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1
Machiya, Tichaona, Rosemary J. Burnett, Lucy Fernandes, et al. "Hepatitis B vaccination of healthcare workers at the Princess Marina Hospital, Botswana." International Health 7, no. 4 (2014): 256–61. http://dx.doi.org/10.1093/inthealth/ihu084.
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W Kassa, Mamo, Jack J Mkubwa, Jemal Z Shifa, and Tefera B Agizew. "Type of anaesthesia for caesarean section and failure rate in Princess Marina Hospital, Botswana’s largest referral hospital." African Health Sciences 20, no. 3 (2020): 1229–36. http://dx.doi.org/10.4314/ahs.v20i3.26.
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Background: Caesarean Section (CS) is a mode of delivery to decrease maternal and perinatal morbidity and mortality. We aimed to determine the type of anaesthesia used for CS among live-birth deliveries; and the failure rate of spinal anaesthesia (SA) in Princess Marina Referral Hospital, Botswana.
 Methods: Women who underwent CS from May-December 2017 were enrolled in the study. Data were recorded from anaesthesia charts and abstracted using Excel spreadsheet. We established the type of anaesthesia used, comparing the rate of elective versus emergency indications, and failure rate of SA using STATA. Fisher’s exact test used to compare results.
 Results: Among 2775 live-birth deliveries, 30.2% (837/2775) was by CS. Of those, 95.2% (797/837) had had SA and 4.8% (40/837) were GA. Under SA, 27.4% (218/797) were elective, and 72.6% (579/797) were emergency. Under GA 10% (4/40) were elective and 90.0% (36/40) were emergency. The overall failure rate of SA was 2% (16/813), that is 0.9% (2/220) for elective and 2.4% (14/593) among emergency indications; Fisher’s exact test p = 0.2959.
 Conclusion: Our study demonstrated that single shot SA is the most commonly preferred type of anaesthesia for both elective and emergency CS. The overall failure rate of SA was less common in our settings than previously reported.
 Keywords: Caesarean section; types of anaesthesia; spinal failure.
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Banda, Francis M., Kathleen M. Powis, Agnes B. Mokoka, et al. "Hearing Impairment Among Children Referred to a Public Audiology Clinic in Gaborone, Botswana." Global Pediatric Health 5 (January 1, 2018): 2333794X1877007. http://dx.doi.org/10.1177/2333794x18770079.
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Objective. To describe and quantify hearing impairment among children referred to the audiology clinic in Princess Marina Hospital, a public referral hospital in Botswana. Methods. In a retrospective case series, we reviewed medical records of children aged 10 years and younger whose hearing was assessed between January 2006 and December 2015 at the audiology clinic of Princess Marina Hospital in Gaborone, Botswana. Results. Of 622 children, 50% were male, and median age was 6.7 years (interquartile range = 5.0-8.3). Hearing impairment was diagnosed in 32% of clinic attendees, comprising sensorineural (23%), conductive (25%), and mixed (11%) hearing loss, while 41% of children with diagnosed hearing impairment did not have a classification type. Hearing impairment was mild in 22.9%, moderate in 22.4%, severe in 19.4%, profound in 16.9%, and of undocumented severity in 18.4%. Children younger than 5 years were 2.7 times (95% confidence interval = 1.29-5.49; P = .008) more likely to be diagnosed with sensorineural hearing impairment compared with those older than 5 years. By contrast, children older than 5 years were 9.6 times (95% confidence interval = 2.22-41.0; P = .002) more likely to be diagnosed with conductive hearing loss compared with those under 5 years. Conclusion. Hearing impairment was common among children referred to this audiology clinic in Botswana. Of those with hearing impairment, more than a third had moderate or severe deficits, suggesting that referrals for hearing assessments are not occurring early enough. Hearing awareness programs individually tailored to parents, educators, and health care workers are needed. Neonatal and school hearing screening programs would also be beneficial.
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Mudzikati, Lydia, and Angela Dramowski. "Neonatal septicaemia: prevalence and antimicrobial susceptibility patterns of common pathogens at Princess Marina Hospital, Botswana." Southern African Journal of Infectious Diseases 30, no. 3 (2015): 108–13. http://dx.doi.org/10.1080/23120053.2015.1074443.
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Twomey, Michele, Paul C. Mullan, Susan B. Torrey, Lee wallis, and Andrew Kestler. "The Princess Marina Hospital accident and emergency triage scale provides highly reliable triage acuity ratings." Emergency Medicine Journal 29, no. 8 (2011): 650–53. http://dx.doi.org/10.1136/emermed-2011-200503.
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Chandra, Amit, Paul Mullan, Ari Ho-Foster, et al. "Epidemiology of patients presenting to the emergency centre of Princess Marina Hospital in Gaborone, Botswana." African Journal of Emergency Medicine 4, no. 3 (2014): 109–14. http://dx.doi.org/10.1016/j.afjem.2013.12.004.
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Yeh, Pon-Hsiu, Eric Cioe, Aurelio Rodriguez, and Megan Cox. "Epidemiology of Poisoning Patients Presenting to the Emergency Center of Princess Marina Hospital in Gaborone, Botswana." Prehospital and Disaster Medicine 32, S1 (2017): S206—S207. http://dx.doi.org/10.1017/s1049023x17005398.
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Yeh, P. H., E. Cioe-Pena, A. Rodriguez, and M. Cox. "Epidemiology of Poisoning Patients Presenting to the Emergency Center of Princess Marina Hospital in Gaborone, Botswana." Annals of Global Health 83, no. 1 (2017): 30. http://dx.doi.org/10.1016/j.aogh.2017.03.064.
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Rwegerera, GM, M. Bayani, EK Taolo, and D. Habte. "The prevalence of chronic kidney disease and associated factors among patients admitted at princess marina hospital, Gaborone, Botswana." Nigerian Journal of Clinical Practice 20, no. 3 (2017): 313. http://dx.doi.org/10.4103/1119-3077.187335.
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Leba, Kabongo. "Understanding Mortality and Morbidity Meeting at Princess Marina Hospital: Case of Accident and Emergency Department (April 2014 to March 2015)." TEXILA INTERNATIONAL JOURNAL OF MEDICINE 4, no. 2 (2016): 9–22. http://dx.doi.org/10.21522/tijmd.2013.04.02.art003.
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Molefi, Mooketsi, Jose-Gaby Tshikuka, Tuduetso Leka Monagen, et al. "The Burden of HIV-Related Admissions and Mortality at Princess Marina Hospital, Botswana in 2000: A Pre-Combination Antiretroviral Therapy Era." World Journal of AIDS 07, no. 01 (2017): 67–75. http://dx.doi.org/10.4236/wja.2017.71007.
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Molefi, Tsholofelo. "Development of an Accident and Emergency Triage Mobile App Using Open Data Kit." Iproceedings 5, no. 1 (2019): e15248. http://dx.doi.org/10.2196/15248.
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Background The process of triaging is performed as an effective solution to balance limited resources against high patient volumes, based on an assessment of the patient’s medical condition and the application of an established patient categorization protocol. In Princess Marina Hospital (PMH), a national referral government hospital in the capital city of Botswana, the Princess Marina Hospital Accident and Emergency Centre Triage Scale (PATS) has been in use since 2010. Because the rules of these triage scales are very well defined, these protocols have been shown to be amenable to translation into computer algorithms. Thus, clinical decision support systems (CDSSs) that can assist with information management to support clinicians’ decision-making abilities can be developed, leading to improved healthcare quality and patient safety. Objective This study aims to determine the feasibility of development of a mobile triage app based on the adult PATS using Open Data kit (ODK) open source software to be used as a CDSS on smartphones and tablet computers for correct patient categorization. Methods A user-centered design approach was used in designing the app, with participants recruited from the staff at the Accident and Emergency Department (A&E) at PMH. Forty clinical vignettes were used in the evaluation of the performance of the app as compared to the paper-based system currently in use with the emergency physician at PMH providing the gold standard categorization of these vignettes. Usability testing was also performed. Results The app scored 90% (n=36) of the vignettes correctly, as compared to the paper-based system which scored 82.5% (n=33) of the vignettes correctly. Both systems achieved an over-triage score of 7.5% with an equal number of vignettes over-triaged (n=3). The results of the chi-square test indicate that the difference in triage scores between the paper-based system and the mobile app is statistically significant at P=.001 in favour of the ODK app. An overall positive outcome was also achieved in the usability test with ease of use and speed of triage determined to be the most recurring themes in the user feedback survey. While the app does not require an internet connection for triaging patients, a reliable wireless internet connection is required to upload data to the server for viewing by medical officers and physicians in real time, and this can be provided by the hospital as part of the Botswana government eHealth strategy. Additionally, the app developed in this research allows for data collection up to the point of triage categorization, meaning that a separate form would be required for capturing the rest of the information on the PMH A&E triage form. Conclusions The triage app developed in this research was found to determine the triage category of patient vignettes more accurately than the traditional paper-based system based on PATS triage guidelines with good results obtained in usability testing. Future work includes use of the app developed in this research in a live setting involving real patients in the A&E in PMH.
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Kaur, Sukhdeep, Ashwin Chandar, Tina M. Mayer, et al. "Evaluating the challenges of cancer care in Botswana: Chemotherapy utilization and stock outs." Journal of Clinical Oncology 37, no. 15_suppl (2019): e18309-e18309. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e18309.
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e18309 Background: As a significant percentage of cancer deaths are occurring in low- and middle-income countries, there is an unmet need in facilitating cancer care delivery in these countries. Data on stock-outs and shortages of cancer medicines in Botswana have been reported as one of the roots hindering treatment and potentially increasing mortality, with at least 40% of essential drugs being out of stock for at least 30 days in 2015. A methodologic approach was published in 2018 to forecast chemotherapy (CT) volume, however, this was based on incidence and prevalence data, using multiple estimated assumptions. To obtain objective data, we examined trends in CT utilization at Princess Marina Hospital (PMH), largest referral hospital in Botswana, over a 12-month period evaluating indications for CT, dosages, and potential issues with stock outs of essential medications. Here we present the 21 injectable essential CT utilized during this period. Methods: This is a retrospective analysis, with data collected from October 2017 to September 2018 from the log book which is used daily by the pharmacy at PMH to record CT preparations. Data was organized to reflect dosage of CT, regimen used, and its indication. Results: Over 1 year period, 21 injectable CT agents were utilized for cancer therapy, with common treated diseases being Kaposi Sarcoma, Gyn cancer, Breast cancer, and Lymphomas. The 10 most utilized agents are listed with the monthly dosage used. Conclusions: We hope to analyze trends in CT utilization based on the available stocks of drugs at PMH to help optimize plans for purchasing and storing medications, with goal of reducing stock outs. In addition, we will analyze treatment regimens used at PMH and compare to current standard of care CT in the US and Sub-Saharan Africa to optimize cancer pathway protocols used in Botswana. [Table: see text]
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Offorjebe, Ogechukwu A., Adriane Wynn, Neo Moshashane, et al. "Partner notification and treatment for sexually transmitted infections among pregnant women in Gaborone, Botswana." International Journal of STD & AIDS 28, no. 12 (2017): 1184–89. http://dx.doi.org/10.1177/0956462417692455.
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Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV) are sexually transmitted infections (STIs) associated with adverse birth outcomes. Untreated partners contribute to high rates of STI reinfection; thus, partner notification and treatment remain important components of STI care and control. A prospective cohort study was conducted among 300 pregnant women presenting to the antenatal clinic at Princess Marina Hospital in Gaborone, Botswana who enrolled in an STI screening study. Following informed consent and sample collection for CT/NG/TV testing, participants were asked if they were willing to disclose their STI result and to deliver medications to their partner(s). Those who tested positive were asked at a follow-up appointment if they notified their partners. Among the 300 participants, 294 (98%) said they would be willing to tell their partner(s) about their test results if they tested positive, and 284 (95%) said they would be willing to give their partner(s) medication if the option was available. Of those who tested positive and returned for a test of cure, 27 of 32 (84%) reported that they told their partner about the results, and 20 of 32 (63%) reported that their partner received treatment. Almost all pregnant women reported willingness to tell their partner the STI test result and give their partner medications. At test of cure, most women reported informing their partner, although actual treatment receipt was lower. Our findings suggest that pregnant women are willing to utilize patient-based partner notification, but actual partner treatment might be lower than intended.
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Martei, Yehoda M., Surbhi Grover, Warren B. Bilker, et al. "Impact of Essential Medicine Stock Outs on Cancer Therapy Delivery in a Resource-Limited Setting." Journal of Global Oncology, no. 5 (December 2019): 1–11. http://dx.doi.org/10.1200/jgo.18.00230.
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PURPOSE Essential cancer medicine stock outs are occurring at an increasing frequency worldwide and represent a potential barrier to delivery of standard therapy in patients with cancer in low- and middle-income countries. The objective of this study was to measure the impact of cancer medicine stock outs on delivery of optimal therapy in Botswana. METHODS We conducted a retrospective analysis of patients with common solid tumor malignancies who received systemic cancer therapy in 2016 at Princess Marina Hospital, Gaborone, Botswana. Primary exposure was the duration of cancer medicine stock out during a treatment cycle interval, when the cancer therapy was intended to be administered. Mixed-effects univariable and multivariable logistic regression analyses were used to calculate the association of the primary exposure, with the primary outcome, suboptimal therapy delivery, defined as any dose reduction, dose delay, missed cycle, or switch in intended therapy. RESULTS A total of 378 patients met diagnostic criteria and received systemic chemotherapy in 2016. Of these, 76% received standard regimens consisting of 1,452 cycle intervals and were included in this analysis. Paclitaxel stock out affected the highest proportion of patients. In multivariable mixed-effects logistic regression, each week of any medicine stock out (odds ratio, 1.9; 95% CI, 1.7 to 2.13; P < .001) was independently associated with an increased risk of a suboptimal therapy delivery event. CONCLUSION Each week of cancer therapy stock out poses a substantial barrier to receipt of high-quality cancer therapy in low- and middle-income countries. A concerted effort between policymakers and cancer specialists is needed to design implementation strategies to build sustainable systems promoting a reliable supply of cancer medicines.
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Magalhães-Barbosa, Maria Clara, Jaqueline Rodrigues Robaina, Arnaldo Prata-Barbosa, and Claudia de Souza Lopes. "Reliability of triage systems for paediatric emergency care: a systematic review." Emergency Medicine Journal 36, no. 4 (2019): 231–38. http://dx.doi.org/10.1136/emermed-2018-207781.
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ObjectiveTo present a systematic review on the reliability of triage systems for paediatric emergency care.MethodsA search of MEDLINE, Cochrane Library, Latin American and Caribbean Health Sciences Literature, Scientific Electronic Library Online, Nursing Database Index and Spanish Health Sciences Bibliographic Index for articles in English, French, Portuguese or Spanish was conducted to identify reliability studies of five-level triage systems for patients aged 0–18 years published up to April 2018. Two reviewers performed study selection, data extraction and quality assessment as recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.ResultsTwenty studies on nine triage systems were selected: the National Triage System (n=1); the Australasian Triage Scale (n=3); the paediatric Canadian Triage and Acuity Scale (PedCTAS) (n=5); the Manchester Triage System (MTS) (n=1); the Emergency Severity Index (ESI) (n=5); an adaptation of the South African Triage Scale for the Princess Marina Hospital in Botswana (n=1); the Soterion Rapid Triage System (n=1); the Rapid Emergency Triage and Treatment System-paediatric version (n=2); the Paediatric Risk Classification Protocol (n=1). Ten studies were performed with actual patients, while the others used hypothetical scenarios. The studies were rated low (n=14) or moderate (n=6) quality. Kappa was the most used statistic, although many studies did not specify the weighting. PedCTAS, MTS and ESI V.4 exhibited substantial to almost perfect agreement in moderate quality studies.ConclusionsThere is some evidence on the reliability of the PedCTAS, MTS and ESI V.4, but most studies are limited to the countries where they were developed. Efforts are needed to improve the quality of the studies, and cross-cultural adaptation of those tools is recommended in countries with different professional qualification and sociocultural contexts.
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Wynn, Adriane, Doreen Ramogola-Masire, Ponatshego Gaolebale, et al. "Prevalence and treatment outcomes of routine Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis testing during antenatal care, Gaborone, Botswana." Sexually Transmitted Infections 94, no. 3 (2017): 230–35. http://dx.doi.org/10.1136/sextrans-2017-053134.
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ObjectivesChlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV) are curable, mostly asymptomatic, STIs that cause adverse maternal and perinatal outcomes. Most countries do not test for those infections during antenatal care. We implemented a CT, NG and TV testing and treatment programme in an antenatal clinic in Gaborone, Botswana.MethodsWe conducted a prospective study in the antenatal clinic at Princess Marina Hospital in Gaborone, Botswana. We offered pregnant women who were 18 years or older and less than 35 weeks of gestation, CT, NG and TV testing using self-collected vaginal swabs. Testing was conducted using a GeneXpert® CT/NG and TV system. Those who tested positive were given directly observed antibiotic therapy and asked to return for a test of cure. We determined the prevalence of infections, uptake of treatment and proportion cured. The relationships between positive STI test and participant characteristics were assessed.ResultsWe enrolled 400 pregnant women. Fifty-four (13.5%) tested positive for CT, NG and/or TV: 31 (8%) for CT, 5 (1.3%) for NG and 21 (5%) for TV. Among those who tested positive, 74% (40) received same-day, in person results and treatment. Among those who received delayed results (6), 67% (4) were treated. Statistical comparisons showed that being unmarried and HIV infected were positively association CT, NG and/or TV infection. Self-reported STI symptoms were not associated with CT, NG and/or TV infection.ConclusionThe prevalence of CT, NG and/or TV was high, particularly among women with HIV infection. Among women with CT, NG and/or TV infection, those who received same-day results were more likely to be treated than those who received delayed results. More research is needed on the costs and benefits of integrating highly sensitive and specific STI testing into antenatal care in Southern Africa.
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Chandar, Ashwin, Sukhdeep Kaur, Tlotlo Bathethi Ralefala, et al. "Building international partnerships to improve global oncological care: Perspective from Rutgers-CINJ Global Oncology Fellowship Program." Journal of Clinical Oncology 37, no. 27_suppl (2019): 159. http://dx.doi.org/10.1200/jco.2019.37.27_suppl.159.
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159 Background: With cancer accounting for 1 in every 7 deaths worldwide and 60-70% of cancer deaths occurring in low- and middle-income countries, any advancement in cancer care should include understanding to alleviate structural inequalities that produce these global oncological disparities. Rutgers-Cancer Institute of New Jersey (R-CINJ) Oncology Fellowship program, through partnerships with Rutgers Global Health and University of Botswana (UB), established a global oncology program in 2018 to provide young oncologists in training with this educational opportunity. Aims included understanding challenges faced by cancer patients in Botswana, evaluating opportunities to improve oncology care at Princess Marina Hospital (PMH), scholarly collaborations, and exchange knowledge. Methods: In partnership with PMH, UB, and Ministry of Health and Wellness (MOHW), R-CINJ created a global oncology program consisting of a 1 month rotation at PMH in Gaborone, Botswana, as well as longitudinal research/quality improvement (QI) projects. Two 3rd year oncology fellows rotated with house officers and oncologist at PMH. Weekly video conferences facilitated communication during the elective. Projects continued throughout 3rd year of fellowship, in conjunction with programmatic meetings. Results: Fellows gained exposure to cancer care using limited resources. In working with PMH staff, mentorship was provided, QI ideas were shared, and organizational changes were implemented. Scholarly activity was undertaken to examine trends in chemotherapy utilization at PMH over a 12-month period to assess patterns of malignancy and issues with stock outs. Relationship between pathology at PMH, UB, and Rutgers-CINJ and Rutgers Biomedical Engineering was established to expand digital pathology services in Botswana. Conclusions: Our global oncology program is a successful start to an ongoing partnership to help improve cancer care in Botswana. Future directions include development of cancer protocols in Botswana, helping limit medication shortages, and establishing telemedicine based collaboration to assist with diagnosis and improve pathology turnaround time.
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Anakwenze, Chidinma, Rohini Bhatia, William Rate, et al. "Factors Related to Advanced Stage of Cancer Presentation in Botswana." Journal of Global Oncology, no. 4 (December 2018): 1–9. http://dx.doi.org/10.1200/jgo.18.00129.
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Purpose Botswana, a country with a high prevalence of HIV, has an increasing incidence of cancer-related mortality in the post–antiretroviral therapy era. Despite universal access to free health care, the majority of Botswana patients with cancer present at advanced stages. This study was designed to explore the factors related to advanced-stage cancer presentation in Botswana. Methods Patients attending an oncology clinic between December 2015 and January 2017 at Princess Marina Hospital in Gaborone, Botswana, completed a questionnaire on sociodemographic and clinical factors as well as cancer-related fears, attitudes, beliefs, and stigma. Odds ratios (ORs) were calculated to identify factors significantly associated with advanced stage (stage III and IV) at diagnosis. Results Of 214 patients, 18.7% were men and 81.3% were women. The median age at diagnosis was 46 years, with 71.9% of patients older than 40 years. The most commonly represented cancers included cervical (42.3%), breast (16%), and head and neck (15.5%). Cancer stages represented in the study group included 8.4% at stage I, 19.2% at stage II, 24.1% at stage III, 11.9% at stage IV, and 36.4% at an unknown stage. Patients who presented at advanced stages were significantly more likely to not be afraid of having cancer (OR, 3.48; P < .05), believe that their family would not care for them if they needed treatment (OR, 6.35; P = .05), and believe that they could not afford to develop cancer (OR, 2.73; P < .05). The perception that symptoms were less serious was also significantly related to advanced stage ( P < .05). Patients with non–female-specific cancers were more likely to present in advanced stages (OR, 5.67; P < .05). Conclusion Future cancer mortality reduction efforts should emphasize cancer symptom awareness and early detection through routine cancer screening, as well as increasing the acceptability of care-seeking, especially among male patients.
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Chandar, Ashwin, Sukhdeep Kaur, Deborah Toppmeyer, et al. "Building international partnerships to improve global oncological care: Perspective from Rutgers-CINJ Global Oncology Fellowship Program." Journal of Clinical Oncology 37, no. 15_suppl (2019): e18161-e18161. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e18161.
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e18161 Background: With cancer accounting for 1 in every 7 deaths worldwide and 60-70% of cancer deaths occurring in low- and middle-income countries, any advancement in cancer care should include understanding to alleviate structural inequalities that produce these global oncologic disparities. Rutgers-Cancer Institute of New Jersey (R-CINJ) Oncology Fellowship program, through partnerships with Rutgers Global Health and University of Botswana (UB), established a global oncology program in 2018 to provide young oncologists in training with this educational opportunity. Aims included understanding challenges faced by cancer patients in Botswana, evaluating opportunities to improve oncology care at Princess Marina Hospital (PMH), scholarly collaborations, and exchange knowledge. Methods: In partnership with PMH, UB, and Ministry of Health and Wellness (MOHW), R-CINJ created a global oncology program consisting of a 1 month rotation at PMH in Gaborone, Botswana, as well as longitudinal research/quality improvement (QI) projects. Two 3rd year oncology fellows rotated with house officers and oncologist at PMH. Weekly video conferences facilitated communication during the elective. Projects continued throughout 3rd year of fellowship, in conjunction with programmatic meetings. Results: Fellows gained exposure to cancer care using limited resources. In working with PMH staff, mentorship was provided, QI ideas were shared, and organizational changes were implemented. Scholarly activity was undertaken to examine trends in chemotherapy utilization at PMH over a 12-month period to assess patterns of malignancy and issues with stock outs. Relationship between pathology at PMH, UB, R-CINJ, and Rutgers Biomedical Engineering was established to expand digital pathology services in Botswana. Conclusions: Our global oncology program is a successful start to an ongoing partnership to help improve cancer care in Botswana. Future directions include development of cancer guidelines and protocols in Botswana, helping limit medication shortages, and establishing telemedicine based collaboration to assist with diagnosis and improve pathology turnaround time.
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Mokokwe, L., G. Maabane, D. Zambo, et al. "First Things First: Adopting a Holistic, Needs-Driven Approach to Improving the Quality of Routinely Collected Data." Journal of Global Oncology 4, Supplement 2 (2018): 155s. http://dx.doi.org/10.1200/jgo.18.68700.
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Background and context: Routine collection of quality oncology data remains underprioritized in resource limited settings. For breast cancer (BC) care at Princess Marina Hospital (PMH) in Botswana, this hampers its use for oncology program evaluation and clinical research. The Peo Data Acquisition Core (DAC), part of a consortium for planning of a noncommunicable diseases center for research excellence in Southern Africa, engaged relevant stakeholders and departments at PMH to establish health care worker driven processes that support sustained improvements in the quality of routinely collected breast cancer data. Aim: Assess PMH BC care needs to support the improvement of routinely collected data. Strategy/Tactics: Conventional routine data quality assessments guide iterative identification of data quality gaps for improvement, but tend to consume additional human resources to implement and prioritize data quality over existing provider concerns. We undertook a holistic approach to identifying needs challenging the improvement of data routinely collected about PMH BC patients. Program/Policy process: A need assessment began with mapping of patient care process, capturing process steps, including subprocesses, actors, and an inventory of related data capture systems. The assessment also gathered care providers' perceptions of challenges to providing care as well as perceptions of the up-time of an existing electronic health record (EHR). Outcomes: BC patient management involves multiple care providers who attend to patients in different locations within the hospital. Except for EHR captured laboratory data, nearly all other documentation of patient care occurred through paper-based registers, diaries and general clinical forms. Providers indicated the overbooking of patient appointments and use of different formats to manage patient data as key challenges for them. EHR appointment scheduling components appear underutilized by providers, and a brief monitoring of provider perceptions of the EHR's speed and reliability suggests it is poorest in the mornings - at a time when providers are the busiest attending to patients. What was learned: Needs assessment findings suggest several opportunities to respond to provider recognized challenges through greater adoption of EHR usage. Establishment of a Quality Improvement (QI) group that champions improvements in routine BC data quality should integrate standardization of patient data formats and EHR centralized appointment booking. QI group composition should include both care providers and an EHR IT technician.
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Westmoreland, Katherine D., Francis M. Banda, Andrew P. Steenhoff, Elizabeth D. Lowenthal, Erik Isaksson, and Bernhard A. Fassl. "A standardized low-cost peer role-playing training intervention improves medical student competency in communicating bad news to patients in Botswana." Palliative and Supportive Care 17, no. 1 (2018): 60–65. http://dx.doi.org/10.1017/s1478951518000627.
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AbstractObjectiveThe purpose of this study was to demonstrate effectiveness of an educational training workshop using role-playing to teach medical students in Botswana to deliver bad news.MethodA 3-hour small group workshop for University of Botswana medical students rotating at the Princess Marina Hospital in Gaborone was developed. The curriculum included an overview of communication basics and introduction of the validated (SPIKES) protocol for breaking bad news. Education strategies included didactic lecture, handouts, role-playing cases, and open forum discussion. Pre- and posttraining surveys assessed prior exposure and approach to breaking bad news using multiple-choice questions and perception of skill about breaking bad news using a 5-point Likert scale. An objective structured clinical examination (OSCE) with a standardized breaking bad news skills assessment was conducted; scores compared two medical student classes before and after the workshop was implemented.ResultForty-two medical students attended the workshop and 83% (35/42) completed the survey. Medical students reported exposure to delivering bad news on average 6.9 (SD = 13.7) times monthly, with 71% (25/35) having delivered bad news themselves without supervision. Self-perceived skill and confidence increased from 23% (8/35) to 86% (30/35) of those who reported feeling “good” or “very good” with their ability to break bad news after the workshop. Feedback after the workshop demonstrated that 100% found the SPIKES approach helpful and planned to use it in clinical practice, found role-playing helpful, and requested more sessions. Competency for delivering bad news increased from a mean score of 14/25 (56%, SD = 3.3) at baseline to 18/25 (72%, SD = 3.6) after the workshop (p = 0.0002).Significance of resultsThis workshop was effective in increasing medical student skill and confidence in delivering bad news. Standardized role-playing communication workshops integrated into medical school curricula could be a low-cost, effective, and easily implementable strategy to improve communication skills of doctors.
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Popli, Pallvi, Mansi R. Shah, Tlotlo B. Ralefala, et al. "Reducing Oncologic Disparities by Standardizing Cancer Care." JCO Global Oncology 6, Supplement_1 (2020): 64. http://dx.doi.org/10.1200/go.20.61000.
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PURPOSE Shortages in oncology-trained health care providers pose a major challenge in low- and middle-income countries (LMICs) and contribute to delays in the diagnosis and treatment of cancer. Presently, the sole oncologist in the public sector at Princess Marina Hospital, Botswana’s largest oncology referral center, is overextended, causing medical officers to be the primary providers for patients with cancer. Medical officers do not possess formal oncology training, which can potentially lead to imprecise management and suboptimal treatment. In addition, there is no standardized patient interview process in the hematology clinic, leading to inadequately captured patient records. These realities highlight the need for the dissemination and implementation of evidence-based guidelines and intake forms to standardize the delivery of cancer care for practitioners with varying degrees of training. METHODS To serve as a reference for medical officers and oncologists, we reviewed clinical guidelines for the most prevalent cancers in Botswana, namely breast, cervical, prostate, colorectal, and head and neck cancer. We incorporated American Joint Committee on Cancer 8th edition staging criteria into the preexisting guidelines approved by Ministry of Health and Wellness Botswana. We further customized them on the basis of radiology, pathology, and pharmaceutical resource availability in Botswana. Finally, to streamline patient visits, we created intake forms to capture comprehensive hematology-pertinent information. As a quality improvement project, we will record the use and impact of these forms as a tool to standardize the medical records. RESULTS Standardized cancer care guidelines were updated and are under review by the Ministry of Health and Wellness Botswana before circulation. In addition, feedback regarding the new intake forms and their use is currently being recorded. CONCLUSION In low- and middle-income countries, the development of cancer-specific treatment guidelines optimizes disease management through incorporation of evidence-based, resource-adjusted recommendations for clinicians and may aid in reducing global oncologic disparities. As the next phase in the implementation of guidelines, we plan to develop quick-reference cancer pathways for use in public institutions without existing oncologic expertise.
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Martei, Yehoda M., Surbhi Grover, Mohan Narasimhamurthy, et al. "Relative dose intensity and pathologic response rates in HIV-infected and HIV-uninfected breast cancer patients who received neoadjuvant chemotherapy." Journal of Clinical Oncology 38, no. 15_suppl (2020): e19140-e19140. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e19140.
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e19140 Background: HIV-infected (HIV+) breast cancer patients may have significantly worse survival compared to HIV-uninfected (HIV-). If so, identifying the underlying mechanism might lead to effective interventions to reduce the disparity. Relative dose intensity (RDI) < 0.85 has been associated with worse survival outcomes in non-metastatic breast cancer patients. We aimed to determine if RDI of chemotherapy and pathologic complete response (pCR) rates were lower for HIV+ patients who received neoadjuvant chemotherapy (NAC) compared with HIV-. Methods: We conducted a prospective cohort study in newly diagnosed breast cancer patients with locally advanced disease who initiated NAC at Princess Marina Hospital in Botswana between 2/2017 and 9/2019. Clinical and treatment data were collected at baseline and at every treatment visit. Surgical pathology post-NAC was graded as pCR if there was no invasive disease in the breast or lymph nodes. RDI was calculated for each patient, with optimal RDI ≥ 0.85. Dichotomous variables were compared using Fisher’s exact and chi-squared tests; and continuous variables using rank sum tests. Results: 111 patients were enrolled, of whom 84 (75.7%) were HIV-, 26 (23.4%) HIV+ and 1 (0.9%) with unknown status who was excluded from final analysis. HIV+ patients were less likely to receive optimal RDI (0.74 vs. 0.88; p = 0.03). Of the 110 patients 15 (13.6%) were still receiving chemotherapy; 22 (20%) prematurely discontinued chemotherapy of whom 11 (10%) received surgery; 7 (6.4%) completed chemotherapy but had no surgery. 77 (70%) completed surgery which included 11 (10%) with no pathology reports available, 3 (2.7%) inadequate surgical specimens and 63 (57.3%) complete pathology results included in pCR analysis: 1/13 (7.7%) HIV+ patients had a pCR compared to 12/50 (24%) in HIV-(p = 0.27). Conclusions: HIV+ patients were significantly more likely to receive inadequate neoadjuvant chemotherapy dose intensity, and trended towards a lower pCR in this small cohort, which may contribute to adverse treatment outcomes. Further study needed to validate high rate of treatment discontinuation and specific risk factors to inform targeted interventions to improve therapy delivery.
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Shah, Sidrah, Barati Monare, Sandra Urusaro, et al. "Usability and Effectiveness of a Smartphone Application for Tracking Oncology Patients in Gaborone, Botswana." Journal of Global Oncology 5, Supplement_1 (2019): 11. http://dx.doi.org/10.1200/jgo.19.20000.
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PURPOSE Most cancer diagnoses are expected to be in low- and middle-income countries (LMICs) by 2025, and 65% of cancer deaths occur in LMICs. Treatment adherence and patient monitoring are essential to cancer care but are often not possible in LMICs. OP Care, a smartphone application developed to fill this gap, stores medical records virtually and texts appointment reminders to patients. This study assessed its usability and effectiveness. METHODS OP Care was piloted at Princess Marina Hospital in Gaborone, Botswana. The study was a cross-sectional study using surveys. All providers using the application were surveyed, along with all patients who were previously enrolled in the application and attended the gynecologic oncology clinic during the 3-week survey period. Staff demographics, reaction, opinions on usability, and patients’ reactions to appointment reminders were collected. Answers were recorded on a 1 (not at all) to 7 (extremely so) scale. Primary outcomes were the application’s usability and the effectiveness of the text reminders. The University of Pennsylvania Institutional Review Board and the Ministry of Health and Wellness in Botswana gave approval for the study. Patients provided written consent before enrollment. RESULTS Nine staff and 15 patients were surveyed. Staff included three doctors and six nurses, all of whom own a smartphone and use a computer at home. Most staff (78%) did not feel OP Care would increase their work burden and were willing to use the application if implemented permanently (median response, 6; interquartile range [IQR], 1). Most usability questions (17 of 19), such as “I feel comfortable using this system,” scored a median of 6. Most patients believed that the reminder text messages were helpful (median, 6; IQR, 1) but wanted the text reminders to be in the Setswana language (median, 7; IQR, 1). CONCLUSION High usability scores indicate the application is adaptable to other clinics. Although patients appreciate OP Care, the option for call and text reminders in Setswana is indicated. A potential limitation is that patients for whom the appointment reminders were not helpful were not necessarily included, because only patients in the clinic were surveyed. Strengths were inclusion of all involved staff, uniformity in survey administration, and inclusion of numerical analysis.
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Davey, Sonya, Surbhi Grover, Dipho Irene I. Setlhako, et al. "Prescription patterns and associated cost during periods of cancer drug stockouts in a resource-limited setting." Journal of Clinical Oncology 37, no. 15_suppl (2019): e18129-e18129. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e18129.
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e18129 Background: Cancer drug stockouts occur at high frequencies globally, however their clinical effects are understudied in sub-Saharan Africa (SSA). We aim to describe prescription patterns and cost of systemic chemotherapy in cancer patients in Botswana during periods of stockout. Methods: Using a retrospective cohort study of the ten most common solid tumor malignancies treated with systemic chemotherapy at Princess Marina Hospital (PMH), Gaborone in 2016, we conducted a subset analysis of suboptimal events, defined as a cycle with ≥ 7 days delay or therapy switch from initiated guideline regimen, that occurred during drug stockout vs non-stockout periods. We estimated financial cost of therapy per cycle using Management Sciences for Health International Price Indicator Guide. Chi-squared and Wilcoxon rank sum were used for comparisons. Results: 167/378 patients contributed to 320 suboptimal events. 63% (201/320) of events occurred during a drug stockout, of which 43%, 43% and 14% were delays, switches, or both, respectively. There were significantly more delays (56% vs 44%, p < .0001) and switches (75% vs 26%, p < .0001) during stockout periods vs no stockout. The majority of switches during drug stockouts occurred in breast cancer patients receiving curative therapy: 48% (20/42) were “paclitaxel + trastuzumab” ($4673) to “paclitaxel alone” ($35) in HER2 positive patients resulting in a 99% cost decrease; and 29% (12/42) were paclitaxel ($35) to docetaxel ($108) resulting in a 209% cost increase per cycle switched. Colon cancer patients receiving palliative-intent therapy were the second most frequent patients with therapy switches during stockout periods: 42% (8/19) were “capecitabine + oxaliplatin” ($259) to “capecitabine alone” ($105) resulting in a 59% cost decrease. Conclusions: Breast cancer patients form the majority of patients treated with systemic chemotherapy at PMH and experienced the most delays and switches in therapy during drug stockout periods. Changes in drug prescription patterns during stockout periods may be associated with switches leading to inferior but less costly regimens, and in some cases costly regimens with higher toxicity. Interventions that minimize cancer drug stockouts are imperative and further studies to understand impact of stockout on survival are needed in SSA.
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Rubagumya, F., L. Greenberg, A. Manirakiza, et al. "Establishing a Childhood Cancer Survivorship Program in Rwanda." Journal of Global Oncology 4, Supplement 2 (2018): 87s. http://dx.doi.org/10.1200/jgo.18.30400.
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Background: Over 80% of children diagnosed with cancer survive in high-income countries (HICs). While the survival rate remains poor in low- and middle-income countries (LMICs) such as Rwanda, a growing number of children with cancer are surviving to adulthood. These children and young adults will face an increased risk of secondary cancers and late complications from their curative treatment. Cancer centers in HICs have established Long Term Survivorship (LTS) programs to cater for childhood cancer survivors and to capture these complications and/or recurrences at an early stage. They also address the more complex psychological and social aspects of surviving cancer in childhood. Aims: To develop an LTS program in Rwanda, initial training will take place in Botswana where a pediatric hematology-oncology (PHO) program was established at the national referral hospital, Princess Marina Hospital (PMH), in 2007. This training program will allow successful methods and lessons learned from the development of an LTS program in Botswana to establish a similar program in Rwanda with ongoing bidirectional collaboration. Methods: The Texas Children's Cancer and Hematology Centers (TXCH) Global Hematology-Oncology Pediatric Excellence (HOPE) program in Botswana is the only provider of PHO care in the country, provided at PMH, through a partnership with the Botswana government. The program has over 130 childhood cancer survivors in active follow-up. A one-month bench-marking visit will be conducted. During this period, Dr. Rubagumya will spend time with the medical director of the program learning how the LTS program was established and current operations. He will spend time with clinicians during consultations to understand the scope of tests requested, frequently asked questions across all parties: clinicians, survivors and/or caretakers and use of technology to aid in the management of LTS patients. Focused interviews of clinicians, patients, caregiver and administration will be conducted to further understand the challenges of the pediatric cancer survivors and the development of an LTS program in an LMIC face. Results: After this month visit, critical areas of knowledge transfer will include: how to set up a childhood cancer survivorship programs; methods for sustainable operation of a childhood cancer LTS program, and how to help childhood cancer survivors navigate health care systems. A similar model will be established in Rwanda. Long-term mentorship with Botswana colleagues will help to build Rwanda's first LTS. Conclusion: Survivors involved in dedicated LTS follow-up care have better health outcomes. This indicates the need for life long survivorship care. There is a dearth of data on how to establish and operate a childhood cancer LTS program in LMIC settings. Lessons learned through this program will guide us on how to set up such program in Rwanda.
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Grover, Surbhi, Sidrah Shah, Rohini Bhatia, et al. "Development and Usability of a Smartphone Application for Tracking Oncology Patients in Gaborone, Botswana." Methods of Information in Medicine 59, no. 01 (2020): 031–40. http://dx.doi.org/10.1055/s-0040-1713129.
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Abstract Background The majority of new cancer cases are expected to be diagnosed in low- and middle-income countries (LMICs) by 2025, and 65% of cancer deaths currently occur in LMICs. Treatment adherence, patient monitoring, and follow-up are essential to cancer care but are often not possible in these settings. Out Patient (OP) Care, a smartphone application (app) developed to fill this gap, texts appointment reminders to patients and electronically stores medical records confidentially. Objectives This study aims to present the development of this app and evaluate its usability and feasibility as defined by provider and patient experiences in the context of a multidisciplinary cancer clinic in Gaborone, Botswana. Methods OP Care was piloted at a multidisciplinary team gynecologic oncology clinic in Gaborone, Botswana. The app was developed through an iterative process with feedback from clinic staff and physicians. The usability was evaluated using a cross-sectional survey. All staff members in the gynecologic oncology clinic, which typically consists of one doctor and four nurses, as well as a portion of the staff in the (Princess Marina Hospital general) oncology ward used the app. All providers using the app were surveyed, along with all patients who attended the gynecologic oncology clinic during the 3-week survey period. Staff demographics, reactions, and opinions on usability, as well as patients' reactions to the appointment reminders were collected. Agreement to the ease-of-usability statements was recorded on a 1 (not at all) to 7 (extremely so) scale. Primary outcomes were the app's usability and the feasibility of text reminders from the patient's perspective. Results Nine staff and 15 patients were surveyed. Staff included three doctors and six nurses and encompassed all of the staff in the gynecologic oncology clinic as well as a portion of the general oncology ward. All surveyed staff owned a smartphone and used a computer at home. Most (78%) staff did not feel that OP Care would increase their work burden and were willing to use the app if implemented permanently (median: 6; interquartile range [IQR]: 1). Seventeen out of the nineteen usability questions, such as “I feel comfortable using this system,” scored a median of 6, corresponding to “very much so.” Patients reported that the reminder text messages were helpful (median: 6; IQR: 1) and preferred the text reminders to be in Setswana (median: 7; IQR: 1). Conclusion High usability scores indicate that the app can be scaled up to usage in this clinic and others. Although patients appreciate OP Care, the option for call and text reminders in Setswana is indicated.
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Martei, Y., S. Grover, W. Bilker, et al. "Impact of Chemotherapy Stock-Out on Standard Therapy Delivery Among Cancer Patients in Botswana." Journal of Global Oncology 4, Supplement 2 (2018): 90s. http://dx.doi.org/10.1200/jgo.18.30500.
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Background: Cancer drug shortages represent a complex global issue with potentially adverse survival outcomes. Up to 98% of oncologists and pharmacists surveyed in North America reported at least 1 drug shortage in the prior year and 66% reported at least one patient who had clinical care impacted by the shortage. In low- and middle-income countries (LMICs), these shortages are even more frequent. No studies to our knowledge have evaluated the impact of chemotherapy stock-out on receipt of standard cancer therapy in LMICs. Aim: Quantify the association between the duration of chemotherapy stock-out and the risk of having a suboptimal therapy delivery event, compared with standard delivery of therapy among cancer patients in Botswana. Methods: Prevalent cohort study of patients with cervical, breast, prostate, esophagus, Kaposi sarcoma, head and neck cancers, lung, uterine, ovarian and colorectal cancers who received any systemic therapy between 01/01/16-12/31/16 at Princess Marina Hospital, Botswana. Primary exposure was stock-out duration per cycle interval calculated by generating a code for the six different patterns for chemotherapy stock-out, using stock data at the Central Medical Stores. Primary outcome was suboptimal therapy delivery defined as a dose reduction, dose delay or switch in intended therapy. We measured statistical associations using two sample t-test and mixed effects univariate and multivariate logistic regression models. Results: 378 patients were identified who met diagnostic criteria and received systemic chemotherapy in 2016. Of these, 293 received commonly prescribed standard regimens who contributed 1452 cycle intervals and were included in our analysis. Majority of the patients (48%) had breast cancer. The mean duration of stock-out for receipt of standard therapy without events was 3.2 days (95% CI: 2.8-3.7) compared with 7.8 days for patients who had a suboptimal therapy delivery event (95% CI: 6.6-9) ( P < 0.0001). Male sex, age < 65 and HIV-positive status were also significantly associated with an increased risk of experiencing dose reduction, change in therapy or switch in therapy. Adjusting for these factors in a mixed effects logistic regression, each week of stock-out was independently associated with an 80% increased risk of having a suboptimal therapy delivery event (OR=1.8 (95% CI: 1.6-2.0, P < 0.0001)). Conclusion: Chemotherapy stock-out is independently associated with an 80% increased risk of a patient experiencing dose reduction, change in therapy or delay in therapy. The risk increases with longer duration of stock out. Given prior data showing that these events lead to worse survival outcomes, our further analysis is focusing on quantifying risk of stock-out on survival outcomes in this population. to determine whether interventions promoting standard therapy delivery are warranted to optimize survival outcomes.
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Nkhwalume, Ludo, and Yohana Mashalla. "Maternal mortality trends at the Princess Marina and Nyangabwe referral hospitals in Botswana." African Health Sciences 19, no. 2 (2019): 1833. http://dx.doi.org/10.4314/ahs.v19i2.5.
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Senkāne, Olga. "INTERPRETATION OF THE IMAGE OF LATGALE IN THE CULTURE DISCOURSE." Via Latgalica, no. 5 (December 31, 2013): 96. http://dx.doi.org/10.17770/latg2013.5.1647.
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There are cultures that focus on their origins, while there are also cultures oriented towards their destination: the former perceive the time in mythical manner – in its cycles, while the latter perceive it historically– in its linearity. The movement in the time-space continuum and its specifi cs in different cultures is provided by the desire either to pay more attention to the truth already known (the old texts) or to discover new one (new texts). The culture of Latgale is characterised by the prevalence of the old, constant texts or the traditional coding, as attested by persistent invoking of the region’s stereotypical values in the interpretations of the image of Latgale in literature, also the most operative genre of it – poetry. Nevertheless the artistic perception of Latgale in the poetry of the second half of the XX and the beginning of the XXI century shows not only respect towards the old, constant texts, but also intensive generation of new texts in certain periods of development of the regional culture. A very important indicator for identification of either the static or the dynamic culture type in artistic texts is the time: figurative perception of the past, the present and the future. The aim of the present study is to characterise the interpretation of the image of Latgale in the Latgalian patriotic poetry (the second half of the XX and the beginning of the XXI century). The image of Latgale is analysed in the culture discourse, based on the methods of cultural semiotics and phenomenology in treatment of time as well as the opposition of the new and the old. The present study uses as its source the Latgalian traditional (Romualds Spaitāns, Antons Rupainis, Antons Zvīdris, Marija Andžāne, Andris Vējāns, Pēteris Jurciņš, Marta Bārbale, Jānis Gurgons, Augusts Eglājs u. c.) and the modernist (Osvalds Kravaļs, Vilis Dzērvinīks, Antons Kūkojs, Ingrīda Tārauda u. c.) poetry. The semiotician Yuri Lotman lists the most important communicative functions of a text: 1) Information of an addressee; 2) Maintenance of collective cultural memory (in the format of inclusive transcendental abstraction archetype images, concepts, etc.); 3) Inclusion in a certain culture context (coding while respecting the traditions, stereotypical concepts, for the sake of cliché-like comprehensibility, recognisability); 4) Urge for the addressee’s self-examination (direct individual examination of the world’s phenomena and creation of codes). Realisation of the aforementioned functions in Latgalian poetry texts revealing the image of Latgale is clearly indicative of the rules of coding. First, the repeated denotation of abstraction representing and supporting the collective culture memory, its semantics and connotation depends upon the prioritised values of the respective age and society: Latgale as a land (the territorial identity) – territory or a region of a state and Latgale as people (the ethnic identity) – population or nation, part of a nation; second, inclusion into the region’s culture context is related to a wide though variation-less use of stereotypes (symbols, metaphors, rituals) and clichés; third, generation of new codes can nearly only be found in the modernist texts, where the priority is the revelation of direct impressions in formation of both the space-time continuum and the images, though also here in most cases direct impression in the poetry text functions as a projection of the past, a reconstruction (Latgale as the birthplace with the actualisation of place names – including the names of castle mounds, etc. in nostalgic retrospection). The image of Latgale in the coding system of the territorial identity is mainly marked with the cipher of concept "homeland” and in most cases overlaps with the ethnic identity codes, as it nearly always contains some stable and self-explanatory metonymic connection between the land and its inhabitants. In the Latgalian poetry it is related with the following semantically and stylistically expressive interpretations: 1) The protector – the potential/existing member of a family (a bride, a mother) or the one to be protected (an orphan left without the family, the youngest sister), such a connotation is mainly characteristic for allegorical national romanticism and national patriotic neoclassicism texts; 2) The sufferer (pain, a tear on a cheek, etc.); 3) The guardian of ethic values (sweat, conscience, etc.); 4) A birthplace with an accent on belonging (the poetical “I” admits his/her Latgale origin, frequently involving a particular set of place-names, using the reminiscence of the return of the prodigal son, with a shade of guilt in subtext; 5) A chosen, special place – most frequently in analogy /comparison structures as a reminiscence of the Latgalian mythology, folklore: a princess, a legend, soul, Muorys zeme (‘the Land of Māra’), Trešō zvaigzne (‘the Third Star’); also a figurative depiction of particularity of the territory and its inhabitants with the use of positive stereotypes: the land of the blue lakes, the green forests, people with an authentic material culture (castle-mounds, ceramics, linens), a language of their own and their specific religion (temples), hospitable, cordial people, ethnically diverse environment, et c., frequently in opposition ”centre – periphery”, ”the civilised – the natural”; 6) Vital and tough inhabitants.
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Manwana, ME, GG Mokone, M. Kebaetse, and T. Young. "Epidemiology of traumatic orthopaedic injuries at Princess Marina Hospital, Botswana." SA Orthopaedic Journal 17, no. 1 (2018). http://dx.doi.org/10.17159/2309-8309/2018/v17n1a6.
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Molefi, Mooketsi. "Princess Marina Hospital HIV rates:Interrupted time series analysis for policy review." Online Journal of Public Health Informatics 10, no. 1 (2018). http://dx.doi.org/10.5210/ojphi.v10i1.8602.
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ObjectiveWe aimed to assess the effect of the amended Public Health act of 2013 on facility-based HIV testing in Princess Marina Hospital.IntroductionHIV testing remains the mainstay of optimal HIV care and is pivotal to control and prevention of the disease, however efforts to attain optimal testing levels have been undermined by low HIV testing especially in developing countries. Botswana in response, amended its Public Health Act in September 2013 but the effect of this action on facility based HIV testing rates has not been evaluated.MethodsWe carried out an effect assessment using interrupted time-series analysis method, where we accessed electronic medical records of patients seen in Princess Marina Hospital from June 2011 to May 2015. Rates were developed from the proportion of patients that tested each month out of the number that registered, and that figure used that as our data point in the series. September 2013 served as our intervention period in the series. We ran the (i) crude and (ii) sex-stratified model regression models in stata® yielding Newey-West coefficients with their 95% confidence intervals. Graphical display of the models were also produced to visual appreciation and inspection.ResultsTwo hundred and twenty-nine thousand six hundred and ninety two patients were registered between June 2011 and May 2015. Of those tested the significant majority being females (65%). From the Newey-regression output there was no significant change in the level of HIV testing immediately after the intervention however there was a change in trend(p=0.002) post the intervention. Stratification by gender, revealed no statistically significant difference between males and females, either in the levels nor the trend post intervention compared to pre-intervention.ConclusionsThe amendment of the Public Health act of 2013, has brought about trend change in HIV testing however there has not been any apparent difference in the levels nor trends on HIV testing between males and females. Nationwide health facility-based studies could assist assess the overall effect of the amended act on HIV testing rates.References1. Provider Initiated HIV Testing and Counseling: One Day Training Programme, Field Test Version. WHO Guidelines Approved by the Guidelines Review Committee. Geneva2011.2. Donnell D, Baeten JM, Kiarie J, Thomas KK, Stevens W, Cohen CR, et al. Heterosexual HIV-1 transmission after initiation of antiretroviral therapy: a prospective cohort analysis. The Lancet. 2010;375(9731):2092-8.3. Lawn SD, Harries AD, Anglaret X, Myer L, Wood R. Early mortality among adults accessing antiretroviral treatment programmes in sub-Saharan Africa. Aids. 2008;22(15):1897-908.4. McMahon JM, Pouget ER, Tortu S, Volpe EM, Torres L, Rodriguez W. Couple-based HIV counseling and testing: a risk reduction intervention for US drug-involved women and their primary male partners. Prevention science : the official journal of the Society for Prevention Research. 2015;16(2):341-51.5. Shan D, Duan S, Gao J, Yang Y, Ye R, Hu Y, et al. [Analysis of early detection of HIV infections by provider initiated HIV testing and counselling in regions with high HIV/AIDS epidemic in China]. Zhonghua yu fang yi xue za zhi [Chinese journal of preventive medicine]. 2015;49(11):962-6.6. Hensen B, Baggaley R, Wong VJ, Grabbe KL, Shaffer N, Lo YRJ, et al. Universal voluntary HIV testing in antenatal care settings: a review of the contribution of provider initiated testing & counselling. Tropical Medicine & International Health. 2012;17(1):59-70.7. Ijadunola K, Abiona T, Balogun J, Aderounmu A. Provider-initiated (Opt-out) HIV testing and counselling in a group of university students in Ile-Ife, Nigeria. The European journal of contraception & reproductive health care : the official journal of the European Society of Contraception. 2011;16(5):387-96.8. Baisley K, Doyle AM, Changalucha J, Maganja K, Watson-Jones D, Hayes R, et al. Uptake of voluntary counselling and testing among young people participating in an HIV prevention trial: comparison of opt-out and opt-in strategies. PloS one. 2012;7(7):e42108.9. Topp SM, Chipukuma JM, Chiko MM, Wamulume CS, Bolton-Moore C, Reid SE. Opt-out provider-initiated HIV testing and counselling in primary care outpatient clinics in Zambia. Bulletin of the World Health Organization. 2011;89(5):328-35A.10. Tlhakanelo JT, Mulumba-Tshikuka JG, Molefi M, Magafu MG, Matchaba-Hove RB, Masupe T. The burden of opportunistic-infections and associated exposure factors among HIV-patients admitted at a Botswana hospital. 2015.11. Bernard EJ. BOTSWANA’S DRACONIAN PUBLIC HEALTH BILL APPROVED BY PARLIAMENT, BONELA WILL CHALLENGE IT AS UNCONSTITUTIONAL ONCE PRESIDENT SIGNS INTO LAW (UPDATE 3). HIV justice Network. 2013.12. Biglan A, Ary D, Wagenaar AC. The value of interrupted time-series experiments for community intervention research. Prevention science : the official journal of the Society for Prevention Research. 2000;1(1):31-49.
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Tsima, Billy M., Farai D. Madzimbamuto, and Bob Mash. "Use of oxytocin during Caesarean section at Princess Marina Hospital, Botswana: An audit of clinical practice." African Journal of Primary Health Care & Family Medicine 5, no. 1 (2013). http://dx.doi.org/10.4102/phcfm.v5i1.418.
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Background: Oxytocin is widely used for the prevention of postpartum haemorrhage. In the setting of Caesarean section (CS), the dosage and mode of administrating oxytocin differs according to different guidelines. Inappropriate oxytocin doses have been identified as contributory to some cases of maternal deaths. The main aim of this study was to audit the current standard of clinical practice with regard to the use of oxytocin during CS at a referral hospital in Botswana.Methods: A clinical audit of pregnant women having CS and given oxytocin at the time of the operation was conducted over a period of three months. Data included indications for CS, oxytocin dose regimen, prescribing clinician’s designation, type of anaesthesia for the CS and estimated blood loss.Results: A total of 139 case records were included. The commonest dose was 20 IU infusion (31.7%). The potentially dangerous regimen of 10 IU intravenous bolus of oxytocin was used in 12.9% of CS. Further doses were utilized in 57 patients (41%). The top three indications for CS were fetal distress (36 patients, 24.5%), dystocia (32 patients, 21.8%) and a previous CS (25 patients, 17.0%). Estimated blood loss ranged from 50 mL – 2000 mL.Conclusion: The use of oxytocin during CS in the local setting does not follow recommended practice. This has potentially harmful consequences. Education and guidance through evidence based national guidelines could help alleviate the problem.
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Mbuka-Ongona, Deogratias, and John M. Tumbo. "Knowledge about breast cancer and reasons for late presentation by cancer patients seen at Princess Marina Hospital, Gaborone, Botswana." African Journal of Primary Health Care & Family Medicine 5, no. 1 (2013). http://dx.doi.org/10.4102/phcfm.v5i1.465.
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Introduction: In Botswana, breast cancer, the second most common malignancy amongst women, is often diagnosed late, with 90% of patients presenting at advanced stages at Princess Marina Hospital (PMH) Gaborone, the only referral hospital with an operational oncology department. The reasons for this late presentation have not been studied. Determination of these reasons is critical for the formulation of strategies to reduce morbidity and mortality from breast cancer in Botswana. The aim of this study was to explore existing knowledge about breast cancer and the reasons for late presentation amongst patients attending the oncology unit of Princess Marina Hospital.Method: A descriptive qualitative study using free attitude interview was performed.Twelve breast cancer sufferers were purposefully selected and eleven interviews conducted. Interviews were audio-taped, transcribed verbatim and translated. Thematic analysis of data was performed.Results: This study found that breast cancer sufferers had had poor knowledge of the disease prior to the diagnosis. Their knowledge improved markedly during their attendance to the oncology clinic. Screening methods such as breast self-examination (BSE) were not used frequently. The majority of participants had delayed going to the hospital because of a lack of knowledge, fear of the diagnosis and fear of death, misinterpretation of the signs, the influence of lay beliefs and advice from the community. In some cases, however, advice from family and friends resulted in a timely medical consultation. The poor clinical practices of some healthworkers and the inadequate involvement by decision makers regarding the issue of cancer awareness discouraged patients from seeking and adhering to appropriate therapy.Conclusions: Awareness and knowledge of breast cancer was found to be poor amongst sufferers prior to their diagnosis, but their awareness and knowledge improved after the diagnosis. There was limited use of screening methods and a generally delayed seeking of medical attention. The need for increased awareness and use of screening practices was identified to be essential for early diagnosis of the disease and for improved outcomes of breast cancer management in Botswana.
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"The meeting of the Autism Special Interest Group held on 29 May 2002 at Princess Marina Hospital, Northampton." Nutrition & Food Science 32, no. 6 (2002). http://dx.doi.org/10.1108/nfs.2002.01732fab.003.
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Bareki, Peter, and Tenego Tenego. "Assessment of knowledge, attitudes and practices of HIV post exposure prophylaxis among the doctors and nurses in Princess Marina Hospital, Gaborone: a cross-sectional study." Pan African Medical Journal 30 (2018). http://dx.doi.org/10.11604/pamj.2018.30.233.10556.
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Bhebhe, Lynnette, Motswedi Anderson, Sajini Souda, et al. "Molecular characterization of hepatitis C virus in liver disease patients in Botswana: a retrospective cross-sectional study." BMC Infectious Diseases 19, no. 1 (2019). http://dx.doi.org/10.1186/s12879-019-4514-1.
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Abstract Background Hepatitis C virus (HCV) infection is a major cause of chronic liver disease globally. Direct acting antivirals (DAAs) have proven effective in curing HCV. However, the current standard of care (SOC) in Botswana remains PEGylated interferon-α (IFN-α) with ribavirin. Several mutations have been reported to confer resistance to interferon-based treatments. Therefore, there is a need to determine HCV genotypes in Botswana, as these data will guide new treatment guidelines and understanding of HCV epidemiology in Botswana. Methods This was a retrospective cross-sectional pilot study utilizing plasma obtained from 55 participants from Princess Marina Hospital in Gaborone, Botswana. The partial core region of HCV was amplified, and genotypes were determined using phylogenetic analysis. Results Four genotype 5a and two genotype 4v sequences were identified. Two significant mutations – K10Q and R70Q – were observed in genotype 5a sequences and have been associated with increased risk of hepatocellular carcinoma (HCC), while R70Q confers resistance to interferon-based treatments. Conclusion Genotypes 5a and 4v are circulating in Botswana. The presence of mutations in genotype 5 suggests that some patients may not respond to IFN-based regimens. The information obtained in this study, in addition to the World health organization (WHO) recommendations, can be utilized by policy makers to implement DAAs as the new SOC for HCV treatment in Botswana.