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Conrad Musinguzi,1 Leticia Namale,1 Elizeus Rutebemberwa,2 Aruna Dahal,1 Patricia Nahirya-Ntege,1 Adeodata Kekitiinwa1 1Directorate of Health Systems Strengthening, Baylor College of Medicine Children’s Foundation, Kampala, Uganda; 2Department of Health Policy, Planning and Management, School of Public Health Uganda, College of Health Sciences, Makerere University, Kampala, Uganda Background: Leadership is key to strengthening performance of Health Systems. Leadership styles are important organizational antecedents, especially in influencing employee’s motivation, job satisfaction, and teamwork. There is limited research exploring this relationship among health workers in resource-limited settings such as Uganda. The aim of this study was to examine the relationship between transformational, transactional, and laissez-faire leadership styles and motivation, job satisfaction, and teamwork of health workers in Uganda. Method: We conducted a cross-sectional study in 3 geographic regions of Uganda in November 2015, using self-administered questionnaires with 564 health workers from 228 health facilities. Data were collected on health workers’ perception of leadership styles displayed by their facility leaders, their level of motivation, job satisfaction, and team work. Using Pearson correlation, relationships among variables were identified and associations of the components of leadership styles with motivation, job satisfaction, and teamwork was found using multivariable logistic regression. Results: Health workers in Uganda preferred leaders who were transformational (62%) compared with being transactional (42%) or laissez-faire (14%). Transformational leadership was positively correlated with motivation (r=0.32), job satisfaction (r=0.38), and team work (r=0.48), while transactional leadership was positively correlated with job satisfaction (r=0.21) and teamwork (r=0.18). Motivation was positively associated with leaders who displayed idealized influence-behavior (odds ratio [OR]=3.7; 95% CI, 1.33–10.48) and intellectual stimulation (OR=2.4; 95% CI, 1.13–5.15) but negatively associated with management by exception (OR=0.4; 95% CI, 0.19–0.82). Job satisfaction was positively associated with intellectual stimulation (OR=5.7; 95% CI, 1.83–17.79). Teamwork was positively associated with idealized influence-behavior (OR=1.07–8.57), idealized influence-attributed (OR=3.9; 95% CI, 1.24–12.36), and contingent reward (OR=5.6; 95% CI, 1.87–17.01). Conclusion: Transformational styles had a positive impact on stimulating motivation, assuring job satisfaction, and consolidating teamwork among health workers compared with those who demonstrated transactional skills or laissez-faire styles. Recommendation: Supporting transformational leadership skills development in health facility leaders could encourage health worker motivation, strengthen job satisfaction, and maintain cohesion among health workers for better service delivery. Keywords: transformational leadership, transactional leadership, laissez-faire leadership, motivation, job satisfaction, teamwork

Resume Contexte Avec 2,1 millions d’enfants infectes par le virus de l’immunodeficience humaine (VIH) dans le monde en 2008, principalement en Afrique sub-saharienne, la prise en charge medicale represente un defi de sante publique et s’appuie principalement sur la prophylaxie au cotrimoxazole et les tritherapies antiretrovirales. Objectif L’objectif de cette revue est de synthetiser les donnees de l’effet de ces traitements sur la survie de l’enfant infecte par le VIH en Afrique. Sources documentaires Une recherche bibliographique systematique des articles publies en anglais et en francais entre janvier 2004 et novembre 2009 a ete realisee en deux phases sur PubMed™ et Scopus™. Les mots cles suivants ont ete cherches dans les titres et les resumes : « HIV » and « Africa » and [“pediatric” or “children” or “child”] and [“mortality” or “survival”] and [“cotrimoxazole” or “prophylaxis”] dans un premier temps, puis « HIV » and « Africa » and [“pediatric” or “children” or “child”] and [“mortality” or “survival”] and [“antiretroviral”] and [“treatment” or “therapy”]. Selection des etudes Les etudes longitudinales concernant les enfants infectes par le VIH-1 et traites par antiretroviraux ou cotrimoxazole en Afrique et rapportant les donnees de survie ont ete selectionnees. Resultats La probabilite de deces chez les enfants traites par cotrimoxazole etait reduite significativement de 43 % par rapport aux enfants ayant recu un placebo. Aucune etude ne permettait d’evaluer cet effet en dehors des essais randomises. Par rapport a la mortalite observee en l’absence de traitement chez les enfants infectes par le VIH en Afrique, le benefice du traitement antiretroviral a ete evident dans toutes les publications. Mais une mortalite precoce et elevee a ete observee dans les six premiers mois du traitement antiretroviral. Plus de la moitie des deces sont survenus au cours de cette periode. La malnutrition, l’anemie et le faible pourcentage de CD4 etaient les facteurs associes a la mortalite des enfants traites aussi bien par le cotrimoxazole que par les antiretroviraux. Limites du travail Cette revue a pris en compte les etudes publiees dans les revues avec comite de lecture et repertoriees sur Pubmed et Scopus pour s’appuyer sur des donnees validees. Nous avons egalement pris en compte les resumes des dernieres conferences CROI 2009 et IAS 2009 pour limiter les biais de publication en excluant les articles non publies dans les revues avec comite de lecture. La prise en compte des meta-analyses pourrait induire un biais d’information car certaines etudes seraient deja incluses dans ces analyses « poolees ». Toutefois, l’interet de ces meta-analyses residait dans les themes traites et leur niveau de preuve. Conclusion Une meilleure connaissance des determinants de la mortalite precoce chez ces enfants est necessaire pour optimiser leur survie et ameliorer la qualite de la prise en charge. Enfin, l’effet du cotrimoxazole chez des enfants deja traites par antiretroviraux est a ce jour mal connu et merite d’etre etudie plus en details.

With 2.1 million HIV-infected children in 2008 in the world, especially in sub-Saharan Africa, the paediatric HIV/AIDS care remains an important public health challenge and is principally based on cotrimoxazole prophylaxis and antiretroviral treatments. This paper aims to review the effectiveness of cotrimoxole prophylaxis and antiretroviral treatment in HIV-infected children in Africa, specifically mortality and treatment outcomes.In two times, we searched the online databases PubMed™ and Scopus™ for articles and abstracts published in English and French between January 2004 and November 2009, with the following terms : « HIV » and « Africa » and ["paediatric" or "children" or "child"] and ["mortality" or "survival"] and ["cotrimoxazole" or "prophylaxis"] at the first time, « HIV » and « Africa » and ["paediatric" or "children" or "child"] and ["mortality" or "survival"] and ["antiretroviral"] and ["treatment" or "therapy"] at the second time. Longitudinal studies on HIV-infected children under cotrimoxazole prophylaxis or antiretroviral treatment were selected when survival outcomes were reported.The probability of death was significantly reduced by 43% where children received cotrimoxazole prophylaxis compared to placebo. Compared to the survival without treatment, the benefit of antiretroviral therapy on HIV-infected children survival was evident in all publications but early mortality was observed within the six first months of antiretroviral treatment. Over fifty percent of deaths occurred in this period. Severe malnutrition, anaemia and lower CD4% were identified as mortality predicting factors in both children received cotrimoxazole prophylaxis or treated by antiretroviral therapy.Better knowledge of determinants of early mortality for these children are important to optimized their survival and improve their quality of care and life. Finally, the beneficial effect of cotrimoxazole prophylaxis when associated with antiretroviral treatment has not been reported and need to be exploring in detail for more information.