 Improving Quality of Care in health facilities through implementation of an Integrated Electronic Health Records System (EHRS) Onesmus Kamau , Hillary Kipruto Stephen Mburu 1

Ministry of Health, Kenya, World Health Organization

Issue Advances in the availability and use of technology to improve quality of life have been achieved, to varying degrees in many countries. They are however plagued by a variety of challenges hampering the use of IT solutions to monitor and manage quality of care. Technology has primarily been used to improve on information flow and management, as opposed to improving client interaction. Description MoH together with WHO and DfID have developed low cost electronic solution with functional client level system that service providers use and are comfortable with, to capture health events as they occur for the clients and has been deployed across six counties in 120 health facilites. The solution is an open source modular system for use by service providers to capture and record interactions with clients from entry to exit of a health facility. It is designed to ensure real time capture of service delivery and management events as they occur in a facility, provide standard guidance to service providers during the process of care for example standard clinical practice, use of ICD10 for diagnosis capture, use of essential medicines list for drug management, Build a repository of health and management events occurring in facilities, Monitoring adherence to clinical and management guidelines during provision of clinical and public services, Highlight notifiable events as they are first captured in facilities. Lessons Learnt The Current experience has been quite positive, responsive with improved availability of clientlevel information thus improving capacity of managers to provide guidance on issues aimed at improving the quality of care thus improving capacity of managers to provide guidance on issues aimed at improving quality of care. The key lesson learnt is the need to ensure that users at all levels are involved in the design of the system and investment in change management long before the system is introduced.

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WEABO18 Beyond Bulk SMS: Using an Intelligent Patient Engagement Platform Mark Achola , Zachary Olson 1

Access.Mobile

Issue As economies develop, access to mobile technologies continues to grow at high rates. Further, health care providers have increasing access to computers and the internet. At the same time, there is still a large burden of disease, both infectious and chronic, throughout many countries in SubSaharan Africa. Unfortunately, healthcare facilities do not have affordable, usable tools to engage patients and drive quality through better practice management. Traditional electronic medical record systems are often too complex, limited in their ability to increase patient engagement and not tailored to the African healthcare market and socio-economic context. Description Access.mobile improves access to quality healthcare services through mobile and cloud-based technology. The integrated solution enables consumers to find a health facility or pharmacy that fits their needs; allows front-desk workers to manage patient records as well as patient queues along with appointments and billing; facilitates patient outreach; and provides important facility analysis for management. One of the most important features of access.mobileâ&#x20AC;&#x2122;s solution â&#x20AC;&#x201C; amHealth - is the ability to reach out to broad patient groups with detailed health advice. The software allows clinicians to quickly filter patient groups by demographics and diagnoses to send them health advice. They can also send messages to all their patients at once to notify them of promotions, closures, and campaigns. By engaging with patients in this way, clinics can improve patient affinity and loyalty. Lessons Learnt We have found that patient engagement throughout the continuum of care can drive improvements in access and quality of healthcare. Given the ubiquity of mobile phones in African countries, SMS, and increasingly smartphones, are an effective medium for hospitals, clinics and health workers to communicate important health information with patients and also a channel for bi-directional communication. The use cases can range from health campaigns through bulk SMS to SMS driven vouchers to medication reminders and health tips. Not only can this information influence positive health seeking behavior, but it can also drive improve patient satisfaction. Recommendations Research has shown that using mobile phones for patient engagement can be an effective way at increasing access to services and improving quality of care. An important next step is to further assess the types of engagement and messaging that have the greatest impact and implement systems that allow this to take place. Access.mobileâ&#x20AC;&#x2122;s amHealth allows for just that by giving practitioners the tools to intelligently engage with patients in areas that relate specifically to them.

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WEABO19 Improving access to tertiary care by use of air ambulances in Africa: A subscription model Joseph Lelo Amref Flying Doctors Issues Availability of emergency medical care can make an important contribution in reduction of morbidity and mortality in low and middle income countries. Africa faces unique challenges in this respect due to poverty, conflict and vast distances that people need to cover to obtain medical care. With the development of highly sophisticated tertiary care facilities, especially in the East African region, the need to move critical patients to and between hospitals is becoming an increasingly common phenomenon. In many areas the distances involved in these transfers and the urgency of the cases has led to the use of aerial transport of retrieval teams and their patients. Affordability of these services has been a challenge to most. Description Air ambulance service providers in sub-Saharan Africa do and should form an integral part of the referral system for critically ill or injured patients especially in Africa where tertiary healthcare and critical care units are largely inaccessible. Services offered by Air ambulances are of high quality but costly and therefore out of reach for the majority of the African population. We describe a subscription model that reduces costs and improves accessibility to air ambulance services in medical emergencies across the East African region. Starting from as little as $25 per annum, over 140000 clients across the greater East African region have gained access to emergency aeromedical evacuation to a hospital of choice in Nairobi which is considered the centre of medical excellence in the region. Lessons Learnt Reduction in the cost of access to air ambulance services has seen improvement in outcomes for patients with medical emergencies transported rapidly and safely to hospitals with capability to intervene. With growth in number of subscribers, it is possible to maintain availability and high quality in aero-medical services. There is need for improvement of public hospitals and well as increased capacity for critical patients in tertiary referral centres. Next steps Establishment of an excellent referral system and a rapid and safe means of getting patients to a centre of medical excellence should be a priority for African Governments. Involvement of air and ground ambulance providers is necessary in the development of a national emergency medical system. Keywords Aero-medical, air ambulance, Africa, challenges, referral system

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WEABO20 CBHIS Chalkboards Data for Decision Making at Community Level Samuel Biwott , Eric M, Angela M, Hassan O, Ibrahim O, Bill A, Poore K, Duncan H 1

Save the Children, Kenya

Background: Strengthening Community level data use for action was informed by community power mapping and adopted as contextual multifaceted intervention of improving community and facility level demand, access and utilization for Maternal and Child health service in 3 Wajir Subcounties,15 points of care and 25 Community units. To inform strategic decision programme approved use of routinely updated community based health information system Chalkboard to guide community dialogues. Based on the advocacy principle of â&#x20AC;&#x153;Nothing for us without usâ&#x20AC;?informed participation of the community in their own health. Methods: The pronged intervention was theorized on risk benefit behavioral science and is implemented jointly through CHAs, CHVs, facility in charges, community elders and Religious leaders. Strategy activation was jointly done on phased approach after identification of CHAs and training on CHS, distribution of MOH 513 log box, household mapping and adoption of MOH 515 CHAs Reporting summaries for the targeted community units. Community power mapping determined the roles and engagement plan for all stakeholders. Finalization was done by data flow mapping and reporting followed by scheduled routine support supervision and follow up. Results: Implementation of the intervention has realized 146 Chalkboard guided community dialogues in 2016 and successfully tracing, referral and linkage, -County approval use of chalkboard to guide discussion and action in all active CUs, -TBAs roles have been converted to birth companions and CHVs sustainability through IGAs have been approved, -Observed community participation in making decision for their own health evidence by men participation health of their pregnant women, -The reporting rate of MOH 515 has improved from 0 CUs in 2015 to 25 CUs in 2016 and transmitting same effect to catchment facilities reporting rate at 93% Conclusions: Chalkboard review has innovated tracer box for immunization and ANC mothers, -Community Ownership of their health has seen parents referring other community member and husband task to ensure pregnant women attend missed ANC clinic, -Chalkboard review has been used as an opportunity for passive surveillance of trends of disease and movement of beneficiaries, -Observed change of behaviour among husband demanding their pregnant women to be given key combined Iron Folate and husband coming to structured men baraza with their pregnant women mother to child booklet to review on progress

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WEABO21 Increasing diet diversity through school and kitchen gardens Sospeter Gitonga1, Kutna J., Kurraru P. Amref Health Africa, Kenya

Issues Malnutrition, due to deficiency in micro nutrients, contributes significantly to poor maternal and child health outcomes in Turkana County. Nutritional indicators are worrying with stunting at 23.9 percent, wasting at 22.9 percent and underweight is at 34 percent. Description As part of addressing these deficiencies, of 600 school going children and families and 210 women in mother to mother support groups in Kakuma Refugee camp and Turkana West Sub County respectively were targeted with a school and kitchen gardening based on junior farmer field and life school and farmer field school approaches from early 2016 coupled with nutrition education. The overall objective of the project is to improve health and nutritional status of beneficiaries thus ensuring year-round availability and intake of micronutrient-rich foods to the resource poor households and in particular women and children under five years. This paper present preliminary findings on the improvement in availability of highly nutritious vegetables from school gardening using kitchen waste water and household level kitchen gardens. Lessons learnt Monthly production of vegetables from school gardens increased from 563kgs to 3,145kgs from April to August 2016 while around 180 mothers from host community have replicated the kitchen gardens at the household level. School and kitchen gardening offers opportunity for improving availability of foodstuff and dietary diversity in arid areas. Next steps Scale up kitchen gardening concept to mother to mother support groups in other health facilities within Turkana West Sub-county and assess availability and consumption of vegetables and increase in household incomes. Increase capacity of waste water collected in schools for hand washing, drinking and kitchen taps to support gardening activities in a sustainable manner.

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WEABO22 Fine-scale spatial modeling of child under nutrition in Kenya Kevin Mwenda University of California, USA Background Undernutrition remains a significant obstacle to children under five years old in Kenya. For instance, according to the Kenya Demographic Health Survey Key Indicators report in 2014, 26% of children under five were found to be stunted. Typically, child undernutrition metrics in Kenya are collected at the household level but reported primarily at the county or national level, which leads to significant spatial uncertainty that inhibits fine-scale (pixel-level) insights at a more localized level. Using these datasets makes it difficult to develop a complete and accurate picture of the child undernutrition crisis and hence discover the most effective spatially-aware policies and interventions to address this prevalent issue. Objectives The primary objective for this research was to create fine-scale maps of child undernutrition in Kenya from the house-hold to the pixel level, based on each pixelâ&#x20AC;&#x2122;s unique underlying socioeconomic, health, climatic, and environmental status. Methods This paper employs localized geostatistical modelling techniques to create spatial prediction maps of child undernutrition at the pixel-level, while factoring in the effects of socioeconomic, health, climatic, and environmental spatial covariates, all of which are found to affect child undernutrition outcomes in a spatially explicit manner. Results Our results show that overall, localized geostatistical models yielded a higher model accuracy compared to the traditional regression methods. The pixel-level child undernutrition surface maps created from household information showed a relatively good fit across the entire country. Conclusions Through an evaluation of interactions of socioeconomic, health, climatic and environmental variables with child undernutrition, our research offers promising avenues for localized fine-scale policy implementation that we hope will ultimately improve the lives of the undernourished Kenyan children. Recommendations We recommend that intervention policies towards child under nutrition not be â&#x20AC;&#x2DC;one-size-fits-allâ&#x20AC;&#x2122;; rather, they should aim to account for the unique socioeconomic, health, climatic and environmental conditions in each region with the realization that the aforementioned conditions work hand-inhand to yield spatially varying child under nutrition metrics.

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WEABO23 Microresearch survey of parents` and guardians` knowledge and practice on under nutrition of children aged 6 months to 5 years at Mama Lucy district hospital, Nairobi Kenya Edna Ojee , Oduor Bernard , Perez Obonyo , Safina Dhadho , Kagasi Eunita , Penninah Mugo , 5 Elizabeth Cummings 1

University of Nairobi, Kenya, Jomo Kenyatta University of Agriculture and Technology, Kenyatta 4 5 University, Kenya Methodist University, Dalhousie University 1

Aim The survey assessed parents’ and guardians’ Knowledge and practice on under nutrition and established the nutritional status of the children using anthropometric measurements which were compared against WHO standard charts. Our aim was to determine whether there was an association between their knowledge and practice and nutritional status of their children. Methodology Cross-sectional quantitative survey. Data collection using questionnaires with open and closed ended questions assessing parents`/guardian knowledge on malnutrition; children’s anthropometric measurements were taken and recorded and Z scores checked against WHO standard charts. A knowledge scale was developed and relationship between parents’/guardians’ knowledge score and nutritional status of the children assessed. Results Among those with highest education mean knowledge on malnutrition/under nutrition score was only 53%. Logistic regression showed no significant association between nutritional status and knowledge score. Post-secondary education was protective for malnutrition, even after controlling for child's age, gender, residence, annual income, maternal nutrition knowledge (OR=0.15, CI= 0.03-0.65, p=0.012). Breastfeeding for 6 months was also protective (92% of children were well nourished). Conclusion Gaps in parent /guardians’ knowledge on malnutrition were identified; our recommendations are that addressing the gaps will contribute to improving children’s nutritional status in Kenya and reducing morbidity and mortality.

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WEABO24 Matooke (banana) peels: The nutraceutical imperative for fighting diabetes in Uganda John Ejekwumadu , Kiiza, Roland , Kasozi Kennth1, Iwueke Vivien 1

Kampala International University, Uganda, Imo State Polythecnic, Umuagwo, Nigeria

Background Diabetes mellitus (DM) is a metabolic disease characterized byhigh blood sugarlevels overa prolonged period. In Uganda, Musa paradisiaca(banana) is a common delicacy. In Ugandan communities, bananas are peeled before cooking. In West Africa however, the unpeeled banana is used as antidiabetic. Objective The objective of the study was to assess the hypoglycemic and body weight changes in T1DM Wistar rats treated with green banana peel extracts. Materials and Methods 32 male, 7 week old Wistar rats were used for the study and divided into 6 groups. Experimental T1DM was induced with alloxan and treated with insulin, distilled water (10 mg/kg) and extract at 1000 mg/kg, 2000 mg/kg and 4000 mg/kg. Body weights were taken before and after induction prior to administration of treatment dosages. A glucometer was used to determine serum glucose levels inmMol/dl and an electric digital scale was used to determine weights in grams (g). Data was recorded in Excel version 20, analyzed using SPSS Version 20 and ANOVA, spearmanâ&#x20AC;&#x2122;s rank correlation tests determined in-group effects at 95% confidence interval. Results and Discussion The rats showed no signs of toxicity up to a dose of 10000 mg/kg. Phytochemical screening of the aqueous extract revealed saponins, tannins, phenols, flavonoids, cardiac glycoside, alkaloids, steroids and terpenoids. The study demonstrated that Musa paradisiaca peelings tightly regulates blood glucose levels (P < 0.005) and maintained body weights at high doses (â&#x2030;Ľ 2000 mg/kg) which is crucial in the management of DM. ANOVA test showed that 2000 mg/kg (P=0.001), 4000 mg/ kg (P=0.002) had significant therapeutic effect in the management of T1DM. Conclusion and Recommendation In line with the findings, banana peels are anti-diabetic; bananas therefore should be cooked with the peels on so as to derive its established anti-diabetic benefits.

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WEABO25 Coupling Community Resilience and Behaviour Change Communication (BCC) towards improved nutrition in Kwale, Kilifi and Kitui Counties, Kenya Nancy Mwangi , Anne Musuva , Tom Ngaragari 1

Population Services Kenya

Background In Kenya, malnutrition is the single greatest contributor to child mortality. In Kitui, Kwale and Kilifi counties, the stunting rates are at 46%, 39% and 30% respectively, higher than the national average of 26%. PS Kenya is supporting community nutrition counselling geared towards enhanced capacity of communities to manage and mitigate nutrition shocks through improved nutritional practices at community level. Objectives 1) Identifying barriers and motivators to ideal Maternal infant and young child feeding (MIYCN) practices 2) determining current MIYCN practices to inform the behaviour change campaign aimed at strengthening community resilience and improving MIYCN practices. Methodology A descriptive exploratory qualitative study was conducted using FGDs targeting caregivers 18-49 years in the 3 counties. 126 caregivers participated i.e. Kitui (38), Kilifi (47) and Kwale (41). Data was coded manually and analysed using an interactive process involving a search for key patterns and concepts. Results Households acquired their food from farming, purchases and on relief food; struggled with access to vegetables with children fed on porridge, milk and ugali. There was limited knowledge on a balanced diet, timing, duration and benefits of exclusive breastfeeding, ANC services, growth monitoring and Vitamin A supplementation. The influencers on nutrition practices were women and husbands and most mothers expressed confidence in getting their nutrition information from health facilities, radio stations, community health workers, women groups (chamas). Conclusions and Recommendations A campaign dubbed â&#x20AC;&#x2DC;Shika tanoâ&#x20AC;&#x2122; or high five was developed to act as a positive reinforcement to MIYCN practices and build resilience through integration with Nutrition allied sectors. There remains urgent need to address knowledge gaps on MIYCN at community level. BCC ought to recognize and include key influencers in household nutrition decision making. BCC must also link services that address food security, livelihoods and general wellbeing of communities.

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WEABO26 Is the National Health Insurance Scheme Pro-Poor? The need to make inclusive progress on health outcomes Bashiru Jumah SEND-Ghana Background For over two decades, the government of Ghana initiated a number of interventions to facilitate access to varied social services by the poor. Notably, the National Health Insurance Scheme (NHIS) was established in 2004 to secure the provision of basic healthcare services by replacing out-ofpocket payment system for poor and vulnerable groups. Anecdotal evidence had suggested that this scheme was not pro-poor Objectives To assess the pro-poorness of the NHIS, specifically two key interventions - the Free Maternal Health (FMH) policy and Livelihood Empowerment against Poverty (LEAP) and whether the poor and marginalised in society were benefiting from these government schemes meant to increase access and also help the poor to access services equitably. Methods The study analysed data on scheme subscription from the 3 regions of northern Ghana due to high incidence of poverty as well as the Greater Accra region due to growing incidence of urban poverty. Mechanisms for exempting indigents from premium payments were also examined. 120 communities from 20 districts were randomly selected from the 4 regions in consultation with NHIS offices. Using an electronic platform, two semi-structured questionnaires targeting scheme and non-scheme were administered. In-depth interviews were also conducted for scheme managers whilst focus group discussions were conducted for LEAP and FMH beneficiaries. Results The study observed that by 2013, 38% of Ghanaians were registered as active scheme members. However, only 14%, of indigent population in the Upper West, 3.8% in the East and 5.6% in the Northern regions were registered by the scheme during the same period. With regards to the FMH policy it was observed that there were unapproved charges in all 4 regions of the study. Conclusion A number of operational challenges and the lack of harmony in determining poverty indicators have combined to affect the right of the poor to access quality health care. Recommendations There is therefore the need to strengthen institutional collaboration by all stakeholders, as well as redefinition of indigents in line with extreme poverty indicators.

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WEABO27 A review of Community-Based Health Insurance Schemes (CBHIS): Lessons from Nigeria and Ghana Nanlop Ogbureke Christian Aid, Nigeria Background Evidence shows a direct link between health risks and poverty due to high health expenditure. Poverty can predispose a household to health risks, which can further aggravate their socio-economic status through decreased productivity and high out-of-pocket healthcare costs. Objectives To explore perceptions, barriers and opportunities for establishing a CBHIS and provide recommendations on feasibility of supporting a rural CBHIS and requirements to do this. Methods A qualitative study with in-depth interviews and FGDs with stakeholders of both existing and proposed CBHIS including representatives of Primary Health Centres, Healthcare Maintenance Organizations, NHIS at state and national level, community members. Results Selected schemes reveal that strong government partnership is imperative for establishing CBHIS. Significant gaps in the NHIS role as a regulator and an implementer of CBHIS with unclear “regulatory” powers was found where NHIS directly implemented unsustainable CBHIS schemes which failed due to the lack of financial security there exists the challenge of attempting to balance the donor’s legal framework with that of the NHIS Act where donors exist. No mechanism for “automatic” continuation of enrolment was found. Conclusions Peculiarities of the healthcare system, infrastructure, and the demographic and economic makeup of Nigerian communities must be considered within the obtainable frame work for CBHIS. Evidence shows CBHIS is one of the solutions for providing healthcare coverage to the large population of informal and rural citizens of Nigeria with the potential of providing the improved healthcare access. Recommendations Assure funding support for an agreed length of time to avoid reputational risk to continuity; create awareness of the benefits of CBHIS and ensure active participation in decision-making processes and operations. Partners should push for increased health financing, the expansion and coordination of CHIS and resourcing of PHCs as a means to achieving universal health.

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WEABO28 Is the National Health Insurance Scheme Pro-Poor? The need to make inclusive progress on health outcomes Uwineza Clarisse University of Rwanda Background Community based health insurance is among the strategies that Rwandan government is using to increase accessibility of health care services to the entire population, especially the most vulnerable groups since 2003. Women’s health was threatened by many health problems like HIV/AIDS, malaria, pregnancy complications, shortage of skilled birth attendants, lack of family planning, unsafe abortions and health improvement was among the first targets and good achievements has been made so far. Objective The aim of this study is to highlight the contribution of community based health insurance in improvement of women’s health in Rwanda. Methods Different methods have been employed, including literature review involving articles published from 2000 to 2016, and search words were: Women’s health, national health insurance scheme, health development and Mituelle de santé. We reviewed also demographic health surveys reports from 2005 to 2015, and then correlated all findings with my observation during my clinical clerkship since 2014. Results After the introduction of community based insurance, Rwanda’s maternal mortality ratio (MMR) has trended down at a rapid rate (50% between 2000 and 2010), Rwanda demographic health survey data showed MMR of 1071/100000 LiveBirths in 2000, 476/100 000 LB in 2010 and 210/100000LB in 2015. The Maternal to Child Transmission is at 12% in 2016 from 80% in 2000. The birth rate per women is 4.4 in 2016 from 6.4 in 2000, this is attributed to the increased access to health care services and contributed to the increase in women’s life expectancy to 65 years in 2015 from 49 years in 2000. Conclusion National health insurance scheme is a good strategy to improve women’s health especially in developing countries, where financial barriers prevent them from accessing health care services.

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WEABO29 Assessment of acceptability and willingness to pay (WTP) for HIV services among patients in a Kenyan HIV clinic Lilian Otiso , Geoffrey Ombui , Jordan Kyongo , Lina Digolo , Elizabeth Muthuma 1

LVCT Health, Kenya, Strathmore Business School, Kenya

Background HIV has largely been a disease that affects the poor in developing countries. WHO recommended elimination of user fees for HIV treatment in 2004 to increase access to HIV care. In Kenya, HIV services are delivered free through public and non-governmental facilities. Global financing for HIV has flat-lined and the country has prioritized domestic financing for sustainability. Objectives This study sought to explore willingness to pay (WTP) for HIV care and treatment services among patients at LVCT Health clinics in Nairobi and Kisumu. It also sought to examine the factors that influence WTP and health care payment methods that patients in the clinics could use to pay for services. Methods The study applied a cross-sectional survey design utilizing self-administered quantitative data with open ended questions among 337 respondents. Quantitative data were analysed using SPSS version 20. Data analysis techniques involving descriptive statistics, Chi square tests and logistic regression were carried out. Qualitative data was coded and presented in themes. Results Only 16% of respondents found it acceptable to be charged for the services stating patients are poor and wouldnâ&#x20AC;&#x2122;t afford treatment. 64.5% were willing to pay if donors withdrew, but majority (74.5%) were willing to pay less than Ksh 2000 per visit (estimated required amount Ksh 5000). There was significant association (p<0.05) between WTP and education, income and presence of medical insurance. 50% of patients stated that they would use cash to pay for services at the clinic while 40.6% would use National Health Insurance Fund with regional variation. Conclusions and recommendations Though willing to pay, majority of HIV patients are poor and would not be able to afford user fees for HIV treatment making them vulnerable to its effects. For equity and sustainability, health insurance seems like a viable option that should be explored to finance HIV treatment.

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WEABO30 Disparities in health care access Hillary Omala Community Health Association of Kenya, Kenya Issues Universally, National Social Health Insurance schemes are normally designed on the principal of cohesion. Health insurance is a perceived right for all: sick and well, low and high income, active and inactive, formal and informal sectors. Contributions are calculated on the basis of ability to pay, not of anticipated risk. Such schemes should never shut out the population at risk based on their inability to regularly pay their subscriptions. Description Virtually, <17% of the Kenyan population is covered under NHIF. Membership is compulsory for all salaried employees drawn from all sectors. Members contribute between KES 150 to KES 1,700 per month based on their income. The benefits package includes coverage of a portion of outpatient and inpatient expenses at contracted hospitals. Services are only offered to active members. Lessons learnt The rate of reported illnesses is on the increase. Over 85% of those who report illnesses would consult a health care service provider. The rich are more likely to consult a provider when sick than the poor. Between 2003 and 2013, Inpatient service utilisation rates increased from 15 admissions per 1,000 population to 38 admissions per 1,000 population respectively. However, between 2007 and 2013, out-of-pocket expenditure rose by 42% for out-patient services. Per capita spending on admissions increased with levels of income/wealth. Insurance did not explain the demand for outpatient care (2013 Kenya Household Health Expenditure and Utilisation Survey). Next steps The aforementioned findings clearly reflect the impact of often contradictory health policies particularly those based on the banner of cohesion. Thereâ&#x20AC;&#x2122;s an urgent need to; a) define populations at risk, b) assess access and utilization and c) design specific programs, policies and strategies that will reduce disparities in health care access and utilization. Key Words: Access to healthcare, active membership, population at risk and strategies.

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WEABO31 Factors influencing Willingness and Ability to pay new NHIF premiums amongst the selfemployed in Nairobi, Kenya Reuben Mutuura Moi University, Kenya Background NHIFâ&#x20AC;&#x2122;s core function is to collect contributions from all Kenyans earning an income of over Ksh 1000 and pay hospital benefits out of the contributions to members and their declared dependants, whilst ensuring that Kenyans of all walks of lives have access to quality and affordable healthcare. This though is not mandatory for the self-employed workers to join the organization Objective The purpose of the study was to investigate factors influencing the ability and willingness to pay NHIF premiums amongst the self-employed in Muthurwa Market, Nairobi, Kenya. Methodology Descriptive method was applied where non-random sampling technique was used. The data was collected through questionnaires which were administered to 390 self-employed workers. Three key informants from the NHIF organization senior management were also interviewed. Results There were more men (72.1%) than women (27.9%) where slightly more than half of the respondents were aged between 20-29yrs old (53.1%). More than half (55.4%) had attained secondary education and 44.6% were second hand cloth/shoe dealers. The highest income level (60%) earned was between Ksh5,000 and 15,000. Those that had children below 18yrs old were 63.3%. The NHIF registered members were 19.5% with 59.3% willing to register in future. 72.1% knew the current NHIF premium with 92.8% aware of the proposed premium. On the other hand only 20.8% were aware of the current benefits of the cover and 6.5% were aware of the proposed benefits. Those that were willing to pay more for wider coverage were 42.3% before being told about the current benefits while 79.2% were willing to pay the new premium after explaining the benefits to them. The factors that showed association with the willingness to pay more after knowing the proposed premium and benefits were; age (p=0.005), marital status (p=0.001), income (0.05), presence of children (0.001) and number of children (p=0.042). Conclusion The willingness and ability of the self-employed workers in payment of the new NHIF premium was influenced by socio-demographic characteristics, which included age, marital status, income level, presence of children and the number of children. The willingness was also affected by knowledge of the NHIF current premium and associated benefits.

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Recommendations NHIF as an organization should; increase sensitization about their services, consider reducing the premium, make NHIF services accessible, centralize NHIF organization and NHIF service providers.

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WEABO32 Targeted demand creation strategies increase uptake of screening for hypertension amongst Kenyan males Wanjiru Mundia , Mwebia Bessy , Makoyo Job , Adipo David 1

Population Services Kenya

Background An estimated 27.8% of Kenyan adult men are hypertensive/ on medication reinforcing Hypertension is a major risk factor for Cardio Vascular Disease in Africa. In 2014, Astra Zeneca launched the Healthy Heart Africa (HHA) initiative to improve awareness, detection and HTN management in Kenya. PS Kenya is an implementing partner through select Tunza and other private health providers serving in middle to low income populations. The project sought to document strategies used to increase the proportion of males accessing screening, detection, and management of HTN. Objective To assess the contribution demand creation strategies on uptake of hypertensive care in Kenyan males ≥ 30 years. Methodology Using Ministry of Health (MOH) Community health Volunteers (CHVs) as front line workers, they were trained on hypertension messaging, SBCC techniques and attached them to HHA facilities. They adopted multiple strategies to create awareness and demand for screening: household visits, conducting one-on-one and small group discussions about hypertension at bus stops, workplaces and other locations. Monthly monitoring of key indicators including screened by gender and sharing this progress with CHVs informed review and change of demand creation activities due to proportionately low uptake of men compared to women. PS Kenya conducted refresher training on social profiling of the target audience to identify his daily activities and as a result, CHVs increased education, awareness and screening activities in male-dominated work places e.g., flower farms, prisons, quarries, Export processing Zones and conducting ‘moonlight outreaches’ in the evenings at bus stops for men returning home from work. Results The period between April 2015 and June 2015 screened more women (65%) than males (35%). With revised strategies, the program reported the highest male screening in December 2015 with 52%, a 60% increase. Further along the continuum of care indicates lower proportion of elevated blood pressure by males (9%) vs Females (12%) and less proportion of males treated (41%) vs female (59%), outlining opportunities for better targeting and conducting call backs to those lost to linkage. Conclusion Early and consistent monitoring indicated lower uptake among men for HTN screening. Social behavior change strategies are key in ensuring a gender balance within hypertension detection and management programs.

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WEABO33 mproving care for NCDs by providing mental care Annie Njenga , Robin van Dalen, Albert Orwa,Dixon Chibanda, Aquila Vera, Charlotte Vinkers, Nagaraju Bussa, Ishank Jain, HoiKee Wong, Koel Chatterjee 1

Philips, Kenya

Issue There is no health without mental health, yet mental health care is nearly non-existent in most African countries. The largest treatment gap for mental disorders is found in sub-Saharan Africa where the ratio of psychiatrists to the population is estimated to be 1: 1million. Depression and anxiety disorders can be chronic, severely impair quality of life, cause excess mortality, and incur substantial societal costs. Specifically in Kenya, mild to moderate depression rates in primary care has been estimated to be between 11- 42%. Description Philips Innovation Hub and The Friendship Bench, an NGO based in Zimbabwe, have teamed up to work on Inuka (Swahili for ‘lift up’) an online coaching platform to deliver problem solving therapy through ordinary people trained as coaches. The Friendship Bench has developed a face to face intervention that follows the same methodology to treat Common Mental Disorders (anxiety, depression) so by translating this approach to a digital platform, we are looking to scale up and impact more people. Lessons learnt Testing the prototype gave very positive feedback that brought sufficient evidence for the team to proceed with the development phase. For example, in a test with 13 base of the pyramid primary care patients who completed two sessions, they rated high on the use of INUKA “I want to use INUKA again” (4.7 out of 5 average score). Other lessons learnt include: in order to close the mental care gap, terms such as ‘depression’ and ‘mental health’ cannot be used as they are stigmatized terms to most people and will block their efforts to find help. Instead, a more people-friendly approach is needed, which is why we decided to name ourselves Inuka and not a ‘mental care platform. Next steps Improve the prototype and run larger tests in primary care and online with actual customers. Keywords Digital innovation, transforming healthcare, public private partnerships, primary healthcare, mental care, depression

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WEABO34 Decentralisation of cervical cancer screening and treatment of early stages in rural area in Senegal Bara Ndiaye , Sylla Thiam , Mouhamed El Bachir Lo 1

Amref Health Africa, Senegal

Issue In Senegal, it is estimated that 1000 new cases of cancer are diagnosed every year and cervical cancer is among the top common cancers in women.Cancer programs prevention are often scarce and, cervical cancer services are still centralized in referral hospitals in the capital city Dakar. Then, the majority of the population particularly those living in rural areas have very limited access to these services. It is widely acknowledged that public awareness, effective screening programs with early detection and treatment of cervical cancer, and strengthening existing health services can reduce the burden of the disease, as shown in developed countries. Description Amref Health Africa developed and implemented a pilot project to decentralize the screening and early treatment of cervical cancer in 3 rural districts in Senegal. Our approach involved 4 interventions : (i) Strengthening capacities of midwives and nurses on screening methods using visual inspection of the cervix with acetic acid (VIA) and followed immediately by visual inspection with Lugols iodine (VIA/VILI) in women with a positive VIA result; (ii) Management of early stages of cervical cancer with cryotherapy in health centers; (iii) Community awareness and sensitization of women in childbearing ageand (iv) Supervision and coaching of health workers. Program/Policy process Strengthening capacities of midwifes and nurses management of early stages of cervical cancer with cryotherapy in health centers; Community awareness and sensitization of women in childbearing age; Supervision and coaching of health workers Lessons learnt Between October 2014 and September 2015 1680 women were screened and 109 of them presented early stages of cervical cancer. Ninety-nine percent of the patients (108) benefited from cryotherapy treatment locally; only one case was referred for further investigations. Mid-term results indicate that the decentralization of screening and prompt treatment of early cervical cancer stage is possible and there is a need to strengthen and expand the intervention in other areas. Next steps The extension of the strategy in other districts of the pilot areas is a priority for health authorities as well as the deployment in other regions.

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WEABO35 Cultivating physician champions in prevention and management of non-communicable diseases in Samburu county, Kenya David Onchonga County Government of Samburu, Kenya Background Physician champions are clinicians who are trusted by the community in offering clinical services successfully and when practicing, they normally pull a huge crowd of clients in health facilities. In most instances, these physicians play a key role in health education and promotion of people living with non-communicable diseases such as cancer and diabetes. The study was undertaken to evaluate the impact of engaging physician champions in managing non communicable diseases in Samburu County. Objectives To evaluate the impact of engaging physician champions in managing non communicable diseases in Samburu County. Methodology The study was conducted in the county referral hospital in Samburu county through advertising in the media houses that physician champions who are well known and loved by the community members were to screen community members on non communicable diseases for free. The dates were set and rooms were provided for the activity. Registration was paramount for any client to be seen by the physician. Data collection After intensive advertisement and media publicity, the county referral hospital on the material day received overwhelming community members who came for free screening on non communicable diseases. Result A total of 8780 community members were screened in one week and 112 were found to be having non communicable conditions and were immediately initiated to drugs and management of their conditions. Conclusions Cultivating physician champions can yield to more community screening and treatment of non communicable conditions

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WEABO36 Prevalence and factors associated with poor medication adherence among type 2 diabetes mellitus patients on follow-up at Kenyatta National Hospital Gabriel Waari Jomo Kenyatta University of Agriculture and Technology, Kenya Background Patient non-adherence with medication regimen is a common problem facing health care providers treating adult patients with Type 2 diabetes mellitus. The outcomes of poor adherence to medication among Type 2 diabetes mellitus patients include poor glycaemic control, increased diabetes related complications, increased hospital admissions and higher health care costs. Objectives The objectives of this study were to assess the prevalence of adherence to recommended medication, to determine the association between the patients’ self-reported adherence and glycaemic control and factors associated with poor medication adherence among Type 2 diabetes mellitus patients. Methods A cross-sectional study was conducted from November 2015 and January 2016 at the diabetic clinic at Kenyatta National Hospital, Kenya. Two hundred and ninety Type 2 diabetes patients were recruited using systematic sampling method. A structured questionnaire was used to collect information on patients’ demographic characteristics, prescribed medications, challenges and attitudes relating to their diabetic medication and care. Adherence level was determined by the patients’ self-report and scored on the Morisky Medication Adherence Scale -8(MMAS-8). The patients’ glycaemic control was determined by assay of glycosylated haemoglobin (HbA1C). Results: The prevalence of medication adherence based on the MMAS-8 was low for 28.3 % [95% CI: 23.1, 33.5], medium for 26.2% [95% CI: 21.1, 31.3], and high for 45.5% [95% CI: 39.6, 51.3] of the study participants. Glycaemic control was good (HbA1c < 7%) for 102 (35.2 %) of the study participants. A significant association was found between medication adherence and glycaemic control i.e. better glycaemic control with higher levels of medication adherence( p= 0.033). On multivariate analysis factors found to be independently associated with poor adherence were; patients with duration disease between 2 – 10 years (OR=2.07, CI= 1.01-4.22), ever being admitted for diabetes mellitus (OR = 2.94, CI=1.60-5.41), dissatisfaction with family members support in regard to diabetes mellitus management (OR = 2.99, CI=1.12-7.98), presence of a challenge to drug access (OR=1.76, CI=1.01-3.05) and satisfaction with attending clinician (OR= 3.58, CI= 1.36 - 9.43). Conclusions This study found suboptimal medication adherence that was significantly associated with poor glycaemic control. Strategies need to be developed to sustain adherence among the more experienced diabetic patients, improve medication access, health service satisfaction and educate and involve close family members to support these patients. The MMAS-8 can be used by medical practitioners at hospitals to quickly and easily identify poorly adhering patients for focused interventions.

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WEABO37 Association between socio-economic and psychological experiences of parents with children on leukemia treatment in Kenyatta National Hospital, Kenya Roselyne Okumu Kenyatta national Hospital, Kenya Background The survival rate for children with leukemia has increased dramatically since the late 1990s; treatment effects of the disease can be extremely stressful for families. Research on psychological and socio-economic effects of leukemia treatment had been conducted in Western countries, but little is known within Africa including Kenya. Methodology This was a cross-sectional study with a sample of 62 out of 72 parents of children undergoing leukemia treatment at Kenyatta National Hospital (KNH). Data were collected between May and August 2015 using structured questionnaires while qualitative data were collected by using focus group discussions. This manuscript is based on quantitative data which was entered into EpiData 3.1 and analyzed using SPSS version 20. Psychological distress index was created by counting the number of psychological experiences reported by respondents. Kendall’s Tau-b was used to test association between the psychological distress index and socio-economic characteristics; a p-value of ≤0.05 was used to indicate statistical significance. Results The respondents experienced anxiety, shock and fatigue. Spending a higher proportion of family’s income was associated with higher psychological distress index (p=0.009). The economic challenge led to significant heightened tension in the family (p=0.021). Conclusion Financial challenge is a major cause of psychological distress thus need for financial support through collaboration with government institutions e.g. NHIF, development agencies and NGO who can contribute towards the treatment cost. Need to decentralize effective leukemia treatment centres. Psychological support and counselling should be done to alleviate tension. The nurse needs to be empathetic when caring for the child and family as well as to apply the ethical principles of justice and beneficence so that the child gets the best care despite the financial challenge.

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WEABO38 Acceptance of the Ebola virus vaccine by the community in Guinea Sylla Thiam Amref Health Africa, Senegal Background The rVSV-ZEBOV vaccine was tested as Prevention means to Ebola virus through a vaccine trial led by the WHO in the region of Lower Guinea between April and July, 2015. The preliminary results of this vaccine trial showed that the rVSV-ZEBOV vaccine was safe and effective in the prevention of the Ebola virus disease ten days after its administration. With the prospect of moving to scale up for a large part of the population, a study on acceptability of the vaccine was conducted to identify possible challenges. Methods Interviews were conducted on the basis of a standard questionnaire administered to 209 people in Coyah, ForĂŠcariah, Kindia and Dubreka. Quantitative data were entered in the Epidata version 3.1 software and then exported to the software Stata 13 (Stata Corp., Texas, USA) for analysis. Descriptive statistics and chi square test at 95% confidence interval were used to measure the association of selected variables in the study. Results Nearly 78% of the people interviewed agreed to be vaccinated and 73% of those interviewed were willing to encourage their close ones and relatives to take this vaccine. Nevertheless, 22% of the survey participants expressed doubts or had mixed feelings about the vaccine. The main concerns raised in the qualitative interviews conducted focused on the quality of the vaccine, the side effects of the vaccine, fear of being contaminated by Ebola during vaccination exercise and lack of adequate information. Knowledge of the existence of the new vaccine was higher in areas where the community was involved in response activities (Coyah and Forecariah) than in the areas where the community was not involved (Dubreka and Kindia). Similarly the willingness to be vaccinated (p= 0.003) or encourage relatives to do the same were higher in the prefectures of ForĂŠcariah and Coyah compared to the Prefectures Dubreka and Kindia (p = 0.011). Conclusion The results of this study show that there is need for public information on the new Ebola vaccine, especially in prefectures where acceptance is low, by involving local authorities, community leaders and community-based organisations to conduct outreach sensitization outreaches.

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WEABO39 It's as though Ebola infected the health system itself. Experiences of Kenyan health workers who volunteered in West Africa during the 2014/15 Ebola outbreak Job Mogire , Karina Kielmann 1

Institute for Global Health and Development, Queen Margaret University, Kenya

Background The 2014/15 outbreak was the largest Ebola outbreak witnessed to date; it resulted in 65 times more casualties than the preceding outbreak, 11000 deaths and affected about 28000 people directly. Since it occurred in countries with weak health systems, it unveiled inherent weaknesses particularly in coordination of international responses, health workforce management, and the culture of infection prevention. Thus, all internationally-recruited health workers traveling to West Africa were entering a complex scenario. This paper sought to describe those experiences. Methods 6 duly registered, voluntarily consenting medical doctors who volunteered during the outbreak were interviewed, their transcripts transcribed and discourse analysis conducted on the transcripts to generate themes that characterized their experiences in West Africa. Ethical approval was obtained from Queen Margaret University. Findings Though emanating from a developing country, these doctors were surprised at how fragile the social and physical infrastructure was in the afflicted countries; they felt that the health system was weak primarily because primary healthcare was in disarray, referral systems were weak or nonexistent, health workforce and other core health inputs were deficient; as a result the public had lost trust in the health system. Doctors struggled to cope with a multitude of challenges: fear of infection, working in hot weather yet having to done a bulky protective gear, working with local health workers who commuted to the Ebola-ridden villages, fitting into a chain of command with team members from diverse health systems, training systems and remuneration structures. Doctors did not feel safe, were unsure about their medical evacuation in case of infection and experienced intense emotional stress when they encountered death, very sick patients for whom they could do little else than basic care, and because they were disconnected from family. None of the doctors felt they were adequately prepared for the responsibilities that awaited them; many had to become team leaders for the first time; all respondents felt leadership tasks over peers and older health workers esp. those from developed countries were their most challenging aspects of their work. Conclusion Even for health workers from neighbouring countries, fitting into and working in setting of severelyresource limited health systems is challenging. The risks involved are high and they impact health workers' effectiveness. Preparation prior to deployment is critical in improving health workers' experiences and effectiveness. Training should cover both technical aspects, e.g. Ebola disease, its transmission and supportive treatment, as well as non-technical aspects e.g. team work, leadership, community entry and conflict resolution in humanitarian settings.

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WEABO40 Prevalence of Strongyloides Stercoralis in a rural community of North-Western Ethiopia Arancha Aramendia , , Melaku Mekonen , Derejew Zewdie , Mulat Yimer , Tadesse Hailu , Esperanza 3 3 Rodriguez , José Saugar 1 3

Mundo Sano Foundation , Bahir Dar University, Institute of Health Carlos III, Madrid, Spain. 2

Background Soil-transmitted helminthiases (STH) are extremely prevalent neglected tropical diseases (NTDs). Efforts to control their impact are based on mass drug administration (MDA), with albendazole. Their endemicity determines the MDA launching, targeting school aged children. Strongyloides stercoralis is excluded of STH, although good reasons for its inclusion: ability to cause long-lasting infections and hyper-infections in immune-suppressed. Needing a non-standard diagnosis; different treatment required (ivermectin); and scarcity of data about epidemiology explain this exclusion. Diagnosis for STH (which identifies egg, not larvae), fails to detect S. stercoralis. Objectives Knowing the prevalence of S. stercoralis using techniques forlarva detection; checking the prevalence at community (adults and children); supporting the University for research in STH control. Methods We conducted a cross-sectional study in a rural community of Ethiopia (March-June 2016). Stools were examined by formol ether concentration (FEC), for egg detection; and Baermann technique (BT), for larva detection. Chi-square test was used to check association between age/gender-S. stercoralis. (p≤ 0.05). Results We included 792 people. 43.7% male and 56.3 female. The age ranged from 5 up to 85 (mean 24.4, SD 16.6). Prevalence of S. stercoralis was 6.94% by FEC and 32.96% by BT. The prevalence by combination of both was 34.22%. No association between the gender and S. stercoralis was found. A strong association was found with the age, been 71.2% of the infected ≥15 years old, while 28.8% were ≤14 (p<0.001). Conclusions and Recommendations S. stercoralis is underestimated when only egg-detection is used,-The prevalence in adult population in our sample is significantly higher, suggesting the convenience of including all the community in STH studies, -Further studies must be implemented, for improving control measures in endemic sites, (e.g. including ivermectin in MDA), as S. stercoralis is not included in STH control programs, -For community service, universities are important in operational research.

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WEABO41 Lessons learned and best practices in establishing National Emergency Operations Centers (EOCS) Manpreet Singh Dalberg Global Development Advisors, Kenya Issue Emergency Operations Centers (EOCs) play a critical role in detecting, preventing and responding to public health emergencies, but implementation has been limited to-date. This session will discuss best practices from our experience supporting the establishment of EOCs in West Africa. Description The 2014 – 2016 Ebola outbreak caused the death of over 11,000 people in Liberia, Guinea and Sierra Leone, and demonstrated the weakness of current emergency management systems across the African continent. This outbreak prompted a rethink of disaster management strategies across the continent. The 2016 – 2020 WHO AFRO strategy for health security and emergencies represents a majorattempt to encourage closerinter-sectoral collaboration, and to strengthen IHRcore capacities in member states. In particular, the strategy defines a target that 80% of WHO AFRO member states have an EOC by 2020. EOCs play an important role in detecting, preventing and responding to allhazards. For example, Nigeria established an EOC in July 2014, when Ebola appeared in Lagos, using systems and public health staff trained in Nigeria’s polio eradication campaign. This allowed for a coordinated response to contact tracing and isolation contributing to the successful containment of Ebola in Nigeria. We have experience supporting the establishment of EOCs in Mali, Guinea Bissau and Senegal, in partnership with the Bill and Melinda Gates Foundation, WHO and national governments. We propose a session focused on operational recommendations to establish EOCs across the African continent. Lessons learned and Recommendations There are six key elements to an EOC: Coordination, Convening, Preparation, Communication, Data Collection, and Operations. Although the specific organizational model can vary and is context dependent, successful implementation depends on ensuring that the EOC has the mandate and organizational positioning to act quickly and decisively. Collaboration frameworks and working norms can be established during times of non-crisis.

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WEABO42 Decentralizing health services, a strategy to strengthening disease surveillance: A case of community based TB care in Kisii County, Kenya Vinnce Onserio , Grace Ogeto , Mary Mogaka 1

Young Women Christian Association of Kenya

Issues Kenya is ranked number 13th among the 22 high TB burden Countries in the World a clear indication that TB still remains to be a major cause of mortality. Although, a number of strategies have been adopted by both the government and the private sector to address TB, some have recorded success while others have failed. Community involvement in TB prevention and control is one among the many strategies that have been used. Description During the implementation of the c-TB programme by YWCA as an SR under the umbrella of AMREF Health Africa as the PR in the Global Fundâ&#x20AC;&#x2122;s New Funding Model, the programme recorded successful stories. In Gucha South Nyatike Dispensary, an MDR case was reported and with the joint effort from both the ministry and the SR through the engaged Community Health care workers the case was effectively addressed until the patient got successfully cured of the MDR-TB. In Kitutu Chache North (Marani) Sub- County of Kisii County, also the Community strategy let to the diagnosis of an MDR case of a school going student. In general, the community strategy for TB prevention and control has proved to be effective. Lessons learnt The approach offers close and a well coordinated link, by involving the community through the CHEWs and CHVs, the sense and spirit of ownership is instilled thus making the community to observe the principle of Primary Health Care. Community structures should be strengthened.

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WEABO43 Best practices in establishing the Kenya Public Health Emergency Operations Centers (PHEOC) Joyce Onsongo , Joan Karanja , Leonard Cosmas , Daniel Langat , Lyndah Makayoto , Jama Abdi , 3 Senait Fekadu 1

WHO Kenya, Ministry of Health, WHO/AFRO Regional office, Brazzaville 2

Issues WHO African Region continues to experience recurrent outbreaks of emerging and re-emerging epidemic-prone diseases and other public health emergencies. WHO recommends establishment of public health emergency operations center, PHEOC to coordinates activities of all relevant stakeholders involved in prevention, detection and response to public health events (PHEs), in line with IHR 2005 requirements. Description Over the last few years, Kenya has experienced PHEs, ie outbreaks such as cholera, measles, SARI, Kalaazar, Chikungunya, Wild polio Virus, and disasters such as terrorist events, fires, floods, road traffic accidents, structural collapse that require a coordinated response from various sectors. Lessons learnt and best practices Kenya inaugurated the first Public Health Emergency Operations Center (PHEOC) in May 2016. In response to Ebola Virus Disease 2014, the Ministry of Health requested WHO for support to establish a National PHEOC. WHO country office in consultation with WHO /AFRO developed a PHOEC protocol. Initial investment for the PHOEC set-up was realized with funds mobilized by WHO country office. The facility is established under the MOH in the National Public Health Institute (NPHI) building. The PHEOC is fully equipped with video and tele conferencing, computers and communication equipment. The PHEOC is linked with NDOC and other key departments. Personnel are assigned to PHEOC who have undergone EOC orientation training. A list of experts and Rapid Response Teams (RRTs) is maintained at the EOC for immediate investigations. PHEOC plan of action, Standard operations procedures (SOPs) and guidelines have been developed. PHEOC is linked with the national health reporting system (DHIS2) and integrated disease surveillance (IDSR). Regular PHOEC reports provide key outputs on, rumour updates, outbreak situation reports (SITREPs) and, weekly bulletins. Next steps The Ministry of Health with support from WHO and partners is committed to fully operationalize the PHEOC for enhanced public health emergency preparedness and response. Key Words: Public health events, emergency, PHOEC.

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WEABO44 Developing a model of advancing research culture in young African health professionals: The case of Rwanda Ntacyabukura Blaise University of Rwanda Background Research initiatives by young Africans and for Africans have remained insufficient and unripe to respond on diseases burden. Most of the research projects are run by overseas organizations and sometimes we donâ&#x20AC;&#x2122;t maximize related profits. Lack of different kinds of resources and skills are the major challenges underlying the question, nonetheless a strategic approach, guaranteeing sustainable outcomes was unidentified. Recently we developed a model of advancing research culture in young African future health professionals. Description Starting with a global health course, graduates interested in research get enrolled in a research capacity building program for approximately ten months, composed of periodical tasks and to be realized in cohort system. Serial trainings and research activities was carried out with active mentorship along with measurable outcomes. Lessons learnt Africa does not only need field technicians or field specialists, but also good researchers to guide evidence based practices to sustain its ongoing development. Based on 71.6% of outcomes generated, there is a great will of involving students in research as professionals. We have witnessed a respectable commitment and partnership among participants, with a supportive flow of outcomes even though a huge impact can be achieved only if applied in different corners of our continent. Keywords Research, young researcher, health professionals, sustainable, scientific training.

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WEABO45 Power and Politics in Health Priority Setting at county level following devolution in Kenya Rosalind McCollum , Lilian Otiso , Robinson Karuga , Sally Theobald , Tim Martineau , Miriam 1 Taegtmeyer 1

Liverpool School of Tropical Medicine, Great Britain, LVCT Health 2

Background Devolution in Kenya transferred financial responsibility and authority for service priority setting, including health to 47 locally elected governments. Devolution came with high expectations for greater health equity, efficiency and stronger community participation in decision making. However, health has been one of the most controversial of all services devolved. Objective We conducted a qualitative study to understand the incentives and norms that affect priority-setting processes and resource allocation and identify recommendations for improved health planning. Methods We collected qualitative data from 14 national level key informants, 117 in-depth interviews with county level technical and political decision makers from ten counties and 49 in-depth interviews with health workers from sub-county to community level in three counties. Qualitative data were digitally recorded, transcribed and coded before thematic framework analysis. Results Kenya’s move towards devolution partly arises from a context of marked disparities and inequities between counties. We identified a range of health decision-makers at the county level, representing technical, political and community positions. The level of influence and power of decision-makers varied between counties, with some describing what appeared to be a beneficial, inclusive decisionmaking process incorporating political advocacy for community demands while paying due consideration to technical advice. Other counties revealed sub-optimal decision-making processes where politicians motivated by ensuring re-election moved forward with decisions with perfunctory public participation and limited regard for technical plans. Where this occurred politicians tended to accelerate health ‘hardware’ such as infrastructure and equipment, to the neglect of ‘software’ such as community health interventions, potentially undermining quality of service and equity in health outcomes. Conclusions and recommendations County governments don’t currently ensure balanced contributions from all stakeholders, but need to seek this in order to achieve more effective priority setting, with greater community empowerment to hold leaders to account for providing accessible and quality-assured health care.

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WEABO46 Safe Surgery 2020: A collaborative partnership in Global Health Edwin Macharia , Ashley Eberhart , Erin Barringer 1

Safe Surgery 2020 & Dalberg Global Development Advisors, United States

Issues Surgically treatable conditions account for a third of the global disease burden, with almost 5 billion people in LMICs lacking access to safe surgery. Safe Surgery 2020 is a multi-partner initiative with support from GE Foundation to design and support country-level and hospital-level solutions that make surgery safe, accessible, and affordable. We support surgical teams operating in some of the worldâ&#x20AC;&#x2122;s lowest-resource settings to transform patient outcomes. Description Safe Surgery 2020 partners with countries to support development of national surgical plans, understand emerging priorities, and select hospitals where our implementing partners Dalberg, Jhpiego, Harvard Medical School, G4 Alliance, and Assist International co-create and adapt solutions for local contexts. We aim to drive major improvements in volume and quality of emergency and essential surgical procedures conducted in district-level hospitals. Key objectives include: (1) Support increased prioritization of surgery at national level, and support national surgical planning; (2) Develop and scale a leadership development program for surgical teams to improve their ability to communicate effectively, problem solve around resource constraints, and transform surgical outcomes; (3) Enable increased innovation in safe surgery through partnerships and direct programs in priority areas for our partner countries, including medical oxygen, power, and human resources; and (4) Support robust M&E systems for program monitoring and improvement, and building national capacity for reporting on surgical indicators. We are currently working with health ministries in Ethiopia and Tanzania, and the Regional Health Bureaus in Tigray and Amhara in Ethiopia. Lessons Year 1 of implementation has yielded insights and recommendations around collaborative partnerships in global health, infusing corporate innovation approaches into development practice, and engaging with governments on national surgical planning and implementation. Next steps From 2017 to 2018, we will work in three countries with Ministries of Health and over 60 districtlevel hospitals to transform quality of care and create a blueprint for scale-up.

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WEABO47 Anti-Tetanus Antibody Responses among Men Seeking for Safe Medical Male Circumcision Services in Uganda Richard Muwanika Makerere University, Uganda Introduction The safety of VMMC services continues to be a key concern as Uganda scales up circumcision, with tetanus infection being observed among men receiving circumcision. Post circumcision tetanus infection has been reported with surgical wounds listed among the portal of entry for the Clostridium tetani spores. This research study was conducted to establish the proportion of men with minimum immunity and gain of sufficient immunity following the administration of tetanus toxoid in both adolescent and adult males seeking for voluntary medical male circumcision services in two Ugandan districts of Mpigi and Rakai. Methods A total of 147 subjects were enrolled and received the TT vaccination. Prior to vaccination, we took off a blood sample to measure participant responses using a commercial enzyme-linked immunosorbent assay. Two more blood samples were taken off post vaccination on day 14 and 28. Results Before vaccination, 34.0% (50/147) of the respondents had minimum immunity against tetanus of at least 0.1IU/mL. Among the participants with minimum immunity at baseline, 46% (23/50) had sufficient immunity of greater than 0.5IU/mL where booster vaccination can be given in 2-5 years. One dose of Td vaccination provided sufficient immunity in 85.6% and 95.6% of the study subjects by day 14 and 28 respectively. Conclusions Our findings reveals that only 34.0% of the population seeking for voluntary male medical circumcision services had minimum immunity against tetanus and one tetanus toxoid dose offered sufficient immunity to unprotected males.

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WEABO48 Safe Cleft Surgery in Gertrudes Childrens Hospital Lilian Mutegi Gertrudes Childrens Hospital, Kenya Background Smile Train has always wanted to give every child a chance to smile. Gertrudeâ&#x20AC;&#x2122;s Childrenâ&#x20AC;&#x2122;s Hospital as one of the partners has not been left out in helping achieve this goal. To promote this, strategies have been put in place to ensure the safety of cleft surgery. Purpose To come up with uniform standards of care during the peri-operative period of cleft surgeries. This entails a multidisciplinary approach, this involves; the team that assesses the patientâ&#x20AC;&#x2122;s fitness for the surgery, the team involved during the surgery and the team that offers post operative care. Results From January of the year 2016 to date, approximately 72 cleft surgeries have been done and they were all successful. This has been made possible due to the implementation of the multidisciplinary approach. Conclusion It was noted that most of the cancelled surgeries in the Theatre Booking Register were cleft surgeries. This was due to underlying conditions that were noted during the initial assessment on the patients, like low blood count and infections.

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WEABO49 Amref Health Africa/ Smile Train Cleft Lip Palate Repair Epidemiological Findings Compared to Worldwide Epidemiological Reports Asrat Mergia NaPAN, Ethiopia Background Access to reconstructive surgery is limited in eastern African countries. 6,972 patients with clefts from nine eastern African countries received surgical repair between 2006 â&#x20AC;&#x201C;2016 under the Smile Train/ Amref Health Africa Reconstructive surgery outreach programme. The present study reviews epidemiological data of these patients. Methods Demographic and clinical patient data were collected from the Amref Health Africa/Smile Train database. These data were recorded in Excel, analyzed using SPSS. Results The distribution of clefts was: 75% clefts of the lip (CL), 18 % clefts of the lip and palate (CLP), and 0.36% clefts of the palate only (CP). The male to female ratio was 1.54:1, and the unilateral: bilateral ratio 5.17:1, with left-sided predominance 1.54:1. Associated anomalies were found in 0.05% of patients. The most frequent surgeries included primary lip/nose repairs, unilateral (78%) and bilateral (12%). The median age at surgery was 10.34 years. The average hospital stay was 2 .2 days. The reported complication rate was 0.1 %. Conclusions Our results did not follow trends of worldwide epidemiologic reports of 25% CL, 50% CLP, and 25% CP, and 2:1 unilateral: bilateral ratios. Fewer than expected patients, especially females, presented with isolated cleft palates, suggesting that limitations in economic resources and cultural aesthetics of the obvious lip deformity may outweigh functional concerns. A fewer than expected associated anomalies suggests either true ethnic variation, or that more severely-affected patients are not presenting for treatment.

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WEABO50 Prevalence of and associated risk factors for high risk Human Papilloma Virus among sexually active women, Swaziland Themba Ginindza University of KwaZulu-Natal, South Africa Background High-risk human papillomavirus (hr-HPV) infection and the dual burden of HIV remains a huge challenge in some LICs such as Swaziland with limited/no data. We estimated the prevalence and investigated determinants of hr-HPV, including HIV infection among sexually active women in Swaziland. Methods A total of 655 women aged 15-49 years from 5 health facilities were randomly enrolled using a cross-sectional study design. Cervical cells were tested for hr-HPV types using GeneXpert HPV Assays. Results The overall weighted hr-HPV prevalence was 46.2% (95%CI: 42.8–49.5). Of hr-HPV infected women, 12.4% (95%CI: 8.6–17.5) were HPV16 positive, 13.8% (95% CI:12.0–15.8) were positive for HPV18/45, 26.7% (95%CI: 24.2–29.3) for HPV31/33/35/52/58, 7.6% (95%CI: 7.6–11.9) for HPV51/59 and 11.0%, (95% CI: 7.9–15.3) for HPV39/56/66/68. Prevalence of hr-HPV decreased with increasing age. HIV infection remains very high (46.2%; 95%CI: 35.7-46.2) and was associated with hr-HPV infection (Adjusted OR=4.9, 95%CI: 3.043-7.8, z<0.001). Overall hr-HPV/HIV coinfection was 24.4% (95%CI: 20.3–29.1) and it was significantly higher among younger age groups (p<0.001).Prevalence of multiple HPV types was significantly higher in HIV-positive versus negative women (27.7% and 12.7% respectively, p<0.001). Conclusion The prevalence of hr-HPV infection is high among sexually active women. HIV was significantly associated with hr-HPV infection. Furthermore, the study has provided essential information about the HIV link with HPV infections which may explain the high incidence. This can contribute to policy development and planning of prevention strategies incorporating HPV infection prevention especially among the youths and HIV infected people.

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WEABO51 Targeted HIV testing to close the adult-paediatric treatment gap in 6 districts of central Uganda Rebecca Kivumbi , Hasifa Nambi, Abdallah Kabwaago, Catherine Senyimba, Jane Nakawesi, Yvonne Karamagi, Barbara Mukasa 1

Mildmay Uganda

Issues A large gap between the number of children and adolescents accessing ART, and that of adults still exists despite all the interventions. Mildmay Uganda is implementing the “Un finished Business” ELMA project for accelerating pediatric HIV/AIDS services. Project implementation is in 25 health facilities in 6 districts of Wakiso, Mpigi, Luweero, Mityana, Mubende and Masaka. Description The project main objective is to fast track inclusion of 8334 children (0-14 years) and 3505 adolescents (15-24 years) into HIV care and treatment services. A total of 25 ‘know your child status’ counselors were recruited to the 25 health facilities to support in counseling all the adults (index clients) in HIV chronic care to bring their children for HIV testing services (HTS). Approximately 450 health care workers from all the entry points were trained in HIV testing services i.e. outpatients, in patients, MCH clinics; community and the Adult ART clinic and now able to do HIV testing. Between 1st October 2016 and 30th September 2016, 738 children less than 2 years were identified and of these 423 were linked to care. 2 to 4 years; 650 tested positive and 350 were linked to care. Between 5 and 14 years 771 were identified and 542 were linked to care. 2220 Adolescents tested HIV positive and only 987 of them were initiated on ART Lessons learnt Targeted testing (entry points) is an effective strategy in closing the adult paediatric treatment gap. Conclusion Scaling up paediatric HIV counseling and testing requires innovations i.e. capacity building, human resource support and continuous mentorship at all entry points. There is need to strengthen linkage to care services.

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WEABO52 Short-term Effectiveness of a Community Health Worker Intervention for HIV-infected Pregnant Women in Tanzania to Improve Treatment Adherence and Retention in Care: A cluster-randomized trial Rita Noronha , Sandra McCoy , Nerissa Nance , Joseph Masanja , Abdul Mashauri , Ntuli Kapologwe , 4 3 2 1 Karen Webb , Prosper Njau , Nancy Padian , David Ngilangwa 1

Amref Health Africa, Tanzania, School of Public Health, University of California, Berkeley, California, 3 USA, Ministry of Health, Community Development, Gender, Elderly, and Children (MOHCDGEC), 4 Dar es Salaam, Tanzania, Organisation for Public Health Interventions and Development (OPHID), Harare, Zimbabwe

Introduction Community health workers (CHWs) have the potential to enhance services to prevent mother-tochild HIV transmission (PMTCT) and improve womenâ&#x20AC;&#x2122;s adherence to antiretroviral therapy (ART) and retention in care after delivery. This study aimed to evaluate an intervention to integrate CHWs with PMTCT services in Shinyanga Region, Tanzania. Methods We randomized 32 facilities offering PMTCT services, within strata defined by facility size, to the intervention (n=15) orcomparison (standard ofcare, n=17) groups. The interventionwas implemented for 9 months and included; formal linkage of CHWs to health facilities; CHW-led ART adherence counseling; loss to follow-up tracing by CHWs; and distribution of Action Birth Cards, a birth planning tool. Intervention effectiveness was determined with a difference-in-differences strategy based on clinical and pharmacy data from HIV-infected postpartum women at baseline (births in 2014) and endline (births April-Oct 2015). Data were collected from 1,152 and 678 mother-infant pairs at baseline and endline, respectively. Data analysis was done using Stata 13. Results Intervention and comparison facilities were similar at baseline. In comparison sites, there were significant improvements over time in the timing of ART initiation, retention in care, and MPR. Among women with evidence of prior HIV care, the intervention was associated with a non-significant 5.0% point improvement in retention in care at 90 days postpartum (95% confidence interval (CI): -5.9, 15.9, p=0.36) and a 11.3 percentage point improvement (95% CI: -0.7, 23.3, p=0.06) in medication possession ratio (MPRâ&#x2030;Ľ95%)at 90 days postpartum. There was no change in the timing of ART initiation. Conclusions Temporal changes in the comparison group indicate that scale-up of Option B+ has improved uptake of PMTCT services. The intervention had the strongest effect on increasing ART adherence among postpartum women in care when CHWs are used. Further evaluation of this approach is warranted. Key words CHWs, PMTCT, Adherence, Retention, Tanzania

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WEABO53 Improved Pediatric Tuberculosis (TB) Case Finding at Mwenge Military RCH Facility, Dar es Salaam Tanzania Edward Chilolo , Denis Janga, Geert Haverkamp, Robinson Mwanjela, Julieth Rwezaura, Saumu Mweri, Wanze Kohi 1

PharmAccess International, Tanzania

Issue Improved Pediatric Tuberculosis (TB) Case Notification at Mwenge Military RCH Facility, Dar es Salaam Tanzania. Description Tanzania, a high TB burden country with TB prevalence of 295/100,000 population faces a challenge of diagnosing children with TB. The NTLP estimates that children contribute 15-20% of National TB case notification if proper measures for pediatric TB case finding are in place. Currently children contribute only 9% of the total National TB case notification. In 2012, the Ministry of Health and Social Welfare developed a pediatric TB guideline aiming to improve pediatric TB services. PharmAccess, in collaboration with the Tanzania Peoples` Defense Forces (TPDF), NTLP and National AIDS Control Program conducts mentorship/trainings on pediatric TB to health care workers (HCWs) in Mwenge military Reproductive and Child Health (RCH) facility in Dar es Salaam. Three HCWs were trained on pediatric TB in 2011, 5 in 2012, 6 in 2013, five clinicians were trained on Chest X-Ray reading/interpretation in 2013, 4 HCWs were trained on TB DOT in 2014, 2 HCWS were trained on MDR TB in May 2015 and 3 HCWs were trained on Three I`s (Isoniazid preventive therapy, TB Infection control and Intensified TB case finding) in June 2015. Introduction of the National pediatric TB guideline, training/mentorship have led to increased pediatric TB case detection at Mwenge RCH as follows: pediatric TB notification for the period from July 2011, 2012, 2013, 2014 to September 2015 were 30, 38, 41, 48 and 51 respectively. The number of children attending Mwenge RCH over the same period was 4846, 11280, 13310, 14415 and 13860 over the same years. Hilda Mlay, a TB DOT nurse of the facility says â&#x20AC;&#x153;Before attending the trainings I was not able to presume a child with TB, answer questions from the guardians, document on TB unit register/ treatment cards, and educate treatment supporter on how to document on patient identity card. But currently I am able to do everything concerning TBâ&#x20AC;?. Lesson Learnt Staff development improves health services. Next Step Continued capacity building to HCWs so as to end TB epidemics by 2030.

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WEABO54 Characteristics and Treatment Outcomes of Extra Pulmonary TB Patients in Kenya Benson Otieno Ulo , Faith Ngari , Enos Masini 1

Amref Health Africa, Kenya, Ministry of Health, Kenya

Background Patients with extra pulmonary tuberculosis (EPTB) usually receive less priority in national TB Programmes. However, in many countries, their numbers remain either stable or are increasing while numbers of patients with pulmonary disease are decreasing. They usually represent 15% to 20%, or higher, of all TB cases in populations with low and higher HIV prevalence respectively. Diagnosis in many low-income countries is often based on presumptive and circumstantial evidence. In Kenya published information on EPTB is lacking, especially with regard to epidemiological characteristics and the most predominant forms. “Treatment completion” is considered a successful outcome. However, treatment can be completed without improvement of the patient’s health condition. Weight, a better gauge of successful treatment, is inconsistently recorded. Methods We analyzed routine service provision data in the national case-based electronic data system, Tuberculosis Information from Basic Units (TIBU) for January 2013 to December 2014. Comparisons were made between EPTB and new smear-positive pulmonary tuberculosis (NPTB) patients. All “transfer in patients” were excluded in the analysis. Results Of the 109,223 patients, 31,636 (17.5%) had EPTB and 55.5% were males. Pleural effusion, lymph node and meninges tuberculosis accounted for 62.45% of all EPTB. Children <15 years represented 13.3% of cases, with lymph node disease (43.3%) being most common among them followed by pleural effusion 14.6%. EPTB of the pericardium was the highest under ‘EPTB other’. Less that 1% (N=31,636) of EPTB patients had a confirmed bacteriological/histological diagnosis. There were 26,651 (84.2%) patients who successfully completed treatment. There was significant high proportion of deaths among EPTB patients (8%) compared to 3.8% among NPTB. The best treatment completion rates were in children <15 years (88.1%) and only 4.2% died compared to 8.6% of adults. Patients with TB meningitis and milliary had the worst outcomes. HIV positivity rate was 38.3% among EPTB and 87.6% (N=12,128) who were HIV co-infected were on antiretroviral therapy (ART). HIV positive status was associated with poor outcomes. Conclusion and recommendations Patients with EPTB generally do well in Kenya, although national TB Programme would benefit through more attention to accurate diagnosis, weight monitoring and earlier ART initiation in HIVinfected patients.

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WEABO55 Environment or Our Behaviors, What To Fear: 2016 Cholera Outbreaks in Rwanda Ntambara Nelson University of Rwanda Background In 1998, the cholera epidemiological curve in Rwanda, by Medicin Sans Frontiers was suggesting a yearly sporadic cholera cases with outbreaks every 2-3 years depending on herd immunity and environmental factors. Prevention projects were implemented until 2003 and no cholera outbreaks recorded, 13 years ago now. In June this year, Rwanda sustained a new outbreak where in three days, sixty patients were isolated and three of them died. This study was to reveal risk factors and practices in Karongi and Rubavu districts, near Lake Kivu, responsible of that and probably next outbreaks and suggest interventions required for sustainable prevention of this epidemic. Method used We visited Cholera camp in Rubavu District and interviewed patients, care takers, health center’s nurses, fishermen community members and observed their habits. Results From 2003 to 2016, the population in endemic areas has increased to a level that basic and old infrastructure can’t satisfy them. Restaurants, women and children use lake water in cooking and cleaning while this lake has been confirmed to be infected with Cholera strains. 12 restaurants have been closed due to poor hygiene but the region has a remarkable loss of clean water. All admitted cases, 60% were male and 40% female. The average onset of symptoms was 48 hours and the common symptoms were acute heavy diarrhea and vomiting. These patients reported to have used lake water before the attack and they didn’t use any measure to clean it. Recommendation Policy makers ought to bring good hygiene practices and clean water in this region as soon as possible, through community mobilization, sensitization and community work. Nearby health professionals, NGOs and medical students are required to update people’s knowledge on cholera and reinforce prevention.

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WEPE01 Exploring the perceptions of pediatric health care workers on audit and performance feedback in fourteen selected Kenyan county hospitals Peter Waiganjo Amref Health Africa, Kenya Background Poorservice deliveryin the Kenyan public healthcare institutions can be attributed to non-compliance to evidence based practices and clinical guidelines by the health providers. This has resulted to drug dose errors, poor compliance with evidenceâ&#x20AC;?based standards and high mortality rates from avoidable and treatable illnesses in children. It is through audit that intervention approaches and processes are developed and implemented in a healthcare system to improve service delivery. Health systems must be improved if continued and sustained gains in health outcomes are to be made particularly in low and middle income countries. Methods Through an exploratory qualitative research design using semi-structured interviews and focus group discussions, the perceptions of the healthcare workers on audit and feedback were explored. A total of 53 paediatric healthcare workers from were purposively sampled through 10 focus group discussions and 10 semi structured interviews. Data were transcribed, themes explored, and revised in two rounds of coding and analysis in Microsoft Excel, subjected to a layered analysis and reviewed. Results Eight major themes of exploring the perceptions and behaviour of the healthcare workers to A&F were identified: commitment to improve care; opportunity to reflect on quality of care delivered; understand hospital morbidity and mortality; reinforced standards on care; used data for planning; enhanced teamwork, A&F as an incentive; and enhanced supportive supervision. The reporting and the data within the hospitals were accurate and reliable and used for decision making. Conclusion The audit and performance feedback reports positively influenced the perceptions and the behavioural attributes of the health workers on their performance. There was general perception in the improvement of paediatric care and reduction in variation in practice and documentation process in the hospitals.

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WEPE02 Epidemics in the era of globalization: An alarm for stronger global health systems governance Dawit Buda Washington University in St Louis, US Background Intensified globalization as well as the epidemic named ‘Ebola Virus Disease’ emerged during the late 1970s and early 1980s. In the consequent decades, whereas globalization has been embraced at the global scale; EVD has remained disguised, neglected and deadly within its endemic countries. By the mid-2014, however, EVD blasted into a global threat, affecting three continents. The central argument of the article is that globalization has ‘globalized’ epidemics. However, local and international health systems failed to pass the test of the epidemics; and the 2015 EVD catastrophe exposed that the epidemics management system is fragile and characterized by ‘vacuums’ at local, regional and global levels in the developed and developing countries. Evidences Comprehensive search of Ebola related articles was conducted from PubMED, JSTOR and Google Scholar in summer 2015. Totally, 77 materials were identified of which 21 are used for the analysis of the paper based on the screening criteria. Findings Unabated gap in global governance was the major factor behind the unprecedented upsurge of EVD in 2014/15. EVD exposed the vacuum in global governance and fragility of health systems. Increased population and increasing global movement of people, goods and services have increased both the tendency and threshold population in danger. Accordingly, effective global response could be achieved either through calibrating WHO or nurturing a new institution to lead globally while simultaneously being embedded at local levels. Both options would be feasible in a resilient health system, backed up by technology, and harmonized by a global prevention strategy/protocol.

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WEPE03 Capacity building of community pharmacy practitioners as primary health care workers in Ethiopia and Partnering with them in the Prevention, Control of non-communicable diseases and childhood illnesses: An approach to strengthen community pharmacy service Tadesse Abegaz , Tamrat Abebe , Shitaye Dechasa , Daniel Erku , Sewunet Belachew 1

University of Gondar, Ethiopia

Background Community pharmacies are the primary health care units (PHUs) where individuals usually seek treatment for their illness. Visiting these health care centers for the sake of medical care was dated back during ancient times in Ethiopian context. The burden of chronic disease and childhood illnesses is a global problem. Community pharmacists are ideally situated to assist in the detection and referral of at risk individuals. However, community pharmacists lack adequate knowledge and skills for effective disease management. Poor history taking and inappropriate drug selection were the common shortcomings of pharmacists. Hence, these professionals should receive appropriate training so as to deliver the right service for the right patient with affordable cost. Objective The aim of this project was to scale-up the experience of Ethiopian community pharmacists in the management of chronic diseases and childhood febrile and to create a sustainable alliance between these professionals and government hospitals. Methods Community pharmacists all over the major towns of Ethiopia were recruited for the training. The training was held at University of Gondar referral hospital, drug information center from May 1-June 30 2016. Lectures, case scenarios, panel and focused group discussions were used as instructional methods. The training was delivered by clinical pharmacists, nurses and physicians working in Gondar university hospital. Results More than eighty community pharmacy practitioners were involved in the training. Association of the Ethiopian community pharmacists has been established. Clinical practice manual was prepared by the project team members and distributed for all members of Ethiopian community pharmacists. Conclusion and recommendation During monitoring and evaluation of our project we found that, the project has strengthened the experience of community pharmacists in the management of common community health problem. It is recommended that further trainings should be provided for these health professionals on other common community health aliments.

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WEPE04 Parents/guardians knowledge and practice on under nutrition of children aged 6 months to 5 years at Mama Lucy district hospital, Nairobi Kenya Oduor Bernard , Ojee Edna, Perez Obonyo, Safina Dhadho, Kagasi Eunita, Penninah Mugo, Elizabeth Cummings 1

Kenya Medical Research Institute, Kenya

Background The aim of this study was to assess parents/guardians’ knowledge and practice on under nutrition and establish the nutritional status of the children & to determine the association between their knowledge, practice and nutritional status of their children. Methodology A cross sectional quantitative and qualitative survey was conducted and data collection done using questionnaires with open and closed ended questions assessing parent /guardian knowledge on malnutrition; children’s anthropometric measurements and Z scores determined. A knowledge scale was developed and the relationship of parents’/guardians’ knowledge score and nutritional status of the children was assessed. Focused group discussions were tape recorded, notes taken and analysed using grounded theory. Results Prevalence of malnutrition based on WHZ was 3.5%, 9.1% were stunted while 3.8% were under weight. Prevalence of malnutrition was high among boys 4.5% compared to girls 2.7%. Prevalence of stunting based on HAZ was 9.5%: boys 12.1% & among girls 2.2%. Prevalence of underweight determined by WHZ was 3.9%; 5.6% among boys & 2.2% among girls. The parent/guardian mean knowledge score on child malnutrition was below average and there was no association between parents’/guardian’s knowledge on malnutrition and child growth indices. Logistic regression showed no significant association between malnutrition & total knowledge/ practice scores. Children of mothers with a college/university education had lower odds of being malnourished than children with mothers with a primary school education or less (OR= 0.20, CI 0.05-0.81, p=0.024). Conclusions Gaps in parent’s/guardians’ knowledge on malnutrition were identified. Increasing parent/guardian knowledge on malnutrition through nutrition/health education programswill contribute significantly to improving children’s nutritional status in Kenya thus reducing morbidity and mortality. Key words WHZ-weight for height, HAZ-height for age, WAZ-weight for age

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WEPE05 Healthcare professionals' awareness, knowledge, attitudes, perceptions and beliefs about Ebola at Gondar university hospital, Northwest Ethiopia: a cross-sectional study Tamrat Abebe University of Gondar, Ethiopia Background A poor understanding of Ebola Virus Disease (EVD) among Health Care Professionals (HCPs) may put their lives at risk. We aimed to assess the awareness, knowledge, attitudes, perceptions, beliefs of HCPs towards Ebola at Gondar University Hospital (GUH) in Northwest Ethiopia. Methods We conducted a hospital based, cross-sectional survey among 245 randomly selected HCPs working at GUH from August-October, 2015. A validated, self-administered questionnaire was used to collect the data. We calculated descriptive statistics with p<0.05 being statistically significant. Results Of the 245 participants, 211 (86.1%) completed the study. The majority had heard about EVD and used news media (62%) as a source of information. Still, many were afraid of getting EVD (56.4%; p=0.001). A significant number of HCPs thought EVD can cause paralysis like polio (45%) and can be treated with antibiotics (28.4%). In addition, 46.4% of the HCPs felt anger or fear towards Ebola infected patients (p=0.006). Conclusion We identified poor knowledge and negative incorrect beliefs among doctors and allied health professionals. There is a need for intensive training for all HCPs reduce EVD risk. Key Words Attitudes, Ebola Virus Disease, Health Care Professionals, Knowledge, Ethiopia

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WEPE06 Inappropriate prescribing of antithrombotic therapy in Ethiopian elderly population using updated 2015 STOPP/START criteria: a cross-sectional study Henok Tegegn , Akshaya Bhagavathula , Tamrat Abebe , Sewunet Belachew 1

University of Gondar, Ethiopia Background Inappropriate use of anti-platelets and anticoagulants among elderly patients increases the risk of adverse outcomes. The aim of this study was to assess the prevalence of inappropriate prescribing of antithrombotic therapy in hospitalized elderly patients. Methods A retrospective cross-sectional, single-center study was conducted at the Gondar University Hospital. A total of 156 hospitalized elderly patients fulfilling the inclusion/ exclusion criteria were included in the study. The Screening Tool for Older Person’s Prescription/Screening Tool to Alert doctors to Right Treatment criteria (STOPP/START) version 2 was applied. Results A total of 70 IPs were identified in 156 patients. Of these, 36 (51.4%) were identified as potentially inappropriate medications by the Screening Tool for Older Person’s Prescription criteria. The prevalence of IP per patient indicated that 58 of the 156 (37.2%) patients were exposed to at least one IP. Of these, 32 (55.2%) had at least one potentially inappropriate medication and 33 (56.9%) had at least one potential prescribing omission. Patients hospitalized due to venous thrombo embolism (adjusted odds ratio [AOR] =29.87, 95% confidence interval [CI], 1.26–708.6), stroke (AOR =7.74, 95% CI, 1.27–47.29), or acute coronary syndrome (AOR =13.48, 95% CI, 1.4–129.1) were less likely to be exposed to an IP. An increase in Charlson comorbidity index (CCI) score was associated with increased IP exposure (AOR =0.60, 95% CI, 0.39–0.945). IPs were about six times more likely to absent in patients prescribed with antiplatelet only therapy (AOR =6.23, 95% CI, 1.90–20.37) than those receiving any other groups of antithrombotics. Conclusion IPs are less common in elderly patients primarily admitted due to venous thromboembolism, stroke, and acute coronary syndrome, and those elderly patients prescribed with only antiplatelets. Patients with higher CCI were, however, associated with increased IPs exposure. Our study may guide further research to reduce high-risk prescription of antithrombotics in the elderly.

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WEPE07 Drug-related problems in medical wards of Tikur Anbessa Specialized Hospital, Ethiopia Mohammed Ayalew University of Gondar, Ethiopia Background This study was aimed to determine the prevalence of drug-related problems (DRPs), identify the most common drugs, and drug classes involved in DRPs as well as associated factors with the occurrence of DRPs. Methods A prospective cross-sectional study was conducted on 225 patients admitted to medical wards of Tikur Anbessa Specialized Hospital, Addis Ababa from March to June 2014. Data regarding patient characteristics, medications, diagnosis, length of hospitalization, investigation, and laboratory results were collected using data abstraction forms through review of patientsâ&#x20AC;&#x2122; medical card and medication charts. Identified DRPs were recorded and classified using DRP registration forms. The possible intervention measures for the identified DRPs were proposed and communicated to either the physician or the patient. Data were entered into Epi Info 7 and analyzed using SPSS version 21. Results DRPs were found in 52% of study subjects. A drug-drug interaction (48% of all DRPs) was the most common DRP followed byadverse drug reaction (23%). Anti-infectives and gastrointestinal medicines were commonly involved in DRPs. Drugs with the highest drug risk ratio were gentamycin, warfarin, nifedipine, and cimetidine. The number of drugs taken by the patient per day is an important risk factor for DRPs. Conclusion DRPs are common among medical ward patients. Polypharmacy has a significant association with the occurrence of DRP. Drugs such as gentamycin, warfarin, nifedipine, and cimetidine have the highest probability of causing DRP. So, patients who are taking either of these drugs or polypharmacy should be closely assessed for identification and timely correction of DRPs.

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WEPE08 Addressing challenges in TB management in Private Health Sector in Kenya; KMET case study Oscar Okoth KMET, Kenya Background Kenya is rated 15th among the 22 high TB burden countries that collectively contribute 80% of the global TB burden. The country records over 600 cases of Multi-Drug Resistant TB with an estimated 200 deaths every day. HIV remains the main fueling factor behind the large TB burden in the country. Nyanza region reports the highest TB/HIV co-infection (15.3%) twice the national average (7.4%). In 2009 the region reported 21,185 cases and over 75% were co-infected. Problem Engagement of private sector in TB activities in Kenya is minimal despite the sector attending to over 52% of health clientele, this therefore poses both threat and opportunity in fight against TB infection. Findings from a survey conducted by KMET on TB management in private clinics in Nyanza region showed that providers were not screening for TB, few clinics offered treatment and no referrals were being made on time for the TB suspect cases a situation that can result to risk of spreading the disease due to delay in management and poor treatment outcome. Project description KMET and PSK in partnership with MOH implemented a TB Reach pilot project in 24 private clinics in central Nyanza for a period of one year. The project adopted three approaches; Capacity building for providers on TB management services; Demand creation for TB services by Community Health Volunteers and partnership with MOH for commodity supplies and support supervision. Results A total of 323,410 clients were screened, 20,151 were suspects and significantly 16,616 tested by microscopy and 115 by gene Xpert technology. 1,173 cases were confirmed positive for microscopy and 41 for gene Xpert and initiated on treatment. Conclusion To reduce TB burden in Kenya, itâ&#x20AC;&#x2122;s important to engage both public and private sector. Next step To source for grants for scale up.

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WEPE09 Assessment of Hypertension Management Services at Primary Health Facilities in Kisumu East Sub county Kisumu County, Kenya Oscar Okoth , Japheth Ogendi 1

Maseno University, Kenya

Background Hypertension is an important modifiable risk factors for the development of cardiovascular diseases. Globally its account for 9.4 million deaths annually. African region has the highest prevalence worldwide at 46% of adults aged 25 and above, whereas up to 80 million people are hypertensive and this is expected to double by the year 2025. In Kenya, hypertension affects almost 1 in every 3 individuals aged 45 to 54 years and half of all adults over the age of 55. Problem: In Kenya, only physicians are authorized to manage hypertension. In 2012 due to insufficient physician workforce to contend with the dual burden of infectious and non-communicable diseases, the country adopted a strategy of task shifting and decentralization of services. Where hypertension services can be delivered through a primary health-care system and offered by non-physicians. However there has not been a systematic evaluation of this strategy, thus critical need for data on current status. Method A cross-sectional survey, utilizing quantitative research methods will be used to collect information from key informant on: category of services; providersâ&#x20AC;&#x2122; capacity; status of supplies and equipment; record keeping, reporting and referral system used for management of hypertension in purposively selected 21 facilities in the study region. Data will be collected by standardized semi-structured questionnaires administered to three key informants per facility (1 clinician or nurse, 1 pharmacy personnel and 1 data personnel) specific to each area of type of key informant. Results Data will be analyzed by use of Statistical software SPSS (version 20). Descriptive statistics will be determine by frequencies and means, and presented by use of bar charts and histograms. Logistic regression analysis will be used to identify the factors associated with the provision of services. Finding and Recommendation The data will be useful in improving on quality of services to reduce morbidity and mortality.

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WEPE10 Prevalence of Fasciolosis in Cattle, Sheep and Goats Slaughtered in Slaughter Slabs and Knowledge of Livestock Handlers In Trans-Nzoia West, Kenya Protus Mutotsi Moi University, Kenya Background Fasciolosis is a helminthic disease of ruminants caused by liver fluke of the genus Fasciola, which is one of the most neglected diseases that can lead to human infection and has the widest geographic spread of any emerging vector-borne zoonotic disease occurring worldwide. Objectives The main objective was to determine the prevalence of fasciolosis among ruminants slaughtered in Trans Nzoia West. Specific objectives were to establish the trend of fasciolosis in ruminants, to determine the relationship between fasciolosis prevalence and rainfall patterns and to assess the knowledge of meat sellers and farmers in relation to fasciolosis. Methods A 5 year secondary data retrospective study was carried out in Trans Nzoia West, Trans Nzoia County. Study population consisted of ruminants slaughtered, meat sellers and livestock farmers. Results A total of 104,221 cattle, sheep and goats were slaughtered in the 5 year period in which 6,098 (5.85%) were infested with fasciolosis prevalence of 6.52%, 6.08% and 4.10% in cattle, sheep and goats respectively. Most meat sellers (72.2%) were able to identify fasciolosis in infested livers, 88.9% reported liver flukes infestation resulted in loss of income while 58.3% were not aware of nutrition depletion associated with fasciolosis. Of the farmers interviewed, 52.9% grazed in swampy areas, 66.7% dewormed after 3 months, 78.4% had heard about fasciolosis and 80.0% did not know the cause of fasciolosis. Majority (95.0%) were not aware of the snail species spreading liver flukes while 77.5% did not know that fasciolosis was a zoonotic disease. Conclusion Fasciolosis was prevalent in the area and caused great economic loss to the meat sellers. Most farmers were not aware of its cause and zoonotic nature. Recommendations Fasciolosis control should be approached at multidisciplinary angle and farmers should be educated on the disease and its zoonotic nature.

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WEPE11 Oral health care among children aged 6 months to 5 years in Huruma Estate, Uasin Gishu County Protus Mutotsi , Andrew Chesire , Evelyne Urembo , Abigael Kinyulusi , Irene Bulialia , 1 1 1 1 Rebeccah Chepkemboi , Dennis Rotich , Providence Kiptoo , Ken Okemwa 1

1Moi University, Kenya Background Oral health is the well-being of the oral cavity and itâ&#x20AC;&#x2122;s supporting structures. It has been given less priority in Kenya with less dentists and inadequate budgetary allocation. Most common oral health problems include dental cavities, periodontal diseases, malocclusion, Baby Bottle Tooth Decay and tooth decay. Tooth decay evokes aesthetic and functional complains in children. Oral diseases are expensive to treat and they are increasing in Kenya because diet rich in sugars. Methods A cross-sectional study involving children aged 6 months to 5 years was carried out in Huruma estate. A sample size of 343 was used, Proportionate stratified sampling with the villages as strata was used to select the number of respondents. Interviewer administered questionnaire and observation checklist were used for data collection. Findings Of the respondents, 71% claimed that their children clean their teeth of which 65% were assisted. Most (61%) cleaned once a day and 88% use toothbrush as a cleaning tool. Ninety percent of the children who clean their teeth use toothpaste as a cleaning agent .Of the respondents 54.5% did not bottle feed their children, 82.6% knew that sugary foods cause tooth decay and 81.9% agreed that a tooth brush should be changed regularly. Most (87.5%) reported to have never taken children for dental check-up and majority did not have health insurance covers (62.1%) Conclusion Majority of children did not clean frequently as required and most were assisted in the cleaning process. Most caretakers were aware of the major causes of oral health problems and their prevention measures but did not observe. There is poor dental clinic attendance. Recommendations Parents should check the diets of their children and take the responsibility of ensuring that children clean their teeth daily .The systematic implementation of preventive oral care and communityoriented oral health programmes are needed.

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WEPE12 Detection and stage classification of Plasmodium falciparum from images of Giemsa stained thin blood smear Dick Jan Montijn Momala, Netherlands Background The conventional method for the diagnosis of malaria parasites is the microscopic examination of stained blood films, which is time consuming and requires expertise. Some studies have been performed for the automatic detection and stage classification of malaria parasites. In this study, we proposed segmentation and life stage classification with a random forest classier. We built a large data set for the segmentation and stage classification of malaria parasites with ground truth labels provided by experts. This data set is freely available and can become a standard benchmark. Methods We made use of Giemsa stained images obtained from the blood of 17 patients infected with Plasmodium falciparum. Experts labeled each of the images. We applied a two-step approach: segmentation followed by life stage classification. In segmentation, we classified each pixel as a parasite or non-parasite pixel using a random forest classier. Gaussian blur and average intensity features of red blood cells and background were used to classify pixels. Segmentation was evaluated with classification accuracy, Dice coefficient and free-response analysis. In life stage classification, we classified each of the segmented objects into an early ring, late ring or early trophozoite, mid trophozoite, early schizont, late schizont, segmentation, white blood cell or debris. Results Our segmentation method gives an accuracy of 98:30% with an average Dice coefficient of 0:825 which is a 13% improvement compared to the conventional Otsu method. We found that the inclusion of average intensity features of red blood cells and background considerably improves the 1 segmentation. We obtained an overall accuracy of 58:84% when classifying all life stages. Stages are mostly confused with their neighboring stages. When we reduce the stages to ring, trophozoite and schizont only, we obtain an accuracy of 82:73%. Conclusion Pixel classification gives better performance than the conventional Otsu method. Effects of staining and background variations can be minimized with the inclusion of average intensity features in pixel classification. The proposed method and data set can be used in the development of automatic tools for the detection and stage classification of malaria parasites.

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WEPE13 An innovative decentralised model of training HR4H in rural Zambia Martina Weber , Klaus Thieme 1

SolidarMed - Swiss Organisation for Health in Africa, Zambia

Issues In Zambian Rural Health Centres, nurses are likely to be the sole available health professional. Equipping professionals for these demands is only possible by training them in the rural context: Without having experienced the reality and challenges of rural practice the outlook for quality performance and staff retention is poor. Description The project utilizes the WHO recommendation to increase the access of health workers in remote and rural areas by training people in the rural for the rural. A decentralised nurse and midwife training was piloted from 2012 till today by St. Lukeâ&#x20AC;&#x2122;s School of Nursing (Mpanshya, Zambia) in collaboration with SolidarMed â&#x20AC;&#x201C; the Swiss Organisation for Health. It put WHO global policy guidelines into practice by training nurse and midwife students in a decentralised set-up at four different rural hospitals. Lessons Learnt Students gain a wider variety of experiences. Exposure to different hospitals is a better preparation for practice, -The model has increased the output of graduates - which directly addresses the human resource crisis in Zambia, -National stakeholders (Ministry of Health/General Nursing Council) recognize the pilot as a method of increasing output of trained professionals with additional benefits for the hospitals, -The hospital workforce reports that the students are enabling improved patient care. Recommendations Decentralised sites enable a training institution to deliver training to higher numbers of nurses and midwives, with a better student to mentor ratio and an exposure to a variety of learning environments. The innovative approach of decentralised practical nurse training should be translated to other developing countries to improve the quality of training and to address the human resource crisis especially in rural areas by training people in the rural for the rural.

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WEPE14 Patients perception of nursing care Jones Maloba Kenyatta University, Kenya Excellent health care is what those in need of healthcare services wish for, and it is equally the main goal for those providing the healthcare services. As focus has shifted from the healthcare providers to the healthcare consumers; patient satisfaction is being increasingly used worldwide for the assessment of quality of services provided by healthcare institutions. Of all the healthcare workers, nurses spend maximum time with the patients. Therefore, the nurse is in unique position to influence and promote effective consumer relationships. Patients’ experiences with quality of care and patient satisfaction in hospital are considered to be important elements in quality improvement work in hospitals, and are also seen as indicators of quality of healthcare. Patients’ evaluation of quality of care and their satisfaction with quality of care may affect health outcomes. Patients who are satisfied with their nursing care are more likely to follow treatment and consequently to have better health outcomes. Patient satisfaction is also an important contributor to both physical and mental health-related quality of life. For every hospital patients are the main users. The primary function of the hospital is patient care. From a management point of view, client satisfaction with healthcare is important for various reasons. Firstly satisfied patients are more likely to maintain a consistent relationship with specific provider. Secondly by identifying sources of patients’ satisfaction, an organization can address system weakness, thus improving its risk management. Thirdly, satisfied patients are more likely to follow specific medical regimens and treatment plans. Finally, patient’s satisfaction measurement adds important information on system performance, thus contributing to organization‘s total quality management.

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WEPE15 The role of CXCL10 and heme in malaria pathogenesis Felix Botchway Korlebu Teaching Hospital, Ghana Background Plasmodium falciparum malaria remains one of the most frequently lethal diseases affecting children in sub-Saharan Africa, yet the immune mediators that regulate pathogenesis and the wide variation in clinical manifestations of malaria are poorly understood. Malaria mortality is associated with exaggerated host responses to inflammatory factors such as free heme and C-X-C motif chemokine 10 (CXCL10). The aim of this study was to determine whether the overproduction of CXCL10 and Heme play roles in malaria pathogenesis and also determine the effect of CXCL10 polymorphism(s) in CXCL10 production in malaria. Methods This was a case control study involving a total of 499 children (382 malaria subjects and 117 non malaria subjects) aged 1 -14 years. Full blood count was estimated using Mindray BS 5300. Plasma levels of CXCL10 was measured among the study participants using Quantikine Elisa kit using optimal concentrations of standards and antibodies according to the manufacturer's instructions. The data was analyzed at 450 nm wavelength using a Spectra Max 190 fluorescence micro plate reader. Data was presented as mean ± standard error or median and interquartile range (IQR). A p-value < 0.05 was considered statistically significant. Pearson’s rank test was used to determine if there was any association between CXCL10 and Heme levels in malaria. Five known Polymorphisms in the CXCL10 gene promoter region was determined. Following extensive bioinformatics analyses, five reported single nucleotide polymorphisms (SNP) in the CXCL10 promoter was screened using PCR-restriction fragment length polymorphism assay , only one (−1447A>G [rs4508917]) was identified in this study. Stratification analysis of confounding factors on association between CXCL10 SNP -1447A>G genotypes and malaria was performed by logistic regression analysis. Results There was significantly lower hemoglobin levels (12.1g/dL) in the malaria patients compared with 12.5g/dL in non-malaria subjects (p<0.001). There were significant difference in hematocrit values between malaria and non-malaria subjects (36.4 and 38.0 respectively, p <0.001) and in White cell counts in malaria compared to non-malaria white cell counts (6.9x109/L and 5.8x109/L respectively, p<0.0001). There was also significance difference in platelets counts between malaria and nonmalaria platelets levels (140x109/L and 271x109/L p<0.0001). There was significant increases in plasma concentrations of CXCL10 in malaria subjects compared to non -malaria controls. (Nonmalaria 180.4 pg/mL (IQR 101.1–328.6), malaria 705.7 pg/mL (IQR 459.0–1154), p < 0.0001). There was significant increase in plasma concentration of Heme in malaria compared to non -malaria controls 60.33 μM (IQR 47.67–74.34), malaria 119.57 μM (IQR 72.34–192.41), p < 0.0001) There was strong linear relationship between CXCL10 and Heme levels in malaria subjects (r =0.492, p<0.0001). (AOR =11.7% CI = 5.4-25.6; P <0.001).

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Association of age, gender and −1447A>G genotypes on malaria risk results in a significant increased risk for malaria associated with patients aged less than 5 years (AOR =3.3; 95% CI = 2.05.2; P< 0.0001) compared with children older than 5 years was observed. Also there was significant association among male patients less than 5 years with children older than 5 years (AOR = 0.5; 95% CI = 0.3–0.9; P = 0.017). A strong risk for malaria associated with -1447 A>G genotype was evidence among the patients aged less than 5 years Conclusion Plasma levels of heme and CXCL10 were significantly increased in malaria compared with nonmalaria subjects. Polymorphisms in the CXCL10 gene promoter sequence were associated with increased CXCL10 production. These results suggest that the −1447A>G polymorphism in CXCL10 gene promoter could be partly responsible for the reported variation underlying severity of malaria outcomes.

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WEPE16 Needs Assessment, Prioritization and Intervention on the Key One Health Challenges Encountered in Oltome Village, Loitokitok Subcounty, Kajiado County, Kenya Protus Mutotsi1, William Kiplagat , Hellen Akoth , Faith Imbiti , James Wachira , Michelle Gathecha , 2 Diallo Yaya 2

Moi university, Kenya, University of Nairobi

Introduction One health is the collaborative efforts by various disciplines forged to solve complex health challenges. In conventional training, institutions train professionals in single line of thinking. There is need for systems thinking due to the complexities of health challenges. It is because of this need that OHCEA organized a program geared towards capacity building to students from various disciplines in Moi and Nairobi universities aimed at addressing one health challenges. Objectives The main purpose of the study was to assess community one health needs in Oltome village and prioritize them. The study also sought to develop and implement sustainable interventions for the selected priority need(s) using a one health approach and develop a monitoring and evaluation framework for the interventions carried out. Methods The study was conducted in Oltome village, Amboseli ecosystem .Purposive sampling was used to identify the study area. Community discussions and key informant interviews were conducted to assess and prioritize one health needs. Results The majorchallenges identified included animal diseases; coenurosis, Contagious Caprine and bovine Pleura Pneumonia, cysticercosis, lumpy skin disease, foot and mouth rot disease , human diseases; poor hygiene and sanitation, open defecation, amoebiasis, typhoid, STIs and eye conditions, poor transport and human-livestock wildlife conflict. Coenurosis was the prioritized disease and the group carried out health education and demonstration as the intervention measures. Log frame was developed for monitoring and evaluation process. Conclusion The major one health needs identified in Oltome village included coenurosis, poor hygiene and sanitation, bedbugs and poor transport. Coenurosis was prioritized indicating their value for livestock. Recommendations One health approach should be adopted for teaching in universities. County government through health and veterinary department should allocate resources to address the identified challenges. Key words One health, coenurosis, prioritization

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WEPE17 Sexual risk taking behaviour in HIV positive female sex workers in Nairobi Makobu Kimani , Lambert Nyabola , Joyce Olenja 1

Kenya Medical Research Institute/Wellcome Trust, Kenya, University of Nairobi, School of public Health 2

Background From the Kenya modes of transmission study, sex workers and their clients are key drivers of new HIV infections. The objective was to determine the prevalence and determinants to risk taking behavior in HIV positive female sex workers (H+FSW) in the SWOP clinics. The clinics provide comprehensive medical and behavioral change interventions to sex workers. Methods The design was cross sectional with qualitative and quantitative arms. The target population was 6340 H+FSWs. Sample size was 431. Data was collected by use of a structured questionnaire, and 3 FGDs. Quantitative data was analysed using SPSS version 21. Selected verbatim quotes were used to supplement quantitative findings. Results A total of 431 individuals were interviewed. Of these, 339 were on HAART while 92 were on cotrimoxazole only. Condom use was high at 62% of all respondents. 73% were in active sex work at the time of the study. Contraceptive prevalence was over 90%. Most respondents could engage in unprotected sexual activity on demand of the client provided he was ready to pay extra. Fishers exact test and Chi square, those on HAART were more likely to engage in risky sexual behavior as compared to their counterparts, specifically, not using condoms (X2= 4.73, p=0.05) and unprotected anal sex (p=0.0332). Conclusion and Recommendations H+FSW expressed an increased chance of engaging in unprotected sexual activity if they were aware of the partners’ HIV positive status. The choice to or not to use condoms culminated from a ‘combination of decisions’ by the sex worker influenced by demands from the client. Contraceptive method was influenced by the availability, ease of use, fewer side effects and any effects on the menstrual cycle. Strategies that teach on safer sex negotiation practice need scale up. There is a need to consider partner involvement in prevention efforts.

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WEPE18 Population based survey of chronic non-communicable diseases in Dubti and Asayita towns of Afar region, Northeastern Ethiopia Engida Yisma , Seifu Nigussie , Nejimu Beza , Yohannis Bacha , Worku Etefa , Belachew Melese 1

Addis Ababa University, Ethiopia, Samara University, Samara, Ethiopia 2

Background We conducted population based survey to estimate the magnitudes of chronic non-communicable diseases in Dubti and Asayita towns of Afar region in northeastern Ethiopia. Methods We conducted a surveyof548 randomly-selected individuals in the two towns using a clustersampling method to ensure that the individuals were representative to the towns. We utilized interviewer administered structured questionnaires which were adapted from WHO STEPS instruments. The WHO STEPS guidelines were also used to measure blood pressure (BP), pulse rate, weight, height, waist and hip circumference, and biochemical markers such as random blood sugar level, total cholesterol and triglycerides values. We collected whole blood sample after cleaning the cubital area by 70% alcohol and stored in 3 ml vacutainer tubes. After cared transportation, analysis of blood samples was done in Assaita hospital. The study was conducted after obtaining ethical clearance from the IRB of Samara University. Results The specific observed prevalence of hypertension was 17.9% (95% [CI]: 15.0%–21.0%) while the reported prevalence of hypertension was 11.7%. The prevalence of overweight (BMI ≥25kg/m2) was 8.8% (95% [CI]: 6.0%–11.0%). Central obesity as measured by Waist to Hip Circumference (WHC) was present in 38.5% of the study population showing a huge difference between women (31.2%) and men (8.0%). On biochemical analysis of blood samples, 233 (70.2%) of the study participants (72.2% women and 67.4% men) had high total serum cholesterol level (given the cutoff point). Regarding high triglyceride, it was detected in 228 of the study population giving an overall prevalence of 68.7%. The prevalence was higher in women (72.0%) than men (65.7%). The prevalence of raised random blood glucose was 4(1.2%) (95% CI: 0.03, 2.38). With regards to the behavioral risk factors, the prevalence of smoking was 13.5% (95% confidence interval [CI]: 11.0%–16.0%), alcohol consumption 13.0% (95% [CI]: 10.0%–16.0%), consumption of fruits and vegetables below adequate level 97.9%, and low level of physical activity 18.1% (95% [CI]: 14.83%– 21.30%). Conclusion The prevalence of chronic non-communicable diseases (CNCDs) and the magnitude of the various categories of risk factors associated with CNCDs were considerably high in the study population.

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WEPE19 Reducing presumptive treatment for malaria in rural Southeastern Nigerian communities Nanlop Ogbureke Christian Aid, UK, Nigeria Country Program Office Background Malaria, a major public health problem, places huge demands on the health system and poses significant social and economic burden on families and communities. Currently, Artemisinin-based combination therapy (ACT) is the first line drug for malaria treatment and slide microscopy as gold standard for diagnosis used at primary health facilities in resource-constrained rural settings. There is an increasing need to reduce the presumptive treatment of malaria in order to reduce programme costs and delay drug resistance as well as document evidence on the acceptance and use of mRDT and ACTs. Methods A multi-phased cross-sectional mixed method was used. Quantitative and quantitative data were collected using structured questionnaires, FGDs and KIIs. Results Findings showed reducing presumptive treatment of malaria at service delivery points (SDPs) at the community level, increasing acceptance and use of mRDT by health care providers, and between linkages malaria prevention, testing and treatment. Findings also provide valuable information on opportunities for achieving the objectives of the national strategic plan to eliminate malaria through appropriate testing and treatment at both public and private facilities and improving knowledge, attitude and practices of community members in relation to malaria. Conclusions Improving malaria management in rural communities is feasible by reducing presumptive treatment of malaria at SDPs at the community level, increasing acceptance and mRDT use by health care providers, and demonstrating linkages in malaria prevention, testing and treatment for malaria programming at the community level. Recommendation The results are valuable in achieving the objectives of the national strategic plan to eliminate malaria through appropriate testing and treatment at both public and private facilities. Similarly, this would also contribute towards improving the economic wellbeing of communities and suggest mechanisms for improving access of poor community dwellers to essential health interventions taking into account the association between them.

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WEPE20 Effective HIV Care and Support Interventions in Nigeria: A rights based approach Nanlop Ogbureke Christian Aid, UK, Nigeria Country Program Office Background HIV-related stigma and discrimination have far-reaching consequences. People living with HIV and AIDS are denied their rights, disowned by their families and experience violence as a result. Access to health, economic and educational opportunities is compromised. All these in turn limit HIV prevention, treatment and care. Objectives To strengthen, develop and expand effective community-based approaches to ensure that: HIVrelated stigma, discrimination and denial is challenged, people living with HIV (PLHIV) and their families have sustainable access to quality care and support services: quality of life of PLHIV is improved and their rights promoted. Methods Quantitative and qualitative data collection methods which include desk-reviews, FGDs, questionnaires and KIIs. Results Increased access to quality care and support through the Home Based Care (HBC) services (45% at midterm evaluation to 81% at end-line). Savings and Loans Association (SLA) Welfare fund was established for sustained home and hospital based care, support and access to treatment. Improved sustainable livelihoods and nutritional status; SLA membership increased from 57% at midterm to 88.5% at end line. A steady decline in the level of stigma, discrimination and denial was reported (increasing from 32% to 86%). PLHIV collectively pushed for the signing of the national anti-discrimination act. Conclusions PLHIV become increasingly resilient, thereby reducing the barriers to HIV care and support and increasing access to quality HIV treatment options when sustainable rights-based approaches are used. Recommendations Shaping the National HIV prevention policy using evidence; coordinate and mobilize government, faith actors and CSOs to advocate for the implementation of the HIV anti-discrimination Act as an enabler for PLHIV to seek redress when discriminated against; deliberately focus on resilience and integrated health programs that ensures economically empowered communities, making the health development investments more sustainable in view of reducing donor-funds for HIV and prioritize action against sexual and gender based violence.

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WEPE21 Improving documentation and reporting through peer mentorship approach Damaris Kinara APHIA PLUS Western project, Kenya Background Vihiga County has 78 health facilities of which APHIA PLUS supports 58 facilities offering HIV care to 10161 PLHV. These triggered the need to support the county by recruiting data clerks to assist in data management by strengthening documentation and reporting of ART data. However, after the deployment of data clerks the following gaps were observed: Some data clerks were updating all CCC registers used in collating monthly reports, underutilization of ART registers like the Preart, ART, Daily activity sheet, C&T tally, and cohort registers, indicators documentation on tools portrayed enormous data discrepancies amd inconsistency trend of 731 current in care and art trends. Methods Peer mentorship approach: Orientation and intensive facility based mentorships were conducted between March to June 2016 across all health facilities in Vihiga County. The Sub county mentoring teams partnered with APHIA PLUS staff to mentor data clerks on documentation and reporting. APHIA PLUS and the sub county team identified data clerks whose facilities were performing excellent and made them Peer mentors. Their role was to visit the facilities with gaps and work alongside the facility data clerks to assist them understand the gaps documentation and reporting and vice-versa the data clerks with gaps would visit their well performing colleagues to learn. Results ART documentation improved in these facilities, utilization of l ART key registers reached 100% and MOH 731 Care and Treatment data consistency improved. Conclusion Peer mentorship is an effective, efficient and convenient approach in improving capacity building of health workers on improving documentation and populating monthly reports. Capacity building all data clerks to attain a level of being county mentors who will support other cadres not related to data in documentation and accurate reporting.

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WEPE22 Analysis of factors affecting adherence to clinic appointments among HIV-patients receiving care in informal settlements of Nairobi Sharon Kipkelwon Amref Health Africa in Kenya Background: Globally, an estimated 36.7 million people were living with HIV in 2015 with 17 million of them accessing antiretroviral therapy. Kenya is among the six HIV ‘high burden’ countries in Africa. Non-adherence to clinic appointments remains a major challenge in HIV care contributing to increased morbidity and mortality of HIV patients. This study assesses patient’s adherence to clinic appointments and factors influencing adherence in two informal settlements of Nairobi, Kenya. Methods: A longitudinal study was conducted between April 2013 and June 2016 among patients enrolled in care at Kibera and Babadogo health centers. A structured questionnaire was administered to patients at twelve months since enrolment in care to find reasons why they missed clinic appointments. Descriptive analysis was used to determine the proportion of participants who missed clinic appointments and some of the factors associated with missing clinic appointments. Results: Of the 458 participants interviewed, 89% (407) disclosed their HIV status of which 36 % (147) did not adhere to clinic appointments. Out of 11% (51) who did not disclose status, 41% did not adhere to clinic appointment. Out of 458 participants, 36% (166) missed one or more clinic appointments of which 6% did not get social support and 94% got social support. Main reasons for non-adherence were; no time off work (47.7%) travelling (39.10%) and forgetting about the appointment (10.10%). Age (p-value 0.145) and satisfaction with services at the care facility (p-value 0.353) were not found to be significantly associated with non-adherence to clinic appointments. Conclusion: Not getting time off work, travelling, and forgetting are the main reasons for nonadherence to clinic appointments. Disclosure of HIV status and provision of social support are not key in improving patients’ clinic adherence. Booking of clinic appointments should factor in patient’s working schedule to enhance adherence.

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WEPE23 KAP study on breast and cervical cancer screening among women in rural Ethiopia Bekele Ariti Amref Health Africa, Ethiopia Background Breast and cervical cancers are the first and second leading cancers impacting women in Ethiopia with an incidence rate of 41.8% and 26.4% respectively. Despite the high toll of morbidity and mortality due to cervical and breast cancers in Ethiopia, lack of awareness and ineffective screening programs contributes to this alarming condition. Objectives To determine the knowledge, attitude and practice about breast and cervical cancer screening and prevention among women in rural Ethiopia, to determine the level of knowledge about female cancers screening and prevention, to identify factors determining women cancer screening and service utilization among women of eligible population and to describe the clients attitude and practice towards screening for cervical and breast cancer Methods This was a cross sectional study involving women aged 18 years and above in North Showa, Gamogofa and Afar 1 and 3 zones. The sample size was 800 and multistage systematic random sampling was used. Questionnaire data was captured in EpiData9 and exported to Stata10 for statistical analysis. Results The response rate was 99.9%. The findings reflect a poor level of knowledge about cervical and breast cancer. Older women with higher level of education and currently employed were found to be predictors of above average knowledge of cervical and breast cancer. Only 12% of the survey participants responded that HPV is a risk factor for cervical cancer. Conclusion and recommendation The results from this baseline study highlight the lack of knowledge about cervical and breast cancer. There is an urgent necessity to inform Ethiopian women about cervical and breast cancer screening. Efforts to promote knowledge on risk factors of female cancers should reach out to all women and men and provide health education as well as community-based interventions.

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WEPE24 Challenges of hypertension diagnosis in urban informal settlement, Kibera slum in Kenya Tecla Namusonge Amref Health Africa, Kenya Background Hypertension is the leading cause of Non Communicable Diseases (NCDs) related morbidity and mortality in Kenya with the prevalence of elevated BP in Kenya at 23.8%. In a bid to address this burden, the Ministry of Health developed a protocol for management of hypertension which states that an elevated BP reading should be confirmed on three separate occasions for diagnosis of hypertension to be made. The objective of this study is to evaluate hypertension diagnosis following initial BP screening in Kibera Informal Settlement. Methodology This is a retrospective cohort study where clients reached with hypertension screening through the Healthy Heart Africa Project between October 2015 and March 2016 were followed up for diagnosis. Data was recorded in manual linkage registers and analysis done for individuals with initially elevated BP who came for subsequent readings until final diagnosis. Convergent parallel which is a mixed method design was used. This method was effective in the collection, analysis and interpretation of both qualitative and quantitative data. The method benefited the study in generalizing the collected data across health facilities and the community. The design aided in explaining particular phenomenonâ&#x20AC;&#x2122;s on hypertension diagnosis by determining the relationships between the variables within the population. Results A total of 34,779 people were screened, out of whom 6,150 (17.7%) had an initially high BP. Only 1,972 (32%) of clients with an elevated BP returned for subsequent readings and completed the diagnosis process. Overall, only 27% (1667) of clients with elevated BP were confirmed to have hypertension. Conclusion and Recommendations There was a high attrition rate along the hypertension diagnosis process. The long diagnostic process posed a challenge for hypertension management in this highly mobile population. Strengthening the diagnosis process within this population will be an adoption of an electronic medical records system.

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WEPE25 Health Seeking Behavior among nurses working in public hospitals in Kakamega County, Kenya Nebert Kiguhe Nairobi Hospital, Kenya Background Nurses are knowledgeable about disease and its treatment and as gate keepers of health they are expected to seek formal treatment when they are taken ill because this is what they teach and expect of their patients. There is evidence that nurses engage in self treatment and kerb side consultations, a complete contrast of what they expect of their patients. It is in this regard that a cross-sectional study with the main objective of exploring health seeking behaviour among nurses working in public hospitals in Kakamega County was conducted. Methods Data was collected using self administered questionnaires and subjected to univariate, bivariate and regression analysis. Results The study found that 62% (n=116) of the nurses utilized formal health care when they were last ill, 33% (n=61)) engaged in voluntary screening services and 34.8% (n=65) said that they knew their health would be better if they engaged in health promotion activities. Majority, 70% (n=81) of the females utilized formal health services as opposed to 30% (n=35) of the males. Increasing nursing education seemed to drive informal treatment, as 79.3% (n=92) of those with a diploma and below utilized formal care as opposed to 20.7% (n=24) of the nurses with a higher diploma and above. Further, there was a significant association between predisposing factors of number of years worked as a nurse (xÂ˛ = 6.072, df= 1, p=0.014); and support nurses receive from the immediate supervisor (xÂ˛ = 5.068, df= 1, p=0.024) with health seeking behavior. Conclusion The study concluded that the predisposing and enabling factors are significant in explaining the health seeking behavior of nurses in Kakamega County and recommends empowering young and male nurses to utilize formal care through education. It also recommends that the County involves nurses in decision making regarding investing in quality health care.

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WEPE26 Hand Washing: A powerful Weapon to Prevention of Diahorrea amongst School Going Children in Gulu, Kitgum and Pader Northern Uganda Teo Namata Amref Health Africa, Uganda Introduction Hand washing with soap is proved scientifically to be effective in reducing the occurrence of diarrhea diseases. Hand washing with soap at critical moments has also been proved to be cost effective and high impact intervention that can contribute significantly to reduction of child morbidity and mortality due to diarrhea diseases. However, despite its life saving potential, hand washing with soap is seldom practiced and difficult to promote. For example, Uganda national coverage for hand washing stands at 29% for rural areas and 31% for urban. This paper therefore seeks to address challenges in practicing hand washing. Methods Employed integrated approach in hygiene promotion. Targeted children as â&#x20AC;&#x2DC;agents of changeâ&#x20AC;&#x2122;. Mobilization and sensitization of targeted communities on the importance of hand washing with soap, demonstration of tippy tap making and calculation of medical bills resulting from diarrhea diseases and time lost. Results Hand washing stations installed in schools and communities are in use. This has resulted into reduced incidences of diahorrea occurrence from 5 to 1 a week as per medical records in Boro Parish thus reduced expenditure on medication. This has led to increase in school daily attendance by pupils (from 2018 to 2048 daily at Vanguard P/S) (attendance records) Lessons learnt and Recommendations Music, dance and drama should be used to attract big mass of communities to participate in hand washing campaign. Community members are willingness to wash hands especially after the toilet. Therefore, reminders are very important for strengthening the practice. Conclusion Turning hand washing with soap at critical times into an ingrained habit could save more lives than any single vaccine or medical intervention, cutting deaths from diarrhea by almost half. Key words Hand washing, Diarrhea

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WEPE27 Increasing Access to Improved Medical, Surgical, Diagnostic and Nutrition Services to Disadvantaged Communities: A case of South Sudanese Refugees in Gambella Region of Ethiopia Abdo Abdulkadir Amref Health Africa, Ethiopia Issue Gambella region is home for its 420000 population and 272721 south Sudanese refugees. Health system of the region has been challenged in terms of capacity in health infrastructure, human resource, referral network and pharmaceutical supply. Presence of refugees posed addition pressure on the health system.The nutritional situation of the region was rated as â&#x20AC;&#x2DC;criticalâ&#x20AC;&#x2122;. This program experience shows effort to improve this dire situation from Aug 2014 to Nov 2015. Description Putting host community and the refugees at the centre, Amref implemented a three pronged strategy which includes building community capacity; strengthening the health system and finally improving the nutrition services. Key interventions include Health promotion sessions; Hospital cleanliness and safety initiative; supply of medical equipment and essential drugs; Operation room renovation and one ambulance donation. Furthermore, tailored health professionals trainings; clinical outreach campaigns in which specialists and subspecialists have been mobilized. As a result, 4760 specialist consultations and 1151 surgical operation have been delivered. South Sudanese refugees make over one fourth of all clients served. In addition Ultrasound (115), Anesthesia support (552), Emergency room services (3,465) and laboratory services (18,893) have been supported. 62.4 meteric tone of supplimentary feeding and 5000 liter oil has been distributed to 1823 children, 1348 pregnant women and 1541 lactating mothers. 11 health centers supported have treated 476 severe malnutrition cases. Integrated interventions targeted at the community and health system is proven to improve demand for health services while significantly change the supply side. To see major change to access and quality of health system there is a need to sustain the interventions. Next steps To sustain the results of the intervention and consolidate the gains from the initial phase, the project has been extended for another one year.

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WEPE28 Community Contribution to Tuberculosis Case Finding and Treatment Success through Civil Society Organizations: Lessons from Nandi East Sub-County Jack Nyaliech , Margaret Kerich , Sam Rop , Arnold Otieno , Mercy Tsimbiko , Magdalene Mangut 1

Ministry of Health- Nandi County, NEPHAK, Amref Health Africa in Kenya 2

Background World Health Organization’s End TB strategy adopted in 2014 outlines partnership with various stakeholders as a key principle in TB case finding and treatment success. Globally, 37.5% of TB cases go undetected, while in Kenya, 20% of TB cases go undetected annually. Kenya National Strategic Plan (NSP) on Tuberculosis, Leprosy and Lung Diseases 2015 – 2018 recognizes the role of the community and Civil Society Organizations (CSO’s) in combating TB. In Nandi East Sub-County there has been a gap in community involvement though CSO’s. Network of people living with HIV/ AIDs in Kenya (NEPHAK) has been engaging the community in fighting TB since 2015. This has seen a gradual increase in the number of TB cases notified, number of successful treatment outcomes and a decrease in lost to follow up cases. Methods 2013 to 2015 data for TB patients notified in TIBU, a case based electronic system, was extracted then analyzed for trends in number of cases notified, treatment outcomes and lost to follow up. Descriptive statistics was used to quantify proportions of patients number notified through Community Health Volunteers referral and treatment outcomes. Results According to case finding analysis, in 2013, 1% (2) were referred by CHVs, in 2014 CHV referrals were 0.8% (1) and while in 2015 CHV referrals increased to 11% (15). Treatment success rate gradually improved from 81% in 2013, to 88% in 2014 and 91% in 2015. The number of cases lost to follow up gradually decreased from 10.5 % in 2013 to 2.5 % in 2014 and 1.45% in 2015. Conclusion and Recommendation CSO’s working with CHVs play an important role in engaging communities to find the missing cases, improve treatment success and reduce loss to follow up. The Kenya’s National TB Programme should consider strengthening the role of CSOs to engage communities in an effort to end TB by 2035.

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WEPE29 The unmet nutritional needs of cancer patients: challenges and opportunities for action Lydia Kaduka , Zipporah Bukania , Richard Mutisya , Yvonne Opanga , Ann Korir , Veronicah Thuita , 1 5 Catherine Nyongesa4, Moses Mwangi , Erastus Muniu1, Charles Mbakaya 1

Kenya Medical Research Institute, Kenya, Kenya Cancer Association, Kenyatta National Hospital, 4 5 Texas Cancer Centre, Rongo University 2

Background Malnutrition often occurs in cancer patients due to a variety of mechanisms involving the tumor, host response and anticancer therapies. This has necessitated integration of nutrition interventions in cancer treatment as outlined in the national guidelines for cancer management in Kenya. Objective To assess nutrition status and dietary practices of cancer patients and existing nutrition interventions in cancer treatment centres. Methods A cross-sectional study done at Kenyatta National Hospital (KNH) and Texas Cancer Centre (TCC). A structured questionnaire was used to collect data on socio-demographic characteristics. Assessments included anthropometry, body composition and dietary diversity. Study permission was obtained from KEMRI and KNH ethical review committees. Results Up to 512 participants (f: 368 (71.9%); m: 144 (28.1%)) were assessed. The leading cancers were breast (39.7%) and cervical cancer (25%) in females and prostate (16.7%) and oesophagus (16.7%) in men. Up to 28.2%, 26.8% and 23.8% participants had stage 3, 2 and 1 cancer, and 43%, 38.9% and 18.1% were on one, two and three forms of cancer treatments respectively. Fatigue and poor appetite were common symptoms experienced within 24 hours at 38.3% and 32.4% and one month at 50% and 51% respectively. 43.1% were obese and 14% underweight. 47.3% had increased risk of developing metabolic complications while 43.1% were at risk of cormobid diseases. The mean body water, average total body fat and average total lean mass was 52.4+9.4, 35+10 and 65+10 respectively. The mean dietary score was 14.4+5.6 with significant differences observed across sex. Only 18.6% participants reportedly received nutrition interventions in form of nutrition counselling and education. Conclusions There is need for targeted nutritional support based on nutritional and clinical status, treatment and expected outcomes; enhanced education and counselling on lifestyle and dietary practice; and addressing comorbidities associated with malnutrition for improved clinical outcomes and quality of life.

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WEPE30 The role of community health workers in tackling malnutrition of under five children: experience from Rwanda Hubert Habineza University of Rwanda Background Malnutrition covers two groups of conditions: obesity and under nutrition, almost half of all children under 5 deaths globally are linked to under nutrition, explaining loss of about 3 millions of young lives a year. 209 out of 667 children under 5 worldwide are undernourished, 34 countries that account for 90% of global burden of malnutrition, 22 are in Africa including Rwanda, a developing country. Its new national health strategic plan for eliminating malnutrition focused on community approach system. This study aims to highlight the role of community health workers in fighting childhood malnutrition in Rwanda and also to generate some recommendations. Methods Multiple approacheswere employed, including online article review, field observation and discussions and reports review. Results Country Data of 2005 for children under five before that intervention showed that 51% of them were stunted, 5% were wasted and 18% were underweight but since 2009, community health workers have intervened in nutrition screening activities at community level and they have been involved in transferring vulnerable children to specialized centers, to get therapeutic milk or therapeutic foods. In 2010, only 44% were found to be stunted, 3% were wasted and 11% were under weight. In 2014, the percentage of stunting, wasting and underweighting were decreased to 38%; 2%; 9%, respectively and from 2009 a decline from 8.3% to 1.08% of severely malnourished under five children was observed Conclusion and recommendations Obviously, based on outstanding outcomes mentioned above, community health workers contribution is well remarkable and also cost effective method for fighting malnutrition. Therefore I recommend health policy makers and health care professionals to create, strengthen and support this approach for the sake of children health.

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WEPE31 Early malnutrition in Africa: A solid legacy of non-communicable diseases Ntacyabukura Blaise University of Rwanda Background Over 4 in 10 children under the age of 5 in South Asia and Sub-Saharan Africa are undernourished. They pass through multiple deprivations of food intake, care and play, clean water, good sanitation and adequate health care, consequently, they become stunted and wasted. Although early childhood under nutrition is rarely mentioned as the direct cause of deaths and poverty, it contributes to more than a half of deaths in children worldwide, depresses GDP and is significantly associated with chronic diseases later in life. Objective The aim of this studywas to highlight the late health consequences that early malnutrition predispose many Africans, where this problem is lightly addressed. Methods Internet based research, where we reviewed medical literature about ‘sub-Sahara Africa’ Early Under nutrition’ ‘ under nutrition as a cause of morbidity and mortality’ ‘epidemiological transition’ and ‘Health outcome’ as the key words. Results Increasing the first 1000 day window is not only an opportunity to prevent under nutrition, but also to prevent overweight and the onset of chronic disease later in life, for example an effective way to address childhood obesity is to ensure feeding patterns, very early in life, to reduce stunting by promoting height gain. Overweight and obesity are key risks for chronic diseases later in life, such as diabetes, hypertension and some forms of heart disease. Early postnatal malnutrition also causes alteration in motivation and reactivity and decrease cognitive flexibility as early brain development is threatened. It increases the susceptibility to infection, which in turn increases nutrient requirements and depresses appetite, making the immune system weaker and delay recovery from diseases hence poor prognosis, sequelae, frequently hospitalization and chronically ill status. Conclusion and Recommendations Based on different evidences, under nutrition provides important background to late health threatening conditions, which keeps increases morbidity in our communities and there after poverty keep increasing, and the sustainable development become unapproachable. African policy makers should emphasize to the prevention of under nutrition in mothers and young children as their first approach to prevention of NCDs.

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WEPE32 HAART has no causal effect on Incidence of Systemic Hypertension among HIV/AIDS Infected patients: Retrospective Cohort study Alemu Debiso Arba Minch University, Ethiopia Background Growing body of epidemiologic evidence suggests that there are a number of modifiable risk factors that lead to increased incidence of hypertension in low income countries. Besides; highly active antiretroviral treatments (HAART) are believed to be increasing the risk of hypertension in HIV patients. But studies disagree as to whether there are a greater incidence of hypertension among HIV/AIDS patients and the role of antiretroviral therapy. Objectives The aim of the study was to assess the incidence and predictors of systemic hypertension among cohort of HIV patients who have follow up at health institution of Gamo Gofa zone Method and Materials The Study was conducted in public health institution of Gamo-Gofa zone by using Retrospective cohort study design. Simple random sampling techniques with stratified sampling with proportional to size allocation were used to select HIV patients. The data was collected by Registered ART nurses, by using structured questionnaire which was adapted from the WHO STEPS instrument. The data were cleaned to check for its completeness, consistency and the presence of missed values and variables, and then it was entered into a pre-designed format in Epi-Info version 7 and transferred to SPSS version 21 and Stata for further analysis. Frequencies, Mean, median, quartile and standard deviation were used to describe the data. After necessary assumption of logistic regression model was checked, bivariable and multiple logistic regression models were fitted to see the predictors of hypertension. Result A total of 834 HIV/AIDS infected (95.4% response rate) were included in this study. The mean systolic and diastolic BP were 115.7mmHg (Âą16.1 SD) and 74.9 mmHg (Âą12.4 SD). The cumulative incidence of hypertension was 20.1% (95% CI: 19.9-20.03), in equal proportion in Pre-HAART (10.1%) and HAART (10.0%) receiving patients. The study revealed modifiable; monthly income (AOR; 2.26, 95% CI (1.26, 4.05), Occupational status 64 % (AOR, 0.36, 95% CI; (0.17, 0.78)), Body mass index (AOR: 12.6, (95% CI: 5.32, 29.8), and regular activities (AOR, 4.91, 95%CI, (1.12, 21.6) and non modifiable Family history of hypertension (AOR: 2.18, 95% CI: 1.32, 3.58) as important predictors of hypertension.

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Conclusion and Recommendation There was high incidence of hypertension among HIV infected patients which may reflect insights for intervention, so that respective bodies focusing on life style modification, like practicing regular exercise to prevent occurrence of Systemic Hypertension among HIV/AIDS Infected patients. The investigators also fail to reject the null hypothesis that there is no association between HAART intervention and Incidence of Hypertension. Key Word HAART, HIV/AIDS, Incidence, Predictors, Systemic Hypertension.

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WEPE33 Rwanda towards elimination of new pediatric HIV infections using Prevention of Mother to child Transmission services Oda Ngirabeza University of Rwanda Background Rwanda launched the services of prevention of Mother to Child transmission (PMTCT) activities in 2001 with the main goals that included: Scaling up health facilities offering PMTCT services, increasing the number of pregnant women receiving PMTCT services, providing ARV (Anti retroviral) prophylaxis to pregnant women in need, ensuring adequate maternity and infant follow-up, following discordant couples and availing family planning services. Strategies used include equipping health facilities for PMTCT, training of staff, supervision and mentorship, supply of reagents and ARVs and community mobilization. Methods A literature review was conducted using Pub Med, RDHS database and google scholar. In total, 10 manuscripts met inclusion criteria:6 studies on PMTCT services approach were analysed ,4 supporting documents regarding PMTCT services elaborated by the Rwandan ministry of health. Findings 94.5% of health facilities in Rwanda are offering PMTCT services with national coverage with 98% of pregnant women attending antenatal care being counselled and tested for HIV. Among 98.2% of women tested for unknown HIV status, 1.6% were found to be HIV positive and given ARVs for life. There is an increased rate of delivery at health facilities as out of 7303 HIV positive pregnant women expected to deliver in health facility, 7020 actually delivered in health facility and 371 delivered at home but notified at health facility. Their babies are also enrolled for follow-up. During immunization visits, HIV exposed infants are identified and sent for PCR and other appropriate follow-up. The percentage of male partners of pregnant women testing in PMTCT program increased from 16% to 84% from July 2002 to June 2012.As a result the prevalence of HIV infection among children aged 18 months decreased from 10.8% in 2005 to 1.83% in 2015. Conclusion Compared to countries like Thailand, Belarus, Republic of Maldova, Armenia and Cuba that have successfully eliminated mother to child transmission, Rwanda is on the track to eliminate mother to child transmission. The review suggests that elimination of mother to child transmission is possible in resource-limited settings and that African countries can learn from Rwanda in setting up and running PMTCT services.

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WEPE34 Physico chemical characteristics of oil consumed at the household level Edna Ndau Sokoine University of Agriculture, Tanzania Background In Tanzania, vegetable oils constitute about 80-85% of the edible oils and fats but very little is known about their quality with respect to public health. Physico-chemical properties namely; refractive index, free fatty acids, acid, peroxide and anisidine values of the oil consumed at the households in Manyara and Shinyanga regions of Tanzania were determined. Methods A total of 320 samples were collected. These oil properties were determined using standard procedures of the Association of Official Analytical Chemists (AOAC). Results In Manyara, 89% of households consumed vegetable oil whereas in Shinyanga 95% of households consumed palm oil. Consumption of poor quality oil can lead to negative health outcomes for children and adults. The physico-chemical properties of the sample oils consumed were compared with standard values recommended by the Codex Alimentarius Commission of FAO/WHO and with other published results. Conclusion The findings are important since good quality of oil is essential for health benefits, specifically for normal growth and development, and may play an important role in the prevention and treatment of coronary artery disease, hypertension, diabetics, arthritis, other inflammatory and autoimmune disorders and cancer.

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WEPE35 Determinants of quality of service in managing malaria by community health volunteers, Bungoma County, Kenya Enock Marita , Oule J., Mungai M., Gichuki R., Musembi E., Jerop M., Ndirangu M., Kandie J., Okutoyi C., Nduri M., Manyonge L., Karanja S. 1

Amref Health Africa, Kenya

Background Kenya adopted World Health Organizationâ&#x20AC;&#x2122;s recommendation of community case management of malaria (CCMM). CCMM has been implemented in Western Kenya and little or no information is available on quality of services provided by community health volunteers (CHVs). This study assessed determinants of CHVâ&#x20AC;&#x2122;s quality of service in CCMM. Methods This was cross sectional study observing 147 randomly selected trained CHVs managing at least three clients and thereafter questionnaire administered. Chi-square tests were performed to determine factors associated with quality of service with level of significance set at 0.05. Results Majority (62%) of the CHVs were found to offer quality services. Among several factors, three were found to be associated with quality of services offered by CHVs including; stock outs of Artemether lumefantrine (AL) (P=0.037), stock outs of rapid diagnostic test kits (RDTs) (P=0.001) and ever had support supervision (P=0.007). CHVs who had ever had supervision were 4 times more likely to perform better than those not supervised (OR=4.2, 95% CI (1.38-12.85)). Conclusion Majority CHVs offered quality services in CCMM. Uninterrupted supply of RDTs, ALs and provision of supervision are essential in the performance of CHVs in CCMM.

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WEPE36 Infection prevention among community health volunteers managing uncomplicated malaria in communities of Bungoma County, Kenya Enock Marita , Karanja S. , Gichuki R. , Ndirangu M. , Mungai M. , Oule J. , Musombi E. , Nduri M. , 1 1 1 1 1 1 2 Manyonge L. , Jerop M. , Kandie J. , Okutoyi C. , Koech T. , Machache E. , Bakyaita N. , Machini 3 1 B. , Carter J. 1

Amref Health Africa, Nairobi, Kenya, World Health Organization, Nairobi, Kenya, Ministry of Health, National Malaria Control Program, Nairobi, Kenya

Background Infection prevention is important at all levels of health care. In the fight against malaria, Kenya adopted the World Health Organization’s recommendation of community case management of uncomplicated malaria in 2012. This concept is being implemented by Amref Health Africa with support from Global Fund from 2012 to 2017. Since little or no information on infection prevention among community health volunteers (CHVs) who offer community case management of uncomplicated malaria is known, this study sought to establish safety and infection prevention levels during testing for malaria using Rapid Diagnostic Tests (RDT). Methods A cross-sectional study was conducted among 147 randomly selected CHVs in Bungoma County, Kenya in October, 2015. Direct observation was made during performance of malaria RDT followed by administering of a structured questionnaire. Data were analyzed descriptively. Results Under observation, 31.1% CHVs used disposable gloves satisfactorily compared to 3.4% who did not use gloves satisfactorily; in 65.5% gloves were not available. About 26.7%, 51.4% and 21.9% CHVs reported to “always”, “sometimes” and “never” use gloves respectively. Skin disinfection at the puncture site using an alcohol swab was done for 98.7% of patients; however in 22% of these, the procedure was not carried out correctly. In 1.3% patients, no skin disinfection was done. Disposing of contaminated items was only done correctly in 24.7% of cases. Needle stick injuries were reported by 3.4% CHVs. CHVs supervised at least monthly and quarterly were 76%, and 13% respectively while 11% were never supervised. Conclusion There were major safety and infection prevention gaps that needed urgent intervention; some gaps could be managed during support supervision. As a result of this study, the Kenya Ministry of Health with support from Amref Health Africa and other partners developed National Biosafety Guidelines for Malaria Rapid Diagnostic Testing at Community Level including an appropriate model for healthcare waste disposal for CHVs which is expected to be rolled out in 2016.

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WEPE37 Spatial Patterns of Childhood Diarrhea in Ethiopia: Evidence from Ethiopia Demographic and Health Surveys (2000, 2005, 2011) Getahun Bogale, Kassahun Gelaye, Degefie Degefie, Yalemzewod Gelaw Ethiopia Background Childhood diarrhea is a major public health problem, worthily in Sub-Saharan African countries including Ethiopia. Exploring the spatial pattern of diarrhea is important to identify where the disease is clustered. This study analyzes the spatial patterns and hotspot identification of childhood diarrhea in Ethiopia. Objective The aim of this study was to assess the extent of spatial patterns of childhood diarrhea in Ethiopia by taking three consecutive Ethiopia Demographic and Health Surveys (DHS) data. Methods A total of 29,358 under-five children were extracted from a database of three consecutive demographic and health surveys (2000, 2005, and 2011) of the country and included to the study. Local Moranâ&#x20AC;&#x2122;s I was used to measure positively correlated (high-high and low-low clusters) or negatively correlated (high-low cluster and low-high clusters) of high values (High-High), cluster of low values (Low-Low). Bernoulli Probability model was used to identify the clusters of childhood diarrhea. Results The spatial clusters of childhood diarrhea were detected at national level in all study periods (Moranâ&#x20AC;&#x2122;s I: 0.3830-1.3296, p<0.05). Significant regional differences in the incidence of diarrheal disease with explicit survey time were revealed. The statistical analysis showed that SNNP, West Oromia, and Gambela regions (Log Likelihood Ratio (LLR): 55.37, p<0.001 for 2000), SNNP region (LLR: 45.69, p<0.001 in 2005), and Gambela, West SNNP and Oromia, and Benshangul-Gumuz regions (LLR: 51.09, p<0.001 in 2011) were highly diarrhea affected areas. Conclusion and recommendation This study identified that childhood diarrhea exhibited significant spatial variation over the past one decade in the country. An understanding of the risk areas can help design effective interventions to reduce childhood diarrhea in these areas. Keywords Childhood, Cluster, Diarrhea, Pattern, Spatial, Ethiopia

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WEPE38 Influence of psychosocial factors on alcoholism rehabilitation of alcoholics of selected Kenyaâ&#x20AC;&#x2122;s rehabilitation centres Lucy Mutuli Masinde Muliro University of Science and Technology, Kenya Background Alcoholism is a global problem as the alcoholics become a social misfit and an economic burden to the society. In Kenya much resources has been invested in addressing alcoholism. Presently, there are an increased number of rehabilitation centers, increased budgetary allocation on alcoholic treatment and prevention. However, despite the existence of all these resources and structures, Kenya is still experiencing a high prevalence of alcoholism revealed through significant adverse health outcomes to diminished production in all sectors of the economy, insecurity and nonattainment of development goals. Objective This cross-sectional study aimed at eliciting the factors that affect treatment of alcoholics during the rehabilitation process of three months. Methods Purposive sampling was used to select three rehabilitation centers from a total of 10 in Nairobi County. Focus group discussions collected Qualitative data from key informants during April to June, 2016. Content analysis was utilized for data analysis. Results Data was categorized as attitudinal beliefs, normative beliefs and control beliefs which either inhibited or facilitated the rehabilitation process of alcoholics during the three months. Attitudinal beliefs were reported to significantly affect rehabilitation of alcoholics at (p=0.952) with a >0.05 alpha level. Conclusion Alcoholics attitude which is the developed from perceived advantages and disadvantages of alcoholism rehabilitation can either enhance or inhibit effective alcohol rehabilitation. Recommendation Itâ&#x20AC;&#x2122;s crucial for policy planners, NACADA and treatment providers to understand the psychosocial factors affecting alcoholism rehabilitation before designing programs and materials for alcohol rehabilitation. Since an alcoholicâ&#x20AC;&#x2122;s decision to effective alcoholism rehabilitation is determined by a combination of psychosocial factors that include attitude, subjective norm and perceived behavioral control which need to be identified and assessed.

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WEPE39 Progress on Trachoma Trichiasis Surgeries intervention in Mangochi district in Malawi Young Samanyika , Joachim Osur , Boniface Hlabano 1

Amref Health Africa, Malawi, 2Amref Health Africa HQ, Amref Health Africa in South Africa

Issue The project is addressing high prevalence of Trachoma Trichiasis (TT) in Mangochi district in Malawi. Description of the intervention Before the onset of the trachoma elimination project, it was estimated that more than 12,500 people had TT in the endemic districts of Malawi which, without treatment, would have led to blindness. Amref Health Africa - Malawi is supporting Mangochi district, which is one of the endemic districts using the Queen Elizabeth Diamond Jubilee Trust (QEDJT) funds. It is expected that a total of 615 TT cases should be managed Mangochi district in order to reach elimination threshold of < 0.1% prevalence by 2017. The surgeries component of project involves TT Case mobilization and provision of surgery services through outreaches/camps that are conducted at health centre level. Results of TT surgery outreaches So far as of July, 2016, a total of 434 cases have been managed through surgeries, epilation and merely offer of surgery services to all cases that require them (though some refuse). This represents a 71% achievement towards the Ultimate Intervention Goal (UIG). Lessons learnt and recommendations No one approach is perfect and efficient in TT case finding. There is always need for flexibility. It is necessary to tackle the district in portions, this helps identifying hot spots for the TT cases. Conducting the surgeries close to the people encourages them to come for services. Bad surgery outcomes of TT as well as of other conditions like cataract contribute to high rate of refusals. Quality assurance in surgeries is therefore very important. It is important to motivate TT case finders to encourage them to be doing case finding.

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WEPE40 Factors associated with delayed HIV diagnosis in infants in tier three and four public health facilities in Kisumu County, Kenya Collins Wangulu Kenyatta National Hospital & AAR Healthcare (K) Ltd, Kenya Background HIV and AIDS still remains a global challenge, with the bulk of infection in children being in subSaharan Africa. Kisumu County has one of the highest HIV prevalence (15%) in Kenya. Few(37%) of eligible HIV infected children in the county are on care and treatment due to delayed HIV diagnosis among HIV sero-exposed infants and has led to a higher under five morbidity and mortality than the national average. Objectives The study was to determine factors associated with delayed infant HIV diagnosis of sero-exposed infants in tier three and four public health facilities in Kisumu County, Kenya. Specifically, it sought to establish the caregiver-infant factors associated with delayed infant HIV diagnosis, to determine the health worker factors associated with delayed infant HIV diagnosis and to find out the health facility organizational factors associated with delayed infant HIV diagnosis Methods The study was a cross-sectional survey conducted between September and December, 2015 within tier three and four public health facilities (n=7) in Kisumu County, Kenya. Systematically sampled caregivers (n=224) of HIV exposed children attending their routine clinics at the facilities, all health workers (n=51) working in Maternal and Child Health (MCH) department and administrators (n=7) of the health facilities were interviewed. Data was collected using structured questionnaires and analyzed using chi-square, Studentâ&#x20AC;&#x2122;s t-test and multiple logistic regression analysis. Results & Conclusion Delayed infant HIV diagnosis was independently associated with lower level of schooling (OR: 6.3, 95% CI: 1.5-26.0; p=0.011), lack of knowledge of mother-to-child transmission of HIV (OR: 11.5, 95% CI: 3.7-36.1; p<0.001) and non-disclosure to persons other than relatives (OR: 6.0, 95% CI: 2.0-7.4; p=0.001). Reduced likelihood of delay was associated with an increased work relationship score among health workers (OR: 0.02, 95% CI: 0.00-0.71; p=0.032) and evaluation of targets score (OR: 0.94, 95% CI: 0.89-0.99; p=0.015) within health facilities. Other factors that could further delay infant HIV diagnosis in Kisumu County include long distance to central testing laboratories from facilities, sample transport using courier services, physical paper based result delivery and use of clinic appointments for feedback Recommendations Kisumu County Government needs to empower women through promoting girl child education and overcome information gaps and social fears about HIV through health education. Public health facilities need to promote good inter-personal relationships among health workers and adopt a human resources performance management system. More studies are needed to assess other factors that could further delay infant HIV diagnosis 248

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WEPE41 Beyond the Global Nutrition Report 2015: Opportunities for Kenya within the UN Decade of Action on Nutrition Benjamin Masila Public Health Officers and Technicians Council, Kenya During the last two decades, 200 million have been lifted out of hunger and prevalence of chronic malnutrition in children reduced from 40% to 26%. Among the most significant impacts of climate change is the potential increase of food insecurity and malnutrition. Good nutrition provides a vital foundation for human development for meeting our full potential. When nutrition status improves, it leads to positive outcomes for individuals and families. The second ICN 2014 commits to raise the profile of nutrition within relevant national strategies, policies, and align national resources accordingly. Malnutrition in Kenya remains a big public health problem: high stunting rates (35%), a current rise in diet-related non-communicable diseases, like diabetes, cancers, kidney and liver complications. Kenya is the only country in Africa on course to meet all five WHA maternal and child nutrition 2025 targets. Progress on stunting is noteworthy with great overall progress made but it is uneven and could occur faster through strong political commitment; supportive contexts with notable poverty reduction; improvements in womenâ&#x20AC;&#x2122;s empowerment; improved performance of specific nutrition practices and programs. On 1st April 2016 the UNGA proclaimed the UN Decade of Action on Nutrition, 2016-2025, to trigger intensified action to end hunger; eradicate malnutrition worldwide; ensure universal access to healthier and more sustainable diets for all people. This paper discusses the accelerated progress opportunities for Kenya in finding pathways to nutrition and food security resilience in response to climate change in East Africa within the UN Decade of Action on Nutrition and the SDGs.

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WEPE42 Hepatitis B and hepatitis C virus co-infection with HIV among HIV Testing and Counseling attendees in Tanzania: A retrospective study David Ocheng , George Mgomella , Sagamo Mattaro , Mwanakombo Khama , Lusungu Ngailo , 1 1 1 1 1 3 Alex Msauka , Amos Nyirenda , David Ngilangwa , Rita Noronha , Florence Temu , Festus Ilako , 3 4 Jane Carter , Maarten Mulder 1

Amref Health Africa, Tanzania, University of Cambridge, UK, Amref Health Africa Headquarters, 4 Kenya, Amref Flying Doctors, Netherlands

Background Hepatitis B and C viruses co-infection is known to influence progression, management and outcome of human immunodeficiency (HIV) infection. However, there is limited published data in Tanzania on the prevalence of HIV and hepatitis co-infection. Moreover, hepatitis is not routinely tested but only done as part of blood safety requirement. Methods This cross-sectional study tested frozen stored serum from routine blood samples collected from 2,058 clients attending 27 (51.9%) out of 52 ANGAZA HIV Testing and Counseling (HTC) sites in Mainland Tanzania from December 2001 to June 2009; a period of 91 months were tested for HIV, HBsAg and HCV serology. According to ANGAZA HTC HIV rapid testing protocol, all 5th reactive (positive) and 20th non-reactive (negative) sampleswere submitted to AmrefHealth Africa Laboratory in Dar es Salaam as part of the EQA retesting programme to assure the quality of HIV rapid testing. At the HTC sites, HIV rapid testing was performed in accordance with National HIV rapid testing algorithm, while retesting in the Laboratory used the 4th generation ELISA tests. Overall there was a very good concordance of 98.9% between sites HIV rapid test and ELISA test results. In Tanzania, non-laboratory staff primarily performs HIV rapid testing as part of a government approved task sharing to ensure HTC services reach many people. Descriptive and inferential data analysis using Stata 12 were conducted. Results Antibodies to HIV, HBsAg and HCV were tested in 2,058 frozen stored samples. HIV, HBsAg and HCV antibodies were detected in 24.8%, 2.5% and 10.7% of samples respectively. Dual co-infection with HBV and HCV was presenting four sera (1.8%); HIV co-infection with HBV was detected in 61 sera (27.6%); and HIV co-infection with HCV was detected in 14 sera (2.7%). None of the sera tested had all two viruses present. Conclusion There is a high prevalence of HIV, HBV and HCV infection among HTC attendees in Tanzania. Efforts to scale up prevention HIV care, treatment and control programmes in the country should also seek to address HBV and HCV co-infection, and especially as improved treatment regimens for viral hepatitis infection are currently available.

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WEPE43 Assessment of WASH in Slums of Akaki-Kality and Yeka Sub Cities of Addis Ababa Moges Yohannes , Wosen Mariam , Admasu Tsadik , Lisan Tena 1

Lielena Research and Development Consultancy, Ethiopia, Amref Health Africa in Ethiopia 2

Background Amref Health Africa in Ethiopia designed a project to improve water, sanitation and hygiene (WASH), and increasing livelihood opportunities for communities living in slum areas of Akaki and Yeka subcities of Addis Ababa. The objective of this assessment was to gather and document benchmark information that will help to measure the changes through the contribution of the project in relation to WASH and livelihood opportunities. Methods A cross-sectional study design with both quantitative and qualitative data collection methods was used. The information gathered using survey questionnaire among 691 households employing two stage cluster sampling method, 15 FGD (Focus Group Discussion) and 18 KII (Key Informant Interview) was made with government and community representatives, solid waste collection groups, and students. The quantitative and qualitative data was analyzed using SPSS Version 20 and thematic content analysis respectively. Results Nearly 70.3% had access to water facilities within â&#x2030;¤500 meters radius, 72.6% of the households had access to toilet facilities and 65.5% of them used shared latrines. Only 13 % of the households have designated place for hand washing with water and soap near latrines. Hand washing practice at five critical times was 56.7%, and 31.4% of them wash their hands after visiting toilet. The incidence of diarrhea over the past two weeks of the survey was 19%. The finding of KII and FGD indicated that the hygiene and sanitation service of schools was poor to accommodate the increasing number of children, and monthly income of waste collectors from waste collection is not enough to support their families. Conclusions and Recommendations The finding of this study revealed that there is a need of improving access to sanitation service provision, awareness creation, capacity building of waste collection groups, and creating an effective enabling environment to address the needs of slum communities and schools.

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WEPE44 Attitudes and practice ofhealth promotion forNon-Communicable Diseases among healthcare workers at Kenyatta National Hospital Elizabeth Kamau , Lambert Nyabola , Richard Ayah 1

University of Nairobi, School of public Health, Kenya

Introduction Briefcounselling in healthcare facilities has been shown to be effective in changing health behaviours. Thus healthcare workers are at a vantage point to provide lifestyle counselling opportunistically during a patient visit. Objective To determine the attitudes and practice of health promotion for non-communicable diseases among healthcare workers at the Kenyatta national hospital. Methods A cross-sectional descriptive study was carried out among doctors and nurses at Kenyatta National Hospital. A mixed method approach was applied where 192 participants were selected through stratified sampling. Data was collected through self-administered questionnaires, where frequency and percentage distributions tables were used to quantitatively describe the study population. Chisquare test was used to evaluate the association between attitudes and practice of health promotion and healthcare workersâ&#x20AC;&#x2122; socio-demographic factors. Twelve respondents were purposively sampled for in-depth interviews. The interviews were transcribed and data analysis was done using content analysis of thematic areas. A narrative approach was used to describe study findings. Results Of the 156 participants, 69.2% were female, the mean age was 36 years. Most of the respondent, 72% demonstrated a positive attitude towards health promotion. Less than half of the respondents inquired about a patientâ&#x20AC;&#x2122;s lifestyle practices during routine visit, while physical activity was the least inquired about practice (17%), while 41% followed up on at risk patients. A comparison between the attitude of healthcare workers and their practice of health promotion was found to be significant (Odds ratio = 3.54, p-value = 0.001). Conclusion Healthcare workers with a positive attitude were three times more likely to have good health promotion practices Recommendation To address the training deficiency of healthcare workers on health promotion for non-communicable diseases, especially on counselling techniques for lifestyle behaviour modification. Additionally, to develop a framework on incorporation of health promotion into clinical practice, this will aid in proactive screening of non-communicable diseases.

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WEPE45 The Experience of Urban WASH Project in Addis Ababa, Ethiopia Hanna Hamela Amref Health Africa, Ethiopia Background Ethiopia is characterized by low sanitation coverage. As a result, 73% of the urban population including the capital city, Addis Ababa use unimproved sanitation facilities. Therefore, urban WASH projects work to increase access to improved sanitation facility. Objective To assess Urban WASH projectâ&#x20AC;&#x2122;s relevance, efficiency, effectiveness and progress in achieving set objectives. Methods A community based cross-sectional study design was employed on August 2015 with sample of 550. Quantitative data was collected using face-to-face interview with 550 respondents who are members of urban slum community (99.6% response rate). Sample size was calculated using single population proportion formula and two-stage stratified random sampling method used to select study participants. The survey was conducted in nine woredas of Addis Ketema, Lideta and Kikos sub-cities. Households were randomly selected using registers of health extension workers as a sampling frame. 19 Key Informants Interviews and six Focus Group Discussions were conducted. Direct observations were held on three communal latrines and shower facilities, two biogas plants and three school latrines constructed by the project. Results The project design addressed pressing hygiene and sanitation need of slum community members and aligns with strategies of the Government of Ethiopia (GoE) and MDGs (Millenium Development Goals). Massive improvement seen on hand washing practice, knowledge of diarrheal disease causes (unhygienic food preparation: 88.9% and contaminated water: 87.5%) and prevention methods (washing hands: 85.3%, using latrine: 56% and drinking safe water: 74.5%).Access to improved latrine facility increased by 20% (51.4% to 73.1%). Majority of respondents improved solid waste storage practice (97.5%) and reusing of solid waste practice increased (4% to 33.6%). Moreover, prevalence of diarrheal disease in two week period preceding the survey reduced from 6.4% to 1.2%. As per the qualitative assessment on the qualitative part sustainability ensured through capacity building and linkage of sanitation facilities with income generating activities. Some sustainability threats include low community participation during sanitation facility construction and government slum area demolishment program. Conclusions The project improved community knowledge on poor hygiene and sanitation disease causes and prevention, increased hand washing practice, improved sanitation facility access and enhanced safe solid waste disposal and reusing practice. It also reduced diarrheal disease prevalence and ensured sustainability. However, gap is observed on liquid waste disposal practice and government partner involvement in initial project design and planning stage. 7-9 March 2017 Nairobi, Kenya

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Recommendations Strengthening government partnersâ&#x20AC;&#x2122; participation at all project cycle stages; strengthen construction work follow up system, increase community participation in project activity implementation and monitoring. Moreover, improve liquid waste disposal practice.

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WEPE46 Successful Partnership between NGOs and Corporates MaqC Eric Gitau , Yulia Koval-Molodtsova , Katinka Lansink 1

UNICEF & dance4life Liaison Kenya , Dance4life International, Netherlands 1

Background Partnerships between NGOs and the private sector have become a major focus in development programs. Joining efforts and sharing responsibilities by governments and businesses to achieve sustainable development has even been included in the UN Sustainable Development Goals. Still little is known about the engagement of the private sector in improving sexual and reproductive health and rights (SRHR) in developing countries. This workshop aims to provide an insight in how dance4life and the Female Health Company have been collaborating successfully on women empowerment since 2015. We will share learning points and conditions for success. Additionally, the NGO participants will do an interactive exercise on how to look at corporate partnerships. Methods There are valuable lessons dance4life and the Female Health Company have learned from their NGOcorporate partnership.We will discuss the model of the five conditions for success founded on 1) trust 2) clarity of partnersâ&#x20AC;&#x2122; values, roles and responsibilities 3) commitment 4) creating opportunities for successful experiences and 5) flexibility and conflict management. We will explain how to broaden a partnership each year: from piloting to solidifying a foundation to a strategic partnership. Based on its experiences and a training, dance4life has created a toolkit on how to create corporate partnerships which will be handed out to the participants afterwards. Results The jointly defined objective of our partnership is to empower and educate young people to make safe sexual choices. Since 2015, the Female Health Company has trained dance4life peereducators in several African countries on safe sex, with special attention to the FC2 Female Condom as an empowerment tool for girls and women to protect themselves from STIs, including HIV, and unplanned pregnancies. We did a joint awareness campaign and we advocated for womenâ&#x20AC;&#x2122;s empowerment. In total we have reached over 11,000 people via trainings and workshops and via social media. In the second year of our partnership we broadened our partnership by making it more strategic; we entered in several alliances. In year three we will focus on joining forces in alliances in several key countries. Key words Partnerships, NGOs-corporates, strengthening efforts

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WEPE47 Building the Capacity of Community and Facility Based Health Workers using the Quality Improvement model: A case for Busia District in Eastern Uganda Evarine Nampewo , Ramadhan Kirunda , Evelyn Akumu , Joshua Thembo , Rose Acen 1

Busia District Health Services, FHI 360, Uganda 2

Issues Uganda is increasing her focus on Community Based service delivery as one of the mechanisms that will contribute to universal access to Health services. However, quantity rather than quality of community based health services still remains the focus for many programs, yet there is sufficient evidence suggesting that quality of health services must be the central focus if universal access to health services is to be achieved. Description In June 2015, APC started establishing the first community-based family planning (CBFP) Center of Excellence (COE) in Busia district. APC adopted a collaborative Quality Improvement model where CHWs were trained as internal coaches and Midwives as mentors of QI. The COE serves as a learning site for other CBFP implementing districts, with a network of 7 QI teams comprised of CHWs, Midwives, health facility incharges, the district family planning focal person and CBFP clients. Focus is on CBFP service standards, generating change ideas, FP compliance, QI principles, plotting data on run charts and interpretation of results. By October 2016, twelve (12) QI Educational coaching sessions had been conducted for each of the teams, using the Plan-Do-Study-Act (PDSA) model. Lessons learnt CBFP QI complements continuous medical educationwhich improves the capabilityand competence of CHWs to offer and midwives to quality control CBFP services, -The focus on quality has a direct positive bearing on retention. CBFP retention rate is higher (71%) than the national rate which is currently at 53% (FP-CIP 2014), -Building a quality improvement culture for CHWs with the involvement of clients increases community confidence in community health services, strengthens the relationship between midwives and CHWs and can potentially strengthen the bigger Health service system. Recommendations Community Based Health programs should adapt the QI model for a stronger health system because of the demonstrated potential to increase uptake of health services at community level.

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WEPE48 Using e-learning to upgrade nurses and midwifes in West Africa Sylla Thiam , Mabator Ndiaye , Alioune Sow , Ibrahima Gueye 1

Amref Health Africa, Senegal

Background With the aim of contributing to reduce maternal, newborn and child mortality by filling the health workforce gap, Amref Health Africa has implemented, since 2013, an e-learning Program called ” Capacity Building Program of Nurses and Midwives’’(CBPNM) in West Africa, in partnership with the West African Health Organization (WAHO) and the Ministries of Health. This program was piloted in Senegal, to upgrade nurses and midwifes via e-learning in order to equip them with new skills, while maintaining them in their workplaces. An external evaluation was conducted to assess the program implementation. Methods A cross sectional study including both qualitative and quantitative data, was used. Data were collected from interviews; focus group discussions and documents review in six regions (out of 14). Results The pilot phase has set up 10 e-learning centers with 22 tutors and 25 teachers recruited. Out of a total of 200 midwives and nurses trained, 165 students (82.5%) succeeded to the final exam in late 2015 and are now qualified with a bachelor degree. The performance of students experienced through the resolution of health problems was the major satisfaction. Conclusion The pilot phase has been successful and the programme is being scaled up in other countries in West Africa such as Ivory Coast; and preparations are in progress in Guinea, and Benin where maturity assessments have already been conducted.

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WEPE49 In vitro Antimicrobial Resistance Pattern of Bovine Mastitis Bacteria in Ethiopia Befekadu Wakayo Jigjiga University, Ethiopia Abstract to be accessed from author. Email: fikeurga@gmail.com

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WEPE50 Increasing Access to Water and Sanitation Facilities to Reduce Waterborne Diseases in Serengeti District, Tanzania Charles Mlingi , Rita Noronha , Sia Lyimo , Florence Temu , David Ngilangwa 1

Amref Health Africa, Tanzania

Background About half and the other 12% of Tanzanians do not have access to safe water and toilets respectively. Women and children are mostly affected with this shortages in terms of hours they spend to fetch water and episodes of diarrheal diseases. Amref Health Africa implemented a three-year project in Serengeti district in Mara Region, Tanzania to increase access of water and sanitation facilities. The district is characterized with high poverty level and low access of water and toilets as compared to those of national. We conducted project’s final evaluation to detect change brought to the district. Methods A cross-sectional comparative study between baseline (2008) and final evaluation (2011) surveys using mixed methods was conducted in 2011. Multistage sampling was used i) to select 22 villages, and ii) to select 384 and 396 individuals for structured questionnaire. Data were analyzed using SPSS 16. Results Overall the households getting water within 400 metres or spending about 10 minutes increased from 25% (2008) to 65% (2011). Proportion of people with access to clean and safe water supplies increased from 7,553 people (27%) to 24, 250 people (89%). Percentage of households with improved sanitation increased from 238/3535 households (7%) to 19/36 households (52.8%). Also project’s contribution to district water coverage increased from 47% in 2007 to 52% in 2010. In terms of promotion of good sanitation, health and hygiene there were increased use of safe drinking water in project community households and primary schools. Furthermore, number of households sensitized on appropriate hygiene and sanitation practices increased from 2113 (35%) to 3,923(65%). Conclusions In order to increase awareness and adoption of improved and appropriate hygiene and sanitation practices in the project areas, active involvement of communities in every step of project’s implementation is vital. Key words: access, water, sanitation, Tanzania

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WEPE51 Attitudes towards Ending Female Genital Mutilation in Serengeti District, Tanzania Godfrey Matumu , Pius Chaya , Rita Noronha , Serafina Mkuwa , Florence Temu , David Ngilangwa 1

Amref Health Africa, Tanzania

Introduction Female Genital Mutilation (FGM) has no known health benefits. It is harmful and has increased risk of problems during childbirth. In Tanzania, it is estimated that 14.6% of girls and women of age between 15-49 years have undergone the practice. Amref Health Africa conducted a study to measure different FGM baseline indicators before implementation of Tokomeza Ukeketaji (Stop FGM) Project. Methods This was a mixed methods baseline survey conducted in 2016 in Serengeti district in Tanzania. The district is known to have a high prevalence of FGM in the country. A total of 1,392 participants were randomly selected and interviewed. Quantitative data were descriptively analysed while qualitative data was thematically analysed using SPSS 20 and Nvivo software respectively. Results The median age of respondents was 25 years. More than half were male, had primary education and married. Almost all respondents had heard about FGM and they considered it as common in their communities as instituted and supported by their culture (99.6%). Many of the girls and women were aware that FGM causes; death (80.2%), psychological problems as a result of FGM (44.7%), infertility (24.9%) and sexual disorders (46.2%). However, handful of respondents felt is important for their daughters or sisters to undergo FGM (males 31.5%; females 29.2%). While 62.8% of the respondents felt that the practice should be criminalized and 74.4% reported that they would not encourage FGM. Furthermore, FGM ceremonies are draining family resources and 81.7% of the respondents reported that families are forced into debt to finance the circumcision ceremonies of their daughters. Conclusions The attitude against FGM in this population is very high. This implies that, there is need for immediate development of agenda to feed the advocacy activities that will end the practice in the area completely through enforcement of available laws. Key words Attitude, ending, Female Genital Mutilation, Tanzania

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WEPE52 Determinants of delayed care seeking for TB suggestive symptoms in rural Ethiopia: a community based unmatched case-control study Robel Belachew Addis Ababa University, Ethiopia Introduction Early tuberculosis case finding and adequate chemotherapy is a top priority to interrupt transmission of the infection and prevent death and complications caused by delayed care seeking. This study has identified the magnitude and determinants of patient delay to seek care. Objective To measure the prevalence of patient delay and identify factors associated with care seeking delay among presumptive tuberculosis cases. Methods Population based unmatched case control study was employed. The WHO standard TB screening tool was used to screen and identify presumptive TB cases (> 15 years of age). Presumptive TB cases who sought care after the first 14 days since the symptoms first started were taken as cases while those who sought care in the first 14 days were the controls. A pretested interview questionnaire was used to collect data pertaining to socio demographic characteristics and health care service related variables from the study participants. Multiple binary logistic regression model was used to identify determinant factors for patient delay. Result A total of 9,782 individuals were screened, 980(10%, 95%CI; 9.4%-10.5) were found to be presumptive TB cases. Among the presumptive TB cases 358(76%, 95% CI; 75.6%-76.4%) sought care in the first 14 days with the median patient delay of 15 days IQR (5-30 days). The most common suggestive symptom mentioned by the participants was night sweat 754(76.4%) but history of contact with a TB case was mentioned only by 207(21.1%) participants. Individuals in the age range of 45 to 50 years had lower odds of delaying for care (AOR 0.31, 95%CI 0.15, 0.61) than those in the range of 15 to 24. Previous history of TB treatment (AOR16.16, 95%CI 9.94, 26.26) and limited access to either traditional or modern mode of transportation (AOR 2.62, 95% CI 1.25, 5.49) were independently associated with patient delay. Conclusion Older age, previous history of TB treatment and lack of access to traditional or modern means of transportation increased the odds of patient delay. The findings suggested the need for enhancing access to the health care service through strengthening community based TB program and enhancing geographic accessibility of health care facilities.

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WEPE53 Improving Access to Community Food and nutrition systems for People Living with HIV: an illustrated assessment of food and nutrition interventions in high food insecure regions of Kiambu, Kenya Muhamed Akulima , Rudia Ikamati 1

Amref Health Africa, Kenya

Background There were estimated 236,548 People Living with HIV (PLHIV) in Central/Eastern Kenya in 2013. Kiambu County had 46,656 PLHIV; 42,400(91%) adults and 4,200(9%) children aged 1-14 years. PLHIV stay in vulnerable households with limited access to food and chances for good health. We therefore implemented integrated community food security and nutrition interventions targeting 200 households for 1233 PLHIV. These interventions included drought resistant crops and livestock, food banking, linkages for therapeutic feeding, vegetable drying, and storage with products valueaddition and standards certification. The objective of this study is to assess the performance of food security and nutritional interventions implemented through 8 Quality Improvement Team (QITs). Methods A retrospective cohort study conducted between August 2016 to January 2015. Child Status Index (CSI) tool collected data on the number of households with access to at least two meals per day (average >20days per month) and QIT journals provided descriptive information on monthly food security interventions (change ideas). The Run Chart (Time series Matrix) and Probability Matrix were applied to analyse the changes in trends in food access at households levels. Results CSI data showed at pre-interventions, 98% of 200 households had average 1meal/day. In 20 months, 75% out of 90% target of 200 households accessed at least 2meals/day. Run Charts showed 20 data-points (Months), Median (87.5) with 7 runs across median line for probability range (6-16 Runs) at 5% risk level. Run Charts showed increasing numbers of households with >2 meals/day between January-April 2015 and between January-August 2016.The number of data-points trends, runs and shifts fulfilled Run Chart rules for validating changes and measuring performance of food interventions . Conclusions There was improvement in householdsâ&#x20AC;&#x2122; access to food. This suggests that integrated food and nutrition interventions through QITs contributed towards attainment of the food access goal. QITs are imperative structures in addressing food system challenges. Key words Food security and nutrition interventions, Child Status Index, Community quality improvement Teams, Run Charts,

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WEPE54 Determinants of Voluntary Medical Male Circumcision uptake by adults in Rongo Sub-County Kenya Vincent Aloo Maseno University, Kenya Background Voluntary medical male circumcision (VMMC) to older men (25-39) at immediate risk of HIV infection is effective in achieving prevention goals for this group. Emergent contextual determinants pose concerns for uptake by older men. Objectives The overall objective of the study is to investigate the determinants of voluntary medical male circumcision uptake by older men in a rural non-circumcising community in Migori County Kenya. Specifically, this study aims to identify and describe social, cultural, and perception determinants that influence the uptake of VMMC by older men. Methods A cross sectional study using quantitative and qualitative research methods was implemented. The methods included multistage sampling from sub locations for questionnaire interviews with 384 participants. 5 focus group discussions (FGDs) with a purposive sample of 50 men and women. The questionnaire, interview guides, and consent forms were translated, back-translated and approved by Maseno University Ethics review committee. The transcripts were translated from Dholuo to English and coded and analyzed into themes. The quantitative and qualitative data was collected and corroborated. Results Women, cultural practices fulfilledwith sexand perceptions ofpainwere identified as keydeterminants of male circumcision uptake. Conclusions and Recommendations The study concludes that women as sexual partners are an opportunity for increasing uptake of male circumcision. The implementation of VMMC should harness cultural opportunities that encourage uptake. Advocacy and counseling messages on pain should be refined to increase uptake by older men.

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WEPE55 Strengthening the capacity of different role players and stakeholders on Integrated school health service to reduce water borne diseases in Limpopo province, South Africa Pearl Ndhlovu , Maurice Vusi Ntuli , Boniface Hlabano 1

Amref Health Africa, South Africa

Issues A two-year pilot project was implemented to test a replicable model of building the capacity of key target players and frontline services providers, who are usually the first point of call for health care seeking by learners. This aimed at strengthening school health services for the purposes of realizing MDGs 2, 3, 4, 5, 6, and 7 Description The project strengthened the capacity of different role players and stakeholders (CHWs, SGBs, School Principals), LO educators, Peer educators, school health clubs, local health facilities, policy forums, health and education departments) on school health services with special reference to Sexual and Reproductive Health and Rights, school health mobilisation and sensitization, reducing high risk behaviours, school health management, needs identification of school going children, harmonization of health services provided by both the Departments of Education and Health. Lessons learnt A total of 720 (8.5%) of the screened learners were found to be with conditions necessitating referral for further oral/dental examination and care/treatment. A total of 49 School Governing Body members, 57 LO educators, 68 Community Health Workers, 24 School Health Nurses, 205 Peer Educators, 149 school health clubs, were trained to reach out to â&#x20AC;&#x153;in and outâ&#x20AC;? of school youth. 8000 youth was reached with different health messages. Most performance indicators at end term evaluation (ETE) were improved compared with the baseline values. Next steps The program was relevant, effective, efficient, sustainable, and the Department of Education and the School Authorities must thrive to sustain the gains of this project by continuing to support the LOEs and School Health clubs.

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WEPE56 Crude childhood vaccination coverage in West Africa: trends and correlates of completeness Jacob Kazungu Pwani University, Kenya Background Africa currently has the lowest childhood vaccination coverage rates worldwide. In Eastern Africa <50% of children are fully immunised. If the full benefits of childhood vaccination programmes are to be enjoyed in sub-Saharan Africa, all countries need to improve on delivery of vaccines to achieve high coverage and to ensure equity. In this paper, we reviewed trends in vaccination coverage, dropout rates and explored the country-specific correlates of a fully immunised child (FIC) in West Africa. Methods We utilized available datasets from Demographic and Health Surveys (DHS) for Benin, Burkina Faso, The Gambia, Ghana, Guinea, Cote dâ&#x20AC;&#x2122;Ivoire, Liberia, Mali, Niger, Nigeria, Senegal, Sierra Leone and Togo to obtain prevalence estimates of vaccination for 6 basic vaccines-Bacillus Calmette-Guerin (BCG), Polio, Measles and Diphtheria, Pertussis and Tetanus (DPT) vaccines in children aged 12 â&#x20AC;&#x201C; 23 months. We also calculated the DPT1-to-DPT3 and DPT1-to-Measles dropout rates and calculated the prevalence of the fully immunised child (FIC). Using Chi-squared tests and multivariable logistic regression models, we explored the factors predictive of FIC within each country. Results Overall, there was a trend of increasing vaccination coverage in the region. However, the mean prevalence of FIC was 49% although it varied significantly by country. There was a high DPT1- toDPT3 and DPT3-Measles dropout in most countries in the region. Although no single risk factor was consistently associated with FIC across countries in this region, having a health card, delivery in a health facility, a visit to a health facility within two months of birth, and higher maternal education factors associated with increased odds of vaccination. Conclusion The low FIC prevalence and high dropout rates highlight existing weaknesses and the need to strengthen the healthcare and immunization delivery systems in this region. Country-specific correlates of complete vaccination should be explored further to identify interventions required to achieve and sustain high vaccination coverage. Despite the promising increasing trend in vaccination coverage in West African countries, a lot more effort is required to achieve global vaccination coverage targets.

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WEPE57 Malaria in pregnancy: A case of Ruhengeli District Hospital in Rwanda Umuhoza Alice University of Rwanda Background The increased susceptibility of pregnant women to malaria infection has long been recognized as a burden worldwide particularly in Sub-Saharan Africa. Globally, 125 million women are at risk to malaria every year and 10,000 deaths occur during pregnancy. In Rwanda, there was a significant increase of prevalence in 2014. Pregnant women from malaria endemic areas experience a variety of adverse complications such as maternal anemia and miscarriage and deaths. The aim of this study is to evaluate the management and understand the outcomes of pregnant women admitted to Ruhengeri District Hospital in Rwanda for malaria. Methods Different methods have been employed including document review of articles and reports on malaria prevalence and outcomes in pregnant women from Rwanda. I have made observations and informal interviews in the hospitals during my clerkship, with pregnant women admitted for malaria. All Data was analyzed using Epi Info 7. Results The total number of patients is 31, average age was 27.8 years old, while Gravidae (G) were: G1= 13( 41.9%), G2=10( 32.3%), G3= 6(19.3%), G4=1(3.2%) and G5=1( 3.2%). The gestation weekâ&#x20AC;&#x2122;s average was 23 weeks and 35% was admitted in June (41%) has severe malaria where12.9% had aborted. 80% have been treated by Artesmin combination and 19.3% by Quinine. The average of hospitalized pregnant women was 3.9 days (94.4 Hours) and no death case. Most of the cases are in the rainy season. Conclusion The treatment that is now available is efficient as many get cured and there are no many complications and no deaths. The needed intervention in this area could be preventive and focusing on primigravida women. Pregnant women as everyone else, are required to consult as early as possible if symptoms of malaria start. Key words Malaria, pregnant women, Artesmin combination.

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WEPE58 Are free maternal healthcare services programs an impediment to qualitycare? An examination of the Kenyan experience Estelle Sidze , Christine Fenenga , Djesika Amendah , Thomas Maina , Martin Mutua , Stephen 1 5 2 Mulupi Marijn van der List , Chris Elbers 1

African Population and Health Research Center, Kenya, Amsterdam Institute for Global Health 3 4 5 and Development, AIDSPAN, The Palladium Group, The PharmAccess Foundation

Background Maternal mortality has remained relatively high in Kenya at about 510 deaths per 100,000 live births in 2015. A free maternal services (FMS) program was introduced in public health facilities in 2013 to increase skilled delivery and improve inclusiveness in the health sector, and plans are underway to move the program to a national insurance program under NHIF. Methods Using a triangulation of Kenyan Demographic and health survey (KDHS), monitoring and evaluation (M&E), exit interviews, and qualitative data, this study investigates the impact of the FMS program on quality of maternity care in public health facilities in Kenya. The core indicators considered in the study are related to provision of essential elements of antenatal care (ANC) and post-natal care (PNC), occurrence of pregnancy and childbirth complications, and women satisfaction with services. Results Preliminary analyses indicate upward trends in processes of care during ANC and PNC between 2003 and 2013, both at national level and in urban and rural settings. The 2013 DHS data which captures 6 months post-implementation of the FMS program show almost universal levels (9 in 10 women) in blood pressure measurements, urine and blood tests, and immunization against tetanus. The proportions of pregnant women receiving information on pregnancy complications during antenatal care have also increased to a national level of 60% in 2013. Findings on main maternal complications indicate upward trends before (2012/2013) and after (2013/14) for almost all complication types except for obstructed labor.

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WEPE59 Integration of Comprehensive Care Services with Chest Clinic at Awendo Sub County Hospital Peter Omware Ministry of Health, Kenya Background Awendo is a facility in Migori county in which in 2013 HIV/TB clients were being seen separately in CCC and chest clinic despite the rooms being adjacent to each other. This resulted in delays in initiating the clients on ART (some after completing TB treatment), poor outcomes of the clients being managed for the co morbidity and inter mingling of CCC and TB clients for long duration in waiting bays. Objectives To determine the effects of integration of CCC services in TB settings. Methodology This is a retrospective study comparing data between the years 2013 when the CCC services were not integrated in Chest clinic and 2014 and 2015 when interventions were put in place. Strategies employed were: ACME on the Diagnosis and management of TB/HIV confected patients to step up immediate HAART and dispel cliniciansâ&#x20AC;&#x2122; fear of combined drug toxicities, enforcing infection prevention at the PSC and chest clinic such as fast tracking coughers, TB clients and CMEâ&#x20AC;&#x2122;S on infection prevention and health talks to clients and community on importance of immediate HAART in improving TB treatment outcomes. Results The number of patients HIV-TB coinfected for 2013 116(73%) but reduced due to improved diagnosis and better infection prevention practices, in 2014 33 (53.2%) and in 2015 34 (54.8%). In 2013 the number of coinfected patients on ART was 63 (54.3%) but improved in 2014 and 2015 to 29 (87.9%) and 34 % (97.1%). The number of clients that died in 2013 coinfected were 16, but in 2014 and 2015 declined to 2 and 5 respectively. Conclusion Integrating HIV services in chest clinics improves diagnosis and out comes in HIV/ TB confected patients Recommendations Promote HIV/TB integration and infection prevention in facilities.

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WEPE60 Sputum analysis gold standard for diagnosis of Pulmonary TB Peter Omware Ministry of Health, Kenya Back ground In 2013 in Awendo Sub County Hospital the diagnosis of pulmonary TB at the chest clinic was still being done using X-rays in steady of relying on sputum analysis using microscopy and gene expert. Objectives To determine the effects of use of sputum analysis in the diagnosis of pulmonary TB. Methodology This is a retrospective study comparing data between the year 2013 before when the standard operating procedures for diagnosing pulmonary TB were not being strictly followed, and 2014 and 2015 after interventions. Strategies employed were: -Sensitization of clinicians on the use of ICF cards and sputum analysis in the diagnosis of Pulmonary TB and -Use of gene expert in sputum negative suspects to detect genuine cases of pulmonary TB. Results The number of cases of TB detected declined from 162 cases in 2013 to 62 both in 2014 and 2015 thus a reduction in work load by 62%.In 2013 smear negatives were 73(60%) of the total number of diagnosed with pulmonary TB while smear positive 49(40%), while in 2014 smear negatives were 11(24%) of the total with pulmonary TB while smear positive 34 (76%). In 2015 smear negatives were 11 (23%) of the total with pulmonary TB while smear positive 37 (77%) The impact of implementing the sops on deaths Type of TB 2013 2014 2015 Sputum positive 6 1 1 Sputum negative 6 1 1 Extra pulmonary 4 0 3 Sputum negatives contributed large proportion of clients that died and on anti TB in 2013, but in 2014 and 2015 the number of deaths reduced due to active screening using sputum leading to early and correct diagnosis. The impact of implementing the sops on defaulters Defaulters 2013 2014 2015 Sputum positive 2 0 0 Sputum negative 9 0 0 Extra pulmonary 3 0 0

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Sputum negatives contributed large proportion of clients that died and on anti TB in 2013, but in 2014 and 2015 the number of deaths reduced due to active screening using sputum leading to early and correct diagnosis. The impact of implementing the sops on defaulters Defaulters 2013 2014 2015 Sputum positive 2 0 0 Sputum negative 9 0 0 Extra pulmonary 3 0 0 Sputum negatives contributed large proportion of clients that defaulted on anti TB in 2013, but in 2014 and 2015 there were no defaulters due to having fewer clients that enabled quick detection and tracing. Conclusion Sputum analysis in pulmonary TB diagnosis improves outcomes in TB therapy Recommendations Promote the use of sputum smear microscopy and gene expert as the gold standard in diagnosis of pulmonary TB.

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WEPE61 A different kind ofRRI: The role ofconstant follow-up forNon-Symptomatic Non-Communicable Diseases Rose Mulindi Jhpiego, Kenya Issues The Healthy Heart Projectâ&#x20AC;&#x2122;s purpose was to ensure proper continuum of care for hypertension in both the community and facility level in two counties in Kenya; Kiambu and Kirinyaga; in line with the Kenya Strategy for Non-Communicable Diseases 2015-20. CHWs within the two counties were equipped with blood pressure machines and dispatched to the community and placed at facility entry points to take BP measurements. All those with elevated pressure readings were referred to a clinician who would take confirmative readings and diagnose accordingly. In the initial only 14% of those with elevated actually reported for follow-up with the physicians. This indicated a very high attrition rate among clients with elevated pressure between March 2015 to January 2016 when no follow-up was made. Descriptions An RRI was conducted in January and over 10,000 clients with elevated HTN were called individually to remind them to see a clinician and given appointments. In the first week in Kiambu only 27% of the 8000plus clients showed up for follow-up. It was decided to make more than one phone call to remind clients of their clinic appointments. Lessons Learnt In the first week after one call, only 27% of the clients showed up. In the two subsequent weeks, 35% and 43% of the clients showed up respectively. The results of the week by week follow-up indicated that clients are more likely to come when called up more than once. Recommendations Considering that HTN is mostly asymptomatic, it is therefore evident that with NCDs client followup must be intensified to ensure that clients come to the facility for management.

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WEPE62 Knowledge level of diabetic patients about implications of glycemia, a case from Rwanda in Nyanza district hospital Eric Twizeyimana University of Rwanda Background Diabetes is a major challenge for health and development in the 21st century. This chronic and incurable disease is largely preventable but remains responsible for millions of deaths every year and many more life-threatening complications. No country, rich or poor, is immune to the epidemic. The prevalence of diabetes in Rwanda is about 3.2% of the population. The aim of the study was to know if diabetic patients are aware of what glycaemia results mean to their life and to generate some recommendations. Methods 37 patients were given an interview each one and 23 were females while 14 were males. The interview was given individually during the time they were doing a glycaemia test and I preferred an individual interview for the confidentiality of their personal information. Each answer was recorded and the analysis of data was done using Microsoft Excel. Results 30.43% of females replied that they know the meaning of the results of glycaemia obtained during the test and 69.56% of females have replied that they do not know the meaning of glycaemia and its measurement.35.71% of males have replied that they know what is glycaemia and the significance of the results obtained after the test while 64.28% of males have replied that they do not know glycaemia, its significance to their lives and also the meaning of its measurement results. Conclusion and Recommendations The level of knowledge about glycaemia implications in Rwandan diabetic patients is low. We should start think of how we could plan some outreaches for education of the patients and also how we could increase health education during consultation of patients so that they can know what do to improve their condition.

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WEPE63 Gastric cancer in Rwanda: An emerging threat Muvunyi Hamza University of Rwanda Background Gastric cancer is the third most common cause of cancer-related death worldwide, the fourth most common cancer in male and fifth in female globally. The Sub-Saharan Africa changed to “the stomach cancer region” mostly in great lakes countries, due to different reasons like lack of trace minerals in the volcanic soils. As old studies’ estimates are becoming inaccurate and not collating with clinical consultations. The aim of this study is to highlight the current level of gastric cancer in Rwanda. Methods A systematic literature review of articles, reports and newspapers published since 1996 was done, searching words were gastric cancer in Rwanda, in eastern Africa, in Africa and globally, gastric cancer in male, in female, H. Pylori infections and gastric cancer, peptic ulcer diseases and gastric cancer, risk factors of gastric cancer in Rwanda and Rwanda demographic and health survey (20142015) then a total of fifteen articles, three reports and one newspaper were selected. I correlated those studies with my clinical clerkship observations. Results Medical practitioners are now facing a large number of people consulting with gastric disorders, on a background of insufficient diagnostic tools like upper GI endoscopy. In 1996, the gastric cancer prevalence in Rwanda was at 9% though cross country researches and in 2014-2015, it attained 25%. Conclusion and recommendations In an uninformed setting, the prevalence has multiplied by three in only twenty years’ period, suggesting a high demand of side by side interventions, therefore every health workers, policy makers and researchers are recommended to tackle, control and manage this emerging threat. .

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WEPE64 Impacts of engaging natural leaders in community units strengthening disease surveillance in the community Mary Kanyaman CEC Health- Samburu County, Kenya Background Community disease surveillance is the ongoing systematic collection, analysis and interpretation of outcome of a disease or condition in the community. In Kenya, the integrated disease surveillance is the approach used in all the health facilities to ensure conditions of Public Health importance are captured on weekly basis to analyze trends. The study was carried out to determine the impact of engaging natural leaders in the community units in strengthening disease surveillance and improving reporting rates. Objectives To evaluate the impact of engaging natural leaders in strengthening disease surveillance in the community. Methodology The study was conducted in community units in Samburu county Kenya. We conducted a prepost trial with randomized comparison group. We used cluster randomization, in which community health units were clusters. Of a total of 10 eligible community units, we selected a probability sample of 4 community units using stratified sampling, systematic sampling was used to randomly assign 2 community units to the intervention arm and 2 community units to the comparison arm. Data collection After intensive training of the selected natural leaders on community disease surveillance for the two-intervention arm community units,we developed questionnaires to interviewthe healthworkers working in both the intervention and comparison community units link facilities on integrated disease surveillance reporting rate. Result The study found out that in the intervention arm, the facilities reported an improved community disease surveillance reporting to the link facilities from 32% before the training to 87% after the training. Conclusion and recommendation Natural leaders if trained on community disease surveillance reporting, there will be an improved reporting of the diseases of public health importance, therefore in each community units, itâ&#x20AC;&#x2122;s prudent to identify and train natural leaders.

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WEPE65 Causes of current malaria skyrocketing: the case of Rwanda Christain Habineza University of Rwanda Background Malaria has been a burden on global health for many decades now. Almost half of the worldâ&#x20AC;&#x2122;s population (3.2 billion) is at risk, with 214 million cases and 438 000 malaria deaths estimated in 2015. 90% of cases were from the African region. Rwanda was in good progress to eradicate malaria before 2013. Unfortunately, malaria cases have increased by 68.4% in the last 2 years. Researchers are wondering on the causes of this recent outbreak. This study aims to show the possible reasons why malaria is skyrocketing in Rwanda. Information from this review will be helpful in malaria eradication strategies development. Method This study systematically reviewed different Ministry of Health and Rwanda Biomedical Center reports, scientific journals. Results Malaria is a big burden on Rwanda as it affects almost 18% of the population, with morbidity and mortality rates at 9% and 4% respectively. Its cases in Rwanda skyrocketed from 352,626 in 2011 to more than 2 million in 2015. This study found that outdated mosquito nets distributed in 2013 countrywide, mosquito resistance to insecticide, inadequate effective ITNs during (2010-2011), poor use of mosquito nets, and climate change are major causes. Other factors include windows and doors opening during evening time; stagnant water and bushes around houses. In addition, incomplete coverage of mosquito net supplies countrywide (77%). Conclusion and Recommendation Based on these findings, a slight abandonment in malaria control and prevention strategies can lead to its catastrophic outcomes (complications and deaths). Multidisciplinary interventions, constant malaria prevention and control strategies, and early diagnosis are highly recommended for its eradication in addition to consistent community mobilization and sensitization. More researches about mosquito resistance and malaria progress are highly recommended. Key words Malaria, insecticide-treated mosquito net, Rwanda. .

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WEPE66 Mapping of nomadic routes to improve nutrition status in communities in Samburu County David Onchonga , Duke Mogaka, Joshua Omwoyo 1

County Government of Samburu, Kenya

Background Poor nutrition in Africa continues precipitating myriad of health conditions in the continent and beyond. The rate of stunting is very high in some settings especially those in the northern arid nomadic pastoralist of Kenya. This study was done to map nomadic routes in Samburu County with the purpose of improving nutrition status of the children and pregnant women who migrate during drought periods in search of pasture. Objectives To undertake mapping of nomadic routes with the purposes of following the pastoralists during drought periods to supplement the children and pregnant and lactating women with nutritional supplements. Methodology The study was conducted in all the fifteen wards in Samburu County to understand the routes that nomads follow during the drought seasons. Focused group discussions were conducted and key informant interviews were carried out to document clearly the routes in which community members follow during drought seasons. Data collection Data from the interviews and focused group discussions was collected, collated and analyzed using thematic content analysis. A write up was done and feedback disseminated to various levels of government. Result The study found out that in Samburu County, there were distinct routes that nomads follow during short and long drought spells. The elders and other key opinion leaders were able to come up with clear routes in which community members follow and also the duration of stay in each route. The study was able to capture the available infrastructure in each of the administrative unit. Conclusions Proper mapping and understanding patterns of movement of community members is a positive innovation in which the vulnerable groups (children and pregnant women) can be followed by health workers to provide them with nutritional supplements. .

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WEPE67 Sustainability Mechanisms for community health care projects using the Health System Strengthening Approach Christopher Semei1, Resty L. Nanyonjo, Moses Kamba, Harriet Chemusto, Paul Gonza, Mary Odiit, Barbra Mukasa 1Mildmay Uganda Background: Funded projects face challenges with sustainability when donors pull out in Uganda. Illiteracy, ignorance, attitude, and top-down approaches without involving stakeholders contribute to the failure of the established projects in health are. From the available literature, HSS project implemented by Mildmay Uganda central region aims to bridge this gap. Methods: Cross sectional study designs using qualitative methods were used to establish the extent the project had strengthened the health systems. 30 KII interviews with stakeholders, 9 FGDs with beneficiaries and observations were conducted to collect data. Transcripts and grids were developed for analysis. Results: Through HSS project, six building blocks were implemented at all district facilities involving stakeholders to attain ownership and getting empowered with skills through capacity building and trainings. Project planning, implementation and reviews regularly held by the districts, Mildmay and implementing partners. M&E was done to record satisfaction & share results, findings were disseminated for improvement to enhance sustainability following donor exit. Functional systems such as District Aids Committees, District Health Team, Sub-county and District OVC Committee meetings are in place. 100% of the districts have technical teams known as district mentors that support facilities in all the thematic areas. Training of facility staff to enhance knowledge and skills as well as developing training logs to capture what is trained (90%). Districts involve Mildmay in HIV strategic work plan development and support supervisions. Districts have taken the leading role in most of their activities increasing ownership for sustainability. Conclusion and Recommendation: For projects continuity, stakeholdersâ&#x20AC;&#x2122; involvement must provide project knowledge, decision making, work plan development and implementation, empowering districts teams to conduct activities as Mildmay provides technical support for sustainability. Proper probity and accountability play a vital role as well as having a sustainability plan and effective leadership at all levels in healthcare. .

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WEPE68 Adolescent Empowerment Programs Improve Retention into HIV Care in 6 Central Districts of Uganda Hasifa Nambi , Rebecca Kivumbi, Dorothy Nakkazzi, Harriet Chemusto, Yvonne Karamagi, Barbara Mukasa 1

Mildmay Uganda

Background Uptake of chronic HIV care, treatment and retention services by adolescents and children has remained low despite the interventions. And yet the HIV pandemic has shattered the traditional family systems exposing adolescents and children to orphan hood and poverty. As a result adolescents have dropped out of school and are engaging in risky behavior such as drug abuse, alcohol, and sex trade which has contributed to non-adherence and reduced retention into HIV/AIDS chronic care. Description Mildmay Uganda is implementing a 30 months ‘unfinished business’ project to close the adultpaediatric and adolescent HIV service delivery in 6 districts of Wakiso, Mpigi. Luweero, Masaka, Mityana and Mubende. In an effort to mobilize and economically empower adolescents, 22 adolescent corners one in each targeted health facility were established. Youths attending the adolescent corners were supported to form ‘artificial family systems’ in form of community youth led groups and Economic Support groups. The youths were placed in groups of 30 Village saving and loans associations. Members meet on monthly basis, save any amount affordable by all and loan it to members at a reasonable interest. The adolescents in addition had short term courses offered for a period between 1 to 3 months. These were to build their capacity in marketable skills identified through market research. Lessons learnt There has been increased uptake of adolescent friendly services, increased uptake of the free HIV testing services and linkage to care. Conclusion Empowering HIV positive adolescents economically and provision of adolescent friendly services should be extended to other health facilities in the 6 districts as a way of retaining them into chronic care. .

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WEPE69 Health Care System Challenges and their Impacts on Carers of children with disabilities in low resource settings in Kenya: A study of the carers experience Alice Lakati , Anne Geniets, Niall Winters, Laura Hakimi, Jarim Oduor Omogi 1

Amref Health Africa HQ, Kenya

Background Little is known about the challenges that carers face looking after children with disabilities in settings affected by poverty and limited access to health care and equipment. To care for a disabled child in these low resource settings requires resilience and resourcefulness. This study aimed to examine these challenges and their impact on the caregivers of children with disabilities in one urban and one rural low resource setting in Kenya. Methods A mixed-methods design was used to identify challenges and impacts of caring for children with varying degrees of impairments in two low income settings, in Nairobi and in Makueni County, Kenya. Qualitative data from in-depth interviews were thematically analysed and triangulated with quantitative self-assessments using the caregiver strain questionnaire (CGSQ) and the Parent Experience of Child Illness (PECI) scale. Results The study found high levels of stress and strain among care givers of children with disabilities. Caregivers reported that they are shy to ask health workers questions of their children conditions, they experienced frustration in getting appropriate health care and are frequently referred to facilities beyond their reach. Occupational and physiotherapy services are not available to the caregivers. Community health volunteers, where available to the caregivers, are recognized as an important link to the health care system and source of support. Conclusion The paper highlights number of specific challenges as voiced by caregivers of children with disabilities in low resource setting that need to be tackled when refocusing the health care system to manage NCD induced disabilities for all Kenyan citizens. Access to physiotherapy and occupation therapy services is not available to children in low socioeconomic NCDs increasingly are becoming a health priority in the system and that more research is needed to inform policies with regard to children with disabilities from low resource settings. .

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WEPE70 Prevalence of and risk factors for needle stick and sharp injuries among nurses at regional referral hospitals, Ethiopia Fisseha Amdie University of Gondar, Ethiopia Background Needle stick and sharp injuries (NSSIs) represent major occupational hazards in health care especially in developing countries. In addition to the risk for exposure to infectious agents or tissue damage, evidence suggests that these injuries can have negative psychological effects and decrease worker confidence. Healthcare worker experience, prior education and training as well as the availability of improved needle design have been associated with the risk of NSSI. The aim of this study was to assess the prevalence and risk factors for needle stick and sharp injuries among nurses working at regional referral hospitals in Ethiopia. Methods A cross-sectional study was conducted from March to April, 2014 in Northwestern Ethiopia in state referral hospitals in the Amhara region. A total of 406 nurses were selected by stratified sampling. Self-reported frequency of NSSI was assessed for the previous 2 months, 1 year and lifetime NSSI and demographic data were collected along with risk factors for NSSI. Forward, step-wise logistic regression was used to identify factors associated with needle stick and sharp injuries. Independent variables that had p-value less than or equal to 0.2 were entered in to multivariate logistic regression model to control the effect of confounders. The strength of association of variables were assessed using odds ratio with 95% CI and statistically significant was considered at p-value less than 0.05. Result 398 study participants were included in the analysis (98% response rate). The prevalence of NSSIs among nurses in the previous 2 and 12 months was 32.9% and 35.9% respectively. Risk factors for NSSI included categorical years of work experience (AOR=2.83, 95% CI: 1.09, 7.33), working shift (AOR=3.40, 95% CI 1.17, 9.87) and reporting needle recapping (AOR=2.98, 95% CI: 1.69, 5.26) were significantly associated with needle stick and sharp injuries. Conclusion and recommendation The prevalence of NSSIs among nurses in the study area was high. Based on the results of this study, nurses with > 10 years, those who recap needles and work the evening shift may require special intervention to reduce the risk of NSSI.

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WEPE71 Level of knowledge and perceptions of Diabetes in 2 urban cities of Rwanda Oda Ngirabeza , Blaise Ntacyabukura 1

University of Rwanda

Background Diabetes, one of the 4 main NCDS is one of the biggest public health challenge throughout the world. Evidence suggests that basic knowledge on diabetes and associated risk factors is crucial in preventing or delaying type 2 diabetes mellitus and its complications. However, few studies done in Rwanda showed that the level of knowledge is poor and inadequate .Few interventions were put in place afterwards. This study came to assess the impact off those interventions on the level of knowledge of diabetes and its associated risk factors and how this knowledge impacts their attitude towards the prevention of diabetes. Methods A cross-sectional analytical study was carried out in Kigali city and Huye district, the interview was done using a structured questionnaire designed for the study. The questionnaire included questions on demographic information, general knowledge on diabetes and attitude of participants towards prevention of diabetes. Results 100 Participants, 24(24%) females and 76(76%) males aged between 17 and 71 years were interviewed. The percentages ofcorrect responses to questions on diabetes definition, riskfactors and complications were 16%, 65% and 75% respectively.82% knew that diabetes was preventable,79% knew at least one of the preventive measures. On attitude and practice of healthy lifestyle section; 21% had regular physical activity, 53% consumed a healthy diet and 30% had regular medical check-up. Conclusion This study demonstrated that different interventions done on diabetes have improved the level of knowledge in the general population.However,knowledge doesn't influence attitude and practice towards prevention of diabetes.

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WEPE72 Causes of increased malaria in Rwanda: the course of its control Iradukunda Hilarie Rwanda Background In 2015, there were roughly 214 million malaria cases and an estimated 438, 000 malaria deaths globally; Sub-Saharan Africa continues to carry a high share of the global malaria burden. In 2015, the region was home to 89% of malaria cases and 91% of malaria deaths. In Rwanda 2012, 514173 cases of malaria were reported, a year later in 2013, 948,000 were reported and then in 2015, 1,957,000 cases reported with 424 deaths. During the first 4 months of 2016, 1 353 861 cases reported with 243 deaths. The objective of this study is to determine what was the cause of this rising, and to evaluate how far is the journey to overcome malaria. Methodology This research was done using electronic literature review, the searching words were: malaria in Rwanda, the cause of malaria rising in Rwanda, current situation of malaria in rural and urban areas in Rwanda, RDHS 2015-2016 (Rwanda demographic and health survey), Presidentâ&#x20AC;&#x2122;s malaria initiative. A total of 10 abstracts from 2012, 2 reports, 2news papers were selected, then I correlated my findings with my clinical clerkship observation. Results Climate change from rainy season has been reported to raise malaria in 63% of all districts(76% being in endemic areas), it played a big role in rising malaria cases from 2012 to 2015 at a 3 times fold rate with 37% mortality rate and 300% morbidity. Since 2013, over 3 million sub-standardized mosquito nets have been distributed, mosquito insecticide resistance at 77.4% since 2010 and recent migration of 65% from the north to the east of the country. Apart from that people neglected usual preventive measures. Measures taken to reduce malaria include providing new and insecticide treated nets, indoor residual spraying, health system strengthening and capacity building, behavior change communication, monitoring and evaluation, operational research. Conclusion and Recommendation The main causes of malaria rising in Rwanda were climate change, use of sub-standardized nets, mosquito resistance to insecticide and migration and new measures have been initiated to control malaria upsurge. I highly recommend side by side interventions, to control and tackle this emerging threat from both the citizen and all heath care system.

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WEPE73 Impact of food prices on Child Nutrition Gladys Kivati Africa Research Consortium Background Since the global food crisis of 2008, nutrition has gained prominence in the global development agenda. Many countries face a serious public health challenge from under nutrition with 24% of all children under 5 are stunted. Organizations around the world are trying to improve the nutritional status of vulnerable populations by providing food aid. A majority of Kenyan households are net buyers of food and depend on markets for purchase of their foods. As a result, market performance and food prices directly influence levels of household consumption. This in turn influences nutritional outcomes especially to communities at the base of the pyramid. According to a report published by Grace et al 2004, food prices have negatively influenced child nutrition. The recent prices increase in food prices in Kenya have forced communities to buy cheaper and lower quality food items as a result negatively impacting nutrition. Given the glaring important role of markets and food prices has on child nutrition outcomes, little attention has been focused on understanding the connection of price and nutrition outcomes in children. Objective To address the research gap, the main objective of the study was to a) examine the co-relation between food prices and nutrition among children under the age of five years in low income households in Nairobi b) Assess the level of knowledge and understanding of nutrition among mothers with children under the age of five years c) Carefully analyze market dynamics associated with food prices in low income households in Nairobi. Methods We combined data from various sources and employed desktop research, focus group discussion and key informant interviews with the target population. We employed a series of multi level regression models to study the composition of price variance at spatial and temporal levels. Results Findings suggested various opportunities for policy influence aimed at promoting nutrition among children by reducing food prices.

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WEPE74 Community health volunteers can effectively implement disease surveillance of priority diseases at village level in Kenya Eddie Machache Amref Health Africa Headquarters & Ministry of Health, Kenya Background In 2009, the Ministry of Health, Kenya, in collaboration with Amref Health Africa, established a pilot project to introduce a Community Based Disease Surveillance (CBDS) system into three districts in Kenya. The project aimed to provide Community Health Volunteers (CHVs) with the capacity and means to identify, refer and report patients with suspected priority conditions, according to the national Integrated Disease Surveillance and Response (IDSR) strategy, to local health facilities for diagnosis and management. Methodology A national project steering team was created comprising senior officers from the Units of Disease Surveillance, Outbreak and Response; and Community Health Services, and Amref Health Africa. Criteria for selection of pilot sub-counties included high burden of communicable diseases and areas with established community structures. Priority diseases were grouped into major conditions with simplified lay case definitions. Data collection, referral and reporting tools were developed, using a paper-based system. Sub-county Health Management Teams (SCHMTs) and Community Health Extension Workers (CHEWs) received refresher training on principles of IDSR and the CBDS system; who in turn trained CHWs and health care personnel at the link health facilities. Results and Discussions: Three districts in Kenya participated in the CBDS pilot project. A total of 64 CHEWs from 32 Community Health Units (CHUs) and 1600 CHVs were trained. Data will be presented on reporting rate of CHVs, total number of cases referred and attendance rate at health facilities; and number of suspected priority conditions reported by type, since the project start. Conclusions The project has established clear pathways for early detection of suspected priority conditions, and referral and reporting between different levels of the health system, starting from village level. With adequate support and supervision, CHVs can play a critical role in detecting suspected priority disease syndromes and outbreak surveillance within their local communities. The reporting system complements the passive, facility-based IDSR surveillance and management system for priority diseases and outbreaks; however establishing a CBDS system requires major resource inputs.

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WEPE75 Barriers to and Comparative Effectiveness of Anti-hypertensives Towards, blood pressure control in Ethiopia: BACEAT study Tadesse Agabez University of Gondar, Ethiopia Background There was lack of plethora of data on the barriers and comparative effectiveness of antihypertensives on blood pressure in Ethiopian population. The current study sought to determine the barriers to BP control. It also aimed to determine the comparative efficacy of different anti-hypertensives in hypertensive patients attending Gondar university hospital (GUH). Methods A hospital based retrospective cohort study was conducted in GUH from 1/October /2016 to 10/ December/2016. All hypertensive patients on medication were included in the study. BP and target organ damages were retrospectively followed for a mean period of five years. The data were entered into and analyzed by SPSS for windows version 21. Descriptive statistics and Binary logistic regression was computed to determine the predictors of BP. One way analysis of variance was carried out to test the mean difference in blood pressure lowering and associated incidence of target organ damages among individual antihypertensive medications. A p-value of <0.05 was set at priori with 95% confidence interval to test the level of significance. Results Of the 578 hypertension patients evaluated, 543 (93.9%) fulfilled the criteria. Nearly two-thirds (58.2%) of the participants were females. The magnitude of BP control was found to be 72.9%. Factors such as high salt intake (AOR=6.271 [2.047-19.214], CI=95%), comorbidities [COR=2.394 [2.15-6.736], [AOR=2.914 [1.935-9.084] and non-adherence [COR=1.333 [1.49-2.686], [AOR=1.637 [1.15-3.513] increased the likelihood of uncontrolled HTN. Mean reduction in systolic BP was significantly varied among anti-hypertensives (x2 =19.1, p=0.01) and diuretics containing regimens were associated with a well-controlled systolic BP. In addition, the incidence of cardiovascular complications of hypertension was different among different regimens (p=0.02). Conclusion Blood pressure control was relatively higher in the set-up. High salt intake, comorbid conditions and non-adherence were strongly linked with uncontrolled blood pressure. Hence, individuals with high salt intake should receive strong advice on the optimization of their salt intake. BP lowering agents showed different effects on systolic BP and cardiovascular complications. Selection of antihypertensive medications should be tailored towards agents that are able to reduce the systolic blood pressure and cardiovascular complications.

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WEPE76 Qualitative detection of Proviral-DNA of HIV-1 in infants to determine the efficacy of Antiretroviral Therapy in the prevention of vertical transmission of HIV-1 in the Gambia Lamin Cham National Aids Control Program, Gambia Background The priority of Gambia is to eliminate maternal to child transmission of HIV and in line with this priority, the country implemented an antiretroviral therapy (ART) program. With this, all HIV infected pregnant and breastfeeding mothers and infants have access to ARV drugs. This study aims to determine the prevalence of vertical transmission of HIV among women receiving the ARV drugs. Methods Dried blood spot samples were collected from 109 HIV-exposed infants enrolled in 12 ART sites across the country. A qualitative detection of proviral-DNA of HIV-1 was performed using the RealTime Abbott PCR assay. Data from 105 mothers were analyzed using SPSS version 16.0 and association of risk factors to PCR results were analyzed using (Crosstabs) Pearson Chi-Square. The p-value of significativity is set at p<0.05. Results This study has found the prevalence of vertical transmission of HIV is 0.0% (0/64) among women that received ART, 7.1% (2/28) among mothers that received HIV prophylaxis only, and 38.4% (5/13) among women who neither receive HIV-prophylaxis nor ART during pregnancy or breastfeeding. Other risk factors of vertical transmission such as late initiation of treatment, default during treatment and first born of twins were found to be significantly associated with vertical transmission p=0.001, p=0.022 and p=0.000 respectively. Conclusions This studyhas found that the earlyintervention ofART at the onset ofpregnancythrough breastfeeding can eliminate Maternal to Child transmission of HIV and a high risk of vertical transmission was found among women who neither receive prophylaxis nor ART. If the effectiveness of the antiretroviral therapy is maintained, Gambia, in the near future will attain the WHOâ&#x20AC;&#x2122;s goal to eliminate Maternal to Child transmission of HIV. Keywords ARV drugs, ART, prophylaxis, maternal to child (vertical) transmission, PCR, HIV-exposed infants, Gambia.

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WEPE77 I will feel like I am talking to God. Exploring perceptions towards mhealth technology for blood pressure control in Ghana Arti Singh , Michelle Nicols , Bhavana Singh , Carolyn Jenkins , Isaac Nkrumah , Nana Ayisi Boateng , 3 Ellis Owusu Dabo 1

KNUST Hospital, Ghana, Medical University of South Carolina, USA, Kumasi Centre for Collaborative Research, Scientific DIrector

Background Sub-Saharan African (SSA) countries including Ghana are experiencing an epidemic ofcardiovascular disease (CVD) propelled byrapidlyincreasing rates ofhypertension. Inadequate diagnosis, suboptimal control and non-adherence to treatment of hypertension (HTN) are an emerging major public health concern as the population with HTN in Ghana grows. Mobile health (mHealth) has increasingly been signaled as an effective means to expedite communication and improve medical regimen adherence, especially for patients with chronic health conditions such as HTN. Objectives To explore the perception and attitudes of hypertensive patients towards the use of mHealth for blood pressure control (BP) in Ghana. Methods 7 focus group discussions among 45 patients aged 40 and over living with HTN in Kumasi, Ghana. The semi structured interview guide explored patientâ&#x20AC;&#x2122;s attitudes and perceptions surrounding 4 domains: 1) experiences and challenges of current HTN management 2) current mobile phone use 3) desired mHealth applications and 4) expectations of and barriers to mobile phone use in BP control. Results The main themes identified related to challenges in BP control were a lack of lifestyle educational messages by the physicians and inadequate patient-physician time spent in the consulting room. Expectations of mHealth use were mainly to provide education on diet and exercise as well as clinic appointments reminders. Voice calls were preferred to text and video messages. All participants found mhealth highly acceptable and usable for BP control, however, a perceived barrier was fears of mhealth replacing physical consultations with physicians. Conclusion/recommendation Patients with HTN are willing to embrace mHealth to assist in the management of their BP particularly for providing educational messages on lifestyle as well as clinic appointments and reminders. Although mobile phone use among patients with HTN is high, more research is needed to explore usefulness of this technology in larger populations with HTN. Keywords mHealth, Hypertension, mobile phone, Qualitative study, focus group discussions

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WEPE78 Kinship support and infant mortality in Northern Ghana: Assessing the grandmother hypothesis George Wak University of Ghana, Ghana Introduction In Africa and elsewhere, grandmothers have considerable influence on matters pertaining to child health and general upkeep at the household level. It has thus been hypothesized that the extended post-partum longevity among females is a natural means by which they live long to assist in the care of their grandchildren. This paper seeks to validate this hypothesis by examining the effect of the presence of the grandmother on infant mortality in rural northern Ghana. Method The study uses data from the Navrongo Health and Demographic Surveillance System (HDSS) for the period 2000 to 2013. The HDSS was set up in 1992 and under the system, fieldworkers visit each household every four months to collect and update their socio-demographic information. Specific information collected includes pregnancies, births, deaths, migrations, educational status and vaccination status of children. Weibull regression model was used to simultaneously investigate the effect of presence of grandmothers on infant mortality. Results A total of 54,639 children born between 2000 and 2013 were selected for this analysis. Results of the regression analysis showed that children of household with a grandmother were 14 percent less likely to die compared with those without a grandmother. After controlling for maternal education, age, place of residence and place of birth among others, the result remained the same. Also female children and children in urban setting had a higher survival advantage in both the unadjusted and adjusted models. Maternal education and age, place of birth, birth order and number of children per pregnancy were all found to be predictors of infant mortality. Conclusion We conclude that kinship support in childcare given by grandmothers can enhance child health and survival. It is therefore important to conduct more research to identify specific roles grandmothers can play in childcare to improve survival.

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WEPE79 Clinical characteristics and prognosis of heart failure patients with reduced and preserved ejection fraction admitted to University Of Gondar Referral Hospital, North West Ethiopia: A retrospective cohort study Tamrat Abebe University of Gondar, Ethiopia Background Heart failure (HF) is one of the major cardiovascular disorders with high morbidity and mortality. In Sub Saharan African countries, HF has turned out as a leading form of cardiovascular diseases, and has considerable socioeconomic impact.There are differences in clinical characteristics and survival status among patients with preserved (HFpEF) and reduced (HFrEF) ejection fraction. Objective: The main aim of this study is to outline the clinical characteristics, medication profile, assess the survival status and prognostic factors of Ethiopian HFpatients with HFrEF and HFpEF. Method This is a retrospective cohort study; we used patient's medical records, who were admitted to University of Gondar Referral Hospital in the period of December 2010 - December, 2015 due to HF. Kaplan meier curve was used to analyze thesurvival status and log rank test was used to compare the curves. Cox regression was used to analyze independent predictors of mortality in all HF patients. Result Of 850 patients who were admitted due to HF, 311 patients met the inclusion criteria. Majority of the patients had HFpEF (52.73%) and tended to be women (76.22%)and had etiologies of Valvular heart disease,were hypertensive, and took calcium channel blockers and anticoagulants. Conversely, patients with HFrEF had etiologiesof ischemic heart disease and dilated cardiomyopathy and prescribed angiotensineconverting inhibitors (ACEI) and beta blockers. Kaplan meier curves and log rank test(p= 0.807) showed that there was no statistically significant difference in the mortalitydifference among patients with HFpEF and HFrEF. Cox regression analysis showedadvanced age, lower sodium level, higher creatinine level and absence of medicationslike ACEI, spironolactone and statins independently predicted mortality in all HFpatients. Conclusion Similar clinical characteristics were found in both groups of HF patients.There was no difference in survival outcome between patients with HFrEF and HFpEF Key words Heart Failure, Ejection Fraction, Clinical Characteristics, Survival, Ethiopia

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WEPE80 Study of co-morbidity in patients with high blood pressure in a tertiary hospital Olusola Adeyemo , Chike Ezedimbu 1

Olabisi Onabanjo University Teaching Hospital, Nigeria

Background Hypertension is defined as a persistent elevation of blood pressure > 140/90mmHg. Hypertension, the most common cardiovascular disorder affecting approximately one billion people globally, remains the leading single contributor to global burden of disease and mortality accounting for approximately 9.4 million deaths annually. Objectives To study the co-morbidities in hypertensive patients in a tertiary hospital in Nigeria between the year 2013-2015. Methods Case series study and 175 subjects above the age of 30 were used. The study measured the demographic variables (sex, age, occupation, level of education, year, and marital status) and comorbidities (cardiomyopathy, diabetes mellitus, kochâ&#x20AC;&#x2122;s disease, heart failure, chronic renal failure, infarctive heart disease, dyslipidemia, cardiovascular accident and chronic obstructive pulmonary disease). Univariate and multivariate analysis was done with SPSS 20. Results Prevalence of co-morbidity associated hypertension was 2013 (28%), 2014 (33.7%) and 2015 (38.3%); showing 5% annual rise in presentation. More females (53.7%) and male (46.3%) were found in this study. Result shows further that 15.9% of the hypertensive patient had cardiomyopathy only as a co-morbidity while 0.6%, 1.1%, 1.1%, 0.6% and 0.6% of the patients with cardiomyopathy had obesity, diabetes mellitus, Kochâ&#x20AC;&#x2122;s disease, heart failure; diabetes mellitus and kidney disease respectively. This reveals that a total 19.9% of the hypertensive had cardiomyopathy as co-morbidity. Analysis revealed further at 95% confidence interval, there is association between co-morbidities and (sex, occupation, level of education, year and marital status). Conclusion A large proportion of women (53.7%) present because of co-morbidity. This is contrary to the conventional opinion where hypertension is more prevalent among men. As patients advance in age, co-morbidities as well become more evident 31-40years (6.9%), 41-50years (14.9%), 51-60years (24.6%), 61-70years (31.4%), >70years (22.3%). Recommendations As much focus is needed on the management of hypertension, such should be emphasized on the prevention of co-morbidities of hypertension

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WEPE81 Prevalence and factors associated with psychosocial stress among clinical, medical and pharmaceutical students Shamsudeen Usman , Tolulope Balogun , Joseph Odeyemi , Ayeni Akinwunmiayodeji 1

Olabisi Onabanjo University Teaching Hospital Sagamu, Nigeria

Introduction Stress is a global health issue which is regarded as a force that can propel every human being to behave either positively or negatively. Medical training especially in the clinical years may result in high stress levels due to academic and psychosocial demand. This study is to contribute to knowledge and provide evidences on the prevalence and factors associated with psychosocial stress among clinical, medical and pharmaceutical students of Olabisi Onabanjo University. Methods A cross-sectional descriptive survey of 200 clinical medical and pharmaceutical students. It was conducted on students from 400 level to 600 level (Medical and Pharmacy students). A semistructured self-administered questionnaire also containing the Cohen Perceived Stress Scale was used to elicit information from respondents and to assess the severity of stress among students. Results About 50.8% of the respondents belonged to the age range of 20-24 years. Majority (69.5%) of the respondents were clinical medical students. 58% of the respondents had moderately perceived stress. 2.5% of the respondents had highly perceived stress level. 62% of the respondents, whose course of study was a source of stress, were in the moderate perceived stress group. 53.6% of the respondents who had had one or more re-sit experiences were in the moderate perceived stress group. Coping mechanisms of respondents included majorly listening to music, sleeping more, watching movies and hanging out with friends. Conclusion Most of the respondents perceived their training as stressful. It is evident from these findings that an urgent need for medical educators to introduce stress management courses or programs into the curriculum and establishment of student friendly functioning Guidance and Counseling Centres which would benefit the students maximally.

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WEPE82 What is the relationship between anthropometric and retinol status in under-five children? Edna Ndau Sokoine University of Agriculture, Tanzania Background We examined the relationship between anthropometric status and retinol status of children aged 6-59 months. Methods Using a sample of 568 children in two regions (Manyara and Shinyanga) of Tanzania. We controlled for different factors at household level namely, household assets, dietary diversity, patterns of oil consumption, knowledge, attitudes and practices concerning vitamin A, serum retinol of the mother, and retinol content of oil consumed by the household. Results Children in the sample were on average normal regarding wasting (mean weight-for-height z-score was 0.16, and median 0.07) but mildly stunted (mean height-for-age z-score was -1.18; median -1.44). However the prevalence of vitamin-A deficiency in children these regions, 72.1% in Manyara and 71.7% in Shinyanga, was found to be higher than the national average previously reported. Conclusions One possible factor is the declining coverage of vitamin A mega-dose, which has implications for increased infection and for child survival.

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WEPE83 Retention and treatment outcomes of an under nutrition program for HIV patients involving ready-to-use therapeutic food at Gondar University Hospital, Ethiopia: A cross-sectional study Henok Tegegn , Akshaya Bhagavathula 1

University of Gondar, Ethiopia

Background Despite global efforts to eradicate poverty and hunger, under-nutrition is still a major health problem, especially in Sub-Saharan Africa, where HIV/AIDS prevalence is also a serious burden. We aimed at assessing the retention and outcomes of under-nutrition treatment program in Gondar University Hospital, Ethiopia. Methods A cross-sectional study was conducted in HIV positive children and adults participating in the Ready-to-use Therapeutic Food (RUTF) treatment program at Gondar University Hospital ART clinic for one year from November 2012 to November 2013. Six hundred and thirty six patient records were followed-up for one year. Outcome variables were Mid-Upper Arm Circumference (MUAC) values measured as severe, moderate acute malnutrition, normal after treatment, non-respondent, relapsed and lost to follow-up using the hospital records of HIV positive children and adults eligible for the program. Univariate and multivariate analysis were performed to compute Crude Odds Ratio (COR) and Adjusted Odds Ratio (AOR). Statistical significance was set at p-value<0.05. Results Among 636 clients, 44.2% achieved MUAC measures â&#x2030;Ľ 125 mm for children and â&#x2030;Ľ 21 cm for adults at 4 and 6 months. 70.1% of those were children while 29.9% of the 281 were adults. Moreover, a more positive initial response to ready-to-use therapeutic food was found among children as there was significant increase (p<0.05) in MUAC value after the second month of initiating treatment while adults achieved a significant (p<0.05, p<0.01) in MUAC at the 4th and 6th month respectively. There was a significant association between age, nutrition status and treatment outcome, while sex, HIV status, education and residency were not associated with treatment outcome. Recovery and weight gain rates were below 50%. Defaulter rates were higher than the Sphere standards and recovery was better in children than adults. Conclusion Integrated RUTF and HIV program and strict follow-up and education or counseling of HIV positive patients should be strengthened.

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WEPE84 An assessment of barriers for teachers to carry out sexual education in Rwandan schools Gasana Joel University of Rwanda, Rwanda Introduction The lack of sex education and knowledge about family planning and reproductive health are influencing the incidence of people getting sexual transmitted diseases (including HIV/AIDS). This affects the number of children born per woman and the number of teenage pregnancies. Objective This study aims to identify teacher’s barriers, when they carry out sexual education in primary and secondary schools. Methods The study was based on 414 questionnaires answered by pupils in primary and secondary school, 4 Focus Group Discussions (FGD) with teachers, 9 interviews with pupils, 2 individual interviews with principals and 1individual interviews with teachers of teachers’ education. The qualitative data; hereunder the FGDs and interviews were analysed with Bandura’s Self-efficacy theory to identify teacher’s barriers, when carrying out sexual education. Results We found that the teachers have lack of knowledge about Sexual and Reproductive Health, didactic materials, and there is a need of integrating the social and cultural aspect of SRH in the teachers’ education. In addition the parents should be more involved in the children’s lives, school and sexual education. We furthermore found that the parents, religious leaders and the community’s opinion influence the teachers’ self-efficacy and can therefore be a barrier for the teachers to conduct high quality sexual education.

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WEPE85 Improving Attendance of fourth antenatal clinic visits in Isiolo district hospital using Weltel service Khaemba Antony , Olago Victor , Galma R , Muhula Samuel , Lester Richard , Koki Kinagwi2, Dida 2 4 3 A , Salo B , Karanja Sarah 1

WelTel International mHealth Society, Aphia plus Imarisha, AMREF Health Africa in Kenya, 4Isiolo County Referral Hospital

Background According to Kenya Demographic Health Survey (2014), over 49% of pregnant women in Isiolo County do not attend the recommended four antenatal visits. WelTel service is a combination of two way SMS and phone communication between health care providers and ANC clients. A weekly check in message is sent to an antenatal client who is enrolled in the WelTel platform to check in on her status, a client is expected to reply to the SMS depending with her status. Clients who report having problems are called and either counseled or given an appointment. The study aims to determine the effect of WelTel service in improving fourth ANC visits Methods 424 pregnant women attending their 1st ANC visits in Isiolo District Hospital in June 2015 to August 2015 were recruited in the study. Out of the 424, 225 were enrolled in the WelTel platform while 199 were not enrolled in the platform. All study participants had phone access and their gestational age was less than 20 weeks. The participants were followed up from June 2015 to February 2016 to determine the number of 4th ANC visits that they attended. Data on ANC visits was collected from ANC registers and Kobocollect and analyzed using STATA 13. Results 18 (26.08%) of the 69 clients enrolled in the platform in June completed the four ANC visits as compared to 7(10.77%) of the 65 non WelTel clients. 26(27.08%) of the 96 WelTel clients attended four ANC visits as compared to 5(8.47%) of 59 non WelTel participants recruited in July and 21 (24.13%) of 87 WelTel clients recruited in August attended four ANC visits as compared to 8(10.67%) of 75 non WelTel clients. With the p value of 0.0071 the impact of WelTel service is statistically significant Conclusion Clients enrolled in the WelTel service were more likely to attend the recommended four ANC visits. The results show that mHealth interventions can be used to improve health indicators among vulnerable and remote populations.

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WEPE86 Predictors of modern contraceptive use in Ghana, 1998-2008 Clementine Odei University of Ghana Background Ghanaâ&#x20AC;&#x2122;s population growth ranges 28% and 36% from 2000-2010 with total fertility rate of 4.2 in 2015. Family planning services have been available in Ghana for over five decades now to reduce fertility and increase prevalence of modern contraceptive use to 28% by 2010. However contraceptive prevalence as at 2015 was 22%. Low use of modern contraceptives has contributed to unintended pregnancies, unsafe abortions and maternal mortality. Studies have been done to determine the predictors of modern contraceptive use in Ghana, however not much has been explored to determine the changes in the predictors over time. Objectives To determine factors that predict modern contraceptive use and changes in the predictors between 1998 and 2008. Methods Secondary data from the Ghana Demographic and Health Surveys conducted in 1998, 2003 and 2008 were analyzed. Chi square test was used to determine association between demographic characteristics and current contraceptive use. Logistic regression was used to determine variables that best predict contraceptive use. Results Discussion of family planning among partners (OR: 5 56.7 95% CI: 4.42 -10.22) and (OR: 4.8 95% CI:3.59-6.47) respectively, husbandâ&#x20AC;&#x2122;s approval of family planning, formal education and parity were significant predictors. Place of residence and marital status which were predictors in 1998 no longer predicted modern contraceptive use in 2003 and 2008. Conclusion and Recommendation: Discussion offamilyplanningwas the strongest predictorfollowed by husbandâ&#x20AC;&#x2122;s approval of family planning, parity and educational status. There were changes in the predictors for the period under study. Family planning programmes should include education on how partners should discuss contraceptive use. Female education at least up to high school level should be given priority by the government. Family planning programmes at all levels should involve men. Keywords predictors, parity and contraceptives.

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WEPE87 The Resurgence of Medical Apartheid through Dialysis Rationing in South Africa Jessica Casimir University of Florida, United States Despite the implementation of a democratic regime built to resolve the inequities of the past, the Republic of South Africa has failed to appropriately deliver social change to the majority of historically marginalized and economically disadvantaged population. The rise of neoliberalism and corporatist policies have created a two-tier healthcare system that is under-resourced nationwide. South Africaâ&#x20AC;&#x2122;s private healthcare is lauded as tantamount to the systems seen in Western Europe and North America whereas public sector facilities lack comparable infrastructure and are prone to poor management and underfunding. As a result of these organizational and financial woes, accessibility to quality care is determined on the basis of race and class. Often times, this can result in unfair and unethical medical practices which privilege certain individuals and handicap others. Dialysis rationing, one of these practices, is a method utilized within public healthcare facilities which restricts access to renal replacement therapy (RRT) through medically prescribed criteria such as overall physical condition influenced by lifestyle behaviors, weight, and age. Yet, evidence shows that life-or-death decisions are made on benchmarks that inadvertently demerits black and Coloured South Africans. The first section of the paper will explore the development and challenges of government-sponsored healthcare and its negative impact on the management of acute renal failure and chronic kidney disease. Secondly, I will investigate the social epidemiology between the in-country HIV/AIDS epidemic and the manifestation of HIV-associated nephropathy as a national public health crisis. Lastly, policy recommendations will be provided in order to resolve this debilitating healthcare issue.

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Abstracts and Poster Sessions Day 3

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Thursday THPE01 Blessings by Cultural Elders as the Most Acceptable Alternative Cultural Ritual in Replacing Female Genital Mutilation for Uncircumcised Girls among Maa Communities in Kenya and Tanzania Nguura P.N , Nailantei N , Leshore C , Lesurmat M , Ondigo M , Majiakusi G , Ofware P 1 Amref Health Africa 1

Background The search for culturally acceptable alternatives to female genital mutilation (FGM) is crucial to the eradication of FGM. This study therefore sought to identify the alternative cultural ritual that Maa communities in Kenya and Tanzania find most culturally acceptable replacement for FGM. Methods A mixed methods cross-sectional cluster survey conducted in four alternative rites of passage (ARP) project areas namely: Magadi, Loitokitok (Kajiado County), Samburu (Samburu County) and Kilindi (Kilindi District) in Tanzania. Results 1,386 households were drawn from the ARP clusters and individual interviews were conducted with 489 females; 401 males and 496 young unmarried girls (10-24 years), both circumcised and ARP graduates selected randomly. In each selected household, one female (15-49 years) or males aged 18 years (Morans 18-30 years and adult men 18 years +) were interviewed interchangeably. Over fifty percent of both the young girls aged 10-24 years (62.5%) and adult men and women (53.8%) identified ‘blessings of the ARP girls by the elders’ as the most culturally accepted alternative ritual to replace FGM, followed by ‘going to school’ (young girls, 40.6%, adults, 33.8%); ‘blessings by the parents’ (young girls, 28%, and adults, 34%) and ‘blessing by the religious leaders’ (young girls, 28.2%; adults 25.5%). Conclusions and Recommendations Cultural elders’ blessing is the most acceptable replacement ritual for FGM to the majority of both Maasai girls and adults. Innovative ways of increasing cultural elders’ engagement in community Anti-FGM programmes should be pursued. Key words Alternative rites of passage, FGM, Cultural elders

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THPE02 Repeat HIV testing and counselling among mothers attending maternal, neonatal and child health clinics in Eastern Uganda health facilities: Missed opportunity Joseph Ekong Management Sciences for Health, Uganda Background It is clear that early identification and provision of antiretroviral treatment to all pregnant women with HIV is the best way to PMTCT. Repeat testing of mothers during subsequent trimesters of those found HIV-negative after their first test is recommended to monitor their status and initiate treatment of those found HIV positive. This study was aimed at determining the rate of HIV repeat testing of mothers attending maternal, neonatal and child health clinics. Methods Strengthening TB and HIV & AIDS Responses in Eastern Uganda (STAR-E), a USAID project funded by PEPFAR and implemented by Management Sciences for Health, followed by reviewed data from the 154 STAR-E supported health facilities for the period of January 2013 to December 2015 to determine the extent of repeat testing of mothers attending the facilitiesâ&#x20AC;&#x2122; antenatal clinics after training of health workers comprehensively. Data was entered into DHIS2, later abstracted and exported into Excel version 2010 for analysis into frequency tables Results A total of 373,805 pregnant women registered for antenatal care during this study period and all (100%) accessed HTC services offered as part of the PMTCT program at all the 154 primary health facilities in the 12 districts with 6,513 (1.7%) testing HIV positive at their first visit. Of the 367,292 women who tested HIV negative at their first visit, 130,620 (35.6%) received a repeat test with 848 (0.7%) of them having sero converted at the repeat test after testing negative at their first visit hence yielding overall project total of 7,361 HIV positive women and a regional prevalence of 1.97. All HIV positive women were enrolled into option B+. Conclusions HIV may be acquired during pregnancy and postpartum and would not be detected unless repeat HIV testing is conducted. Repeat HIV testing was able to add to the number of HIV-positive pregnant women receiving PMTCT services who initially tested negative. However, the data indicates that only half received a repeat test, indicating that health care providers need to increase their counselling and follow-up of mothers who initially test HIV negative to ensure that they receive repeat testing and to capture those who sero-convert during pregnancy.

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THPE03 Measuring Client Satisfaction by Color Coded Cards, ASK Project, Ethiopia, 2015 Muluken Dessalegn Amref Health Africa, Ethiopia Issues Service quality is the major concern in service delivery. While addressing the needs of the clients in the rural communities is neglected, Amref Health Africa by the ASK project funded by Dutch Ministry of Foreign Affairs to improve quality of SRHR service for young people introduced colour coded cards to assess client satisfaction. Description Amref Health Africa has introduced the use of red, green and yellow cards to measure client satisfaction in different health centers in North Showa. Clients (often illiterate) are informed about the cards and can choose to leave a card in a box after they receive services indicating if they are "satisfied" (green), "not satisfied, not unsatisfied" (yellow) or "unsatisfied" (red). Lessons learnt According the pilot study for instance, in one health center in July 2014 the results were 18% green, 58% yellow, 24% red. By mid-October the results were 67% green, 23% yellow and 10% red. Therefore, the impact is very huge in improving the quality of services and in the provisions of client centered service. The program is very effective in improving the satisfaction level of the clients, and increases the accountability of health care providers in improving the service. The tool is best approach to identify where the gaps of the health centre are and to intervene according the findings of the assessment. Next steps Considering the cost effectiveness, simple application, and high reliance and impact in a short time, to scale up the applications and increase the involvement of local governments/ leaders to take up the lead role and use the applications

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THPE04 mHealth in cervical cancer awareness, screening, treatment and prevention Tom Nickson mHealth Solutions, Kenya Issues Cervical cancer is a major public health concern among women in the developing world. In Kenya it is the second common cancer in women but the most common cause of cancer deaths. Although this cancer is easily prevented and controlled through screening, early detection and treatment of pre-cancerous lesions, most of the eligible women of reproductive health in Kenya have never been screened. Consequently, many cases present late when treatment is more difficult and more expensive to obtain. One major problem is identifying the few needing treatment among vast populations. Description We developed an eHealth platform that uses SMS/USSD technology in provision of local, rapid and accurate risk assessment, and treatment advice for cervical cancer which targets all women between 18-69 years. It also enables transmission of information to appointment clinics for remote identification of women who need to be screened. In addition, it records clinical observations, predicts complications and obtains problem-solving support, including from distant senior-level clinicians. Healthcare providers access data on an easy to use web based dashboard. Providers without internet access the patient data using a dedicated real-time USSD short code accessible from any cellular phone with GSM connectivity. Lessons Learnt With mobile penetration currently at 80% (over 33million users) and increasing at a rate of about 1.5% each quarter, use of mobile technologies would potentially enable delivery of clinical services and enable all eligible women to have a maximum access to quality cervical cancer screening and treatment services across all income areas. Recommendation The benefit of mHealth has been quickly acknowledged and should be adopted and deployed in resource constrained environments. Women would be screened and treated using visual inspection and cryotherapy technique (VIA). VIA is administered by a trained nurse, requires only basic supplies â&#x20AC;&#x201C; a speculum, cotton swabs, and vinegar â&#x20AC;&#x201C; and offers an ultra-cheap diagnosis on the spot.

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THPE05 Use of WhatsApp Group to Improve PMTCT Data, the Case of Navakholo Sub-County Lydiah Bwana , Wanyungu Haggai , Oindo Clement, Stephen Okoth 1

PATH, Kenya

Background AIDS, Population and Health Integrated Assistance Plus (APHIAPlus) Western Kenya Project supports among others, all the 4 Counties in Western region. Navakholo Sub-county, in Kakamega County, is one of the Sub-counties partnering with the project to strengthen the Health Management Information System (HMIS). Quality data is essential for monitoring, evaluating and improving the delivery of health-care services and programmes. Furthermore, support for public health services, such as HIV/AIDS, remain contingent on demonstrating impact using routine data. However, assuring the quality of routine data from the HMIS, remains a challenge. Every month data is collected, collated into summaries at health facilities and then uploaded to the District Health Information System (DHIS2) by the Sub County Health Records and Information Officer (SCHRIO) However, oftentimes there are inconsistencies between the data available at the health facilities (summary reports) and at DHIS2 level. This created major gaps in data quality. To address this discrepancy, the project in collaboration with the Sub-County Health Management, decided to innovate by using WhatsApp, a social media application. Methodology In 2015, the SCHRIO set up a WhatsApp group with members consisting of healthcare workers, health records officers and project team to discuss data quality and clinical issues. After the monthly reports were submitted, data discrepancies were flagged out and posted on the WhatsApp wall. This triggered the concerned staff from the health facilities to verify and correct the data in the source documents and summary reports and after discussions with the group, the corrections were effected on DHIS2. This was then followed by support supervision for verification. Results Following this innovative approach using a WhatsApp group, the inconsistencies between the summary reports and DHIS2 were significantly reduced and the indicators reflected differently and in the process triggering interventions to improve service delivery. For example, before this approach in 2014, the uptake of maternal and infant prophylaxis was 42% and 46%, respectively. This significantly improved to 98% and 100%, respectively, for maternal and infant prophylaxis uptake in 2015 when the innovation was introduced. Conclusion Use of low cost initiatives like WhatsApp for communicating and discussing issues including data management can have significant impact on the quality of data and ultimately improve service delivery as it also provides a forum to discuss and use data for implementation purposes.

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THPE06 Quality of integrated community case management of child hood illness in Zone 3 and 5 of Afar region, Ethiopia Admasu Woldetsadik Amref Health Africa, Ethiopia Background Afar region is one of the nine regional states of the country with the highest child mortality. Integrated community case management of childhood illness (iCCM) has been introduced in the region since 2011. However, little is known about the quality of iCCM care at health posts. The main purpose of the study was to determine the quality of iCCM care and way forward for its improvement. Methods The study was conducted in Zone 3 and 5 of Afar region. A total of 62 health posts were found in the study area. A facility and community based cross sectional survey with quantitative and qualitative data collection methods were employed. A total of 25 randomly selected health posts and 310 care takers who had received iCCM service participated. SPSS version 20 was used for quantitative data analysis. Results None of the assessed health posts were found with all essential iCCM commodities. The most stocked out supplies were TTC eye ointment, Vitamin A and BP100 which was 84%, 44% and 58% respectively. The four general danger signs were assessed only for 68.6% of the children. Just over half of children (53%) were classified correctly for all major iCCM illnesses. Only 51% of the children were assessed for cough, diarrhea, fever and malnutrition. Only 66.7%, 70.5 %, 71% of children with malnutrition, pneumonia and malaria were classified as having the diseases correctly respectively. Twenty three percent of children received antibiotics when it was not needed. Nearly ninety percent of the respondents who visited the health posts were satisfied with iCCM service they received. Conclusion and recommendation Availability of iCCM commodities, supplies, and job aids was not found at satisfactory level. The ICCM care provided at health posts were good but not complete as per the standards. The child care takers satisfaction with ICCM service was found high. Consistent iCCM supplies to the health posts and ICCM care provision needs improvement to ensure quality.

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THPE07 Effective contraception, counselling, and related factors among women seeking post abortion care in healthcare facilities in Kenya Michael M Mutua African Population and Health Research Center, Kenya Background Globally, about 22 million unsafe abortions occur annually, 21 million of them in developing counties. Often, women experiencing abortion resume sexual activity soon after resumption of ovulation. This paper seeks to investigate post-abortion contraception for women seeking postabortion care (PAC) in healthcare facilities in Kenya. Methods This study uses data from 350 facilities in Incidence and Magnitude of unsafe abortion study conducted in 2012. The outcome variable is whether client was counseled for family planning (FP) and given an â&#x20AC;&#x153;effectiveâ&#x20AC;? method. Results Overall, only 9% of patients treated for PAC received an effective method, 46% ineffective method and 45% did not receive any method of FP. Women with low decision-making capacity were less like to receive an effective method. Unemployed women for example had 23 % lower odds of receiving an effective method of FP. Receiving an effective FP method depended on; previous use, fertility intention, facility ownership, facility having an evacuation room, and number of methods the facility stocked. Conclusion and recommendations The role that women play in determining their post abortion contraception is evident. Women who were in better stead to negotiate for an effective FP method had better chances of receiving an effective method. This includes their ability to influence the outcomes of their treatment, their previous experience with FP and lower fertility intentions. Healthcare facilities have a role to play. Their preparedness to offer FP services influences whether PAC patients receive an effective method or not. The infrastructural capability of the facility to offer quality FP services is an important factor. There is therefore need for engagements in programs that improve womenâ&#x20AC;&#x2122;s choice processes through empowerment programs. In addition, service quality improvement at the healthcare facilities that increases their capacity to offer reproductive health services is a major component of improving the quality of PAC.

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THPE08 Increasing access to provider initiated testing and counseling among pregnant women attending ante-natal clinic in Agan clinic, Benue state in Nigeria Greg Abiaziem , Adetayo Towolawi , Oluwasina Folajinmi , Elizabeth Duile , Oluwakemi Gbadamosi 1

AIDS Healthcare Foundation, Nigeria

Background There are a lot of barriers hindering pregnant women from accessing routine and quality ante-natal care services in resource constrained settings. These include cost of transportation, long waiting time in clinics, and availability of screening tests for assays such as HIV 1 & 2, HBsAg, HCV, and VDRL. It is imperative for every pregnant women attending Ante- Natal Clinic (ANC) know their HIV status as to prevent Mother to Child Transmission (PMTCT) of HIV. This study aims to explore and identify ways to increase access to HIV testing in pregnant women attending ANC at FSP Agan Clinic. Methods A retrospective cross sectional study using a desk review of HIV testing done among pregnant women between June 1, 2014 and May 31, 2015 in FSP Agan clinic North Central Nigeria. Health workers from the treatment clinic were trained to provide HIV Counseling and Testing (HCT) for pregnant women attending ANC with the option to â&#x20AC;&#x153;opt out â&#x20AC;&#x153;and PMTCT services offered to women who tested positive. Result FSP Agan clinic has successfully integrated Maternal and Neonatal Child Health (MNCH) services in a facility that had no prior PMTCT intervention. Baseline data taken before the mobilization began showed that 62 pregnant women were tested for HCT with 4 (6.4%) positive cases seen and referrals were made to the nearest ART site for PMTCT services. In the subsequent year, a total of 130(109% increase) pregnant women were counseled, tested and received their result in the facility with 14 (10.8%) HIV positive cases seen, 10.8% enrolled and ART. 27 (20.8%) HIV exposed infant received prophylaxis for PMTCT intervention. Conclusion Increased access to HCT for pregnant women in resource constrained settings can improve and strengthen PMTCT intervention in healthcare facilities. More research on follow up models of HIV exposed infants will be needed.

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THPE09 Towards an Agent-Agile Methodology for mHealth applications Development Lawrence Thuku , Elisha Odira , Elisha Omulo 1

University of Nairobi, School of Computing and Informatics, Kenya

The introduction of mobile phones has resulted into immense growth in development of different types of mobile applications. One such type of mobile application is the use of mobile medical applications (mHealth apps) in the healthcare domain. These apps have become increasingly important by both clinicians and patients since their services have improved quality and access of healthcare, making the health sector more efficient through capturing and using real-time health information, preventing diseases and promoting public health. However, several studies have highlighted that such apps could compromise the patients’ data confidentiality, privacy and can be potentially dangerous if used for self-monitoring or diagnosis. Development of mHealth apps is a very complex task and their adoption success will be based on the creation of specific development methods that target mHealth apps development. To prevent their compromise, there is need to have well designed and tested mHealth apps which can be done using a well-designed situation specific development methodology. However, there is absence of formal mobile application development processes for specific situations with regard to mHealth apps. The various proposed methodologies and standards lack evidence on how they work in a real setting and how they would manage the assurance of mobile software to produce application-critical, and certifiable high quality software such as mHealth apps. One of the key significant factors to software project management success is the adoption of methodologies. Agile methodologies have been used as a “silver bullet” or “natural fit” for developing mobile applications. Agent technology has also been used and tested in the healthcare domain with much benefits reported. The purpose of this paper is to investigate on the different mobile application development methods and provide an upcoming mHealth apps development methodology. Since there can never be a “universal best fit” methodology for mobile apps development, this paper explores the need of creating a hybrid methodology based on two archetypical models (predictiveAgent technology and adaptive-agile model). It presents a critical analysis of agile methods and agent technologies and identifies their weaknesses and strengths in developing of mHealth apps. We came up with a hybrid methodology named as Agent-Agile mHealth Applications Development Methodology (A2-mHADM) by adopting the Situational Method Engineering (SME) approach to derive a project specific methodology for mHealth applications development. Keywords Agent technology, Agile methodology, Situational Method Engineering, software development methodology, mobile applications, mHealth apps

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THPE10 Perceived barriers to accessing maternal and child health care services among women of reproductive age in Gulu and Amuru districts Paul Gabula , Patrick Karugusi , Margaret Mugisa , Norman Aweno 1

Amref Health Africa, Uganda

Background The majority of Ugandan women (94%) attend at least one antenatal care (ANC) visit with a skilled provider while 47% attend four or more ANC visits. But fewer women deliver in health facilities (41%) or have a skilled birth attendant at delivery (42%) despite such high ANC attendance. Since June 2014, the MNCH Project has actively involved over 150 women groups, 150 VHTs, 23 health assistants and local leaders in community in mobilization of women of reproductive age to identify barriers to health services care seeking; develop and implement strategies to overcome the identified barriers. Methodology A community-based qualitative and quantitative study was conducted in which exit interviews at health facility level were conducted during the month of July 2015 and later in June 2016 with 201 women of reproductive age (15-49 years) and data collected using structured questionnaires and analyzed using STATA statistical software. Results Cultural barriers: At 18%, traditional norms and practices are a strong barrier towards seeking recommended maternal health services with just 40.2% women of reproductive age being knowledgeable on Safe motherhood practices. Poor quality of services: 20.7% were satisfied time for consultation was enough, 27.9% were satisfied with manner in which the health worker treated them and 41% agreed that the opening hours were convenient. Poor accessibility: 34% of the women reside in more than 10km to the health facilities. 76.6% had walked while 18% came by motorcycle and 4.5% by bicycles to the facility. 87.1% mentioned at least one barrier to seeking facility maternal and child care. Lack of social support: 31% women said their husbands and 58.7% said own-self while in-laws were at 9% in terms of who had the greatest influence on maternal and child healthcare decisions. On place of birth men were rated at 44.8%, own-self was rated at 48.8% while other family members were rated at 6.9%. Conclusions Even with government efforts and partner support to address barriers to MNCH, barriers to MNCH health care seeking among women of reproductive age are still glaring. Interventions to increase and improve MNCH care seeking should target these barriers for improved MNCH indicators.

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THPE11 Improving Postnatal Care uptake using service improvement strategies: A pilot study in rural health facilities in Kisoro District South Western Margaret Mugisa Amref Health Africa, Uganda Issue Postnatal care (PNC) within the first few days is a critical service that saves lives of mothers and infants. The Uganda Ministry of health guidelines prescribes that PNC should be delivered within six hours, six days, six weeks and six months. PNC uptake within six days is 33% at national level, while it is 18% in south western Uganda. Despite the existence of these guidelines its implementation has been inadequate. Amrefâ&#x20AC;&#x2122;s Saving Lives at Birth project piloted health facility service improvement projects in eight health facilities to improve uptake of PNC service in Kisoro District. Intervention Working with district health teams through support supervision and using HMIS data, PNC was identified as poorly utilized intervention in five health facilities. A process involving problem analysis, goal setting and activity identification was done with health workers and community health workers (CHWs). Using documentation journals health workers set baseline and tracked progress of their projects from February to June 2015. The activities implemented included engagement of CHWs in health promotion, tracking mothers; documentation of PNC services, integration of other PNC services with immunization and creating awareness during ANC and OPD. The results indicated improvement in uptake of PNC services, in health centers IIIs of Nyakinama (46.4 to 75%); Gateriteri (61 to 122%), Kagezi (0% to 52%), Kagano (26.5 to 47%) and Nyarubuye (25.6% to 33%),Bukimbiri (8.5% to 30.5%), Iremera (10.5 to 63.2%) and Nteko (0% to 44.1%). Lessons learnt Focused engagement of health workers and CHWs through supervision, mentorship and monitoring using guidelines to track progress of their projects motivated them to achieve their goals. Engagement of health workers and CHWs using service improvement strategies such as problem analysis, solutions development, integration of PNC and immunization services as well as effective documentation can greatly improve PNC uptake at health facility level. Key Words Postnatal Care, Utilization, Improvement

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THPE12 Reframing Abortion Stigma: Role of Ugandan Sengas in Normalizing Conversations on Abortion and Abortion Stigma Erick Yegon Ipas Africa Alliance, Kenya Background Senga (father's sister) is a traditional channel of communication about sexual behavior for adolescent females in rural Uganda. We evaluated a modification of this approach as an intervention reducing abortion stigma through community dialogues aimed at shifting cultural norms and expectations that support women seeking safe abortion services in order to reduce labelling, stereotyping and discrimination of women seeking safe abortion services including young unmarried or women from low-income settings. Methods A comparative mixed methods and post-intervention study in 3 divisions in Kampala with female community members reached by Sengas to validate outcomes observed over the course of the project and evaluate the effect of stigma reduction interventions in Kampala district. Results 156 respondents at baseline and 451(241 in intervention and 210 in control areas) at end line responded to the survey. 81% and 19% of respondents at intervention and control areas reported to have been exposed to the intervention. There was a reduction in respondents with moderateto-high levels of stigma from 51% at baseline to 6% at end line, with a corresponding increase among those that reported low-to-moderate stigma from 26% at baseline to 61% at end line and an increase in those that reported no stigma from 9% at baseline to 33% at the end of the project. Conclusions and Recommendations The observed level of reduction in abortion stigma scores suggests that stigmatizing attitudes, actions and beliefs decreased significantly from baseline to end line. These results indicate a major shift toward lower stigma scores in the geographic areas with senga intervention. We note that these are not matched pairs from baseline and end line, although both samples were drawn from the same geographic area.

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THPE13 Antenatal care and health facility delivery practice among mothers in Konso Woreda, Southern Ethiopia Kussie Urmale , Engida Yisma 1

University, Samara, Ethiopia, Addis Ababa University, Ethiopia

Background Worldwide, developing countries accounted for the majority of maternal deaths. Even though antenatal care and institutional delivery were mentioned among the interventions directed toward improving maternal health, their utilization is unsatisfactory in most resource-poor settings. When compared to other developing countries, antenatal care and health facility delivery practice in rural parts of Ethiopia is low. Therefore, the main aim of this study was to assess antenatal care and health facility delivery practice among mothers in Konso Woreda, Southern Ethiopia. Objective The main objective of this study was to assess antenatal care and health facility delivery practice among mothers in Konso Woreda, Southern Ethiopia from March 21 to April 16, 2016 Methods A community based cross-sectional study was done from March 21, 2016 to April 16, 2016 on sample of 865 mothers who gave birth in the last one year prior to the study in Konso Woreda by employing multi-stage stratified cluster sampling technique. The data were collected using a pre-tested interviewer administered questionnaire. We analysed the data to identify the factors associated with antenatal care and health facility delivery practice using logistic regression analysis. Results The proportion of mothers who made at least one antenatal care visit for their most recent birth was 82.0% (95% confidence interval (CI): 79.0%-84.0%) however, only 54% (95% CI: 50.4%-57.8%) of them had received the recommended four or more visits. Although the proportion of at least one antenatal care visits was high, only 60% (95% CI: 56.7%-63.3%) of the mothers gave birth at health institutions. After controlling for residence, husband education and household wealth quintile in the adjusted logistic regression model, maternal age [95% CI] =4.36 (1.46, 2.96)], possession of communication Medias [95% CI] = 0.18 (0.09, 0.37)] and walking distance (in hours) to the nearest health facility [95% CI] = 2.39 (1.86, 4.84)] were found significantly associated with antenatal care practice. Similarly after controlling for residence and pregnancy intention, provision of delivery care by the nearest health facility [95% CI] = 3.13 (1.62, 6.07)] and proximity of the health facility to the residence [95% CI] = 2.32 (1.16, 4.62)] were found to significantly increase the odds of giving birth at health institutions.

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THPE14 Improving family planning services delivery and uptake: Experiences from the Reversing the Stall in Fertility Decline in Western Kenya Project Joshua Amo-Adjei , Chimaraoke Izugbara , Michael Mutua , Sherine Athero 1

African Population and Health Research Center, Kenya

Issues The Reversing the Stall in Fertility Decline in Western Kenya Project was launched in 2009 in Western and Nyanza provinces, which at the time, had the highest average TFR of 5.5 against a national TFR of 4.6 in 2008. The goals of the project were to address the unavailability and inaccessibility of family planning services by (1) improving the supply of family planning services at community and facility levels, and (2) increasing the knowledge and demand for family planning services Description In collaboration five other partners, the African Population and Health Research Center, Nairobi, in 2009 implemented a family planning project in two counties in Kenya where total fertility rates were higher than the national average. Lessons learnt A majorexperiencewas thatworkingwith organisations and groupswith shared interests substantially enhanced the consortiumâ&#x20AC;&#x2122;s ability to engage with government and other gatekeepers in gaining access to critical material and non-material resources. This led to positive outcomes on service uptake and likely to impact on continuity and sustainability, an enduring bane on public health interventions in African contexts Next steps The consortium was recently awarded an extension grant by the David and Lucile Packard Foundation to identify opportunities for sustainability and expand key project interventions. The interventions for this 18-month extension will support research, documentation, dissemination, advocacy and policy engagement activities as well as institutionalization of key project achievements. During this period, we are focusing attention on dissemination of project achievements for the last six years. Also, the partners are addressing new research questions that emerged from Phases I and II, actively promoting uptake of evidence and sustainability of project activities as the project transitions to county governments.

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THPE15 Development of palliative care services through establishing palliative care course in medical and health sciences schoolâ&#x20AC;&#x2122;s curriculum Othniel Nimbabazi Africa Better Global Health Initiative (Rwanda) & University of Rwanda Background As NCDs are rapidly raising in Africa plus the burden of AIDS palliative care is highly needed, though Palliative care in Africa is facing many challenges and myths that broke it from developing fast including many teachings for palliative care are short courses in few countries, inadequate knowledge and awareness of palliative care, lack of integration in health systems, many graduates cannot chose its specialization without knowing it and myths that it is for caring for people with no hope of surviving. Objectives Demonstrate possible ways for palliative care development in Africa through establishing palliative care in schools curriculum so to have a good number of healthcare providers well trained in palliative care. Methodology Methods of literature review and interview survey with health sciences students Results Few centers for palliative care trainings present on continent, Nations with palliative care courses are still few and it demands to send people abroad short courses. Many graduates have no commitment with palliative care because of less knowledge about it. Development slowed by less awareness of palliative care among people and access its courses is limited to many countries as depending on availability of schools with palliative care program. Conclusion Palliative care development should be based proper awareness among people, education of young generations about palliative care to grow with adequate knowledge and for integration of it in health system and this would reduce costs used for sending people abroad studying short courses. Recommendation Palliative care needs a good health care team with qualified health provider that had been trained before and showed all commitment in palliative care services. Awareness of palliative care services should be took in consideration to inspire and interest future generations and population to know all about palliative care and hospice.

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THPE16 Development of locally designed educational materials on maternal depression to aid health talk delivery of the primary health care service providers in Ibadan Nigeria Oyedunni Arulogun , Adeyinka Adefolarin 1

University of Ibadan, Nigeria

Introduction Reports of the situation analysis of Maternal Mental Health (MMH) service delivery in the state revealed the need for educating service users about maternal depression using local terminologies. This study therefore aimed at designing educational materials which address maternal depression. Objective To develop a culturally adaptable maternal depression education materials which will aid health talk delivery on recognition, consequences, coping/help-seeking vis a vis misconceptions about maternal depression. Methodology This study is qualitative and it employed participatory approach. Guideline on kwsann website was followed in developing the materials. Sixty purposively selected people (health professional and service users) pretested and validated the materials qualitatively and quantitatively using Suitability Assessment of Materials (SAM). Knowledge of service users were assessed pre-post maternal depression health talk with the use of materials. Results This abstract reports the findings of the process for developing the materials only. Development and pretest of locally designed health talk guide, poster, leaflet and song. The local concepts in the materials include the translation into two Nigerian languages; Yoruba and Pidgin, use of Nigerian models, the use of indirect sentences to address bad consequences and addressing misconceptions. Song, poster, and leaflet were rated superior by 92.9%, 71.4%, and 78.6% health professionals respectively and there is a significant improvement of service usersâ&#x20AC;&#x2122; knowledge pre-post maternal depression health talk with p<0.05. Discussion Findings of this study show that knowledge of service users improved with the use of the materials during health talk, this is similar to the impact of educational materials on youthâ&#x20AC;&#x2122;s knowledge of HIV/AIDS. Conclusion This study can serve as a springboard for empowering mothers with information for prevention and early detection of maternal depression in the clinics and public.

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THPE17 Monthly trend analysis of current indicators in care and treatment, a case of Kakamega County Damaris Kinara , Elvis Ochieng , Haggai Wanyungu 1

APHIA PLUS Western Project, PATH, Kenya

Background Kakamega is one of the counties partnering with the APHIA-PLUS project to strengthen the Health Management Information System .There is lack of accurate, timely and complete data from the health facilities to DHIS2. Staff at the Health Facilities collate data and share monthly summaries with SCHRIOs which are keyed into (DHIS2) at the facility or the Sub- County. Some of the data quality gaps such as low utilization of register (MOH 366 & MOH 728 Tally sheet), discrepancies between registers, summary tools and the DHIS2, inaccurate decisions made due to fluctuations in data, and poor retention of patient to care were identified at the facility, sub-county, and County level. Methodology The project working with the County management decided to implement the use of monthly trend analysis as a measure to ensure data consistency. This was initiated by M&E Team with the county Health Management team. It consists of healthcare workers, records officers and project staff discussing data quality. Monitoring of monthly trends is done after collection and entry of data into the project data base .The data is aggregated in excel and entered into monthly analysis template to compare previous month data and the current month to establish the consistency in reports. Sites with discrepancies are followed-up for correction and justification. Once data has been corrected from the facility, the changes are submitted to the sub-county for updating the DHIS. The trend analysis conceptual framework was developed to guide this process. Results There was improved accountability of over 80% of patients currently on care/ ART, improved retention of patients in care & treatment due to monthly follow ups and documentation, and reporting improved hence quality data for decision-making. Conclusion Monitoring of monthly trends of reporting is very essential for accountability, consistency and accuracy of data thus a key strategy in data management, reporting and making informed decisions.

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THPE18 Improving linkage of HIV- reactive patients to Care through monthly analysis of HIV testing and counselling data -A case study in Kakamega General Hospital. Elvis Ochieng1, Rachael Ogola1, Oindo Clement1, Ann Omutsotsi 2 1PATH- Kenya, 2Ministry of Health, Kenya Background The AIDS, Population and Health Integrated Assistance (APHIA) plus West-ern Kenya Project is a United States Agency for International Development (USAID) â&#x20AC;&#x201C;funded project that is being implemented from January 2011 to December 2017.Kakamega County General Hospital is one of the health facilities being supported by the project to strengthen HMIS .It has about 22 HIV testing points where the data is compiled every month. Statement of the problem It was realized that there is effective HIV testing done in the facility but with low enrolment to care. The facility tested 70=90 patients who turned positives monthly but only enrol 30-40 patients leading to almost 50% of patient not accounted for .There was need to track this indicator to ensure proper linkage to care. Objectives To improve linkages of HIV positive patients to care, to improve documentation and follow up of HIV positive clients in the facilities and to determine innovative approaches towards data analysis for HIV positive patients. Methodology M&E team in APHIA-plus Office together with program HTC coordinator and The HMT embarked on the analysis of HTS data to establish linkage of positive patients to care and treatment. This was done through monthly analysis of number of patients who turned HIV positive to ensure that they are enrolled into care. Data entry was done at the project level and monthly analysis was done by generating number of patients who tested positive per facility and determined their linkage coverage. A black book was introduced with detailed information in the facility to register all patients who turned positives and their linkage facilities. We also, ensured that all positives patients are referred to CCC through an escort by a HTS counsellor and registered in the black book with required detailed information for follow up. However, those who would wish to be enrolled elsewhere were given a referral letter and followed up to ensure they are linked to care through phone call by Community Health worker. The letter is in triplicate form with a copy retained at the facility duplicate and triplicate submitted to the facility which the client was referred to. Monthly follow up was done by Peer Educators to ensure linkage to care. Results Improved monthly accountability of up to 80 % HIV positive patients, increased follow up of HIV positive patients to HIV care in the peripheral sites and improved quality of HTC data usage at the site level and sub-county level for decision-making. Recommendations The analysis of HTC data should be done every month to ensure proper linkage to care and follow up and linkage of HIV positive clients should be done to ensure early treatment.

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THPE19 Information use mapping tool for monitoring and evaluation activities at Malava Sub-County Hospital Haggai E. Wanyungu PATH- Kenya Background Malava sub-county Hospital is one of the health facilities supported by APHIAPLUS-Western Kenya project to strengthen Health Management Information system (HMIS) through data management process. There has been an effort in place to improve the information system in the facility through provision of data collection tools including longitudinal registers and summery tools. The MOH emphasize on timely reporting but little attention is paid after meeting the reporting datelines for utilization and intervention. Statement of the problem Even though data is collected, compiled and submitted on time to higher levels using the recommended MOH summary tools, there were noted gaps to empower staff with knowledge and skills to efficiently and effectively monitor and evaluate services offered through immediate consumption of data generated at the facility. Data generated from the summary tools is underutilized at the facility level thus making the facility not to have evidence guided decisions Objectives To use the DDIU tool to identify gaps and come up with ways to mitigate them, to identify existing data reporting channels and opportunities to improve the use and to empower Malava SCH staff with the knowledge and skills to efficiently and effectively monitor and evaluate services offered. Methodology Aphiaplus together with county team identified information use mapping tool giving opportunities for data collection and feedback for use at every service point Results There was improved Opportunities for new feedback mechanisms for data sharing from 43% to 80% of the reports submitted to higher levels Conclusion DDIU is the best practice that improves efficiencies and effectiveness of patient care management through informed decision making. Itâ&#x20AC;&#x2122;s evident that when an information flow was mapped visually, deficiencies quickly become apparent. Large, empty expanses of the chart told the story.

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THPE20 Determinants of choice of place of delivery among women with infants in Kakamega County Stephen Gachuhi , Harrysone Atieli , Samuel Anyona , Peter Ofware 1

Maseno University, Kenya, Amref Health Africa in Kenya 2

Background Kenya has unacceptably high maternal mortality ratio of 510 per 100,000 live births translating to about 8,000 annual deaths. Kakamega County with a ratio of 316 per 100,000 live births is among counties with the highest maternal deaths in Kenya. The choice of place of delivery is shaped by social economic and contextual environment. The study assessed individual, household and facility related determinants of womenâ&#x20AC;&#x2122;s choice of delivery place. Methodology A cross-sectional study was conducted from July 2015 to January 2016 among women who had given birth in the preceding year of the study. A total of 323 (98%) women were selected through multistage sampling and interviewed on fifteen comprehensive variables. Qualitative data was obtained using focus group discussions and key informants. Data was entered into Epi Data 3.1, analyzed using SPSS version 20 and presented descriptively. Statistical data was subjected to logistic regression at 95% confidence interval after controlling for confounders. Odds ratio was employed to determine the extent of association. đ?&#x2018;&#x192; Value < 0.05 was considered statistically significant. Results 85% of births occurred at the health facility while15% occurred in different locations at home. Women who attended four or more ANC visits were twice more likely to deliver at the health facility (OR, 95% CI: 2.310, 1.236-4.318; P=0.021). Women with knowledge on dangers associated with home delivery were more likely to deliver in the health facility (OR, 95% CI: 7.753, 2.816-21.349; P=<0.001). Increase in parity reduced the chance of health facility delivery by 18.1% (OR: 95% CI: 0.819:0.709-0.945; P=0.006). Conclusion and recommendations ANC attendance, knowledge on dangers of home delivery and parity influenced womenâ&#x20AC;&#x2122;s choice of place of delivery. Health education to encourage regular ANC attendance and to increase womenâ&#x20AC;&#x2122;s risk perception of home delivery should be encouraged.

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THPE21 Barriers to utilization maternal and child health care services among women of reproductive age in Gulu and Amuru districts Paul Gabula , Patrick Kagurusi , Margaret Mugisa , Norman Aweno 1

Amref Health Africa, Uganda

Background Majority (94%) pregnant women in Ugandan attend at least one antenatal care (ANC) visit while 47% attend four or more ANC visits. But fewer women (56%) return to deliver in health facilities (SBA). In 2014, we sought to increase the utilization of ANC and SBA using community health workers and women groups. We sought to understand the barriers to utilization of these services. Methodology Facility exit interviews involving 201 women aged (15-49 years) conducted between in July 2015 and repeated June 2016. Data was analyzed using STATA statistical software. Results Reasons for not returning were; Poor treatment by health workers - 79.3%, inconvenient clinic opening hours - 59%, partner support at 23.9%, traditional norms and practices â&#x20AC;&#x201C; 18%, lack of transport - 12.4% and other reasons at 14.9%. More than half of the women - 60% of the women lacked correct knowledge on why they needed to complete the maternity care cascade. Conclusions Poor treatment of women at health facilities remain significant barriers to utilizing services. We recommend that significant effort is made by all duty barriers to address health worker ethics and attitude.

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THPE22 Functionality of Women Groups implementing participatory learning cycles for maternal health in Northern Uganda Paul Gabula , Patrick Kagurusi , Margaret Mugisa , Norman Aweno 1

Amref Health Africa, Uganda

Introduction Using the Participatory Learning Action Cycle model 150 women groups within Gulu and Amuru districts were established in July 2014 aimed at mobilizing women of reproductive to access MNCH services. In June 2016, we sought to study the functionality of the performance of these groups. Methods A mixed methods approach was employed during the study to cater for both Qualitative and Quantitative data including; review of record books, focus group discussions, observations into how the women groups conduct their activities. Results Majority of the groups, 67.3% of the groups were active. Of these, 96.3% of the groups had Constitutions; and 90.7% of the groups had records books. In addition, 41.1% groups felt empowered (reported to be able run on their own, identify problem and influence community in implementing solutions), 30.8% of the groups were involved in community health beyond maternal health including - improving Sanitation and hygiene practices, prevention of malaria and food Security. Twenty three of the groups were already linked and receiving resources other development partners. Conclusion The PLAC approach has greatly empowered women groups It has been noted that women groups have made lots of progress and linking them to other partners will have a ripple effect.

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THPE23 Strengthening Community Structures forImproved Health Care Services - A case of Community Development Committees in Nigeria Kazeem Balogun , Nanlop Ogbureke 1

Christian Aid UK, Nigeria Country Programme

Issues Thereâ&#x20AC;&#x2122;s very little community participation in health planning and resourcing in Nigeria and thus Community Development Committees (CDCs) were instituted to bridge the gap of accountability between communities and the health system. However, there is little investment in building the capacity of CDCs to engage with the government and they tend to be male dominated. Description Our health projects encourage communities to adopt preventive health behavior and demand their health rights. Community Development Committees (CDCs) have been resuscitated using national criteria and their capacity strengthened in roles and responsibilities and basic advocacy skills. Communities develop Community Action Plans used as health advocacy tools to duty bearers resulting in increased resource allocation to health and provision of social amenities. Lessons Learnt Through resuscitating existing CDCs, community members were empowered to take forward identified health priorities and developmental needs. It is imperative that the perspectives of excluded groups, particularly women and children be taken into account. Recommendations Ensure selection of CDC members is participatory and inclusive; develop their capacity and allow them to identify their health and social priorities. Empower CDCs to understand the policy environment and budgetary provisions (externally and internally) to enable them conduct evidence based advocacy and strengthen linkages with policy makers. Think sustainability!

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THPE24 Psychosocial Support and Social Re-integration in Improving the Quality of Life of Obstetric Fistula Survivors in Magu District Tanzania Rita Mutayoba , Amos Nyirenda , Angela Mapunda , Rita Noronha , David Paul Ngilangwa 1

Amref Health Africa, Tanzania

Issues Obstetric fistula is a maternal morbidity bringing about devastating health and social problems to affected women. It leaves women with continuous and uncontrollable leaking or urine and/or feces from the vagina. Women with fistula have to deal not only with physical discomfort of leaking urine but also a great negative impact on personâ&#x20AC;&#x2122;s emotional well-being. Most women suffer from embarrassment, humiliation, stigmatization and shame from their own families and communities around. Separation and divorce from husbands is not uncommon to these women especially those who are childless. Description In Tanzania Amref has about 14 years in providing obstetric fistula services under the National fistula program by building capacity of health care workers to manage fistula cases, increase capacity of hospitals to do fistula repairs, organizing outreach visits and promote community involvement. In recent years, Amref Tanzania has initiated a pilot project to provide a comprehensive management of women with fistula through the continuum of care using a three prong approaches. In Magu district, Amref worked with health facilities and communities to provide health education and create awareness on fistula prevention, occurrence and management. Amref identified fistula survivors and conducted home visits to educate and provide psychosocial counseling to the survivor, family members and community around. Fistula survivors received education on entrepreneurship skills and income generating activities and integrated into community help groups. Fistula survivors benefited from this project are now working confidently as ambassadors in their communities to create awareness and identify new cases. Lesson learnt This programme illustrates that clinical management alone is not enough to address other associated social outcomes around fistula morbidity. Testimonies from fistula survivorsâ&#x20AC;&#x2122; shows that a comprehensive approach which include psychosocial and economic empowerment are critical in management and improving quality of life of fistula survivors. Next steps Scaling up and replication of this model to other areas in the country will be beneficial to improve quality of maternal life.

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THPE25 Assessment of unmet needs of family planning methods in Musoma district, Tanzania: comparison of baseline and end-line data David Ngilangwa , Rita Noronha , Serafina Mkuwa , Godfrey Matumu , Benatus Sambili , 1 1 Sia Lyimo , Florence Temu 1

Amref Health Africa, Tanzania

Background Despite the fact that, knowledge of contraception and its importance in reducing maternal mortality is almost universal in Tanzania, unmet needs for family planning(FP) is estimated to be at 25% among currently married women. Hence, Amref Health Africa implemented a two-year intervention from January 2011 to December 2012 to increase acceptance and use of modern contraceptive methods. study aimed at identifying and documenting changes occurred following the implementation of the intervention. Methods This was a mixed methods descriptive cross-sectional study conducted in Musoma district, in Mara region, Tanzania in May 2013. A multistage random sampling was used to select 283 respondents aged between 15-49 years who stayed within the intervention catchment for more than 2 years for the household interviews. Data was analyzed using STATA 12. Results Of all the participants interviewed, 125 (44%) were males and 157 (56%) were females. The mean age of the participants was 30 years (SD=8.24). Majority of the participants had primary school education (77%), Catholics (56%) and married (67%). The sources of FP information to the community were multiple mass media channels. Women and respondents with less than 30 years had more access to information as compared to their counterparts. Acceptance and utilization of modern contraceptive methods among women and men increased from 18% to 40% (p value < 0.001). About 58% of respondents had at least used contraceptive methods in their lifetime. Additionally, 55% of the participants had used modern contraceptive methods 3 months prior the survey. However, the district data indicated that the FP acceptance rate was 21%. Study also recorded unmet needs of FP at 47%. Conclusions Although the knowledge and uptake of FP increased significantly in study area, but unmet need for FP remains high. Thus, we recommend for strengthening of community-based programmes to reach more targeted population and well as qualitative study to understand factors for the low uptake.

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THPE26 Utilization of cervical cancer screening services in Musoma district, Tanzania Gaspery Misungwi , Rita Noronha , Florence Temu , David Paul Ngilangwa 1

Amref Health Africa, Tanzania

Background Globally, cervical cancer is among the most prevalent and lethal female cancers. About 500,000 new cases and 273,000 deaths occur yearly. Tanzania is estimated to have high incidence rate of 68.6/100,000 when compared with other Sub Saharan African countries. World Health Organization and other partners are implementing cervical cancer screening programs to reduce the burden of cervical cancer. However, its uptake remains to be very low. To investigate the awareness and utilization of cervical cancer screening services amongst women in Musoma district. Methods This was a mixed methods descriptive cross-sectional study conducted in Musoma district, in Mara region, Tanzania in May 2013. A multistage random sampling was used to select 282 respondents aged between 15-49 years who stayed within the intervention catchment for more than 2 years for the household interviews. Qualitative transcripts were analyzed thematically using Nvivo 10 while quantitative data was analyzed using STATA 12. Results About 170 (60%) of the interviewed women were aware of the provision of cervical cancer screening services in the district. Of them, only 19(11%) reported to have sought services and directed to seek outside of the district. In contrast, 10 selected health facilities the district reported to have screening equipments however were not providing services. The reasons given were; HCWs were not aware of the availability of equipments, forgotten the procedures and training they received was not adequate to make them confident. Conclusions Majority of women were aware of cervical cancer screening services, however uptake was very low. Refresher trainings and supportive supervision should be routinely conducted to equip HCWs with screening skills. Education and awareness campaigns targeting mostly women with high parity and low education levels should also continue.

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THPE27 Preferences and use of modern contraception usage among women of the reproductive age in Musoma district, Tanzania Gaspery Misungwi , Godfrey Matumu , Medard Lwakatare , David Paul Ngilangwa 1

Amref Health Africa, Tanzania

Background Family planning (FP) prevents unintended pregnancies and unsafe abortions consequently contribute to reduction of maternal mortality. Additionally, it contributes to economic growth and empowerment of women. Tanzania, with Total Fertility Rate (TFR) of 5.4 births per woman, only 34% of currently married women are using contraceptives while the other 25% have unmet needs of FP. We conducted this study assess the prevalence and reasons for the usage of modern contraceptive methods among married women of reproductive age. Methods This was a mixed methods descriptive cross-sectional study conducted in Musoma district, in Mara region, Tanzania in May 2013. A multistage random sampling was used to select 282 respondents aged between 15-49 years who stayed within the intervention catchment for more than 2 years for the household interviews. Qualitative transcripts were analyzed thematically using Nvivo 10 while quantitative data was analyzed using STATA 12. Results The prevalence of modern contraceptive use among currently married women was 65.2%. Both male and female condoms were the mostly mentioned method by 185(46.1%), followed by injectable contraceptives methods 130 (32.4%), followed by pills 40 (10.4%), norplant 32(8.0%) and intrauterine device 14 (3.5%). Similarly, findings from qualitative showed that most of the women are aware of modern contraceptives; and they would like to space or limit their fertility purposely to contribute in economic activities. Conclusions The usage of modern contraceptive use in this population was high. The district health authority should continue to mobilize and sustain resources to scale-up services to even cover all women. In addition, more education and male involvement as efforts to increase uptake of the services should continue.

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THPE28 Using community based referral mechanisms to promote access to reproductive health services Lawrence Auma , Oliver Furechi 1

Save the Children, Kenya

Issue Save the Children has implemented community based referral mechanism (CBRM) in Bungoma County for two years to support the reduction of maternal and neonatal deaths and improve the access to health care services. The intervention is focused to timely decision making for the health care facility-based access whenever a mother/neonate experiences health emergencies at the household level. Having considered various options including proper linkages with the health facilityâ&#x20AC;&#x2122;s ambulance but the distance, lack of fuel in the middle of the night and the ragged terrains remained the obstacles for successful referral by the facility ambulances. Description Nine steps for initiating CBRM at 20 CHUs were applied with the local leaders and CHU members for proper community Dialogue Days where CBRM was of discussed and embraced as a solution to unskilled deliveries and maternal/neonatal mortality. Twenty bpdboda riders were selected based on the communityâ&#x20AC;&#x2122;s agreed qualification criteria Lessons learnt Key findings included increased knowledge on complications of maternal and neonatal danger signs, increased ANC/PNC visits after the intervention compared to baseline.Within the 20 CHUs with the CBRM there is a very low maternal death reported at the community. CBRM significantly improves access to medical care and services among the rural population. Since its inception, the highest month of CBRM referral was 290 cases while the lowest CBRM referral recorded 180 cases. Ten communities have started to contribute towards the sustainability of their CBRM. Recommendation Community based referral mechanism is the only current intervention that makes access to health care services function as per the MOH guideline. Through the CBRM, the principles of the accessibility for all, quality of health care services, safety and efficiency are realized all the time at the household for the mother and the newborn and if the policy makers can prioritize it and embrace its implementations, then, there will be hope of accessibility for health care services for the hard to reach areas

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THPE29 Potential of Camellia sinensis proanthocyanidins-rich fraction for controlling malaria mosquito populations through disruption of larval development Jackson Muema , Joel Bargul , Steven Nyanjom , James Mutunga , Sospeter Njeru 1

Jomo Kenyatta University of Agriculture and Technology, Kenya, Malaria Research Program, 3 International Centre of Insect Physiology and Ecology, Nairobi, Kenya, Fritz Lipmann Institute (FLI)Leibniz Institute for Age Research, Jena, Germany 1

Background Anopheles arabiensis and A.gambiae (sensu stricto) are the most prolific Afrotropical malaria vectors. Population control efforts of these two vectors have been hampered by extremely diverse larval breeding sites and widespread insecticide resistance. Control of mosquito larval stages using plantderived compounds has the potential to suppress vector populations reducing disease transmission rates. In this study, we evaluated the efficacy of Camellia sinensis extracts against larval stages of A. arabiensis and A. gambiae (s.s.). Methods Late third instar larvae (L3) of A. arabiensis and A. gambiae (s.s.) were exposed to increasing doses of C. sinensis leaf extract and its active fraction for 72 hours, with mortality rates recorded every 24 hours. UPLC/ESI-Qtof/MS was used to determine the main active constituents in the fraction. Results The major bioactive chemical constituents in the C. sinensis leaf extract were identified to be proanthocyanidins. The extract significantly interfered with larval survival and adult emergence in both species (F (5, 24) =1435.92, P < 0.001). Additionally, larval exposure to crude extract at 250 ppm and 500 ppm for 24 h resulted in larval mortality rates of over 90% in A. gambiae (s.s.) and 75 % in A. arabiensis. A relatively lower concentration of 100 ppm resulted in moderate mortality rates of < 50% in both species, but induced growth disruption effects evident as abnormal larvalpupal intermediates and disrupted adult emergence. The estimated LC50 concentrations of the crude leaf extract against A. arabiensis and A. gambiae (s.s.) larvae at 24 h were 154.58 ppm (95% CI: 152.37â&#x20AC;&#x201C;158.22) and 117.15 ppm (95% CI: 112.86â&#x20AC;&#x201C;127.04), respectively.The bioactive polar fraction caused 100% larval mortality in both vector species at 25 ppm. Conclusion Our findings demonstrate the potential of green tea extract and its active constituents in disrupting mosquito larval development which could contribute to improved management of malaria.

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THPE30 Factors that enhance Reintegration of Fistula clients into the community after Surgical Repair of obstetric Fistula in Gulu, Arua and Zombo Districts Oryema Patrick Amref Health Africa, Uganda Background Fistula repaired women have continued to be socially isolated, stigmatized and discriminated, as a result, they often become social outcasts and they need support to reintegrate into the community after fistula repair. While Fistula repairs have been scaled up in Northern and West Nile regions of Uganda, little is known about reintegration of fistula survivors into the community. The aim is to identify reintegration and success factors of fistula survivors into the community after corrective surgical Fistula repair. Methods During the period from May, 2014 to April, 2016, 346 cases of Obstetric Fistula were repaired. The survivors were supported and referred to the health workers who counseled them alongside family members. Amref Health Africa encouraged clients to join existing women community groups for skill trainings. This was a qualitative study comprising of in-depth interviews, key informant interviews and focus group discussions were used to collect data to explore reintegration to family and community after corrective fistula surgery. The study examined restoration of family lives, connection with social norms, ability to do the work they used to do before they developed the condition. Results At follow up, the majority of the women 76 (95%) who received successful surgical repairs reported that they were able to resume social and economic activities they were engaged in prior to the development of fistula. Familial support facilitated both accessing repair and recovery. However, 4 (5%) of Fistula survivors were still leaking were staying with their parents. The barriers to reintegration of Fistula survivors were: failed repairs, lack of spouse support during and after repairs negatively influenced reintegration of fistula survivors. While return to continence, psychosocial counseling and support contribute greatly in the reintegration of Fistula Survivors at both household and community levels. Conclusion The result showed that following successful repair, majority (95%) of the women are able to resume full and productive lives, able to interact with their families, friends and communities, carry out domestic tasks, and support themselves and their familiesâ&#x20AC;&#x2122; financially. Recommendations Long term psychosocial counseling, income generating activities and skill training to be incorporated as part of reintegration package after corrective surgical repairs. Keywords Obstetric Fistula, re-occurrence, social re-integration. 328

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THPE31 A rapid assessment of the social demographics, practices and behaviors of patients repaired during a Specialists Camp at Nyapea Hospital, Zombo District Oryema Patrick Amref Health Africa, Uganda Background Since 2015, Nyapea hospital has been offering specialistsâ&#x20AC;&#x2122; surgical camps to repair fistulae patients. The social demographics, practices and behaviours of patients treated as well as the outcomes of operation are not known. The aim of the assessment was therefore, to identify the social demographics, practices and behaviours of patients treated during the surgical camp conducted from 8th â&#x20AC;&#x201C; 12th February, 2016. Methods A rapid assessment of 22 clients out of 39 that received repairs was conducted to capture social demographics, practices and behaviors. The questions were linked to marital status, occupation, level of education, number of deliveries, (both alive and dead), number of children delivered at health facility, number of times the clients had been repaired that would help the project get an in-depth knowledge of the clients that are being supported. Results Majority 10 (45%) had separated with their partners and only 7(32%) were married. It was also observed that 19(86%) of the clients repaired were from the Alur tribe, followed by the Lenbu 2 (9%) and Lendu 1(5%). Majority of the clients 12(55%) had no education, 9(41%) with primary level and only 1who had secondary education and non reach tertiary level. Majority of the clients, 16 (73%) repaired were peasant farmers. While 4 (18%) where not employed, 2 (9%) were doing business. 15 (68%) of the clients had had first repair since they developed fistula, 5(23%) had been repaired twice, 1(5%) had been repaired 3 times and 1(5%) had had fourth repairs. Conclusion The assessment showed that cases of divorce are high among fistula patients. Surprisingly, fistulae are high among Alur tribe, followed by Lenbu and least among Lendu tribe. Recurrences are high meaning that the success rate of the clients is not good. Recommendations Find out the behaviors, cultural and beliefs that could be linked to Alur tribe that could be leading to high Fistula prevalence amongst them. Adequate counseling by health workers, and adequate follow-up of fistulae survivors in order for them to reintegrate back into the community so that they regain better living conditions since they are no longer living with their partners. Keywords Obstetric Fistula, recurrences, social re-integration.

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THPE32 Knowledge, Attitude and Practice Towards Gender Based Violence Among Adults Residing along Dodoma Babati Road in Central Tanzania Anatori Didi , Tumaini Mashina , Sia Lyimo , Amos Nyirenda , David Ngilangwa 1

Amref Health Africa, Tanzania

Background The road construction sector attracts a large number of migrant workers from rural areas both within a region and across regions. International Labour Organization in 2007 listed a number of work and lifestyle factors which expose workers to the risk of HIV, TB and STI infection. Though the work of road construction tends to be predominantly a male occupation, there are a significant number of women engaged in road construction in some parts of the Tanzania, the majority of whom in informal road construction. Female road workers are especially vulnerable to harassment and violence on isolated sites, and where the work site is also their home, it is extremely challenging for women workers to have any security or privacy. Methods This was a cross sectional study of among sexually active adults aged 15-49 years residing along Dodomaâ&#x20AC;&#x201C;Babati road in central Tanzania in December 2014. The multistage sampling technique was used to select 155 participants. A standardized questionnaire was administered to collect information on condom use in the past 12 months. Descriptive data analysis was done using SPSS 20. Results The study respondents were 155 (43% males and 56.1% females). As regards marital status; single 25.8%, married 63.9%, separated 7.7%, divorced 1.6% and 0.6% widowed. In response to gender based violence practices that has been experienced with last sexual partner, the findings revealed that; threatened to be humiliated was 9% for males and 21% females, insulted was 19% for males and 48% females, slapped by partner was 21% for males and 31% females and forced to have sex 8% and females 12%. Conclusions Generally, gender based violence practices is higher among females compared to males in all aspects, though there are gender based violence practices directed to males. Interventions aiming at gender-based violence mitigations along road construction project areas should focus on both males and females.

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THPE33 Effect of a novel combination of multiple demand creation strategies on utilization of maternal and newborn health services in Bungoma County, Kenya Oliver Furechi Save the Children, Kenya Background In Kenya maternal and neonatal mortality is still very high with a majority of this deaths being preventable. Utilisation of maternal and new-born (MNH) services has a potential to reduce maternal and newborn deaths. In Bungoma County, 40% of pregnant women attended four antenatal care visits (ANC), 51% delivered with a skilled provider (SBA) and a paltry 23% attended postnatal care (PNC) within 48 hours. Save the Children is implementing a combination of interventions; women groups, men only barazaâ&#x20AC;&#x2122;s, mass media, community theatre, integrating traditional birth attendants, training community health volunteers, supporting a community based referral mechanism. Objectives We assessed the effect of the interventions package on utilisation of MNH services within the three sub counties. Our primary outcome variable was the proportion of women delivering with a skilled birth attendant. Methodology A prospective intervention study was undertaking within facilities in three sub counties. Data was pulled from district health information system (DHIS2 in June 2014 and exactly two year later. It was disaggregated at three levels 1) Sub county level, 2) Tier 3 hospitals 3) Tier 2 health facilities. Descriptive statistics were performed to analyse data. Results Tier 2 and tier 3 health facilities represented 91% and 9%respectively. Significant improvement in utilization of ANC 4+ and SBA was observed within tier 2 health facilities and at the sub county level. However no significant change was observed at tier 3. PNC did not significantly improve at all levels. Conclusion and recommendations The intervention package has a potential of improving utilisation of MNH service, however there is need to evaluate the contribution of each package to identify the most optimal interventions. Key Words Demand Creation, MNH

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THPE34 Deploying a novel combination of multiple demand creation strategies to improve uptake of reproductive health in Bungoma County, Kenya Oliver Furechi Save the Children, Kenya Issues In Kenya 488 out of 100000 women and 22 out of 1000 neonates die each year. Some of this deaths can be prevented through increased utilisation of quality maternal and neonatal health (MNH) services. In Bungoma County, 40% of women with newborns attended four antenatal care visits, 51% delivered with a skilled provider while 23% attended postnatal care within the recommended 48hours. To address delays one and two; make decision to go to a health facility and to reach the facility, Save the Children is implementing a novel demand creation strategy in Bungoma County. Description Save the Children is implementing a four year MNH programme in four sub counties in Bungoma County. The programme site has three tier 3 hospitals, 32 tier 2 health facilities and 120 community units with a total of 102,286 women within the reproductive age. The programme has three components with the focus of this paper being component two; increasing demand for and utilisation of MNH services. The package includes; training CHVs, women groups, men only barazaâ&#x20AC;&#x2122;s, mass media, community theatre, re-orienting traditional birth attendants, supporting a community based referral mechanism and partnering with community midwifes. Lessons Learnt Targeted mobilization within tier 2 health facilities has the greatest impact than aiming to saturate all sites to achieve 80% coverage, -Improving utilisation of PNC requires a concerted effort beyond community mobilisation; systemic issues play a major role for a programme to demonstrate significant changes on this outcome Recommendation The intervention package has a potential to dramatically improve utilization of MNH services however there is need to evaluate the contribution of each intervention to inform a decision on which intervention has the highest impact.

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THPE35 Planning for implementation of participatory learning action cycle to improve uptake of MNH service through stakeholder workshops in Bungoma County, Kenya Oliver Furechi Save the Children, Kenya Issues In 2015, WHO recommended participatory learning action cycle {PLAC} through women groups as an intervention to increase utilisation of maternal and newborn health (MNH) services. This approach had been successfully implemented in Bolivia, Bangladesh, India and Malawi resulting into 25% reduced maternal mortality and 36% reduction of neonatal mortality. In Bungoma County, utilisation of MNH services is below the national average and to improve these indicators, Save the Children sort to engage the community on whether and how PLAC can be implemented on a large scale Bungoma County. Description Save the Children conducted three planning workshops; one at the county level and two at the sub county level in October 2014. At each workshop we explored MNH challenges faced by the communities, current practices to solve those challenges and results achieved so far. We introduced this new model and led the group to discuss its potential and whether it was feasible, the potential challenges and what can be done to ensure it success. A total of 21 health mangers, 11community health volunteers, 8 mothers in laws, 5 traditional birth attendants, 3 local administrators, 15 men and 27 women of reproductive age were consulted. Lessons Learnt Engaging the stakeholders prior to rolling out a new intervention has led to increased ownership and smooth take off and communities are inclined towards extrinsic incentives however they also recognize and value intrinsic incentives. Recommendations Establish new groups comprising all women of reproductive age and reach out to older groups on a rolling basis and participants should not be paid allowance to attend meetings, however, they can be issued with a membership card and a certificate on graduation

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THPE36 A community model for family planning group learning and counseling in Gulu, NorthernUganda Dickens Ojamuge , Lillian Ojanduru , Sarah Naikoba , Grace Awor , Jeannette Cachan 2 Esther Spindler 1

Save the Children, Uganda 2 Institute for Reproductive Health (IRH) Georgetown University.

Issues In Northern Uganda, where contraceptive prevalence rate is 24% and unmet need 34% (DHS, 2011), women and men face many barriers in accessing family planning (FP) methods. Evidence shows that trained community agents can effectively bridge this barrier by providing FP methods directly in the community. Yet, few studies have tested group approaches to FP counseling outside health service delivery. Building off this evidence, a proof of concept was conducted to test WALAN, a group learning counseling intervention - that relies on non-health community volunteers, for expanding FP access. Description The proof of concept tested the modelâ&#x20AC;&#x2122;s feasibility in eight villages of the Gulu and Nwoya Districts. Community Development Officers trained 16 youth facilitators to offer community-wide education sessions in body literacy and FP, and group counseling sessions on Standard Days Method and TwoDay Method- two simple fertility awareness methods (FAM) to interested couples. The POC was assessed using 24 direct observations of community learning and group counseling sessions; nine interviews with couples using FAM; three focus group discussions with youth facilitators, and; nine key-informant interviews with providers and leaders. Lessons Learnt Quantitative and qualitative data suggests that youth facilitators can mobilize their communities, deliver sessions and counsel users in FAM. Also, couples who were taught about FAM in a group learned how to use the methods correctly and were comfortable learning about the method in a group, confirming that the model is an acceptable intervention. Next steps Results were used to inform a 12-month pilot intervention that was launched in April 2016 in 15 villages of Gulu, Nwoya and Amuru districts. Results from the pilot will be used to assess the potential scalability of the group learning model to other areas of Northern Uganda and beyond.

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THPE37 Testing the effectiveness of a community theatre approach in Karamoja to increase demand for family planning services Lilian Ojanduru Georgetown University, Uganda Background Ugandaâ&#x20AC;&#x2122;s Karamoja region has some of the lowest national indicators, including a low contraceptive prevalence rate (CPR) of 7.4%. In response, the EDEAN intervention is being tested to increase fertility awareness and improve family planning (FP) use in Karamoja. This presentation, will provide preliminary findings from testing a community theatre approach aimed at diffusing fertility awareness information and increasing demand for FP information and services. Methods A quasi-experimental study is being conducted to assess the delivery, effectiveness and potential scalability of EDEAN, launched in May 2016. Methods include: 1. Baseline and endline surveys from 400 intervention and 200 control households; 2. Systematic observational data from EDEAN activities; 3. Focus group discussions with community members, and; 4. Key informant interviews. Results Baseline survey findings confirm the low levels of fertility awareness and almost universal use of abstinence as a form of natural FP. On average, close to half of the participants in the intervention community (45.5%) scored a low score on the fertility awareness scale, and with only 25.5% achieving a high score. The majority of intervention and control participants reported abstinence (66% and 85%, respectively) as the most common method of FP. Systematic observational data also shows that demand for fertility awareness and FP information is high. Some key challenges include gender dynamics between peer group and audience members, as some female participants may be unavailable or discouraged to participate. Conclusions and Recommendations Responding to 225 million women globally with unmet need for FP, EDEAN has sought to identify ways to reach women and men outside the health system to test whether improved fertility awareness increases FP use. However, building strong linkages with the health sector remains a project gap.

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THPE38 Client satisfaction with Community Case Management of Uncomplicated Malaria by Community Health Volunteers in Bungoma County, Kenya Chrisanthus Okutoyi Amref Health Africa, Kenya Background Owing to the burden of malaria in Kenya, community case management of Malaria (CCMM) has been adopted to overcome barriers to prompt access of Malaria treatment as recommended by World Health Organisation. Community membersâ&#x20AC;&#x2122; feedback is essential in evaluating the outcomes of CCMM as implemented by Amref Health Africa. This study therefore sought to evaluate the extent to which clients were satisfied with Community Case Management of Malaria. Method A cross-sectional study was conducted whereby a client satisfaction tool was administered to 381 clients offered CCMM services at household level. All suspected malaria cases that were tested by CHVs were asked to consent to participate in the assessment. The inclusion criteria included individual or child must be sick or presenting with a new health problem or does not require urgent referral. Data was analysed using descriptive statistics. Parameters used to measure satisfaction are availability of CHVs, convenience of getting CCMM service and promptness to respond to a call by CHVs Results Average age of the respondents was 40 years, 81% were female and majority of respondents practised farming (61%). Majority (93%, 94% and 91%) of the clients were satisfied with availability (obtainability/readiness), convenience (suitability/ease) and promptness (timeliness/punctuality) to respond to a call, when CHVs offer CCMM respectively. They further felt that the time taken to conduct the test, explanations given on treatment and friendliness during CCMM was good (94%, 90%, and 95% respectively). Most (98%) of the clients considered CHVs a regular source of basic healthcare on Malaria. Health education received was highly perceived to be helpful (93%). Conclusion The community was satisfied with CCMM due to accessibility to diagnosis and treatment of uncomplicated Malaria in relation to convenience, promptness and additional health education services received. There is need to support CCMM and if possible improve it.

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THPE39 Improving quality of community maternal and newborn health by use of a simple checklist, a case study of Busia County Geofrey Tanui , Oliver Furechi 1

Save the Children International, Kenya

Issue Supportive supervision for Community Health Volunteers (CHVs) is a powerful approach in improving the quality of Community Based Maternal and Newborn Care (CBMNC). Description Supportive supervision is a continuous technical support provided by a trained Community Health Extension Worker (CHEW) to CHVs who are visiting pregnant/postpartum women and newborn babies at the household level. CHEWs were given technical support and provided with tools to develop a simple quality checklist that detailed minimum acceptable standards to be met when a CHV visits a household with a pregnant/postpartum woman for counselling. The tool was based on the guidance provided in Maternal and Newborn Care Manual for Community Health Worker. Lessons learnt Use of simple yet appropriate tools for CHVs supportive supervision contributes to quality programming in CBMNC. 90% (55) of the CHVs supervised between March and July 2016 made timed visits to pregnant mothers and newborns. Out of 42 CHVs who visited households with pregnant mothers, 38 counselled on individual birth plans while 39 out of 53 CHVs who visited pregnant/postpartum women and newborns counselled on danger signs. Out of 16 CHVs who visited newborns/postpartum mothers, 9 counselled on cord care while 12 counselled on exclusive breastfeeding and recommended breast attachment. Out of 16 postpartum mothers visited at home, 10 went for at least four antenatal care visits and 14 of the 16 gave birth under the help of a skilled birth attendant. Recommendations County Governmentsâ&#x20AC;&#x2122; Departments of health should adopt supportive supervision for quality CBMNC and county Governments and partners should provide tools, technical and financial support for CHEWs to develop simple tools for quality community health services

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THPE40 A promising strategy for zero obstetric fistula cases in Senegal Fatou Gaye , Aboubakiry Koulibaly , Bara Ndiaye , Sylla Thiam 1

Amref Health Africa West Africa, Senegal

Issues In Senegal, the incidence of obstetric fistula is estimated at 400 new cases per year concentrated in Eastern, North East and South regions. Until 2013, interventions of obstetric fistula were done by several communal actors and in an uncoordinated manner with the management of obstetric fistula still not systematic in health structures. This lack of synergy between actors would be a reason for the low success rate of interventions for obstetric fistula. Description Since 2012, to provide a comprehensive and holistic response to this serious public health problem, Amref Health Africa initiated surgical repair fistula camps in collaboration with community actors in high prevalence areas. In 2014, Amref Health Africa brought together all NGOs under one community platform to coordinate obstetric fistula interventions in the field. The platform enabled each NGO to carry out a package of intervention in a specific area or region. In 2016, the community platform evolved into a national multisector platform which Amref Health Africa is the representative of the NGOs. Lessons learnt Between 2011 to 2013, only 54 fistula cases were treated. With the community platform the different roles in prevention, detection and the referencing, treatment and follow up have been clearly defined by actors. This coordination between actors under the leadership of Amref Africa Health increase the impact with, in 2014, 65 surgical cases operated and 8386 people sensitized; in 2015,145 surgical cases operated and16211 people sensitized Next steps Given the increasing number of cases treated, the aim of the institutional platform is to treat 200 cases for the year 2016 and to improve post-surgical and psychosocial support.

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THPE41 The impact of Schools Health Program in the school environment Alioune Diouf , Babacar Dia , Bara Ndiaye , Sylla Thiam 1 Amref Health Africa Afrique de l'Ouest, Senegal 1

Issues In context of inadequate coverage for water and sanitation in rural areas, Amref Health Africa in West Africa supported the Senegalese Government through water sanitation and hygiene Program called School health for child survival in 13 rural primary schools. This study reports on the effect of the Program in school environment and on students’ health. Description Program impacts were assessed through a final evaluation study in 2014 articulated around a quasiexperimental design with a non-equivalent control group. Schools were classified into intervention group (Beneficiaries schools) and control group (non-Beneficiaries schools). 294 students and 06 headmasters were interviewed about access level, knowledge, attitudes and practices regarding water and sanitation, and also the incidence of diarrhea and diseases prevention. Learned lessons The School Health Program has visibly improved the school environment. The study shows a significantly higher access to water, sanitation and hygiene in targeted schools with a decrease on diarrhea incidence. According to the headmasters, the introduction of water in school, the capacity building activities, the tools, the communication for behavior change initiated by schools’ health clubs have contributed to improve students’ experience. Interviews of students revealed that knowledge, attitudes and practices of beneficiaries’ students were positively affected. Next steps The School Health Program has helped set up an environment where education and health go together to improve students’ quality of life.

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THPE42 The Power of a Health related human interest Story - Is Story Telling Part of the Solution Lilian Mugisha Amref Health Africa, Uganda Issue No matter how it is delivered, a good human interest story has always had power. Stories show how people are impacted by health development and play a key role in improving the health of communities. Despite the considerable evidence showing that health-related human interest stories help effect change, the majority of health organisations in Africa do not invest in producing them. This abstract advocates for the documentation and sharing of health-related human interest stories as a means to contribute toward best practices in health care seeking trends and services. Description of Intervention Moving testimonies of the HIV and AIDS scourge and conquering the fear of taking an HIV and AIDS test, obstetric fistula survivors once outcasts in their community now living a more meaningful life, a photographic evidence of a smiling child after undergoing a cleft lip and palate surgery are a few examples of interventions with the power in sharing a human interest story. An example for illustrating is the case story of 15-year-old Mary Amongin from Osokotoit Village in Serere District in Uganda. She lived as an outcast in her community because of obstetric fistula condition. After getting access to health care and treatment through the Amref Health Africa project she regained hope to her lost childhood and painful memories. Her story has been shared across countries and today many are seeking professional medical interventions for girls and women with obstetric fistula. As a result of this story, 401 girls and women have been mobilized in one project within a period of two years and have received surgical fistula repairs. We continue to share human interest stories of lives changed. Through documentation using story writing skills, documentary scripts and media effects we have been able to witness the contribution of storytelling toward attitudes and behavior change in both the health care seekers and health care service providers. Lessons The power of human interest stories has demonstrated the positive impact on health awareness, fundraising, attitudes and behavior. Sharing emotions through storytelling provides desired connection to the communities raising awareness of worthy causes that enables policy makers to effectively respond to peopleâ&#x20AC;&#x2122;s health needs. Key words HIV/AIDS, Health Care, medical interventions, human-interest story, Obstetric Fistula

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THPE43 Effectiveness of using fistula repaired advocates in increasing uptake of fistula care services and skilled deliveries in Mangochi district, Malawi Madalitso Tolani , Seminie Nyirenda , Charles Suya , Shiphrah Kuria , Josephat Nyagero , Joachim 2 Osur , Boniface Hlabano3, William Peno4 1

Amref Health Africa, Malawi, Amref Health Africa HQ, 3Amref Health Africa SA Hub, 4Mangochi District Health Office 1

Background Awareness campaigns through mass media, poster and community sensitization meetings on skill delivery attendance and obstetric fistula as a strategy to encourage women go for skill deliveries and OF patients access care and treatment respectively, strongly achieve success in raising visibility and knowledge on these issues worldwide i.e. women still go for unskilled delivery and few women seek obstetric fistula care services. Consequently, there is a gap in the current scholarly work that aims to reflect and/or propagate successful strategies/interventions which facilitate fistula client case detection and referral for treatment and care. Therefore, the study sought to determine and document the effectiveness of using fistula repaired advocates as a strategy in increasing uptake of fistula care services and skilled births in Mangochi District, Malawi. Methods The research study employed a quasi-experimental design. Specifically, a time-series quasiexperimental design was used to estimate the impact of the intervention over time in comparison to 9 months preceding intervention period. Quarterly trends of fistula case detection and treatment, and skilled deliveries in health facilities were observed and compared to those retrospectively constructed prior to the intervention period. Results A comparison of facility delivery trends in the pre-post intervention periods showed a no significant difference (p-value = 0.575) while trends of mobilized and referred fistula patients for treatment and care showed a significant difference (p-value = 0.011). In fistula camps, 43% and 35% of fistula patients reported health care workers and fistula advocates respectively as sources where they got information about fistula treatment and care. Conclusion Usage of fistula repaired advocates as champions complements health care workers as a strategy for fistula case detection, referral and treatment, and does not directly contribute to improving skilled deliveries in health facilities. Key Words Obstetric Fistula, Fistula Advocates, Skilled Deliveries, Quasi-experimental Design, Time Series.

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THPE44 Strengthening the Health System to Address Obstetric Fistula in Tanzania: experience from Amref Health Africa Amos Nyirenda , Angela Mapunda , Rita Mutayoba , Rita Noronha , Florence Temu , David Ngilangwa 1

Amref Health Africa, Tanzania

Issue In Tanzania, the magnitude of the obstetric fistula problem is not well documented and appears to be on the increase especially in rural areas where poorest women, both young and old, reside. Obstetric fistula is the commonest peri-delivery injury, approximately 1,200 to 1,500 new cases occur each year. Description Amref Health Africa Tanzania is taking a lead role in addressing the problem of obstetric fistula with the aim of building capacities of health care systems through the training of doctors, nurses/ midwives on obstetric fistula awareness creation, prevention, and surgical repair and post operative care. Amref is implementing this project in many parts of the country using the trained health personnel. In ten years, the project reached 10,285 women with fistula from all regions of Tanzania mainland. An observation has shown that 92% of the fistulas do occur due to obstetric related reasons. A focus on strengthening a few health facilities improves the quality for fistula service delivery. Amref is supporting Fistula Outreach Services by road; using flying doctors specialist visits and also building partnership for strengthening district government authorities, non-government actors and participating hospitals to respond on obstetric fistula and reproductive health problems are key to improving maternal health. Lesson learnt Strengthening the health system of regions, districts and communities to respond to fistula and reproductive health problems is key to improving maternal health. Poverty is a major cause of failure to seek care by most of fistula patients. Therefore, reimbursing or subsidizing fistula surgery related costs made more women to come forward for treatment. Health promotion on the prevention of fistula and other obstetric complications is still inadequate at facility and community levels. Next step The government and other stake holders should strengthen health systems to increase access to services for women with fistula and thus improve their health and quality of life. Key words Fistula, health systems, promotion, Tanzania

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THPE45 Assessment of Health Status among Children receiving Community Prevention of Motherto-Child Transmission of HIV services in three selected Districts in Tanzania Anatori Didi1, Tumaini Mashina1, Rita Noronha1, Florence Temu1, David Paul Ngilangwa1 Amref Health Africa, Tanzania

Introduction Prevention of Mother-to-Child Transmission (PMTCT) of HIV has become a crucial intervention initiative in the global fight against the HIV epidemic. With scarcity of healthcare workers, community systems become important in delivery of services. Amref Health Africa Tanzania through its Watoto Salama Project conducted this baseline study to understand health status of community in relation to their health status and existence of community PMTCT. Methods This was a cross sectional descriptive baseline assessment that employed both quantitative and qualitative data collection methods. It was conducted at three different levels: District, facility and community in 2011. The study took place in five districts, namely Iringa rural, Songea and Temeke, to cover 15 wards, three in each district. Women with under-five children and adolescents/youth aged 11-24 years were randomly selected and interviewed. Data were descriptively analysed using SPSS 17. Results A total of 312 women were interviewed. Their median age was 24 years. Majority of had primary education, married and engaged in subsistence agriculture. The study also found that referral system from healthcare facility to mother support groups was existing. A total of 153 mothers and 51 exposed babies received ARVs prophylaxis. However, only find 17 mother-child pairs followed up and referred back to health facility. Out of 312 under â&#x20AC;&#x201C;fives screened for malnutrition, 100, 23 and 10 were severely stunted, underweight and wasted respectively. Four were thin, and none was obese. Moreover, mother support groups were favored and some men were aware of the existence of these groups. The activities carried out by the mother support groups included providing health education, revolving fund and encouraging other pregnant women to attend ANC. Conclusion The nutritional status of children under-five in this population is poor which suggest for implementation of integrated nutritional programmes in Community PMTCT. Key words Community PMTCT, mother support groups, Tanzania

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THPE46 mHealth Technology to Enhance Access to Antenatal Care: Lessons Learned Mercy Simiyu1, Christine Wanjiru1 1Medic Mobile Inc, Kenya Issue Death from childbirth is one of the greatest challenges facing rural African women today. Women delivering outside of a health care institution are most at risk, with no access to life-saving medications or skilled birth attendants. An estimated 454 women per 100,000 (2010) in Tanzania die in childbirth, versus 8.2 per 100,000 in the United Kingdom (2013). Almost 7,900 Tanzanian women die annually due to complications of pregnancy and childbirth. Description In 2015, with Bruyere Research Institute and Shirati Hospital, Medic Mobile designed an mHealth system for use by Community Health Workers (CHWs) on antenatal care (ANC), and stock monitoring tools for the dispensary nurses (DNs) in Mara, Tanzania. The platform helps ensure continuous availability of Clean Delivery Kits (CDKs) in district dispensaries. 196 CHWs and 64 DNs attended system training in September2015. The tool provides timelyreminders and real-time communication between CHWs and health facilities, and helps CHWs educate women on the importance of ANC. CHWs register pregnant women via SMS messages, even in areas with intermittent connectivity. When CHWs text “P 3 Jane” (P for Pregnancy, 3 for gestation period in weeks, with the pregnant woman’s name) to a gateway number, Medic Mobile registers the pregnancy, creates a patient ID, calculates the expected delivery date , and schedules automated reminder messages to the CHW on ANC appointments for each pregnant woman. Lessons Learned Use of familiar technology for mHealth at the community level encourages CHW adoption. When the core technology is managed by the ground partner, the phones tend to be regularly charged and loaded with air-time ensuring project continuity. Recommendations Design mHealth tools with the end-user, mindful of their workflow and tech ecosystem. Empower ground partners to manage the core technology; encourage regular communication between them and the end user to assist with faster troubleshooting.

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THPE47 Improving Performance in and Quality of Maternal Newborn Health Services using the Standard Based Management and Recognition (SBMR) approach in the hard to reach areas of Kenya David Kawai , Bernard Mbogo , Antony Arasio , Peter Ofware 1

Amref Health Africa, Kenya

Issues Amref Health Africa has been implementing a Sexual Reproductive Health &Rights project in Turkana, Wajir, Mandera, Isiolo and Marsabit counties to improve MNH health services and increase enjoyment of sexual rights. These five counties have the highest maternal mortality ratios in Kenya which is linked to poor quality of Maternal and Newborn Health (MNH) services. Description Standard Based Management and Recognition (SBMR) approach was adopted to improve quality of MNH services in Antenatal Care, Intrapartum Care, Post-partum care, Management ofComplications, and Infection Prevention. The approach was implemented in five referral health facilities in the 5 counties. Health Care Managers were first oriented on the SBMR process. Health Care Workers were later selected and trained as SBMR champions. A baseline assessment of MNH standards was undertaken. Internal assessments were later conducted after every module using WHO checklist and scoring tools yielding quantitative data. Lessons Learnt Antenatal care improved from 50% to 75% at second assessment in Turkana; Mandera improved from 25% to 75% while Wajir improved from 25% to 75%. Intrapartum care improved from 27% to 64% at second assessment in Turkana; Mandera improved from 0% to 57% while Isiolo improved from 40% to 64%.-Postpartum care improved from 50% to 100% at second assessment in Turkana; Mandera improved from 0% to 100%. Wajir improved from 0% to 50% while Isiolo improved from 0% to 50%.-In Management of complications, Mandera improved from 14% to 57% at second assessment. Wajir improved from 14% to 43% while Isiolo improved from 0% to 86%.-In Infection prevention, Mandera improved from 0% to 47%. Wajir improved from 0% to 44% while Isiolo improved from 18% to 56%. Next steps To strengthen Health Systems and improve quality of MNH services, there is need to implement and scale up SBMR to lower level facilities.

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THPE48 Access of Female Genital Mutilation Information among the Communities in Serengeti District, Tanzania Nyerere Jackson , Godfrey Matumu , Serafina Mkuwa , Pius Chaya , Rita Noronha , Florence Temu , 1 David Ngilangwa 1

Amref Health Africa, Tanzania

Introduction In Tanzania, the prevalence of Female Genital Mutilation (FGM) is estimated at 14.6% for women at reproductive age. The practice has negative maternal outcomes among those who undergone. Amref Health Africa conducted a study to measure different FGM baseline indicators before implementation of Tokomeza Ukeketaji (Stop FGM!) Project. Methods This was a mixed methods baseline survey conducted in 2016 in Serengeti district in Tanzania. The district is known to have a high prevalence of FGM in the country. A total of 1,392 participants were randomly selected and interviewed. Quantitative data were descriptively analysed while qualitative data was thematically analysed using SPSS 20 and Nvivo software respectively. Results The median age of respondents was 25 years. Majority of the respondents were male, had primary education and married. Less than quarters of female respondents mentioned receiving FGM information when attending the clinic sessions. Only 21.1% of the respondents mentioned receiving FGM information during the antenatal clinics; 19% received information during the postnatal clinics; 21.1% received information during the well-baby clinics and 15.8% received information during the family planning clinics. Respondents suggested the community traditional leaders and elders as the right channel for anti-GBV and FGM information dissemination. According to communities, anything that comes outside this local communication and commanding channel will strive to succeed. Other suggested channels include schools, churches and few mentioned health facilities. Furthermore, 81.4% were positive about integrating FGM education in the antenatal clinics, 80.6% in the post natal clinics, 80.1% in the well-baby clinic sessions and 79.1% in the family planning sessions. Conclusions Our findings show that access to information on FGM at the health facility is very limited. This calls for different stakeholders including Civil Society Organizations, government and bilateral and multilateral to work together in integrating FGM information in different sections within the health sector. Key words Female Genital Mutilation, information, access, Tanzania

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THPE49 Accelerating Targeted HIV Testing Services for Orphans and Vulnerable Children towards 9090-90: A Community Partnering Perspective in Central/Eastern Kenya Rudia Ikamati Amref Helth Africa in Kenya Background In 2014, estimated 200,400 adults and 35,260 children were living with HIV in Central/Eastern Kenya. Adult HIV prevalence was 3.5% while children HIV prevalence was 0.6%. There were 126,076 households caring for 500,000 Orphans and Vulnerable Children (OVC) in Central/Eastern Kenya. Amref Health Africa in Kenya through USAID PEPFAR funded project APHIAplus KAMILI supports 140,000 (28%) OVC. The project initiated community partnership in HIV Testing Services (HTS) to increase number of OVC tested for HIV and linked to care as a contribution towards UNAIDS 90-9090 target through identifying HIV+ OVC and providing ART to achieve viral suppression. Linkages and referrals to OVC HTS were strengthened. Community groups of PLHIV, caregivers, child-tochild mentorship and quality improvement teams were mobilized and empowered to promote HTS uptake and retention on HIV care for HIV+ OVC. The study aimed at assesing changes in proportion of tested and HIV+ OVC through targeted HTS. Methods A retrospective study was conducted between February 2014 and June 2015. Data from the OVC HIV care register at 34 local implementing partners' database collected, analysed and compared. Data on OVC tested with known status, not tested and HIV+ was collected. Data was analysed using SPSS for descriptive information. Results The total number of OVC reached with HTS increased from 73% (102,200) to 81% (113,400). OVC who tested HIV+ increases by 21.5% from 5791 to 7036. The proportion of HIV+ OVC therefore increased from 4.1% to 5.0% of the total 140,000. Conclusion Targeted HTS within community partnership and structures increased OVC with known HIV status. The high increase in proportion of HIV+ OVC suggested targeted HTS initiative. Partners need to adopt, prioritize and promote this approach to strengthen response to OVC HIV care and treatment.

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THPE50 Determinants of Neonatal Mortality in Rural Northern Ethiopia; a Population Based Nested Case Control Study Robel Belachew Addis Ababa University, Ethiopia Introduction In the majority of low and middle income countries neonatal mortality remains high despite the gradual reduction in under five mortality. Newborn deaths which take place in the first 28 days after birth only contribute for about 38% of all under five deaths. This study has identified the magnitude and independent predictors of neonatal mortality in rural Ethiopia. Methods This population based nested case control study was conducted in rural West Gojam zone, Northern Ethiopia among a cohort of pregnant women who gave birth between March 2011 and Feb 2012. The cohort was established by Maternal and Newborn Health in Ethiopia Partnership (MaNHEP) project in 2010 by recruiting mothers in their third trimester as identified by trained community volunteers. Once identified, women stayed in the cohort throughout the period of their pregnancy receiving Community Maternal and Newborn Health (CMNH) training by health extension workers and community volunteers till the end of the first 48 hours post partum. Cases were 75 mothers who lost their newborns to neonatal death at the end of the follow up period and controls were, 150 randomly selected mothers with live post neonatal newborns. Data was collected using standardized questionnaires. Data on neonatal morality was collected after 40 days of bereavement period as it is culturally appropriate. Binomial logistic regression model was used to identify independent determinants of neonatal mortality. Result The neonatal mortality rate was 18.6 (95%CI 14.8, 23.2) per 1000 live births. Small family size, number of births (parity) and previous history of neonatal death were found to determine neonatal mortality. Neonatal mortality declines with an increase in family size where newborns who were born among a family of more than two had lesser odds of death in the neonatal period than those who were born in a family of two (AOR= 0.13, 95%CI 0.02, 0.71). Mothers who gave birth to 2-4 and 5+ children had lesser odds of losing their newborns for neonatal death (AOR= 0.15, 95% CI 0.05, 0.48) and (AOR= 0.08, 95% CI 0.02, 0.26) respectively. Previous history of losing a newborn for neonatal death also increased the odds of neonatal mortality during the last birth (AOR= 0.25 95% CI 0.11, 0.53). Conclusion This study suggested that simple community based interventions could bring a significant change in neonatal mortality. The identified determinants, which are amenable for change, emphasize the need for improving quality of a targeted care among pregnant women to improve pregnancy outcome.

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THPE51 Improving access to skilled birth attendance through the utilization of maternal shelters in Samburu County John Githiaka1, Chege M2, Lengusuranga C3, Mores L1, Koki M1 APHIAplus IMARISHA Amref Health Africa, Kenya, APHIAplus IMARISHA UMB Kenya Programs, Government of Kenya, Samburu County Department of Health 1

Background In the 80â&#x20AC;&#x2122;s and 90â&#x20AC;&#x2122;s Kenyaâ&#x20AC;&#x2122;s health indicators especially on maternal, newborn and child health (MNCH) declined. Various national health policies were implemented to address this decline. While a general improvement was realized, the indicators in northern arid lands (NAL) Kenya remained poor. For example access to skilled birth attendance (SBA) in Samburu County was 12% in 2012 compared to the National average of 60% (KDHS, 2014). To address this problem APHIAplus IMARISHA, a program funded by USAID partnered with the Ministry of Health and community in Samburu County and established maternal shelters to address the SBA. Methodology Discussions were held with health sector leadership, community leaders, community health volunteers (CHVs) and community members. Secondly community sensitization was done on high impact interventions for MNCH including SBA. Thirdly training was conducted for community health committee and CHVs on their roles in MNCH service provision. Thereafter the CHVs identified inadequate access to SBA as the most prevalent health problem affecting the community and prioritized to establish a maternal shelter at the catchment health facility as a waiting home for expectant mothers from far areas. These mothers would come to the shelter when almost due to give birth and be transferred to the health facility maternity unit at onset of labour. The health facility donated land while the community provided local materials and labour to construct this shelter which was fashioned along the traditional Samburu hut. Furthermore the health facility catered for the running costs of the shelters including feeding of mothers housed at the shelter. This is done through re-imbursements from improved performance under the results based financing (RBF) scheme. A standard operating procedure (SOP) for the operation of the maternal shelter was developed. Furthermore a register was placed at the shelter to record the utilization of the shelter. Results Following CHVs mobilization and referral of expectant mothers, there was 86% utilization of the maternal shelter with the shelter contributing to 45% of the deliveries in the health facility. Secondly an exponential increase in average number of deliveries at the health facility was recorded. Thirdly there were decreased maternal and newborn complications as a result of early access to medical attention. Fourth there was improved financing at the health facility through increased reimbursements to the health facility from the RBF.

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Conclusion and Recommendations Maternal shelters are an innovative strategy for improving access to SBA in the hard to reach areas with large distances to the health facility. Establishment of a maternal shelter should involve key stakeholders to enhance utilization and sustainability. The lessons learnt from this maternal shelter were applied and three other shelters were operationalized through community led initiative and utilize the SOPs earlier developed.

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THPE52 Maternal satisfaction and associated factors about delivery services in Public Health Centers of Addis Ababa from April To May 2015 Abebe Mariam , Netsanet Fekede Gizaw , Abiyot Girma 1

Jimma University, Ethiopia, 2Amref Health Africa, Ethiopia

Background Globally about 529,000 women die from pregnancy related causes and at least 3.2 million stillborn babies, 4 million neonatal deaths annually. Literatures show that there are low utilization and satisfaction safe delivery services in developing countries in general and in Ethiopia in particular. This study was done to assess maternal satisfaction and associated factors affecting their satisfaction about delivery services in public health centers of Addis Ababa, Ethiopia. Method An institution based cross sectional study involving an exit interview was conducted from March 13 to April 13 in 16 randomly selected public health centers of Addis Ababa. Four hundred fifty four postpartum mothers were participated. Maternal satisfaction measured by using closed ended question adopted from Donobidian quality assessment that include 13 satisfaction related variables came up with high internal consistency (cronbach`s alpha=0.906) Result From 454 post-partum mothers majority of them 377(83.0%) are 20 to 34 years old. The proportion of mothers who were satisfied about delivery care was (277) 60%. Overall maternal satisfaction about delivery care was associated with number of delivery in life time [AOR=1.74, 95%CI: 1.122.71)], wanted status of the pregnancy [AOR=0.60, 95%CI: 0.35-0.94)], frequency of ANC follow up [AOR=1.69, 95%CI: 1.09-2.63)] Conclusion and Recommendation The overall satisfaction of mothers about delivery care given in the health centers is found to be suboptimal. Satisfaction on providerâ&#x20AC;&#x2122;s care and support have higher satisfaction rate and pain management was the main reason for dissatisfaction of mothers. Level of satisfaction were predicted by wanted status of pregnancy, frequency of ANC follow up and number of delivery in life time. Health information should be given about the service given during ANC follow up and special attention should be given for mothers who give birth for first time.

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THPE53 Psychosocial impact of obstetric fistula: cross paths of three vulnerable women Anna Sarr , Mouhamed Yali 1

Amref Health Africa, Senegal

Issues In Senegal, studies estimate the number of new cases of obstetric fistula around 400 per year. We collected the stories of three women during an Amref mission in Kolda and Sedhiou from 25th august to 1st September 2016. How did those women lived with that stimatiing illness and its devastating effects? Description C.C is 50 and developed the disease while giving birth to twins after her 6th pregnancy. « I gave birth at home, to a girl first. The second baby was a boy and he got stuck. I stayed in this stated with him four days before I could deliver » she says. During the fourth day, she went in town to a hospital where a doctor could help her deliver the baby. However, she is convinced that it was during that medical act that the doctor touched her bladder. She stayed with that obstetrical fistula 14 years before that mission of Amref could take her in charge. S.G is 31 and had problems to deliver her 3rd baby. During the delivery, she had first been evacuated to dispensary of the village and then, the day after in town in Velingara. From there she has been sent to the regional hospital of Tambacounda for a ceasarean after what they discovered that the child was already dead in her belly. To cure the fistula, she went trought three unsuccessfull surgeries and this one might be the fourth. F.N also had problems with home delivery. Married, she gave birth to 10 children among who 7 are dead. She had the fistula while delivering her last baby. She stayed home two days without being able to deliver. « I, then, have been transferred to Ziguinchor for a caesarean but the baby was already dead and even the color of his skin had started to change. That’s how i got that disease but I immediately started to cure it in Ziguinchor hospital » she said. After so many visits to the doctor, empty pockets and discouragement without any improvement, her husband asked her to try a witchdoctor where she stayed an entire year. Lessons learnt Women suffer from home delivery lacking means and psychological support from their husbands or society. -Fistula is not correctly taken in charge of in health structures. Recurrences and high cost of support also discourage women.-Lack of transportation and late decision taking also aggravate the phenomenon. Next steps The national platform led by Amref for the eradication of the obstetrical fistula in Senegal should add to its actions the psychological support to traumatized women after a difficult delivery and fistula marginalizes them even more respect to their community.

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THPE54 Assessment of Drug Storage conditions in Secondary Health Facilities in Akwa Ibom State, Nigeria Aniekan Ekpenyong , Ekpedeme Essien Ndem 1

Bekam Pharmacy, Nigeria, University of Uyo

Background Drugs are meant to be stored in ideal conditions such as an appropriate temperature level, relative humidity and exposure to light among other conditions. Exposure of drugs to inappropriate conditions may render them ineffective or even harmful if ingested. It is therefore important to note that conditions where medications are kept can affect its potency and safety. Objectives This study sought to determine if drug storage conditions in general hospitals in Akwa Ibom state were compliant with the World Health Organization (WHO) and United States Agency for International Development (USAID) relevant guidelines on storage. Methods This study was carried out in secondary health facilities in Akwa Ibom state. A list of all general hospitals in the state was provided by the Hospitals Management Board. The study was cross sectional and descriptive involving a questionnaire guided-interview of 16 store managers. After proper explanation of the objective of the study, consent granted, the interview was conducted. The data collection instrument for store managersâ&#x20AC;&#x2122; interview consisted of a validated, USAID 20â&#x20AC;&#x201C;item structured questionnaire and the information was coded and entered into SPSS software version 20. Results About 70% of store rooms visited lacked electricity which is a major factor in proper storage of drugs especially those that are susceptible to temperature degradation such as vaccines, proteins and antibiotics. Other relevant guidelines were followed in more than 50% of cases. Conclusion This study shows that most secondary health facilities in Akwa Ibom state comply with the relevant guidelines for drug storage. However, the lack of electricity in these facilities upturns this compliance. Recommendation Alternative sources of electricity should be provided for these institutions such as solar energy in order to ensure strict compliance with international standards.

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THPE55 The Integration of HIV Testing Services into Maternal and Child Health (MCH) Services to Reduce Missed opportunities, and enhance access to Prevention of Mother to Child Transmission (PMTCT) services at Samburu County Referral Hospital (SCRH) Miriam Chege , Lamarkat B , Lenaigwai E , Githiaka J , Koki M , Farah A, Odhiambo F , Okubasu L 1

APHIAplus IMARISHA University of Maryland (UMB) Kenya Programs 2 Government of Kenya, Samburu County Department of Health 3 APHIAplus IMARISHA Amref Health Africa in Kenya

Background Nationally, there has been an imperative to eliminate the mother to child transmission of HIV (MTCT). This is further affirmed in the Kenya AIDS Strategic Framework. HIV testing and enrollment into preventive HIV therapy are key interventions provided to pregnant mothers during the antenatal care (ANC) visits to prevent transmission of HIV to the unborn babies. HIV testing is the entry point for the HIV services in mothers and children. However according to the Kenya Demographic and Health Survey of 2014, in Kenya only 53% of women had access to HIV testing and knew their HIV status. There was therefore need to employ effective strategies to upscale HIV testing and enrollment into care among pregnant women to prevent and treat HIV thereby increasing access to PMTCT. Although the recommended standard is to integrate testing for PMTCT at the maternal and child health (MCH) service delivery points, the adoption of this practice was very low in Samburu County due to inadequate sensitization and skills among the health care workers. To address this, the USAID funded APHIAplus IMARISHA programme provided technical support to the Samburu County department of health to undertake integration of the PMTCT services into MCH. Description Sensitization of staff was done on the integration of PMTCT into MCH. The roles of various departments and staff as well as the clients in the integration model were outlined. The system entails identification of HIV positive women at reproductive age at the MCH service delivery points. The HIV positive antenatal and postnatal mothers were then segregated and enrolled into ART, their details entered in register and files updated. The HIV exposed infants (HEI) are also enrolled in care and baby mother pairing done so as to ensure that these children born to a HIV positive mothers do not contract HIV. Regular multi-departmental meetings were held to monitor the progress on the servicesâ&#x20AC;&#x2122; integration and the team membersâ&#x20AC;&#x2122; roles in the integration model. Lessons learnt The integration of PMTCT services in MCH at Samburu County Referral Hospital reduced missed opportunities / default rates from 80% in 2014 to 10% in 2016. Further, in the same period 67 HIV positive women were identified (18 ANC and 49 postnatal) and enrolled into PMTCT. Furthermore 50 HEI were also identified and all received prophylaxis and 4 HIV positive enrolled in care.

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Next steps The integration of PMTCT services into MCH provided a one stop shop for service provision and enhances access to HIV services by mothers by reducing the lost opportunities. It reduced necessity for movement by clients to different departments to seek different services hence enhancing customer experience. The integration also promoted inter-departmental collaboration and coordination. Furthermore, following the lessons learnt in the County Referral Hospital technical support is being provided to integrate these services in the key health facilities in the County.

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THPE56 A Comparison of the Effect of Mode of Formation of Maternal Shelters on their Utilization in Upscaling Skilled Birth Attendance (SBA) in Samburu County John Githiaka , Chege M , Koki M , Mores L , Farah A , Maina A , Lengusuranga C 1

APHIAplus IMARISHA Amref Health Africa in Kenya, APHIAplus IMARISHA UMB Kenya Programs, 3 Government of Kenya, Samburu County Department of Health 2

Background Access to skilled birth attendance (SBA) is a key high impact intervention for addressing maternal, newborn and child health (MNCH). Samburu is one of the Counties that previously performed poorly on MNCH and recorded low access to SBA (KDHS 2014). A key strategy implemented to address access to SBA is establishment of maternal shelters at key health facilities as waiting homes for expectant mothers who are about to give birth. One method employed to establish the maternal shelters was through initiative of and led by healthcare worker whereas a second method was establishment through initiative led by the community with involvement of the health facility. Methods This study aimed to establish whether the mode of establishment of a maternal shelter affects itâ&#x20AC;&#x2122;s utilization by the community. The key research question was whether leadership by the community in establishing a maternal shelter enhances its utilization. The utilization data for maternal shelters established through the initiative of healthcare worker was compared with the corresponding utilization data for maternal shelters established through the community led initiative. Findings After establishment of maternal shelters, access to SBA in the County in general increased from 17% in 2012 to 34% in 2015. Higher increases in SBA were recorded in the health facilities which had maternal shelters. Furthermore maternal shelters established through community led initiative recorded higher utilization and contributed more to SBA at the health facilities as compared to the maternal shelters established through healthcare worker initiative. Conclusion and Recommendations Initiatives to address community problems should to the extent possible be led and driven by the community and supported by other stakeholders. This community leadership and involvement fosters a sense of ownership and enhances participation such as utilization of maternal shelters thereby contributing to improved health and development indicators.

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THPE57 Community Life Center: Strengthening primary care in Africa Albert Orwa , Karthik Subbaraman , Bahaa Eddine Sarroukh 1

Philips, Kenya

Issues The Community Life Center (CLC) is a community-driven integrated primary care intervention. Most primary care interventions are limited by their ability to scale or sustain the growing demand for clinical services. The aim of CLC is to co-create a self-sustainable community health hub that is aimed at improving primary care outcomes. Description This program has three critical goals: (1) improve primary care service delivery indicators; (2) implement community-engagement strategies to enable financial autonomy to the facility; and (3) enable large-scale deployment. With the above in mind, the CLC has five critical components: 1) Community-driven co-creation of the primary care intervention 2) Strengthen human resource skillset to deliver quality healthcare services 3) Improved care-coordination between primary and community care 4) Continuous monitoring and evaluation of the program 5) Stimulating community-driven interventions to enhance financial autonomy The 1st CLC was implemented in Kenya in partnership with MoH Kiambu County. The 2nd CLC is being implemented in Kenya in partnership with MoH Mandera and UNFPA in Dandu, Mandera. We are evaluating primary care performance based on the conformity with pre-existing frameworks defined by WHO and PHCPI. Some of the indicators that are relevant for our immediate consideration include improved service coverage. Lessons learnt We are confronted with three critical challenges which can impact the potential scalability of our solution, namely: (1) dependencies on traditional supply-chain and procurement mechanisms within public health; (2) poor incentives that influence care delivery; and, (3) contextualizing primary care requirements within a standard systems framework. Next steps We are now in the process of demonstrating cost-effectiveness of our intervention with an independent external partner (UNFPA)

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THPE58 Contributing Factors to Obstetric Fistula: An Analysis of Patients Data in Fistula Camps at Monkey-bay Community hospital in Mangochi and Queen Elizabeth Central Hospital, Malawi Madalitso Tolani , Seminie Nyirenda , Charles Suya , Patrick Ngalawango , Shiphrah Kuria 1

Staying Alive project team, Amref Health Africa Malawi, Manager of RMNCH projects Amref Health Africa HQ 2

Introduction Obstetric fistula is one of the most serious and disabling complications of childbirth, which has virtually been eliminated in developed countries but still prevalent in developed world including Malawi. Malawi has a life time obstetric fistula (OF) risk of 4.7%, and Mangochi is among the districts with high OF prevalence (2.7%). This study was conducted to explore contributing factors to OF among women seeking repair services at Monkey-bay community hospital in Mangochi and Queen Elizabeth Central Hospital, in Malawi. Methodology This was a descriptive cross sectional study which employed quantitative methods. Data was collected from 226 confirmed fistula patients seeking repair services from Mangochi district using structured questionnaire. Purposive sampling method was used to select participants and all patients who received fistula repair services in the 2 sites, with support from the Staying Alive project were included. Patients with other obstetric complications were excluded from the study. Results Many of the patients were from the Muslim communities (49.6%), who reported married (81.4%) and that had never attended formal education (50.4%). The study revealed that 44% of these patients developed fistula at 10-19 years old during their first gravidity (48%), and that prolonged labor was the main cause (64%) despite living very far from a nearest health facility (63%). Interestingly, a good number of these women reported developing fistula while they had attended 4+ ANC visits (48.2%), and also delivered in hospitals (79.2%) with the assistance of a skilled birth attendant (85%). Conclusion The study results clearly suggest concentrated and continued efforts to improving quality of maternal care in Malawian health facilities to avert fistula incidences. There is need to build capacity of service providers, strengthen referral systems, and prevent teenage pregnancies. Key words Obstetric Fistula, Purposive Sampling, Obstructed Labor, OF Prevalence and Risk, Antenatal Care.

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THPE59 Factors associated with Utilization of Post-partum Care in Dagoretti sub-county, Nairobi: A comparison between adolescents and older women Shiphrah Kuria , Erastus Njeru , Peter Kithuka 1

University of Nairobi, Kenya

Background High maternal mortality and morbidity is a challenge globally and in Kenya. Adolescents face even higher risks. Quality postpartum care is a key intervention in dealing with this challenge, yet its utilization is low. This study assessed the factors associated with utilization of postpartum care (PPC) among mothers attending maternal and child health clinics and compared the older women and the adolescents. Results will contribute to improving utilization of postpartum care Methods An analytic cross-sectional study done in Dagoretti Sub-county of Nairobi County, Kenya. The study population was mothers of infants seeking MCH services in public facilities. Random systematic sampling was done, 420 mothers were interviewed. Data were cleaned, coded and analyzed using SPSS. Stratification into adolescents and older women was done during the analysis. Results Utilization of post-partum care was 32%. Being given return date (P =0.000),having health information (p = 0.05), college education, delivery by caesarian section(p=0.000), complications at delivery (p =0.001) and attending ANC four or more times were significantly associated with PPC utilization. Facility delivery, attending ANC once and distance to the facility were not significantly associated with seeking PPC. There was statistically no significant difference between adolescents and the older women in the factors that were associated with seeking PPC, p = 0.809. Conclusion Some health system factors, such as return dates, and some clinical characteristicswere independently associated with utilization of PPC. There was no difference between the adolescents and older women in utilization of PPC. Recommendations Mothers should get return dates for postpartum care. Information on postpartum care should be given to mothers at every opportunity. Special effort should be directed towards those less likely to seek care. More research needs to be done on the factors associated with seeking PPC and comparison between the adolescents and older women. Key words Post-partum care, Utilization, Adolescents

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THPE60 Services conducted by the communities MSM sex workers Moise Noupa Alcondoms Cameroon Issue Interventions are a major focus in prevention of HIV which are conducted by NGOs in Cameroon. In some cases the immediate involvement in the initial phase of a MSM sex workers program in sensitizing members their communities may represent a challenge and push NGO act in such way that programs must promote recruitment, increased capacity and rapid and possible involvement of sex workers and see their entrust, increasing responsibilities in the conduct of the program. Description In Cameroon especially in the city of Douala MSM sex workers must ensure that the individual or collective needs of prevention and sex workers must be satisfied to improve the quality of services by providing opportunities retro Action program. Thanks to financial support from the Global Fund Cameroon is developing a new program: the involvement of Care Cameroon in the implementation of the field project that we recruit and finance identity associations to help sex workers and strengthen capacity of behavioral change in the face of new infections and create the points of entry for the strengthening of community leadership. Lessons learnt According to the study conducted in 2016 by IBBS the prevalence rate of MSM in the city of Douala was 24% which is higher than that of the general population which was 4.3% between September 2013 and October 2015. The intervention field project achieved its objectives with over 7447 interpersonal talks and chats conducted by the grace project in its advanced strategy that consisted of going to the MSM and Hop Post for awareness and reference to the free screening campaign and drop center for community care for all MSM who tested positive and the project also led a program to track lost sight of MSM living with HIV. This method can be an innovative approach to misdeeds in the Cameroonian culture.

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THPE61 Improving The Quality Of Laboratory Documentation On Early Infant Diagnoses Using Open Data Kit Phans Sarpong Komfo Anokye Teaching Hospital, Ghana Background Healthcare delivery today is affected by numerous disparate data collection and reporting in most private and public health organizations. These challenges are unresolved data collection and reporting issues, including lack of infrastructural, human resource which increases cost and opportunities lost. These causes the data quality generated in health services to be often poor and inadequate. The emerging of smart phone technology has dominated and has add up the demand to use mobile based for collection and reporting health data to bridge the chasm in our health services. Objective This study reviews existing health data collection and reporting that can be used to improve the quality in the Laboratory Department of Agogo Presbyterian and Komfo Anokye Teaching Hospital on early infant diagnoses. Methods This study uses a cross sectional and experimentation research involving qualitative and quantitative research. Results Data was obtained from 20 participants at the VCT of the ART which is made up of 16 staff and 4 patients. A qualitative data was obtained by interviews approach to investigate the challenges and the evaluation of the proposed prototype. Conclusion The study gave an indication that the proposed prototype was effective with 40% in weekly collection of data and 25% in daily data collection and reporting. The VCT cited high preferences in the current data collection and reporting with the open source application. The availability of mhealth differs in many perspectives in the health care system particularly open source technology, in improving the health data. Recommendations Future studies area such as developing a proposed prototype could concentrate on enhancing health data concept to improve its effectiveness in analysis and process. Further requirements in assessing the prototype in a real environment of health system and using the required from the essential source such as the health data experts to meet the prerequisites.

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THPE63 The use of the eLearning mode of application to upgrade the skills of Midwives Andrew Wabwire , Patrick Bigirwa 1

Amref Health Africa, Uganda

Background The Uganda eLearning Midwives upgrading project was officially launched in February 2010 by the then Minister for Health Hon. Minister Stephen Malinga who noted that, â&#x20AC;&#x153;The demand for nurses and midwives now is not just the demand for numbers but increasingly for nurses and midwives with the competence, skills and experience to meet patientsâ&#x20AC;&#x2122; demands in a weakened health care system. By fast tracking the training of registered nurses and midwives, this eLearning project will greatly enhance the capacity of Ugandaâ&#x20AC;&#x2122;s health system to provide care for the people of this country. Objective The overall aim of the project is to train more midwives to a diploma (registered) level more rapidly in order to help improve the health care of the rural based and disadvantaged populations in Uganda. Uganda was selected because, aside from a clear need, Uganda also has a well-established distance education programme as well as a midwives upgrading programme, currently being offered via classroom-based learning. The eLearning the project is a two year programme, run on a two semester basis. This is a publicprivate partnership. Intervention We have 11 participating nursing schools across the country. The project has been able to train and graduate 65 midwives from a certificate to a diploma level. This represented a completion rate of 74% (eLearners) against 89% (fulltime). Currently, we have had three student intakes; May 2014, November 2014 and May 2015 with 414 students undertaking the programme. The graduation dates will be in May 2016, November 2016 and May 2017 for the students currently studying. Results and Lessons Learnt As the moment, the project has been able to set up 26 eCenters in 23 districts with a total of 141 computers. The capacity building component of the project has been able to train 150 tutors and clinical instructors, 120 Mentors, develop DE guidelines, conduct level 1 Kirkpatrick evaluations, barriers to enrolment, provided CPD centers through eLearning and mLearning with help from UNMC, Conclusion eLearning mode of approach is very fundamental in addressing the HRH challenges in Uganda, it allows Nurses and Midwives study at their own pace with minimal disruption to their work schedules, taking into consideration the practical oriented nature of nursing education; continuing to work at their current job while taking classes thus, allowing them to earn a living and gain work experience; their learning is not constrained by their geographic location; learning at their own pace and studying at their own convenience and improving their ICT skills.

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THPE64 Limited basic computer skills and ICT Skills Transfer Associated with Upgrading Andrew Wabwire , Patrick Bigirwa 1

Amref Health Africa, Uganda

Background Currently, the demand for eLearning programme for nurses and midwives among all stakeholders in the country is steadily increasing and this is evidenced from the number of requests that Amref Health Africa Uganda country office receives from the different health training institutions to provide them with technical support in initiating the eLearning programme in their own schools. The environment is also quite favorable in a sense that government through the Ministry of Education and Sports (MoES) has clearly indicated that eLearning is the best approach to be adopted especially for working civil servants who are desirous of upgrading their skills and knowledge. However, in order to sustain the gained momentum of eLearning in the entire country more funding is still required so as to be able to overcome the current challenges. In conducting ICT trainings for Mentors and Tutors for respective eLearning Nursing schools, it was discovered that all nursing schools did not have a point of reference and support at their respective schools regarding any related general ICT challenges and more so in regard to eLearning model of education. Intervention With support from Amref Netherlands, GSK, SANOFI and Johnson & Johnson, the project was able to train 12 ICT personnel from 15 nursing schools (80%) in order to improve their ICT skills, increase knowledge transfer among the Tutors and Mentors, act as a point of reference for any related ICT challenges but most importantly to enable sustainability of the eLearning program beyond the existence of Amref Health Africa regarding its implementation. The training of these ICT personnel was done on a yearly basis and in addition to involving them in our daily ICT trainings in order to build their capacity and esteem towards implementation at school level. This has helped to eliminate the downtime it would take for an Amref Health Africa ICT personnel to go down to ground at each nursing school to offer ICT support, increased the awareness of the Tutors and Mentors regarding ICT implementation. Results and Lessons Learnt As a result, we reached 80% of the ICT personnel in the respective implementing nursing schools. In relation to this, from training 35 mentors and 20 Tutors in the initial phases of the project, we have gone ahead to train 120 Mentors (98%) and 150 Tutors (90%). Conclusion Therefore, we have been able to meet our required numbers of both Mentors and Tutors with the inclusion of ICT personnel in our respective implementing schools. At all levels of implementation, there requires need to involve the implementing nursing schools at it gives the project a wider scope

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THPE65 Mental health status in post conflict Rwanda: persisting potential disabilities to highlight Fanny Giraneza University of Rwanda Background The 1994 genocide against Tutsi in Rwanda left about one million dead and high number of survivors, prisoners leading to numerous mental health disorders among all groups. Our aim is to investigate rate of post-traumatic stress disorders (PTSD) and its association with major depressive episode which mental health centers are receiving helping in prediction of traumatic stress in population Method Archive and open discussion with patients of mental health department of Kigali University Teaching Hospital, abstracts and publications associated survey conducted in Rwanda Results A country wide prevalence of PTSD was over a quarter and depression with a prevalence of 53.93% in 2008 survey. In 2010, the positive correlations were found between the PTSD symptom severity and other related disorders where its symptom severity score was associated with the severity of depressive symptoms and anxiety and linked to suicidal tendencies in all groups. In 2011, the most commonly diagnosed mental illness was PTSD which affects 29% of countryâ&#x20AC;&#x2122;s population. A substantial proportion of both survivors and prisoners suffered from clinically significant depression (46% vs. 41%), survivors and their descendants indicated being more affected by depressive and anxiety. Regressive analysis of data in prediction of parentsâ&#x20AC;&#x2122; generation revealed that exposure to traumatic stressors, the level of physical illness ,social integration and exposure to war and genocide were the strongest predictors for PTSD symptom severity, whereas age and gender were not. Conclusion The rate of mental health disorders are still elevated leading to physical and mental inactivity. Families of survivors present more symptoms than families of former prisoners. As a recommendation, parent generation improvement and decentralization in mental health care is the major weapon to prevent long term consequences of mental disorders for bright future.

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THPE66 Livelihood insecurities among the elderly in Sub Saharan Africa: social capital a needed tool for sustainable development Adedotun Ajiboye Ekiti State University Teaching Hospital, Nigeria Background The population of older people in Sub-Saharan Africa (SSA) is growing rapidly with increasing life expectancy. While their lives are vulnerable to poverty and growing inadequacies in customary family support systems, they have increasing caregiver roles in their families and communities associated with Acquired Immune Deficiency Syndrome (AIDS) epidemic. In the face of all these, their inclusion in health and social development is minimal due to higher attention given to the younger generation because of the meagre resources in Sub-Saharan Africa. This in turn heightens the level of livelihood insecurities the elderly are experiencing in this region. Amidst these challenges, this paper argues that the livelihood securities and health of the elderly can be enhanced through the accumulation of social capital. Methodology The paper adopts mixed methodology to review existing literatures to explore the importance of social capital in enhancing the livelihood of the older people. Results and Conclusion This paper concludes that â&#x20AC;&#x2DC;positiveâ&#x20AC;&#x2122; social capital through local associations and inter-sectoral networking involving the elderly, families, civil societies, Non-Governmental Organizations (NGOs), national governments, and international organizations possibly will be a better way to significantly improve older peopleâ&#x20AC;&#x2122;s health and livelihoods in Sub-Saharan Africa. The paper offers a number of suggestions to promote the inclusion of social networking strategies in accumulating social capital, policy formulation and implementing project for the older people in Sub-Saharan Africa.

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THPE67 Local Multi-sectoral Leadership and Management to Advance FP2020 in Cameroon Anastasia Kimeu1, Emmanuel Ngappe1 Amref Health Africa, Kenya-HRH2030 Program, Cameroon National Association of Family Welfare (CAMNAFAW)

Issues Family planning (FP) and Primary Health Care in Cameroon receive less attention and resources than secondary, and tertiary care services. As such, human resources for health (HRH) is diverted from community and peripheral clinics to hospital wards and outpatient centers. This mal-distribution of resources has the potential to jeopardize the capacity to meet the FP2020 objective of providing universal access to contraception. Use of other adequate and locally available human resources with diverse leadership skills and endowment is a practical and cost-effective way of optimizing HRH productivity and ensuring access to FP services. Description The local-Leadership, Management and Governance approach was piloted in CAMNAFAW clinics in Soa, Mimboman, Carriere and Nkoulfoulou districts of YaoundĂŠ. Through a consultative process, the Ministry of Public Health (MoPH), CAMNAFAW leadership and FP service providers identified HRH challenges that hinder access to FP services. A sixteen-member diverse team of local leaders mobilized resources to address HRH challenges. Face-to-face and virtual technical assistance provided guidance on implementation, monitoring of progress of action plans and documenting successes and challenges. Lessons Learnt TA and coaching format should be acceptable to local leaders, considering access to and familiarity with technology and Task analysis question on perceived competency should provoke a more thoughtful response. Next steps In Cameroon, the HRH2030 project will: Either provide distance support to CAMNAFAW to implement the l-LMG approach in all their clinics in the country or implement the approach in MOPH clinics in one region, The HRH2030 Program will implement and compare close- and distance-support approaches in two additional Francophone speaking West African countries, The program will produce implementation guidelines, M&E tools and methods. Key words Family planning, leadership & management

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THPE68 Reorientation of Traditional Birth Attendants (TBAs) on theirnew roles, significantly contribute to improved maternal and child health outcomes in Karonga district Seminie Nyirenda , Emmanuel Kanike , Susan Wangai , Racheal Ndiragu , Isaac Phiri , Griffs 2 Nyirongo 1

Christian Aid, Malawi, Adventist Health Services 2

Background The Malawi government banned TBAs to conduct deliveries because of high maternal mortality, instead, TBAs were assigned new roles to support women deliver at health facilities. However, the implementation of these new roles has been a challenge; TBAs continue to deliver pregnant women despite the ban leading to poor maternal health outcomes. Christian Aid and its partners, with funding from DFID are implementing a project targeting reduction of maternal and new-born mortality in Karonga district. This case study presents achievements on maternal health outcomes following reorientation of TBAs on their new roles. Methodology A mapping exercise was conducted to identify TBAs who were still conducting deliveries despite the ban. A total of 392 TBAs were trained on their new roles which included advising women on health matters, ANC and postnatal attendance, danger signs of pregnancy, nutrition during pregnancy, birth preparedness and referral of pregnant and postnatal women etc. Referral forms were developed which assisted in monitoring TBAs performance on their new roles, through health workers and project team. Review meetings with TBAs, HSAs and Health workers were conducted to follow up on issues identified from previous meeting and referrals conducted by the trained TBAs. Results District Health Information system reports have shown reduction in unskilled births attended by (230) 58%, facility maternal death reduced from 8 to zero, both ANC and postnatal attendance increased by 20%. Neonatal deaths also reduced by 41% while the new-born complications reduced by 14%. Conclusion and Recommendations Supporting TBAs in their new roles can significantly contribute to the reduction of maternal and neonatal mortality, hence need for government and development partners to put more efforts.

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THPE69 SafeCare: Creating transparency and trust in the healthcare system through innovative quality assessment methodology Emmanuel Milimo PharmAccess Group, Kenya Background SafeCare is a quality improvement and benchmarking framework for healthcare facilities in lowand middle-income countries (LMIC). The use of standards to assess and benchmarking facilities is an effective tool for regulation and encouraging improvements, but it is time consuming and very costly for both the government and the healthcare providers. This means that for LMIC information on the level of quality for facilities is most likely not there and potential investors fail to invest or engage effectively. Methods Qualified staff with experience in the health sector are recruited in the various countries and trained on the SafeCare methodology. These staff assess the facilities across Kenya and provide a rating using the SafeCare tools. Results Through this innovative approach, more than 2,600 facilities have received an assessment across the countries where this approach is implemented with over 14.7 million USD disbursed to facilities through Medical credit fund. The facilities have invested in infrastructure and buying equipment and supplies to provide better quality care to the more than 2 million people per month that visit the recruited facilities across Africa (PharmAccess website). Conclusion There is great need for innovative approaches at assessing quality in healthcare. Once data on quality is available, the healthcare system will become more transparent and this will attract investors to participate to better the healthcare system.

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THPE70 Improving skilled birth delivery by changing roles of traditional birth attendants to birth companions in Kakamega County Herbert Wanyonyi , Peter Ofware , Belina Shisia 1

Amref Health Africa, Kenya

Background Globally, an estimated 289,000 women died during pregnancy and childbirth in 2013. The Kenya Demographic and Health Survey (KDHS) 2013/14 reported a decrease in Maternal Mortality Ratio (MMR) from 520/100,000 in 2008/2009 to 362/100,000 in 2014. Health indicators for Kakamega County are poorer with MMR being 880 505/100,000, Under Five Mortality Rate 64/1000 and Neonatal Mortality Rate 19/1000. Amref Implemented a project whose overall goal was to have pregnant women at risk and in need of emergency obstetric care identified, referred and managed at an appropriate health facility to reduce morbidity and mortality. Objective The study aimed to determine if change of TBA roles to Birth Companions (BC) contributes to an increase in skilled delivery. Method A prospective cohort study was undertaken to follow converted 345 TBAs from January 2013December 2015. Mapping of all TBAs in project implementation area (Kakamega Central, Mumias East, Mumias West and Matungu Sub Counties) was done. The TBAs were taken through an orientation to change their roles from delivering women at home to accompanying them to health facility for skilled delivery. Quantitative data of the number of deliveries accompanied per Birth Companion was collected quarterly, recorded and analyzed using Excel. Deliveries at link facilities were monitored to document progress. Result A total of 11,427 women were escorted to deliver at health facility over the 3 year period who would have otherwise given birth at home. The relationship of birth companion and health facility staffs improved. Skilled deliveries increased from 58% to 91.2% and 28.8% of deliveries were accompanied by a BC. Conclusion Birth companions have the capacity to be champions and contribute to increase in uptake of maternal health services.

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THPE71 Assessing the Quality Improvement Capacity Building and Technical Support Needs for Medical Directors in secondary and tertiary health facilities in Ondo State, Southwest Nigeria Olatoun Adeola1, Kolawole Adeniran1, Timothy Aknimurele1, Abimbola Oduola1, Ganiyu Agboola1, Abayomi Joseph Afe1 1Equitable Health Access Initiative, Lagos Nigeria Introduction Quality of care has been recognized as a key element for improved health outcomes and efficiency in the World Health Organization's (WHO) widely adopted framework for health system strengthening in resource-poor countries. The public health sector is grappling in Nigeria with challenges of maintaining a high quality care in the face of rapid scale up of health care services to an everincreasing population with limited resources and competing demands. The health service delivery problems in Nigeria have reached a worrisome state such that the FMOH with the support of the National Council on Health (NCH) decided to undertake a Health Sector Reform (HSR) to improve performance and effectiveness. Focus of the leadership in the health sector has been on the quantity and not quality of health care services delivered. QI has the potential to optimize the use of limited resources available from governments and donors. Demonstrable improvements in quality may encourage greater investment in health systems in developing countries by increasing donor, population and governmental confidence that resources are being used well. Continuous Quality Improvement (CQI) processes have not been integrated into the management of health care delivery due to lack of Training and Technical Support on CQI. The CQI process has been proven to improve healthcare delivery on the HIV program in Nigeria and Africa. Methods Hence this study was done to conduct a baseline QI Capacity Building and Technical Support Needs Assessment for Medical Directors in secondary and tertiary health facilities in Ondo State Southwest Nigeria. Results While 100% of the respondents agreed that demand in healthcare had increased in the past 3 years, 100% strongly agreed that QI initiative will provide a lasting solution to healthcare needs in the state. Most of the respondents (63%) were not aware of Patient Satisfaction Survey as a quality improvement method. 98% envisaged inadequacy of human resources as a possible challenge in implementing QI initiatives. Conclusion There is an urgent need to build the capacity of Healthcare Leader in Ondo State and country as a whole to improve the quality of healthcare delivery at public health facilities. Key Words Continuous Quality Improvement (CQI), Health service delivery, Healthcare leaders, Public Health facilities.

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THPE72 Adapting the 2015 Mother Baby Friendly Birth Facility Guidelines in rural Kenya: making childbirth facilities pastoralist friendly Phyllis Maina , Florence Nderitu 1

County Government of Laikipia, Kenya, Mothers Union Anglican Church Of Kenya 2

Background An estimated 40 million women deliver without skilled assistance each year and this contributes to approximately 1000 women a day dying in childbirth or from a pregnancy -related complication. In Laikipia North region of Kenya the proportion of skilled birth deliveries among the semi- nomadic pastoralist community is only 16% attributed to negative attitudes towards the facilities borne of previous negative experiences. We adapted FIGO, ICM,WHO and IPA Mother Baby Friendly Birth Facility Guidelines (MBFBFG) to meet the expressed demand and supply needs of maternal and child health of pastoralist communities in Laikipia North. Methods Drawing on previous research undertaken in these pastoralist communities, the guidelines were adapted to create a Pastoralist Friendly Maternal Health Facility Checklist that was shared during; a stakeholders workshop, interviews with ten health planners and skilled birth attendants (SBA), 5FGDs with health committee members and community health workers, women and traditional birth attendants(TBAs); a facility audit of dispensaries across five group ranches was conducted to assess supply gaps. Assessment of the Checklist effectiveness includes performance indicators and assessment, and patient surveys. Results and Discussion The Checklist was endorsed by the department of health in Laikipia, women, SBAs and TBAs. Women emphasized the importance of privacy, having a companion, being kept warm and 24 hours postnatal observation. SBAs required more adequate delivery room infrastructure and supplies. No facility satisfied all items on the Checklist but many critical elements were achievable. Conclusion and Recommendation This is the first adaptation of the international MBFBFGs to a particular context; this locally adapted Checklist can be used to assist health facilities to provide services that meet the needs of pastoralist women equitably and by communities to ensure local accountability for the services provided.

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THPE73 Effectiveness of Community Health Units in improving Maternal and Newborn Care outcomes; a case of Samburu County, Kenya Fredrick Okinda , Peter Ofware , Josephine Lesiamon 1

Amref Health Africa in Kenya

Background The ministry of health under Kenya National Health Sector Strategic Plan II of 2005-2010 in 2006 introduced community health workers to counter the negative maternal and newborn and child health (MNCH) indicators through community health units (CHUs). Documentation on quantified impact of CHUs on MNCH indicators is scarce in respect to the changes and varied level of support to this strategy since inception. This study sought to compare means of selected MNCH outcomes among facilities with a CHU and those without. Methods A cross-sectional comparative study design to study selected MNCH indicators in health facilities (HFs) with CHUs and those without. Data was reviewed for 12months (Sept 2014-Oct 2015). The study was conducted from health facility records (MoH 711) of 40 health facilities (19 had CHUs while 21 had no CHUs). Data was analysed through descriptive statistics, and t-test to compare means and test of hypothesis Results The mean number of ANC clients was 40.91(95%CI: 44.74, 37.09) among facilities with a CU while in facilities without a CU it was found to be 18.25(95%CI: 19.87, 16.62).FP commodities: the mean number was 24.91(95%CI: 26.98, 22.84) among facilities with a CU while in facilities without it was 12.33(95%CI: 13.30, 11.35). While comparing means for skilled deliveries, α= 0.05, with df = 22, the null hypothesis (Ho=µcu = µno cu)was rejected since the probability indicated by t-value computed (3.091) was less than 0.05 indicating the means in facilities with CHU was significantly different from those without. Conclusion There is a significant difference between the mean numbers of women utilizing health facilities for MNCH services in facilities with community health units as compared with facilities with no community health units. Therefore there is need initiate CHU in all the health facilities in the county. There is need for further research on this area.

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THPE74 Impact of maternal waiting homes in increasing access to reproductive, maternal, neonatal, child and health (RMNCAH) services in Samburu County- Kenya David Onchonga , Mary Kanyaman, Martin Thuranira 1

County Government of Samburu, Kenya

Background Access to RMNCAH services has been a challenge in Kenya. Maternal waiting homes in the health facilities are an equity- based strategy to increase access to RMNCAH services in remote areas. They are low cost solutions for increased skilled delivery and reducing the geographical gap in obstetric care in inaccessible areas. The study was carried out to evaluate the impact of putting up maternal waiting homes in increasing access to RMNCAH services in Samburu county. Objectives To evaluate the impact of putting up maternal waiting homes in increasing access to RMNCAH services in Samburu county Methodology The study was conducted in health facilities in Samburu County, Kenya. We conducted a pre-post trial with a randomized comparison group. Cluster randomization was used, in which health facilities were clusters. Of a total of 27 eligible health facilities, we selected a probability sample of 8 health facilities using stratified sampling. Systematic sampling was used to randomly assign 4 health facilities to the intervention arm and 4 health facilities to the comparison arm. Maternal waiting homes were put up in four intervention arm health facilities and community health volunteers were trained on how to health educate pregnant women on the importance of coming to the maternal waiting homes few weeks to delivery. After an intensive training and mobilization, we developed a tool to monitor the RMNCAH indicators. Result The study found out that in the intervention arm, skilled deliveries increased from 18% to an average of 43%, after intensive training of CHVs. Conclusions Maternal waiting homes is an innovation that if embraced in health facilities will greatly improve RMNCAH indicators in the county.

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THPE75 Economic status and medical education in Rwanda: the huge sacrifice for Rwandans endurance Herondine Uwajeneza University of Rwanda Background Medical students as future health physicians are expected to participate in academic as well as intellectual activities, to translate a series of classroom-learned skills to real-life environments. Medical education requires investing time and money thus studentsâ&#x20AC;&#x2122; economic status impacts all major achievements. As students from Low and Middle Income Countries may be facing real challenges of low economic status, this study aimed to highlight the impact of economic status to medical education, compensating ways and outcomes. Method Informal and formal interviews were conducted to 100 medical students, from the fifth year at University of Rwanda. All results have been collected and analyzed using Epi Info 7. Results Low economic status has been reported by 100% of participants contrary to governmental categories classification. It has a big implication on education as it discourage student from being focused and follow their studies. The 67 (67%) agreed to have low motivation in costing but relevant activities, which limit some possible creative or innovative ideas, 50 (50%) students reported lack of focus due to disturbance from other opportunities not related to medicine, 20(20%) students reported impact on punctuality due to lack of transport, 30(30%) students reported decreased performance and readings due to lack of internet access, whereas drop out of studies due to lack of tuition fees or lack of resources to use in their studies like machine or tablets are the every timeâ&#x20AC;&#x2122;s risks. Conclusion The big toll of diseases that our country faces always waits for fresh support from graduates medical student, but the aimed reaching can become unreachable if the performance keep to be slowed by the issues of economic status. So, different measures need to be taken to improve life status of medical students as a longtime investment towards healthier Africa, our continent.

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THPE76 Impact of engaging practice enhancement assistants in improving quality of care in Samburu county Kenya Mary Kanyaman , David Onchonga, Martin Thuranira 1

CEC Health- Samburu County, Kenya

Background Practice enhancement assistants (PEA) work across primary healthcare practices to improve patient care through staff training, sharing of innovative ideas among practices, support for development of systems and infrastructure, and development and coordination of quality improvement initiatives including continued medical education and upscaling of indicators of public health importance. The study was carried out to evaluate the impact of engaging practice enhancement assistants in improving quality of care in Samburu county Kenya Objectives Evaluate the impact of engaging practice enhancement assistant in improving quality of care in Samburu county Kenya Methodology The study was conducted in government health facilities in Samburu Central sub-county Kenya. We conducted a pre-post trial with a randomized comparison group. We used cluster randomization, in which health facilities were clusters. Of a total of 27 eligible health facilities, we selected a probability sample of 10 health facilities using stratified sampling, in which strata were transmission areahealth facility type. After ordering by transmission areahealth facility type, systematic sampling was used to randomly assign 5 health facilities to the intervention arm and 5 health facilities to the comparison arm. Data collection After intensive staff training (on job training with support supervision) for the five-intervention arm facilities on processes, indicators and clinical practice, we developed questionnaires to interview clients visiting both the intervention and comparison arm facility on their experience on quality of care. Result The study found out that in the intervention arm, quality of care improved from 27% to 72%, The clients interviewed reported more satisfaction on intervention arm. Conclusions: Use of practice engagement assistants can greatly improve the quality of care in the government health facilities and improvement of quality indicators.

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THPE77 Infection control (Patient Safety) in Public Health Facilities; a Mildmay Uganda perspective Christopher Semei , Resty Leonie Nanyonjo, Moses Kamba, Harriet Chemusto, Paul Gonza, Mary Odiit, Barbra Mukasa 1

Mildmay Uganda

Introduction Infection has contributed to morbidity and mortality due to inappropriate practices of handling and disposal of waste, poor hand hygiene, non-effective sterilization methods, poor cleaning, nondisinfection, lack of personal protective equipment, and trainings in infection control. Measures have been put in place to lower the risk of infection in health facilities. Studies evident that infection control in health facilities had hit a deadlock resulting into compromised quality of control measures hence the "infection prevention and control program Method Cross-sectional study design using mixed methods was used in the study. Quantitative methods that adopted a retrospective analysis of the data collected on the key indicators of infection control; 58 KIIs to explore the existence of the individual substances that enhanced infection control through observation were conducted. Results HSS helped identify infection related morbidities and mortalities resulting into designing of infection prevention and control mechanisms. Teams were formed for mentorship and supervision; SOPs established; 3 incinerators constructed; procurement of sterilizers, gas cookers, facial masks, respirators, dust bins, disinfectants and gumboots; training 70 HWs in TB and infection control, Biosafety Planning, and holding of monthly meetings. Today, various ART sites have functional infection control teams and SOPs. 100% of the ART and eMTCT sites started using sterilizers, gas cookers to disinfect delivery and other equipment. Training of HWs has contributed to good Infection control practices, proper waste disposal and management procedures. Conclusion and Recommendation Active involvement of all stakeholders contributes to successful implementation of infection control program. Challenges HWs face need to be addressed. There is need for continuous mentorship on all aspects regarding infection control and prevention. To reduce risks due to infection in health facilities, infection control and prevention measures should be established and adhered to by the health system to increase patient safety during their stay at the health facilities.

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THPE78 Determinants of four Antenatal Care Visits (ANC) visits at critical times during pregnancy: a case of Makueni County, Kenya Background Amref Health Africa in Kenya has been implementing a project dubbed Mama na Mtoto wa Afrika project in Makueni County since 2012. A baseline survey was conducted in 2012, identified structural barriers that impede uptake of Maternal, Newborn and Child Health services in Makueni County including 4 ante-natal care visits (ANC). These barriers included: lack of awareness by mothers on the importance of ANC visits, long distances to the health facilities for rural populations, difficult terrain in Makueni County, young and harsh nurses who were rude to clients as well as critical shortage of staff to attend to pregnant women leading to long waiting time by the pregnant women. This paper therefore seeks to establish the determinants of four ANC visits by pregnant women in Makueni County. Methods A cross-sectional study involving quantitative approach to data collection was adopted. Household interviews were conducted to women of reproductive age (15-49) years who had children aged 0-24 months in the four sub-counties in Kaiti, Makueni, Mbooni and Kilome n=1,208. Data was analysed using SPSS version 18, chi square tests were used to test significance. Comparison was drawn with the pre-intervention baseline status (2012), and end term evaluation (2016). Results The findings revealed that utilization of 4 ANC visits had improved from 49.5% at baseline to 67.9% at end term. 55% had attained secondary level, 80% of the respondents were in monogamous marriage while 75% of respondents were Christians. 70.8% stated that their partners had an economic activity. In terms of parity 68.9% had given birth to 2-5 children. Education level of the mother, marital status, parity, partners education level, place of ANC and transport for ANC were all significant determinants for 4 ANC visits with p<0.05. Religion and motherâ&#x20AC;&#x2122;s employment status were not significant p>0.05. Conclusions and recommendations It is important for future interventions to consider raising awareness on importance of 4 ANC visits using a family based approach, train health care workers on focused ante natal care so that they provide technical and soft skills. Women should be sensitized on the need of family planning and having individual birth plans for ANC. Cultural barriers should be demystified to the community, by raising awareness raising events on the importance of 4 ANC visits.

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THPE79 Evaluation of an initiative to scale up Emergency Obstetric and Newborn Care in Kenya Benter Dinda , Ambrose Agweyu 1

MEASURE Evaluation PIMA, Kenya

Background The Ministry of Health Kenya and partners, including the USAID, contributing to the Ending Preventable Child and Maternal Deaths (EPCMD) initiative embarked on a scale up of Emergency Obstetric and Newborn Care (EmONC) in targeted counties commencing July 2013 and running to date (2016). EmONC is recognized as a high impact intervention that if successfully implemented substantial reductions maternal and newborn deaths can be achieved. Methods The scale up brings together implementing partners to provide technical support to government county health care workers in high volume facilities providing maternal and newborn services. Implementation is informed by data from 6-monthly assessments to monitor progress. The data have been used to re-select target counties, re-focus scope of support (staff training, job aids, and equipment) and quality of care components. Progressively revisions have been made to survey tools, County Dashboards, data quality control, inclusion of equipment mapping and training of county teams. In its third phase, the scale up is conducting a third wave of assessments on progress of the current phase of the enhanced implementation. Results Overall the baseline assessments revealed low levels of facility readiness to provide EmONC by lower and higher tier facilities. Only 2% of health centers and dispensaries and 29% of hospitals surveyed could provide basic emergency obstetric care at baseline in 2014. A mid term review in 2015 revealed significant progress in most counties, such that 6% of health centers and dispensaries and 39% of hospitals could provide BEmONC services by 2015. Results of the 2016 evaluation also indicated further increase of up to 10 percentage point increases in some counties. The scale up triggered improved co-ordination and feedback from County Health Management Teams and between implementing partners. The use of data to inform areas of focus was a critical input for the scale up. Revised survey instruments cover relevant issues including training, job aids, equipment and quality of care for newborns and mothers. Facility-specific profiles provide evidence to focus activities for facilities, sub counties and county management Conclusion and recommendations: The evaluation findings demonstrate significant change in the level of preparedness of facilities to provide EmONC services and improved quality of care. The evaluation recommends establishing mechanisms to sustain the gains made and leverage available resources in achieving the objective of increasing the proportion of facilities with capacity to offer EmONC services.

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THPE80 Recruitment of Off-Track Girls in Kamukunji Sub-County, Nairobi City County Betty Adera Global Communities, Kenya Issues If girls are given a chance to stay in school, get access to health services, delay marriage and childbirth, it's not only them who benefit - so do their children, families, communities, and countries. The issues that girls face will be specific to their age, where they live, their culture and other life circumstances. Programs have to use different, intentional strategies to identify those girls who are most off-track and design programs in such a way that will enable them to participate. Description The DREAMS Program seeks to support the most vulnerable Adolescent Girls and Young Women (AGYW) to live Determined, Resilient, Empowered, AIDS-Free, Mentored and Safe (DREAMS) lives. Through conducting a rapid household assessment in Kamukunji Sub-county, the program enumerated the entire universe of Adolescent Girls and Young Women and identify those who are off-track and most at risk. Respondents were asked to mention some of the major shocks that were affecting households in their settlement. The exercise was conducted using a mobile phone platform where a set of 7 non-sensitive questions were administered to collect demographic information on AGYW. Results The exercise confirmed that out of 24,917 interviewed households, 10,513 members were AGYW aged 10-24 years old. Further disaggregated data showed 3,790 AGYW age 10 to 14; 3,345 AGYW age 15 to 19; and 3,378 AGYW age 20-24. Results showed AGYW living with neither parents nor those married with children as the most off-track. In general, 42% of the AGYW had children and 48% were living without parents. Despite the high number of children who are of school going age, 58% were out of school out of which 18% of them were married with children. Of the 42% who are in school, 22% were in school living with neither parent while 2% were married with children. Lessons Learnt In designing an evidence based program, it is important to understand your beneficiary population.AGYW are not a homogenous group hence understanding their differences helps design programs that meet their different needs.-It is important to segment AGYW based on age cohorts and similar characteristics to be able to reach them with age-appropriate and interventions and services. The most off-track AGYW might not be obvious to identify hence the need to employ a targeted approach Key Recommendations Conducting a rapid household assessment helps to determine all the AGYW beneficiaries in target communities. -Gathering data on AGYW in terms of their education and marital status including who they live with can help determine which of them are most off-track and most at risk.-Use of mobile phone platforms to conduct rapid household assessment is a cost effective strategy.

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THPE81 Adolescent Girls and Young Women achieving their DREAMS against all Odds: Lessons Learnt from the DREAMS Initiative Safe Space Group Model in Kamukunji Sub-County, Nairobi City County Betty Adera Global Communities, Kenya Issues When girls begin puberty, their world starts to shrink and they become increasingly isolated. Many don’t have access to school, social networks that allow them to connect with others. Girls’ access to public spaces shrinks dramatically during adolescence either because they are at risk of harassment or violence or it is socially unacceptable. Due to girls social isolation, simply creating a space where a group of girls, around the same age and from the same community can meet regularly is a critical component of a girl centered program Description The DREAMS Program seeks to support the most vulnerable Adolescent Girls and Young Women (AGYW) to live Determined, Resilient, Empowered, AIDS-Free, Mentored and Safe (DREAMS) lives. Through placing all enrolled AGYW in “Safe Spaces” they are able to build social networks critical for prevention of sexual harassment and violence and expand opportunities. Results As at close of September 2016, a total of 5829 AGYW were enrolled in a total of 202 safe space groups 1950 being 10-14 years; 1065 being 15-19 years and 2814 being 20-24 years. The AGYW within the safe space groups received a) behavioral interventions such as Healthy Chooses for a Better Future and My Health My Choice Evidence Based Interventions (EBIs), family planning education, GBV prevention training, and condom education and distribution; b) biomedical interventions such as post violence care, HIV and STIs treatment, and PrEP; c) social protection support such as education subsidies, cash transfers and socio-economic interventions. Lessons Learnt In designing an evidence based program, it is important to understand your beneficiary population. -AGYW are not a homogenous group hence understanding their differences helps design programs that meet their different needs. -It is important to segment AGYW based on age cohorts and similar characteristics to be able to reach them with age-appropriate and interventions and services. -The most off-track AGYW might not be obvious to identify hence the need to employ a targeted approach. -Building a Girl’s Asset profile is a process of envisioning what success looks like at different ages and places. -Safe space model build social assets and empower AGYW to develop leadership and mentorship skills. Key Recommendations Safe space model is effective at breaking isolation of AGYW and should be embraced as a strategy of reaching the hardest to reach AGYW. -Use of community based safe spaces is key at enhancing participation of AGYW in matters affecting them

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THPE82 Adult patient satisfaction with inpatient nursing care and associated factors in an Ethiopian Referral Hospital, Northeast Ethiopia Fisseha Amdie1, Kokeb Haile1 1 University of Gondar, Ethiopia Introduction Patient satisfaction with nursing care is considered as an important factor in explaining patients' perceptions of service quality. Care assessed to be high quality according to clinical, economic or other provider-defined criteria is far from ideal if as a result of that care the patient is unhappy or dissatisfied. Therefore there is, sound rationale for assessing the satisfaction of patients with nursing care. Objective The aim of this study was to assess adult patients’ satisfaction with inpatient nursing care and associated factors in an Ethiopian referral hospital, Northeast Ethiopia, 2013. Methods Institution based quantitative cross-sectional study was conducted among patients admitted in medical, surgical, orthopedics, gynecology and ophthalmology wards of Dessie referral hospital from March 24 – April 30, 2013. All admitted patients who stayed in the study wards for at least two days during the data collection time were interviewed. The data collection technique was structured interview by using standard questionnaire adapted from Newcastle Satisfaction with Nursing Scale. Data were entered into EPI-Info version 3.5.3 and exported to SPSS version 20 for analysis. Multiple Logistic regression and odds ratio with their 95% confidence interval were used to identify factors associated with patient satisfaction with nursing care. Result The overall patient satisfaction rate was 52.5 %. Respondents’ sex (AOR= 2.20, 95%CI:1.30,3.73), age (AOR=4.77, 95%CI:1.97,11.55), admission ward (AOR= 9.99, 95%CI:3.47,28.79), self reported health status (AOR=2.07, 95%CI:1.27,3.37) and class of admission (AOR=2.56, 95% CI:1.41,4.67) were the variables significantly associated with patient satisfaction with nursing care. Conclusion and recommendation The rate of patient satisfaction with nursing care was found to be low in this study. Being female, age group 18 – 30 years old, good self reported current health status, being admitted in ophthalmology ward and first class of admission were significantly associated with patient satisfaction with nursing care. In-service training programs for nurses, with special emphasis on communication skills, are recommended.

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THPE83 Innovative approaches to improving health service delivery in Limpopo, South Africa through re-engineering primary health care Lynette Mthembu Amref Health Africa, South Africa Background South Africa still faces numerous challenges in making accessible and available quality maternal and newborn child health and nutrition (MNCH&N) services. Amref Health Africa in South Africa supports and strengthens the Governmentâ&#x20AC;&#x2122;s re-engineering Primary Healthcare strategy to improve access to and utilization of MNCH services, family planning uptake and reproductive health outcomes, access to and utilization of school health services in Vhembe and Sekhukhune districts of Limpopo. Methods The project carried out interventions to improve MCWH&N uptake in Limpopo province through capacity building, health systems and community systems strengthening. Baseline and follow up service data were collected and checked for progress and improvements. Data audits were conducted to determine accuracy and reliability. Trends were analyzed pre- and post- intervention. Results Quality and uptake of MNCH services improved in both districts. Number of health facilities offering MNCH that are in adherence to national core standards increased by 80% and the number of facilities experiencing stock outs declined by 10%. Family planning uptake and sexual reproductive health and rights (SRHR) outcomes also improved by 40%. There was 70% increase in the number of community health workers trained in SRHR and 90% of these were having regular meetings with health facility staff. The number of facilities with nurses trained on termination of pregnancy (TOP) increased by 78%. Conclusions Uptake of MNCWH&N services in resource-limited settings can be improved by utilizing innovative alternatives to mitigate the effects ofhuman resource shortage. Such innovations include integration of MNCWH services into existing programs, addressing information gaps, mobilizing traditional leaders and building strong relationships with the government, providing technical assistance and mentorship beyond regular training., These health system based approaches provide a sustainable improvement in the capacity and uptake of services. Key words Primary health care re-engineering, innovations, maternal health services

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THPE84 The Deadly 3 Delays of Maternal and Child Health: Results of a client satisfaction survey on reducing delays in receiving adequate care Boniface Hlabano , Vusi Ntuli , William Muhwava 1 Amref Health Africa, South Africa 1

Introduction The â&#x20AC;&#x153;3 delaysâ&#x20AC;?: delay in deciding to seek care, delay in reaching care and delay in receiving care at the health facility is cited as one of the contributing factors to maternal mortality. Women spend a lot of time waiting to receive care. Amref implemented a project to improve access to quality Maternal and New born Child Health in of Vhembe and Sekhukhune Districts among others by addressing delays that occur in health facilities. Methodology In 2014, a baseline survey was conducted to measure time spent by women to be attended to by health care workers in 10 randomly selected health facilities. After carrying out training of health workers and providing them with adequate resources and equipment, a follow up survey was conducted in 2016 to assess if there have been improvements in timeliness of attendance to women seeking services: antenatal/post natal services. Data was collected using mixed methods: client exit interviews, observation check list and focus group discussions. Results Except for one facility, the rest saw substantial reduction in waiting times. On average, the delay was reduced by about 30 minutes from a high of 83 to 54 minutes. This varied by clinics due to huge client flows in those facilities which service large populations. This meant that attempts to shorten long queues cannot totally eliminate the waiting times (delays). At some facilities, the operating hours (opening/closing times) rendered useless strategies such as appointment approach as this may not be convenient some clients who travel long distances. Conclusion Capacitation of health facility staff in both planning skills (using appointment system), separation of clients according to their presenting conditions and provision of adequate materials and resources goes a long way in reducing the delay in receiving adequate care at the health facility. Key Words 3-Delays, MNCH, client satisfaction

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THPE85 Factors affecting access to health services at the Busia Kenya/Uganda border Boniface Kitungulu1, Dorothy Muroki1, Joyce Olenja1, Missie Oindo, Leanne Kamau, Denise Juma, Fridah Muinde, Martin Sirengo, Helgar Musyoki 1FHI 360, Kenya Background The impact of human mobility on the health of communities living along transport corridors in Eastern Africa has been well documented. However, there is a gap on the health impact of crossborder community interactions. The level of interaction between cross border communities is more regular and somewhat complex. Border communities share common social and environmental dynamics including health determinants, needs, and levels of vulnerabilities. Though there is limited data on transitional access to health services, information available on both sides of the border indicate constant mobility of cross border populations seeking health services. Despite this trend, the factors that influence demand for services across the border are not well understood or documented. Objectives To document factors that influence demand for health services from health facilities across the border by mobile key and vulnerable populations. Methods Assessment covered five cross-border sites; Busia, Malaba, Sio Port/Port Victoria/Majanji (Kenya/ Uganda) and Taveta/Holili and Muhuru Bay/Kirongwe (Kenya/Tanzania). Qualitative methods including 150 Key informants, 200 Focus group discussions and 200 In-depth interviews were conducted with key and vulnerable populations. Data was coded using NVIVO software and subjected to content analysis. Results Cross-border populations are inspired by the perception that there are better services across the border. Setup of the health services, high or low quality services and level of facility are some of the factors identified determining health mobility. Others include cost, distance to services, fear of stigma and discrimination as well as perceived confidentiality. Conclusion and recommendations There is constant mobility by communities across the border in search of health services raising the need for intergovernmental policy to address access to health services for cross-border populations. Seamless access to health services by these communities will help ease the burden of disease. The cross-border health system is bound to lead to higher levels of defaulting, poor tracing and lost to follow up. A cross-border health system jointly established through existing

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THPE86 Employing a multi-faceted approach to addressing infectious diseases in Africa Jennifer Dent BIO Ventures for Global Health, United States Issues Collaboration between public- and private-sectororganizations is critical to successfullyaccelerating communicable disease research and development (R&D) and building R&D capacity in regions most affected by infectious diseases. Description BIO Ventures for Global Health (BVGH) employs a multi-faceted approach to combating infectious diseases that leverages the biopharmaceutical industry’s resources and capabilities. Through its coleadership of WIPO Re:Search – a global consortium dedicated to accelerating new drug, vaccine, and diagnostic development for neglected tropical diseases (NTDs), malaria, and tuberculosis – BVGH is spurring new infectious disease product development. Through WIPO Re:Search, BVGH matches private industry’s assets and resources to qualified academic and nonprofit researchers through collaborative research agreements. Over 100 WIPO Re:Search collaborations focused on basic research and drug, vaccine, and diagnostic development spanning 14 infectious diseases have been established. R&D capacity in Africa has been advanced through the placement of biopharmaceutical company scientists at research centers in Africa to train staff on advanced research techniques. BVGH has placed biopharmaceutical company scientists to train researchers on antibacterial target selection, medicinal chemistry, and drug formulation. BVGH also places companies’ gently-used laboratory instruments at select research centers in Africa to augment research infrastructure and capabilities. Equipment placements have expanded institutional programs and responsibilities and have resulted in peer-reviewed publications. Through BVGH FundFinder, researchers have secured funding to support their drug discovery programs. Lessons learned and recommendations As emphasized by the Sustainable Development Goals, the public, private, and civil sectors all have a critical role to play in addressing global health. Programs and platforms that specifically leverage the biopharmaceutical industry’s strengths to accelerate R&D for infectious diseases and build infectious disease R&D capacity in developing regions – including Africa – must be implemented to realize the SDG targets towards good health and well-being.

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Skills Building Workshop Sessions WORKSHOP 1 Title: Publishing Skills Workshop Organizer: Elsevier with Zoe Mullan, Editor of the Lancet Global Health This workshop will begin with a brief presentation of the inner workings of The Lancet, followed by a discussion on what editors of high-impact medical journals look for in a submission. Using the abstract as a reference point, there will then be a more in-depth analysis of manuscript structure and framing. The session will finish with an overview of the landscape of academic publishing and the increasing demands on researchers to publish in high-impact journals. The damaging impact of ethical “corner-cutting” will be explored and participants will be coached in the essentials of good research and publishing practice. Having a current manuscript in preparation will be useful, but not necessary, to the relevance of the workshop.

WORKSHOP 2 Title: Getting Evidence into Policy and Practice Organizer: African Institute for Development Policy (AFIDEP) Description: The objective of the workshop is to enhance the appreciation, commitment and skills of researchers and policy makers in the translation of knowledge into policy and practice in order to ensure more effective policies and programmes. The workshop will adopt a participatory approach infused with proven principles of adult learning including deliberative discussions and hands-on practice activities on specific proven strategies for knowledge translation. The section will have a pre and post training survey, definition of knowledge translation and its place in science, steps in developing an effective influence strategy, tools and channels to enabling evidence uptake, and participants’ reflection on knowledge translation workshop.

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