Perceived health needs and services gaps for elders on ARV treatment - south east district, Botswana (2014-2015)

A Research Report Submitted in Partial Fulfilment for the Requirements of the Degree Masters in Public Health. November, 2015Background: Health care of older people living with HIV and on ARV treatment has received very little attention in Botswana over the years. The 17.6% national HIV prevalence for Botswana excludes the older people as the Botswana Index AIDS Survey (BIAS) is focused on ages 10-64. This survey is meant to look at current national and district HIV estimations, sexual and preventive trends for each target group, compare HIV rates, behavior, knowledge, attitude, poverty and other factors related to HIV in order to come up with strategies to mitigate and enhance uptake of programs for prevention and control of HIV in Botswana. With little or no information on this group effective and targeted services are not possible hence this study. Objective: To explore perceived health services needs and services gaps for HIV positive older people over 65 years by the older people attending ARV dispensing clinics and HCW in Gaborone and Greater Gaborone, Botswana (2014-2015). Methods: A cross-sectional survey was conducted among 20 older people on ARV treatment and 15 Health Care Workers (nurses and pharmacy technicians) caring for them in Gaborone and Greater Gaborone (2014-2015). An in-depth interview guide was used to explore perceived health needs and services gaps of older people. Respondents were older people of age ranges 65 to 87 years who have been on ARV treatment for an average of 7 years (4 months to 13 years). Results: Older people in Botswana are happy with curative and non-curative services offered as part of their care in ARV clinics. Curative services being ARV treatment, blood tests and consultation are offered consistently to the appreciation of all older people. Counselling services are not consistently done and older people advocate for its strengthening; targeted health education in non-existent, there is limited interaction with medical doctors due to language barrier, poor queue management results in older people waiting for long which is attributed to staff shortage, poor defaulter identification and follow up are also not coordinated. The need for social support increases with their age and medical situation while need for improved nutrition or food ration remains critical for their health and wellbeing restoration. Above all pill burden due to comorbidities is in the increase therefore requiring coordinated patient management to maximise positive outcomes and minimise impact on older people. Conclusion and Recommendations: Need for evidence based care initiatives can never be over emphasised. Despite that older people report high cases of disclosure and adherence, major needs and services gaps that need immediate response are inevitable basing on this study. Their high illiteracy rates impact adherence to services, openness to discuss sensitive issues, limits interaction with English speaking medical doctors and ultimately impact health outcomes. More skilled HCWs should be placed in Botswana ARV clinics to offer comprehensive and high quality services that meet the needs of older people. More longitudinal researches are recommended to better understand the journey of older people living with HIV in the mist of comorbidities. Coordination of services delivery among various professionals remains instrumental if we hope to maximise adherence and benefits of the services offered to older people

Economic Status, Education and Risky Sexual Behavior for Urban Botswana Women

This study investigated the relationship between economic status, education and risky sexual behavior for urban Botswana women. The data used are a nationally representative sample from the Botswana AIDS Impact Survey conducted in 2004. An un-weighted sample of 2215 women aged 15-49, who have had sexual intercourse was considered for analysis. Both bivariate and multivariate analyses are used to gain insights into the potential linkages between economic status, education and risky sexual behavior. The bivariate analysis shows that there is a significant relationship between dependent variable (number of sexual partners) and economic status. However, with the introduction of controls the significant relationship persisted. The findings also show that the married and the living together had a significantly higher chance of having more than one sexual partner compared to the Not married. However, with the introduction of controls the significant relationship that existed between economic status and having had sexual intercourse in exchange for money/gifts disappeared. Moreover, women who believed that an HIV mother can avoid transmission to the baby appeared to have a significantly higher chance of having sexual intercourse in exchange for money/gifts than those who did not believe that an HIV mother can avoid transmission to the baby. Lastly this study revealed that inconsistent condom use is neither a function of economic status nor education, as well as the following socioeconomic environments; age, marital status, religion and awareness/knowledge on avoiding HIV transmission from a mother to a baby. The results of the study, shows that economic status only influences the number of sexual partners and having sexual intercourse in exchange for money/gifts

On the torsional loading of elastoplastic spheres in contact

The mechanical interaction between two bodies involves normal loading in combination with tangential, torsional and rotational loading. This paper focuses on the torsional loading of two spherical bodies which leads to twisting moment. The theoretical approach for calculating twisting moment between two spherical bodies has been proposed by Lubkin [1]. Due to the complexity of the solution, this has been simplified by Deresiewicz for discrete element modelling [2]. Here, the application of a simplified model for elastoplastic spheres is verified using computational modelling. The single grain interaction is simulated in a combined finite discrete element domain. In this domain a grain can deform using a finite element formulation and can interact with other objects based on discrete element principles. For an elastoplastic model, the contact area is larger in comparison with the elastic model, under a given normal force. Therefore, the plastic twisting moment is stiffer. The results presented here are important for describing any granular system involving torsional loading of elastoplastic grains. In particular, recent research on the behaviour of soil has clearly shown the importance of plasticity on grain interaction and rearrangement

Implementation of Integrated E-Learning and Microteaching in Engineering: A Case Study of University of Botswana

It is indispensable for the instructors imparting competencies should have the capability to perform their task efficiently and effectively for the development of workforce skills. In this paper, we discussed the application of combining Micro-lecture methodology with the latest e-learning techniques in a core-engineering course. Audio-visual facilities enabled smart classrooms with micro-lectures using point-based videos, PPTs and images save more time for students to engage more towards practical in the laboratory and to understand the concept easily, which instigates students’ interest and creativeness. This study aims to investigate the effect of using the microteaching methodology in integration with the latest e-learning techniques at the University of Botswana. To achieve this objective evolution is done by considering different pass percentages and online software-based student evolution of course and teaching system. The post-application results showed that the group showed a good rating in grades, presence and knowledge. Students rating received were good i.e. 4.2 and 4.3 in teaching and major course evolution on a scale of five with the pass percentage of 73.1% showing 23% increments from the previous year’s results and excellent reviews

Perceptions of household measuring utensils amongst Mmopane community in Botswana

In assessing adults’ dietary intakes, nutritionists and dietitians often rely on clients’ reported food consumption, estimated in units of households measuring utensils (cups, tablespoons and teaspoons). However, it is yet to be established whether the public can accurately estimate the capacity of household utensils and the amount of food consumed in units of household measuring utensils. The purpose of the study was to examine conceptions of household measuring utensils and establish how well participants estimate the sizes of household measuring utensils comparing with metric sizes of 250 ml for a cup, 15 ml and 5 ml for a tablespoon and a teaspoon, respectively. The study used a cross-sectional survey design with a random sample of 253 participants aged between 18-60 years. Participants were asked to complete questionnaires by identifying a sample that best approximated their perception of a standard (metric) cup, tablespoon and teaspoon. The results revealed that most adults’ perceptions of the utensils differed from the correct measurements (metric sizes) of household utensils. Fifty eight percent of participants identified a sample of 375 ml sample as the one that they thought bestapproximated a standard / metric cup while 19% identified a 330 ml sample as the one that best approximated a metric cup. Only 13% of participants correctly identified a standard cup. Pertaining to tablespoon and teaspoon sizes, only about 7% and 38% participants correctly identified a tablespoon and teaspoon, respectively. The weighted mean size of a cup as perceived by participants was estimated at 332 ml. The mean difference between what participant perceived best explained their understanding of a cup (332ml) from the metric size of 250 ml was statistically significant (significant one sample t-test; T = 20. 234, p< .001; df = 252). Similarly, the average size of a teaspoon as perceived by participants differed from standard/ metric size of a teaspoon (T = -4. 326, p< .001; n= 251). Similarly, observations were made with regard to the difference between perceived size of tablespoon (T = -51.20, p< .001; n = 252) and metric size of a tablespoon. Lastly, participants’ perception of sizes of household utensils was influenced by age, education and gender. The findings underscore the importance of establishing local notions of household measures before assessment methods that rely on their use are administered. Further, the findings suggest the need for clients’ education on household measures prior to use of the same in dietary assessments.Keywords: Botswana, Dietary recall, Dietary assessment, Household measuringutensil

A comparison of risky sexual behaviours between circumcised and uncircumcised men aged 30-44 years in Botswana

Background: The principal mode of HIV transmission in Southern Africa is through sexual intercourse, and this has prompted uptake of safe male circumcision. Engaging in risky sexual behaviour by circumcised men increases the risks of acquiring HIV, though male circumcision coupled with preventive behaviour reduces this risk.Objective: To compare the factors associated with risky sexual behaviour among circumcised and uncircumcised men in Botswana.Methods: Nationally representative data from the Botswana AIDS Impact Survey III were used. A sample of 313 sexually active men was used. The data was analysed by cross-tabulation and logistic regression.Results: The study revealed that uncircumcised men (odds ratio, 5.711) were more likely to have sex while intoxicated with alcohol compared to circumcised men. Low levels of education (odds ratio, 8.736), urban residency (city/town: odds ratio, 1.238 and urban village: odds ratio, 1.098) were more likely to influence risky behaviour (more than one sexual partner) for circumcised men. The results also show that marital status (never married) (odds ratio, 1.947) influences risky behaviour (having sex while intoxicated with alcohol) among uncircumcised men.Conclusion: Low level of education, place of residence and alcohol consumption influences risky sexual behaviour for both circumcised and uncircumcised men. Policies and programmes should thus focus on the attitudes underlying sexual behaviour.Keywords: Risky sexual behaviours, circumcised, uncircumcised men, 30-44 years, Botswan

A comparison of risky sexual behaviours between circumcised and uncircumcised men aged 30-44 years in Botswana.

Background: The principal mode of HIV transmission in Southern Africa is through sexual intercourse, and this has prompted uptake of safe male circumcision. Engaging in risky sexual behaviour by circumcised men increases the risks of acquiring HIV, though male circumcision coupled with preventive behaviour reduces this risk. Objective: To compare the factors associated with risky sexual behaviour among circumcised and uncircumcised men in Botswana. Methods: Nationally representative data from the Botswana AIDS Impact Survey III were used. A sample of 313 sexually active men was used. The data was analysed by cross-tabulation and logistic regression. Results: The study revealed that uncircumcised men (odds ratio, 5.711) were more likely to have sex while intoxicated with alcohol compared to circumcised men. Low levels of education (odds ratio, 8.736), urban residency (city/town: odds ratio, 1.238 and urban village: odds ratio, 1.098) were more likely to influence risky behaviour (more than one sexual partner) for circumcised men. The results also show that marital status (never married) (odds ratio, 1.947) influences risky behaviour (having sex while intoxicated with alcohol) among uncircumcised men. Conclusion: Low level of education, place of residence and alcohol consumption influences risky sexual behaviour for both circumcised and uncircumcised men. Policies and programmes should thus focus on the attitudes underlying sexual behaviour

Development of a Cost-effective Design of a P-V Ventilated Greenhouse Solar Dryer for Commercial Preservation of Tomatoes in a Rural Setting

Commercial preservation of agro-produce by solar drying entails using large-scale dryer units that are generally not affordable by potential users in a rural setting. The objective of this study was to design a photo-voltaic greenhouse solar drying unit with air convection powered by a photovoltaic system as part of a research study to develop a cost-effective commercial solar dryer for the preservation of tomatoes in a rural setting. The design methodology involved. First, the determination of thermophysical properties of local tomatoes and predicting its drying model. Second, determination of design parameters; design equations, design conditions and assumptions, and psychrometric analysis. Third, application of the design parameters under the climatic conditions of Botswana to produce the embodiment of design with the drawings and specifications for a solar hot air dryer unit of 2000 kg batch-load of wet tomatoes. This drying unit is integrated into a solar collector with a cost-friendly thermal energy storage system to store solar energy during the day for use after sunset for better performance

Importance of mechanical cues in regulating musculoskeletal circadian clock rhythmicity: implications for articular cartilage

The circadian clock, a collection of endogenous cellular oscillators with an approximate 24‐h cycle, involves autoregulatory transcriptional/translational feedback loops to enable synchronization within the body. Circadian rhythmicity is controlled by a master clock situated in the hypothalamus; however, peripheral tissues are also under the control of autonomous clocks which are coordinated by the master clock to regulate physiological processes. Although light is the primary signal required to entrain the body to the external day, non‐photic zeitgeber including exercise also entrains circadian rhythmicity. Cellular mechano‐sensing is imperative for functionality of physiological systems including musculoskeletal tissues. Over the last decade, mechano‐regulation of circadian rhythmicity in skeletal muscle, intervertebral disc, and bone has been demonstrated to impact tissue homeostasis. In contrast, few publications exist characterizing the influence of mechanical loading on the circadian rhythm in articular cartilage, a musculoskeletal tissue in which loading is imperative for function; importantly, a dysregulated cartilage clock contributes to development of osteoarthritis. Hence, this review summarizes the literature on mechano‐regulation of circadian clocks in musculoskeletal tissues and infers on their collective importance in understanding the circadian clock and its synchronicity for articular cartilage mechanobiology

Fifth-year medical students’ perspectives on rural training in Botswana: A qualitative approach

Background. The curriculum of the Faculty of Medicine at the University of Botswana includes rural community exposure for students throughout their 5 years of training. In addition to community exposure during the first 2 years, students complete 16 weeks of family medicine and 8 weeks of public health medicine. However, as a new faculty, students’ experiences and perceptions regarding rural clinical training are not yet known.Objective. To describe the experiences and perceptions of the 5th-year medical students during their rural training and solicit their recommendations for improvement.Methods. This qualitative study used face-to-face interviews with 5th-year undergraduate medical students (N=36) at the end of their family medicine rotation in Mahalapye and Maun villages. We used a phenomenological paradigm to underpin the study. Voice-recorded interviews were transcribed and analysed using Atlas TI version 7 software (USA).Results. Three main themes were identified: (i) experiences and perceptions of the rural training environment; (ii) perceptions of the staff at rural sites; and (iii) perceptions of clinical benefits and relevance during rural training. While the majority of students perceived rural training as beneficial and valuable, a few felt that learning was compromised by limited resources and processes, such as medical equipment, internet connectivity and inadequate supervision.Conclusion. While the majority of students perceived rural training as beneficial, students identified limitations in both resources and supervision that need to be improved. Understanding students’ rural training experiences and perceptions can help the Faculty of Medicine, stakeholders and site facilitators to guide future rural training implementation