Water is one of the most important natural resources without which humans cannot survive. Although efforts have been geared toward ensuring an adequate water supply, potable water shortages continue to persist. This paper, therefore, analyses water demand at a local scale to enhance policymakers’ ability to make informed decisions on water demand management. The paper specifically probes the influence of demographic and socio-economic factors on household water demand in Ngamiland District of Botswana. Informed by neo-classical economic theory of supply and demand, a cross-sectional survey of 497 households was undertaken in Maun and Gumare villages. Household survey data collection was done using interview schedules and key informant interviews. The results revealed that gender showed a positive association with household’s monthly water demand, (X2 = 14.961; ρ < 0.05). The result of Spearman’s rank correlation test showed that household income and household size were the significant determinants of water demand. Household size was found to be the most variable influencing demand at a significant but moderate positive correlation with monthly water demand, rs = 0.422 and ρ < 0.05. The paper argues that policymakers might take into consideration the socio-economic parameters, which have a significant influence on water use and demand to implement proper demand management strategies.
Background Existing research on access to health care for immigrants in South Africa has focused on access and use of services by immigrants. Focus has been on immigrants concerns around issues of citizenship acquisition and the burdening of the country's resource-constrained healthcare system. Limited empirical research has been conducted to explore health care professionals’ views, daily experiences and challenges when attending to immigrant patients in South African public hospitals. This study purports to fill in this knowledge gap by capturing experiences and challenges of trauma health care professionals when providing healthcare to immigrants in Durban public hospitals, KwaZulu Natal province in South Africa. Method Data were collected based on a multicase qualitative study design through face-to-face in-depth structured interviews with twentytrauma health care professionals from four trauma centers in Durban public hospitals. Criterion based expert purposive sampling was used to recruit participants for the study. Data collected were analysed using thematic analysis. Results Inability of immigrant patient to converse in English or any other local language posed a major constraint for trauma health care professionals when attending to migrant patients. Poor communication and culturally based differences in interpretations of sickness causality as well as desired treatment were also reported as challenges health professionals face when attending to immigrant patients. Doctors were concerned about how these barriers presented risks of prescribing wrong treatment and the possibility of patient's non-compliance especially those who cannot speak English or any local language. Conclusion To health professionals’ language and communication barrier, different cultural interpretation of sickness and cause of sickness is a challenge health professionals are facing when attending to immigrant patients. There is need for interpreters at hospitals or for hospitals to make it compulsory for patients who do not speak any of the native languages or English to always be accompanied by an interpreter.
Introduction Rural health clinics in low-resource settings worldwide are usually staffed with health care workers with limited knowledge and skills in managing acute emergencies. The Emergency Centre (EC) at the district hospital or primary hospital serves as an entry point for patients with diverse medical needs from health posts and community clinics. The study described the socio-demographic characteristics, primary diagnosis, and disposition of patients transferred from the clinics and health posts to the district hospital in the Kweneng district. Method This study is a chart audit of the triage sheets and admitting medical records (Botswana Integrated Patient Management System, IPMS) conducted for the period June through to December 2020. Descriptive statistics were used to analyze the quantitative data. Frequencies, percentages, and measures of central tendency were calculated using the software, SPSS version 27. Results A total of 1565 charts were reviewed; 56% (n = 877) were females and 43.5% (n = 681) were males. Half of the patients presenting to the EC ranged from ages 21 to 50, with a mean age of 36.49. The most frequently reported reason for referral was “trauma,” (23.5%, n = 368) whereas the second common reason for referral was abortion-related complications (14.2%, n = 222). The highest admissions were from abortion-related complications (20.2%, n = 169). Most patients’ transfers were from clinics and health posts outside Molepolole (59.4%, n = 930). More than half of the patients (64.2%, n = 537) transferred from outside Molepolole were admitted than discharged from the EC. Discussion Our study has shown significant transfers to a higher facility for emergency care. The higher number of transfers are trauma-related cases, whereas most patients were admitted for abortion-related complications indicating the need for skill-building in trauma care and management of abortions.
Introduction This study sought to compare the clinicopathologic features of women with breast cancer presenting in South Africa, Botswana, and the United States (US). Methods Breast cancer samples from Botswana (n = 384, 2011-2015), South Africa (n = 475, 2016-2017), and the US (n = 361,353, 2011-2012) were retrospectively reviewed. Results The median age of sub-Saharan African women presenting with breast cancer (age 54 in Botswana and South Africa) was younger than that of those in the US (age 61) (P < 0.001). Sub-Saharan women were more likely to present with advanced stage disease than US counterparts (64.7% in Botswana, 63.3% in South Africa, 13% in the US, P < 0.001). Triple negative disease was highest in Botswana (21.3%) compared to South Africa (11.4%) and the US (12.94%) (P < 0.001). Differences in receptor status at presentation among the three cohorts (P < 0.001) were not observed when the cohorts were stratified by ethnicity. Black/multiracial patients in Botswana and the US were the most likely subsets to present with the adverse characteristic of triple negative disease (21.3% and 23.2%, respectively). No correlation was found between HIV and receptor status in the Botswana (P = 0.513) or South African (P = 0.352) cohorts. Conclusions Here we report receptor status patterns at presentation in Botswana and South Africa. This study reveals important similarities and differences which may inform policy and provide context for future epidemiologic trends of breast cancer in low- and-middle-income countries particularly in sub-Saharan Africa.
Introduction In South Africa, district hospitals have limited surgical capacity, and most surgical conditions are referred to higher-level facilities for definitive management. This study aims to identify the proportion, type, and volume of district-level general surgery referrals to two regional government hospitals in South Africa. Materials and methods This was a retrospective analysis of secondary data collected on persons who underwent general surgery operations at two South African regional hospitals between January 1, 2016 and December 31, 2018. District-level operations were those included in the South African Department of Health District Health Package. Descriptive analyses were performed to determine the proportions of district-level general surgery referrals and operations. Multivariate analyses were performed to determine factors associated with district-level general surgery operations. Results A total of 9357 persons underwent general surgery operations. Of these, 5925 (63.3%) were district-level operations. The most common district-level operations were lower limb amputations (n = 1007; 17.0%), abscess drainage (n = 936; 15.8 %), appendectomy (n = 791; 13.4%), non-trauma emergency laparotomy (n = 666; 11.2%), and inguinal hernia repair (n = 574; 9.7%). In multivariate analysis, district-level operations were associated with emergency conditions (OR: 5.64, P < 0.001), trauma (OR: 1.43, P < 0.001) and male gender (OR: 2.35, P < 0.001). Conclusions In South Africa, the majority of general surgery diseases treated at regional hospitals are district-level conditions. The definition of district-level conditions could be too broad, and a narrower basket of surgical care for district hospitals would focus training efforts on achievable targets. More resources are needed at regional hospitals to care for their additional surgical burden.
Introduction Providing appropriate high-quality emergency care (QEC) commensurate with patients' needs is critical for continuity of care, patient safety, optimal clinical outcomes, reduced mortality, and patient satisfaction. This concept analysis aims to define and assist in understanding the concept of QEC in resource-limited settings. Methods Quality emergency care concept analysis was conducted using Walker and Avant’s approach. Several literature review methods and dictionaries were used to explore the QEC concept. Results Immediate assessment, rapid diagnosis, and critical interventions are the attributes of QEC for life-threatening and time-sensitive conditions, leading to timely and safe care provision. Discussion Nurses serve as the backbone for most emergency care centers such as primary care, emergency department, and even prehospital care. The first few hours following a potential life- or limb-threatening condition are vital. The emergency care rendered to patients can significantly affect treatment's overall outcome; therefore, quality emergency care is critical. Conclusion.
Objective In Botswana, cervical cancer is the leading cause of cancer death for females. With limited resources, Botswana is challenged to ensure equitable access to advanced cancer care. Botswana’s capital city, Gaborone, houses the only gynecologic oncology multi-disciplinary team (MDT) and the one chemoradiation facility in the country. We aimed to identify areas where fewer women were presenting to the MDT clinic for care. Methods This cross-sectional study examined cervical cancer patients presenting to the MDT clinic between January 2015 and March 2020. Patients were geocoded to residential sub-districts to estimate age-standardized presentation rates. Global Moran’s I and Anselin Local Moran’s I tested the null hypothesis that presentation rates occurred randomly in Botswana. Community- and individual-level factors of patients living in sub-districts identified with higher (HH) and lower (LL) clusters of presentation rates were examined using ordinary least squares with a spatial weights matrix and multivariable logistic regression, respectively, with α level 0.05. Results We studied 990 patients aged 22–95 (mean: 50.6). Presentation rates were found to be geographically clustered across the country (p = 0.01). Five sub-districts were identified as clusters, two high (HH) sub-district clusters and three low (LL) sub-district clusters (mean presentation rate: 35.5 and 11.3, respectively). Presentation rates decreased with increased travel distance (p = 0.033). Patients residing in LL sub-districts more often reported abnormal vaginal bleeding (aOR: 5.62, 95% CI: 1.31–24.15) compared to patients not residing in LL sub-districts. Patients in HH sub-districts were less likely to be living with HIV (aOR: 0.59; 95% CI: 0.38–0.90) and more likely to present with late-stage cancer (aOR: 1.78; 95%CI: 1.20–2.63) compared to patients not in HH sub-districts. Conclusions This study identified geographic clustering of cervical cancer patients presenting for care in Botswana and highlighted sub-districts with disproportionately lower presentation rates. Identified community- and individual level-factors associated with low presentation rates can inform strategies aimed at improving equitable access to cervical cancer care.
Children living with HIV (HIV+) experience increased risk of neurocognitive deficits, but standardized cognitive testing is limited in low-resource, high-prevalence settings. The Penn Computerized Neurocognitive Battery (PennCNB) was adapted for use in Botswana. This study evaluated the criterion validity of a locally adapted version of the PennCNB among a cohort of HIV+ individuals aged 10–17 years in Botswana. Participants completed the PennCNB and a comprehensive professional consensus assessment consisting of pencil-and-paper psychological assessments, clinical interview, and review of academic performance. Seventy-two participants were classified as cases (i.e., with cognitive impairment; N = 48) or controls (i.e., without cognitive impairment; N = 24). Sensitivity, specificity, positive predictive value, negative predictive value, and the area under receiver operating characteristic curves were calculated. Discrimination was acceptable, and prediction improved as the threshold for PennCNB impairment was less conservative. This research contributes to the validation of the PennCNB for use among children affected by HIV in Botswana.
The free convective flow of a Co-ferroparticle suspended nanofluid in a tilted square enclosure with various thermal boundaries including heat generating body is numerically investigated. A heat generating solid body is placed at the centre of the enclosure to study the effective rate of heat transfer. The comprehensive analysis of the results suggests that the angle of inclination and addition of ferro particle have a considerable influence on the flow and heat transfer behaviour. The results are presented in the form of streamlines, isotherms and average Nusselt number for the effect of inclination angle (0° ≤ Φ ≤ 90°), Rayleigh number (10 ⁴ ≤ Ra ≤ 10 ⁶ ) and solid volume fraction ( Φ = 0.02, 0.1 and 0.2). Based on this investigation. It can be found that augmentation in Rayleigh number increases the strength of the circular eddy due to induced buoyancy forces. Increase in size of the solid body suppresses the heat transfer effect. Also the temperature gradient show moderate nature until 45° angle of inclination and show the declination after 45°.
Invasive lobular carcinoma (ILC) represents the second most common subtype of breast cancer (BC), accounting for up to 15% of all invasive BC. Loss of cell adhesion due to functional inactivation of E-cadherin is the hallmark of ILC. Although the current world health organization (WHO) classification for diagnosing ILC requires the recognition of the dispersed or linear non-cohesive growth pattern, it is not mandatory to demonstrate E-cadherin loss by immunohistochemistry (IHC). Recent results of central pathology review of two large randomized clinical trials have demonstrated relative overdiagnosis of ILC, as only ~60% of the locally diagnosed ILCs were confirmed by central pathology. To understand the possible underlying reasons of this discrepancy, we undertook a worldwide survey on the current practice of diagnosing BC as ILC. A survey was drafted by a panel of pathologists and researchers from the European lobular breast cancer consortium (ELBCC) using the online tool SurveyMonkey®. Various parameters such as indications for IHC staining, IHC clones, and IHC staining procedures were questioned. Finally, systematic reporting of non-classical ILC variants were also interrogated. This survey was sent out to pathologists worldwide and circulated from December 14, 2020 until July, 1 2021. The results demonstrate that approximately half of the institutions use E-cadherin expression loss by IHC as an ancillary test to diagnose ILC and that there is a great variability in immunostaining protocols. This might cause different staining results and discordant interpretations. As ILC-specific therapeutic and diagnostic avenues are currently explored in the context of clinical trials, it is of importance to improve standardization of histopathologic diagnosis of ILC diagnosis.
While adaptation interventions offer a window of opportunity to mitigate the susceptibility of mango seedlings to adverse impact of climate variability and change, there is a scarcity of information on how mango seedlings producers respond to climate variability and change in Ghana. Using a qualitative case study with 20 mango seedlings producers selected through purposive and snowball sampling techniques, this study investigates participants’ knowledge and experience of climate variability and change, the effects of the observed changes on mango seedlings and the adaptation strategies employed to counter the risks associated with climate variability and change in a mango production zone of Ghana. Results indicate that floods, droughts, rising temperature, erratic rainfall and windstorm have been observed among the participants, which negatively affect the survival, growth, establishment and quality of mango seedlings. Adaptation strategies, such as creating gutters, applying agrochemicals, grafting and improved seed varieties, planting of trees as shades, irrigation and soil improvement techniques including mulching, have been implemented by the participants to mitigate climate variability and change effects. The practical and policy implications of the results are discussed and recommendations provided.
Background Depression and suicidal behavior are the main causes of disability and morbidity, especially in adolescents living with HIV (ALWHIV). Data regarding these are lacking in Botswana, a country with a predominantly youthful population and ranked among the top four in the world most affected by HIV. Therefore, the present study aimed to estimate the prevalence of depression and suicidal behavior and explore their associated factors in Botswana ALWHIV. Methods Responses were obtained from 622 ALWHIV using the DSM-5 and the Mini-International Neuropsychiatric Interview for Children and Adolescents. Results The mean age (SD) of the participants was 17.7 (1.60) years and more males (54.3%) participated than females. Depression and suicidal behavior rates among adolescents were 23% and 18.9%, respectively. Female participants were more likely to be depressed (AOR = 1.96; 95% CI 1.11–3.45) and have suicidal behaviour (AOR = 6.60; 95% CI 3.19–13.7). Loss of mother (AOR = 2.87; 95% CI 1.08–7.62) and viral load of 400 copies and above (AOR = 5.01; 95% CI 2.86–8.78) were associated with depression. Alcohol use disorder (AOR = 3.82; 95% CI 1.83–7.96) and negative feelings about status (AOR = 8.79; 95% CI 4.62–16.7) were associated with suicidal behavior. Good support (AOR = 0.42; 95% CI 0.23–0.76) and increased frequency of religious activities were protective (AOR = 0.33; 95% CI 0.14–0.79) against depression and suicidal behaviour, respectively. Conclusion Therefore, routine psychologic screening, which includes identifying psychological stressors and maladaptive coping, family and caregiver support services, and psychosocial support platforms, should be integrated into the management package for ALWHIV in Botswana.
The difference between esotericism and exoterism is unlike the difference between circles and rectangles. It is also not the difference between the size and relevance of a specific body of knowledge in circulation. It is rather the extent of the circulation, acceptance, understanding, and meaning of a particular body of knowledge, philosophy, or worldview, over the spiritual and socio-political life of diverse categories of people in society. The infancy of the academic study of esotericism, as well as its interdisciplinary nature, militate against the crystallization of a universally accepted definition of the term 'esotericism'. The various definitions of the term by researchers consistently relate to their research interests. In line with Faivre's concern with the forms of thought of esoteric movements (Faivre 1996), as well as the preoccupation that Versluis has with gnosis generation in esoteric movements (Versluis n.d), our study of Kereke ya Sephiri in Botswana and South Africa examines a) the cultural and religious contexts in which Frederick Modise, a gnostic in his own right, generated the underlying gnosis of his secret society, and b) the import of the content of this visionary mystical revelation in the spiritual and social lives of members of this secret society1. The study of the Setswana term, Kereke ya Sephiri (church of a secret, referring to a Christian-based secret society), is a study of African esotericism in South Africa and Botswana. The principal academic interest in the study of esotericism lies in our quest to identify the fundamental tenets of the worldviews of the specific esoteric society, the eclectic nature of its philosophy, and how this philosophy relates to the orthodoxy of the day (Christianity in this instance). We do so by concentrating on the form of thinking, engendered by esoteric practices. Esoteric groups do not appear or exist within cultural voids. For this reason, by identifying the eclectic or syncretic nature of the fundamental philosophy (gnosis) of these groups, we trace the cultural influences involved in the emergence and consolidation of these worldviews and philosophies. This study shows that African esotericism is not always antithetic or subversive of dominant or institutionalized Christianity.
Introduction: : Antimicrobial resistance (AMR) is a concern as this increases morbidity, mortality and costs, with sub-Saharan Africa having the highest rates globally. Concerns with rising AMR have resulted in international, Pan-African and country activities including the development of national action plans (NAPs). However, there is variable implementation across Africa with key challenges persisting. Areas covered: : Consequently, there is an urgent need to document current NAP, other activities, and challenges across sub-Saharan Africa to provide future guidance. This builds on a narrative review of the literature. Expert opinion: : All surveyed sub-Saharan African countries have developed their NAPs; however, there is variable implementation. Countries including Botswana and Namibia are yet to officially launch their NAPs with Eswatini only recently launching its NAP. Cameroon is further ahead with its NAP than these countries; though, there are concerns with implementation. South Africa appears to have made the greatest strides with implementing its NAP including regular monitoring of activities and instigation of antimicrobial stewardship programmes. Key challenges remain across Africa. These include available personnel, expertise, capacity and resources to undertake agreed NAP activities including active surveillance, lack of focal points to drive NAPs, and competing demands and priorities including among donors. These challenges are being addressed, with further co-ordinated efforts needed to reduce AMR.
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