Community-based health interventions

Background: This study was conducted to gauge how the demographic profile of smokeless tobacco (SLT) users from Gujarat and Andhra Pradesh, India, differs from that of smokers. It also addresses how factors associated with the initiation and continuation of smokeless tobacco vary by age, gender, and education.
Materials and Methods: We analyzed 2011 cross-sectional survey data collected from 4,759 respondents (smokers/SLT users/non-users) in both states. Chi-square analysis was used to make comparisons between the demographic profiles of smokers and SLT users. Multivariable logistic regression analysis was used to obtain the odds ratios (ORs) for initiation and continuation factors regressed on socio-demographic variables (age, gender, education).
Results: Initiation-women were less likely than men to report “peer pressure”, “fashion statement”, and “stress/coping” as
relevant factors for SLT use (OR: 0.45 CI: 0.30-0.70; OR: 0.42 CI: 0.24-0.74; OR: 2.47, CI: 1.47-4.15). Older age groups had lower odds of choosing “peer pressure” than the 15-24 year olds. Respondents with 11 or more years of education were more likely to report “stress/coping” than those with no education (OR: 2.82, CI: 1.06-7.48).
Continuation-women were less likely than men to choose “relaxation”, and “distance from family” as important continuation factors (OR: 0.50, CI:0.32-0.80; OR: 0.20, CI: 0.06-0.65). All age groups were less likely to choose “stimulation” as a factor than the youngest group. Conclusions: Along with confirming and expanding upon previous literature, the findings of this study should encourage further SLT research in women and younger age groups (15-24 and 24-44). They also confirm the need for SLT prevention and cessation interventions in India in other community-based settings, besides schools.

A country's Healthcare system speak volumes about her developmental stage. This paper examines  Mozambique healthcare system and identified the leading health challenges.  HIV/AIDS and Malaria are the two major leading cause of death for adult and children, respectively. Mozambique has a very stunted economic growth with about 6-7 percent which mainly benefits the urban population of which its over 80 percent population lives in the rural areas. Despite the intervention of international organisation, the current healthcare in the country is highly unfair and in a state of disarray.  With the health care system being driven by fee payment method, it is a huge problem for the most of the population to access good health care services due to their poor social and economic status. Introducing national health insurance policy may reduce the burden of self-pay method for the treatment of diseases and ill-health among the Mozambican population.

Despite political change over the past 25 years in Britain there has been an unprecedented national policy focus on the social determinants of health and population-based approaches to prevent chronic disease. Yet, policy impacts have been modest, inequalities endure and behavioural approaches continue to shape strategies promoting healthy lifestyles. Critical public health scholarship has conceptualised this lack of progress as a problem of 'lifestyle drift' within policy whereby 'upstream' social contributors to health inequalities are reconfigured 'downstream' as a matter of individual behaviour change. While the lifestyle drift concept is now well established there has been little empirical investigation into the social processes through which it is realised as policies are (re)formulated and implementation is localised. Addressing this gap we present empirical findings from an ethnography conducted in a deprived English neighbourhood in order to explore: (i) the local context in the process of lifestyle drift and; (ii) the social relations that reproduce (in)equities in the design and delivery of lifestyle interventions. Analysis demonstrates how and why 'precarious partnerships' between local service providers were significant in the process of 'citizen shift' whereby government responsibility for addressing inequity was decollectivised.

Interventionists usually blame cultural factors and traditional attitudes for non-compliance of target populations, a framework Didier Fassin terms as culturalism. Despite their efforts, what the Roll Back Malaria employees find in southeastern Nigeria is a 'troubling' nonchalance towards the programme because target populations' perceptions of malaria differ from the donor/programme perspective. The RBM employees cast the local attitude as culturalism, accordingly framing their exhortations in terms of this discourse. How the Roll Back Malaria employees deployed culturalism to fit with the neoliberal individualizing framework of current international health practices is one more nuanced analytical perspective the article brings to intervention literature.

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objectives Further scale-up of antiretroviral therapy (ART) to those in need while supporting the growing patient cohort on ART requires continuous adaptation of healthcare delivery models. We describe several approaches to manage stable patients on ART developed by M edecins Sans Fronti eres together with Ministries of Health in four countries in sub-Saharan Africa.

Background and Objectives: Based on different studies, substance use is one of the health problems in the Iranian society. The prevalence of substance use is on a growing trend; moreover, the age of the onset of substance use has declined to early adolescence and even lower. Regarding this, the present study aimed to develop a family-based early-onset substance use prevention program in children (i.e., My Family-Study) by using intervention mapping approach. Materials and Methods: This study descirbes the research protocol during which the intervention mapping approach was used as a framework to develop My Family-Study. In this study, six steps of intervention mapping were completed. Interviews with experts and literature review fulfilled the need assessment. In the second step, the change objectivs were rewritten based on the intersection of the performance objectives and the determinants associated in the matrices. After designing the program and planning the implementation of the intervention, the evaluation plan of the program was accomplished. Results: The use of intervention mapping approach facilitated the develop-pment of a systematic as well as theory-and evidence-based program. Moreover, this approach was helful in the determination of outcomes, performance and change objectives, change of determinants, theoretical methods, practical application, intervention, dissemination, and evaluation program. Conclusions: As the findings of this study indicated, the intervention mapping provided a systematic as well as theory-and evidence-based approach to develop a quality continuing health promotion program.

Innovative projects to reduce disparities in cancer treatment and research include partnerships between academic and community cancer centers, patient navigation programs and strategies to promote community awareness, education and engagement. A 4 h training program about cancer clinical trials was developed through a needs assessment and in collaboration with community health workers who served as consultants and a larger advisory board comprised of community health workers, educators and clinical trialists. This program was delivered first as a collaboration between a phsycian who is experienced in the conduct of clinical research and two community health workers, and subsequently by the community health workers alone. We report on four workshops attended by a total of 61 community health workers recruited from Boston-area hospitals, community health centers and outreach programs. Support for and knowledge of clinical trials was measured in a pretest and post-test, which also included a satisfaction rating. Participants had a range of prior experience with clinical trials in the context of their personal and professional experience. Mean accuracy of knowledge about clinical trials increased from 72 to 84%, support for clinical trials improved considerably, and satisfaction with the training experience was high. Knowledge gaps and low levels of support for cancer clinical trials among community health workers can be improved with a short training program delivered by other community health workers. Further research is needed to identify the impact of this training on accrual to cancer clinical trials.

Does the Bell Let’s Talk mental health campaign successfully articulate and undertake one of its core mandates: the reduction of stigma and promoting awareness of mental health? Bell Let’s Talk uses a variety of media to communicate and deliver its campaign messages, and I will examine a piece of their print media: The Bell Let’s Talk Toolkit: Starting the Conversation about Mental Health to determine why and how the material has a sociological approach.

Information on the costs of public health interventions is crucial for policy makers to assess whether scarce resources are being used efficiently. There is growing recognition of the importance of cost analyses of health interventions at a local level particularly in developing countries. There are several methods available for costing of public health interventions but each method has its own strengths and weaknesses. This paper gives an

Abstract

The use of community health workers to administer prompt treatments is gaining popularity in most sub-Saharan African countries. Their performance is a key challenge because it varies considerably, depending on the context, while being closely associated with the effectiveness of case management strategies. What determines community health workers' performance is still under debate. Based on a realist perspective, a systematic review recently hypothesized that several mechanisms are associated with good performance and successful community interventions. In order to empirically investigate this hypothesis and confront it with the reality, we conducted a study in Burkina Faso, where in 2010 health authorities have implemented a national program introducing community case management of malaria. The objective was to assess the presence of the mechanisms in community health workers, and explore the influence of contextual factors. In 2012, we conducted semi-structured interviews with 35 community health workers from a study area established in two similar health districts (Kaya and Zorgho). Results suggest that they perceive most of the mechanisms, except the sense of being valued by the health system and accountability to village members. Analysis shows that drug stock-outs and past experiences of community health workers simultaneously influence the presence of several mechanisms. The lack of integration between governmental and non-governmental interventions and the overall socio-economic deprivation, were also identified as influencing the mechanisms' presence. By focusing on community health workers' agency, this study puts the influence of the context back at the core of the performance debate and raises the question of their ability to perform well in scaled-up anti-malaria programs.

Thirty years after Alma-Ata, there has been an upsurge of interest in community health workers (CHWs) in low- and middle-income countries. This echoes several strategic policies recently endorsed by the World Health Organization and its global call to re-establish the primary healthcare (PHC) policy. However, we are witnessing a reframing of this approach rather than its renewal. In particular, the way CHWs are conceptualized has changed considerably. Far from serving as promoters of social change and community empowerment, today we expect them to act as front-line clinicians. This medicalization of CHWs results from a systemic erosion of health promotion’s influence over the last 20 years. Community case management of malaria perfectly illustrates this shift towards a pragmatic, medically centered, use of CHWs. Taking this example, we will discuss the pitfalls of this task-shifting strategy put forward by international health actors, and make suggestions to reattribute a mission of health promotion to CHWs, as intended by the Alma-Ata’s PHC policy

Fundamental conceptual tensions underlie current debates regarding the implementation of psychosocial interventions with war-affected populations. Three particular tensions structuring current discourse concern the generalisability versus uniqueness of relevant knowledge, the valuing of technical versus indigenous understandings, and the planning of targeted versus community-based intervention. The implications of working out these tensions in the implementation of programmes are explored, leading to the proposal of a model of phased response to psychosocial needs. This distinguishes four discrete phases of potential response: 1 minimal disruption of intact protective influences; 2 re-establishment of protective influences; 3 provision of compensatory support; and 4 targeted therapeutic intervention.

This case study is about Master A. A, a 4 year old boy with sickle cell disease who was diagnosed of osteomyelitis with pathological fracture of the right humerus. Patient has been hospitalised before for dactylitis on the 7 th July, 2015, was treated and discharged home on the 16 th July, 2015. He was however readmitted via Children Outpatient Department of Oni and Son Memorial Hospital, Ibadan, Nigeria on the 21 st July, 2015 on account of history of fever of 6 days duration and swelling of the distal 2/3 third of the left forearm, there was also swelling of the right upper hand which was associated with pain and loss of function. A provisional diagnosis of osteomyelitis with pathological fracture of the right humerus was made by the doctor in charge. He was later reviewed by the paediatric team and was admitted into Ward I for further investigations and proper management. Afterwards, Master A, A had cast applied on the right humerus due to the fracture as confirmed by the X-ray report. Nursing management was carried out by adopting Quality Care Model which was proposed by Duffy J. R (2005).

Theatre-based interventions have been used in health promotion with young people to address HIV and sexual health. In this study, we explored the experience of undergraduate student performers participating in a theatre-based HIV prevention and sexual health education intervention for high school students in the USA.
Undergraduate students enrolled in a credit-bearing course to learn about HIV and sexual health, participatory theatre and health education techniques. We analysed students’ reflective essays written throughout the semester to identify any changes and the intervention processes that promoted these changes. Students experienced five interrelated forms of transformation: (1) increased knowledge about HIV and sexual health; (2) changes in attitudes and communication about sex; (3) artistic growth; (4)
emotional growth; and (5) clarification of career goals and future plans. Intervention processes that contributed to these transformations included improvisation, guided writing exercises, the creation of a close-knit cohesive group and interactions with
a group of HIV-positive speakers. Theatre-based, peer-led sexual health programmes can provide a transformative experience for undergraduate student performers. These transformative effects are linked to specific activities and processes of the intervention
and require examination in future research.

USA Leadership networks Evidence-based interventions Social network analysis Faith-based organizations a b s t r a c t Through two case studies of Catholic parishes in Massachusetts, this study explores the implications of leader-centered versus distributed leadership in Catholic parishes for the implementation of evidencebased health interventions. The two parishes involved in the study differ from each other in several ways. In the first, parishioners are less engaged in leadership activities at the decision-making level in the parish. A small group of lay volunteers work with the parish priest and other ordained leaders on parish activities. In the second parish, a large and active lay volunteer leadership have forged an organizational structure that allows more independence from the pastor's direct oversight. In this parish, lay volunteer leaders are the prime drivers of organizational programs and events. In 2012e2013, three types of networks were assessed at each parish: discussion, collaboration, and outside-of-parish ties. The contrasts between each parish include differences in density of collaboration, in frequency of discussion, and network centrality of the respective parish priests. We further identified key actors in the network structures at each parish. We discuss the implications of these findings for understanding organizational capacity in the context of health program implementation.

BACKGROUND: Community-based health programs (CBHPs) with participatory approaches has been recognized as an important tool in health promotion. The goal of this study was to understand the nature of participation practice in CBHP and to use the data to advocate for more participation-friendly policies in the community, academy and funding organizations.METHODS: In this qualitative study, 13 CBHPs, which were active for last 5 years have been assessed using semi-structural in-depth interviews with programs principal and managers and focus group discussions with volunteers and service users. Data analysis was based on the deductive-inductive content analysis considering the participatory approaches in these programs.RESULTS: The results show that, the main category of participation was divided to community participation and intersectional collaboration. The community participation level was very different from "main," "advisory" or "supporting" level. The process of recruitment of volunteers by the governmental organization was centralized and in non-governmental organizations was quite different. According to respondents opinion, financial and spiritual incentives especially tangible rewards, e.g., learning skills or capacity building were useful for engaging and maintaining volunteers' participation. For intersectional collaboration, strong and dedicated partners, supportive policy environment are critical.CONCLUSIONS: It seems that maintaining partnership in CBHP takes considerable time, financial support, knowledge development and capacity building.

Background: In Cambodia, despite great successes in the fight against HIV, challenges remain to eliminating new HIV infections and addressing sexual reproductive health (SRH) issues in key populations including female entertainment workers (FEWs). To address these issues, the Sustainable Action against HIV and AIDS in Communities
(SAHACOM) project has been implemented since late 2009 using a community-based approach to integrate HIV and SRH services. This study evaluates the impact of the SAHACOM on sexual and healthcare-seeking behaviors among FEWs in Cambodia.

Methods: A midterm and endpoint comparison design was utilized. Midterm data were collected in early 2012, and endpoint data were collected in early 2014. A two-stage cluster sampling method was used to randomly select 450 women at midterm and 556 women at endpoint for face-to-face interviews.

Results: Compared to women at midterm, women at endpoint were significantly less likely to report having sexual intercourse in exchange for money or gifts in the past three months (OR = 2.1, 95 % CI = 1.6-2.7). The average number of commercial sexual partners in the past three months also decreased significantly from 5.5 (SD = 13.3) at midterm to 3.6 (SD = 13.9) at endpoint (p = 0.03). However, women at endpoint were significantly less likely to report always using condom when having sexual intercourse with clients in exchange for money or gifts (OR = 2.6, 95 % CI = 1.5-4.5). Regarding sexually transmitted infections (STIs), women at endpoint were significantly less likely to report having an STI symptom in the past three months (OR = 1.8, 95 % CI = 1.4-2.3) and more likely to seek treatment for the most recent STI symptom (OR = 1.6, 95 % CI = 1.1-1.9). Furthermore, women at endpoint were significantly more likely to be currently using a contraceptive method (OR = 1.4, 95 % CI = 1.1-1.8) and less likely to report having an induced abortion (OR = 1.4, 95 % CI = 1.1-1.7) during the time working as a FEW.

Conclusions: The overall findings of the study indicate that the SAHACOM is effective in reducing sexual risk behaviors and improving the access to SRH care services among FEWs in Cambodia. However, several unfavorable findings merit attention.

Here is presented a retrospective review of the Charis Project's Family Engagement Program (FEN) as it existed in 2014-2017. FEN was a program of women's health education, nutrition supplements, and family visitation. The education program consisted of a 12-week course on nutrition, maternity, and sex education taught individually and in groups, focusing on pregnant Burmese migrant labourers, but including approximately 20% male participation. The nutrition supplements consisted of 5 kilograms of fresh vegetables and 12 eggs weekly to pregnant mothers, from course onset to about six months after childbirth depending on family needs. Family visitation took place during food deliveries, and focused on individual counselling and family stability. The program served 39 families from 2014-2017. FEN did not reduce neonatal mortality (due to a miscarriage and severe congenital birth defect), but resulted in all surviving infants being born normal weight and surviving to the end of 2019, representing a significant improvement over the 25.6% low birth weights reported for Kayin State, Myanmar (Ministry of Health and Sports, Myanmanr (2016)

A variety of health financing schemes shaped on pre-payment scheme have been implemented across Sub-Saharan Africa (SSA) to address the Millennium Development Goals (MDGs). In Mauritania, the Obstetric Risk Insurance package (ORI) focusing on maternal and perinatal health has been progressively implemented at the health district level since 2002. Here, our main objective was to assess the effectiveness of the ORI in increasing facility-based delivery rates, as well as increases in family planning, antenatal and postnatal care, caesarean delivery and neonatal health, from demographic and health survey data between 2002 and 2011. We also examined whether the effects of the ORI varied between strata of the population. The study was based on a quasiexperimental before-and-after design to assess the causal link between availability of ORI and increase in use of maternal health services and neonatal mortality. In combination with geographical information system, difference-indifferences and odd ratio approaches were used to address our objectives. Indicators of access to care for pregnant women and neonatal health and improved in both non-intervention and intervention groups during the study period. There was no global effect of the availability of ORI on facility-based delivery rates, nor on the use of antenatal and postnatal care services, except for qualified antenatal services. However, delivery rates in local health centres with ORI increased more rapidly than in those with no ORI, the contrary was shown for hospitals. Caesarean delivery and family planning decreased with ORI. Although late neonatal mortality rates remained low in the country, a significant decrease was seen in districts without ORI. Except for some strata of the population, ORI has not really met its objective of attracting more pregnant women towards facility-based health care.

Globally, the population is ageing, which has serious consequences for businesses. The prosperity of companies is crucially dependent on the ability to effectively manage their employees, including older workers. Best practice in age management is defined as those measures that combat age barriers and/or promote age diversity. These measures may entail specific initiatives aimed at particular dimensions of age management; they may also include more general employment or human resources policies that help to create an environment in which individual employees can achieve their potential without being disadvantaged by their age (Walker, 1999).
Promoting early retirement is generally not encouraged. Companies now have to encourage longer working lives. Much needs to be done to ensure that work remains a positive experience for workers throughout their career trajectories, and it does not damage their health. It has been found by studies that health is significantly related to retirement timing (both planned and unplanned) (Goyer, 2013, Adams et al., 2014), influences work performance (Merrill et al., 2012; Ilmarinen, 2009), and health-related organisational policies can positively influence employee retention (Towers, 2005). The major contemporary challenges to health at work are those associated with the way work, and work organisations are designed and managed. This is especially true for older workers. A comprehensive and effective approach towards age management can be very beneficial for them. How should companies implement age management? Some possible ways are set out in this policy brief below, which focuses on best practices in age management regarding ergonomic aspects and health interventions for older workers at an organisational level. The intention is to discuss the current situation and to illustrate some organisational techniques in selected countries. This policy brief can serve as an inspiration for, among others, companies and policymakers. Recommendations for successful practice are included. In total, this policy brief covers 8 COST  member countries (the Czech Republic, Finland, Germany, the Netherlands, Slovenia, Spain, Sweden and the United Kingdom) to give a glimpse of the current situation of best practice in age management and show how companies in various states deal with ergonomic aspects, health interventions and the ageing of their labour force.

USA Leadership networks Evidence-based interventions Social network analysis Faith-based organizations a b s t r a c t Through two case studies of Catholic parishes in Massachusetts, this study explores the implications of leader-centered versus distributed leadership in Catholic parishes for the implementation of evidencebased health interventions. The two parishes involved in the study differ from each other in several ways. In the first, parishioners are less engaged in leadership activities at the decision-making level in the parish. A small group of lay volunteers work with the parish priest and other ordained leaders on parish activities. In the second parish, a large and active lay volunteer leadership have forged an organizational structure that allows more independence from the pastor's direct oversight. In this parish, lay volunteer leaders are the prime drivers of organizational programs and events. In 2012e2013, three types of networks were assessed at each parish: discussion, collaboration, and outside-of-parish ties. The contrasts between each parish include differences in density of collaboration, in frequency of discussion, and network centrality of the respective parish priests. We further identified key actors in the network structures at each parish. We discuss the implications of these findings for understanding organizational capacity in the context of health program implementation.

By David Ayre, Lucy Capron, Pedro Guertler and Sarah Royston

The Warm and Informed project was launched in September 2014 as a partnership between Northern Gas Networks (NGN) and The Children’s Society, focusing on two low income areas of Bradford.  The findings in this report are based on:
 Five interviews with project workers and staff from Northern Gas Network
 17 interviews with service users accessing the Warm and Informed project
 16 interviews with service users that had not accessed the project
 Review of Key Performance Indicator data collected by the Bradford Children’s Centres
This evaluation report identifies key themes that have emerged from our interviews with families who have accessed the Warm and Informed project, and brings together our key findings about what worked, what issues there were, and what can be learned for an expansion of any similar work.

This supplement provides a comprehensive and indepth
examination of proven clinical-community
health strategies employed by the Alliance to Reduce
Disparities in Diabetes, across five sites located in
diverse geographic regions of the United States,
including a tribal community. Alliance projects in
these communities focused on African Americans,
Hispanics/Latinos, and American Indians as priority
populations. Each project was implemented with an
understanding that there are cultural norms, community
characteristics, and health care system challenges
that require sustained multicomponent
approaches to ameliorate factors that exacerbate poor
disease management and health outcomes. The articles
increase understanding of what is required to
implement evidence-based approaches shaped by
local experiences in order to meet the needs of diverse
communities affected by diabetes. Lessons learned
have generic elements that can be used in other priority
populations and settings.

Community-based health programs (CBHPs) with participatory approaches has been recognized as an important tool in health promotion. The goal of this study was to understand the nature of participation practice in CBHP and to use the data to advocate for more participation-friendly policies in the community, academy and funding organizations. In this qualitative study, 13 CBHPs, which were active for last 5 years have been assessed using semi-structural in-depth interviews with programs principal and managers and focus group discussions with volunteers and service users. Data analysis was based on the deductive-inductive content analysis considering the participatory approaches in these programs. The results show that, the main category of participation was divided to community participation and intersectional collaboration. The community participation level was very different from "main," "advisory" or "supporting" level. The process of recruitment of v...

Many modifiable risk factors for cardiovascular disease (CVD) (namely hypertension, dyslipidemia, Type II diabetes, and metabolic syndrome) may be ameliorated by improving nutrition and increasing physical activity (PA). This review aims to summarize interventions that have positively facilitated PA adoption among adults in the United States (U.S.) with CVD, and to summarize determinants associated with PA adoption within this population. Studies from 1995 to the present were included, to generate a review addressing PA adoption following the Centers for Disease Control and Prevention and the American College of Sports Medicine’s issuance of the United States’ first joint public health statement providing a “clear, concise public health message regarding physical activity” (Pate et al., 1995).  Services, programs, and education modalities that are culturally relevant to the individual, incorporate elements of behavioral theory, and provide individualized support and feedback from health professionals can facilitate PA adoption in adult CVD patients. Determinants and personal factors associated with greater PA adoption include being Caucasian, male, having education beyond high school, and not having depression. It is in the interest of health and exercise professionals to employ a patient-centered course of action when addressing PA adoption. Individuals can best be serviced when cultural relativity and their phychosocial needs and strengths are incorporated into PA adoption planning.

In Central and Eastern Europe (CEE), health‐mediation programs (HMPs) have become central policy instruments targeting health inequities between segregated Roma and general populations. Social determinants of health (SDH) represent the root causes behind health inequities. We therefore evaluated how an HMP based in Slovakia addressed known SDH in its agenda and its everyday implementation. To produce descriptive data on the HMP's agenda and everyday implementation we observed and consulted 70 program participants across organizational levels and 30 program recipients over the long‐term. We used a World Health Organization framework on SDH to direct data acquisition and consequent data content analysis, to structure the reporting of results, and to evaluate the program's merits. In its agenda, the HMP did not address most known SDH, except for healthcare access and health‐related behaviours. In the HMP's everyday implementation, healthcare access facilitation activities w...

Background: Exercise is an important and effective approach to preventing falls in older people, but adherence to exercise participation remains a persistent problem. A unique purpose-built exercise park was designed to provide a fun but physically challenging environment to support exercise in a community setting. This project is a randomised controlled trial designed to evaluate the effectiveness of an exercise intervention using an exercise park specifically designed for older people in reducing the risk of falls. Methods/Design: This study will be a parallel randomised control trial with pre and post intervention design. One hundred and twenty people aged between 60 and 90 years old will be recruited from Melbourne suburbs and will be randomly allocated to either an exercise park intervention group (EPIG) or a control group (CG). The CG will receive social activities and an educational booklet on falls prevention. The BOOMER balance test will be used as the primary outcome measure. Secondary outcome measures will include hand grip strength, two minute walk test, lower limb strength test, spatio-temporal walking parameters, health related quality of life, feasibility, adherence, safety, and a number of other psychosocial measures. Outcome assessment will be conducted at baseline and at 18 and 26 weeks after intervention commencement. Participants will inform their falls and physical activity history for a 12-month period via monthly calendars. Mixed linear modelling incorporating intervention and control groups at the baseline and two follow up time points (18 weeks and 26 weeks after intervention commencement) will be used to assess outcomes.

Emerging and re-emerging communicable disease outbreaks are a global concern and Uganda is no exception. The West Nile region of Uganda has experienced annual epidemics of cholera, meningococcal meningitis, plaque, measles, hepatitis E among others – usually with high Case Fatality Rates (CFRs) despite interventions of epidemic prevention, preparedness and response (EPPR) entailed in cluster one of the Uganda National Minimum Health Care Package [1]. This paper documents performance of the West Nile districts in EPPR. Specifically, we looked at the levels of preparedness, response and implementation of prevention measures. This was a descriptive cross-sectional study aimed at exploring the possible reasons for continuous and frequent occurrence of epidemics in the region; and with high CFRs. We conducted interviews with members of EPPR committees at district and lower local governments. At the lower local governments, we compared prevention and preparedness levels between epidemic-p...