SUMMARY: Many disasters take place in urban areas

Health behaviour refers to actions undertaken by a person who perceives self to be ill for the purpose of finding an appropriate remedy. Nurses as gate keepers of health are expected to seek formal treatment when they are taken ill because this is what they teach their patients. Nurses' working conditions all over the world are described as squalid with long working hours and workload. This scenario predisposes them to occupational health hazards and at the same time denies them time for self-care. Although nurses are knowledgeable about disease and its treatment and have access to health care, they engage in self-treatment in contrast to what they teach patients. Health behaviour among nurses in Kakamega County was investigated using a cross-sectional design. Data was collected using self-administered questionnaires and subjected to bivariate and logistic regression analyses. The study found that health behaviour of nurses in Kakamega County is below expectation, as 33% (n = 61) engaged in voluntary screening services. Further, 34.8% (n = 65) said that their health would improve if they engaged in health promotion activities. The study recommends empowering nurses to engage in positive health behaviour through education. The county should also provide affordable screening services to its nurses.

In Kenya, the ability of local people to resist the impact of disasters has not been given adequate attention.A descriptive cross sectional study sought to investigate community perceptions and responses to ood risks in low and high risk areas of the Nyando District, Western Kenya. A total of 528 households, six government o cials and ve project managers of Community Based Organizations (CBOs) and Non Governmental Organizations (NGOs) were interviewed. Additionally, seven Focus Group Discussions (FGDs) involving three women, two male and two teacher groups were conducted. Data were analysed using the Statistical Package for the Social Sciences (SPSS) Program. e Chi-square test was used to determine associations and di erences between variables. In the study, 83% of the respondents were aware of Traditional Flood Knowledge (TFK) and 80% acknowledged its use. Perception of the risk is in uenced by several variables, most notably past experience of major oods and having survived them. Residents in the high risk areas had signi cantly higher levels of awareness and use of traditional ood knowledge. ey were more aware of the nature of the ood related health risks they were exposed to and appeared better prepared for future ood risk. ey were, however, more dependent on external aid. On the other hand, residents living in the low risk area reported better success with their response mechanisms. ABSTRACTFlood Risk Perception, local coping capacity KEYWORDS 347

Background: Insecticide treated nets (ITNs) have been identified as a key strategy in addressing malaria problem among young children and pregnant women. Their utilisation among under fives, however, have been found to be low in some areas. Objective: To identify factors affecting net utilisation (sleeping under insecticide treated net) among caregivers of under fives in Makueni District in Kenya. Design: A cross-sectional, descriptive study. Setting: Eight sub-locations in Wote division Makueni district. Subjects: Four hundred caregivers of children aged five years and below. Results: The results indicated that 88.5% of caregivers were aware of ITNs. The proportion of households with children below five years that owned mosquito net were found to be 46.2%, and only 32.0% had at least a treated net. Slightly more than half of treated nets were used by under fives (52.2%) compared to 47.8% used by children over five years including adults. The main reason cited by majority of caregivers as a hindrance to net utilisation was lack of treated nets in households (72.3%). Utilisation of ITNs by under five children was found to be positively associated with knowledge of ITNs (p=0.024), marital status (p=0.018) and occupation (p=0.043). Conclusion: Utilisation of ITNs by under fives was low despite high level of awareness among caregivers. Factors such as awareness of ITNs, marital status and occupation significantly affected ITNs utilisation. Although the government with support from other stakeholders has recently embarked on large scale distribution of nets in high risky districts, more interventions from various stakeholders are needed to increase availability and accessibility of subsidised permanently treated nets, including interventions to address non-compliance to proper utilisation of nets. There is also need for intensive education emphasising on their proper and consistent use. Scaling up proper use of ITNs along with other initiatives can contribute significantly in reducing malaria.

Background This study set out to investigate how incentives for mothers, health workers and boda–boda riders can improve the community-based referral process and deliveries in the rural community of Busoga region in Uganda. Both the monetary and non-monetary incentives have been instrumental in the improvement of deliveries at health centres. Methods The study was a 2 arm cluster non-randomized control trial study design; with intervention and control groups of mothers, health workers and boba–boda (commercial motor-cycle) riders from selected health centres and communities in Busoga region. Among the study interventions was the provision of incentives to mothers, health workers (midwives and VHTs) and boda–boda riders for a duration of 6 months. Monetary and non-monetary incentives were applied in this study, namely; provision of training, training allowances, refreshments during the training, payment of transport fares by mothers to boda–boda riders, free telephone calls through establishment of a pre-paid Closed Caller User Group (CUG) and provision of bonus airtime to all registered CUG participants and rewards to best performers. The study used a mixed methods design. Descriptive statistical analysis was computed using STATA version 14 for the quantitative data and thematic analysis for qualitative data. Results Findings revealed that incentives improved community-based referrals and health facility deliveries in the rural community of Busoga. The proportion of mothers who delivered from health centres and used boda–boda transport were 70.5% in the intervention arm and only 51.2% in the control arm. Of the mothers who delivered from the health centres, majority (69.4%) were transported by trained boda–boda riders while only 30.6% were transported by un-trained boda–boda riders. And of the mothers transported by the boda boda riders, 21.3% in the intervention arm reported that the riders responded to their calls within 20 min, an improvement from 4.3% before the intervention. Mothers who were responded to between 21–30 min increased from 31.4% to 69.6% in the intervention arm while in the control arm, it only increased from 37.1% to a dismal 40.3%. Interestingly, as the time interval increased, the number of boda–boda riders who delayed to respond to mothers’ calls reduced. In the intervention arm, only 6.2% of the mothers stated that boda–boda riders took as many as 31–60 min’ time interval to respond to their calls in post intervention compared to a whopping 54.9% in the pre intervention time. There was little change in the control arm from 53.2% in the pre intervention to 41.2% in the post intervention. Conclusion Incentives along the maternal health chain are key and the initiative of incentivising the categories of stakeholders (mothers, midwives, the VHTs and the boda–boda riders) has demonstrated that partnerships are very critical in achieving better maternal outcomes (health facility-based deliveries) as a result of proper referral processes.