Maternal mortality trends at the Princess Marina and Nyangabwe referral hospitals in Botswana

Background: Despite the fact that about 94% of pregnant women attend ANC, 95% deliver at health facilities and 99% deliveries are assisted by skilled birth attendants in Botswana, the national Maternal Mortality Rate is still high.Objectives: To determine the trend of MMR at Princess Marina and Nyangabwe referral hospitals before and after EMOC training.Methods: Retrospective longitudinal quantitative study design was used to collect data on maternal deaths. Demographic characteristics, maternal death causes, gestation at ANC registration and pregnancy risks were collected for the period before EMOC training and after training, analysed and compared. Descriptive statistics and frequency tables were used.Findings: Maternal deaths were 33 and 41 before and after EMOC training respectively. Majority of the maternal deaths, 78.8% and 70.7% before and after EMOC training respectively occurred among young women in the reproductive ages. Eclampsia wasthe commonest cause of maternal death before EMOC between training & and 58% and 66% of maternal deaths before and after EMOC training respectively occurred among women who had attended ANC services four or more times.Conclusion: Maternal deaths at the hospitals remained similar during the two periods. Qualitative studies are needed to determine why EMOC training has not resulted in significant reduction in MMR in Botswana.Keywords: Maternal mortality trends, princess Marina, Nyangabwe referral hospitals, Botswana

Knowledge about goitre among female school-going children in Wellega Province, Ethiopia

Background: About 30% of the world population is affected by Iodine Deficiency Disorder and Ethiopia is among the top ten countries in the world with severe iodine deficiency. The objective of this study was to explore the knowledge about goitre and preventive measures among female school children aimed at reducing the occurrence of goitre.Methods: Quantitative, descriptive cross-sectional study design was used to explore the knowledge about goitre among school-going children in three schools in Wellega Province, Ethiopia. Descriptive statistics was used to analyse, organise and interpret the findings.Results: A total of 364 girls aged between 15–19 years participated in the study. Overall, 71.4% did not have the knowledge about goitre, one third (28.6%) knew that goitre is caused by iodine deficiency and less than half (48.4%) knew that iodinated salt prevents occurrence of goitre. Sixty one per cent did not know which local foods aggravate goitre, 35.7% indicated that goitre affects both males and females and a small proportion identified pregnant women, children and adolescents as vulnerable groups for goitre. Only 38% received information about goitre from the schools.Conclusion: The level of knowledge about goitre among school girls in Wellega Province is low. It is recommended that concerted efforts targeting adolescents to acquire knowledge about the causes and prevention of goitre should be made and further studies should be done to explore perceptions and cultural factors that may contribute to the knowledge gap

Sexual and reproductive health among high school adolescents in West Shoa zone, Oromia region in Ethiopia

Adolescent‘s sexual and reproductive health is a challenge in many low and middle-income countries. We assessed the knowledge and attitude towards sexual and reproductive health among adolescents in West Shoa zone, Oromia region, Ethiopia. The study was cross-sectional using simple multi-stage random sampling and a structured questionnaire was used to collect data among adolescents aged 15 – 19 years. Frequency distribution of dependent and independent variables were computed and Odds ratios were calculated to determine association between variables. Most participants were from poor and illiterate families. Slightly over half of them had heard about sexual and reproductive health and the knowledge of emergency contraceptive was limited. About 80% of the girls who had become pregnant ended the pregnancy with an abortion and discussion between parents and adolescents on sexuality issues were poor. Effort to empower adolescents and communities with correct sexual and reproductive health is required; academic curricula should be reviewed and health facilities should be engaged to provide sexuality education. Keywords: Adolescents, knowledge, communication on sexual and reproductive health La santé sexuelle et de la reproduction des adolescents est un défi dans de nombreux pays à revenu faible ou intermédiaire. Nous avons évalué les connaissances et les attitudes vis-à-vis de la santé sexuelle et de la reproduction chez les adolescents de la zone de Shoa Ouest, dans la région d‘Oromia, en Éthiopie. L‘étude était transversale et reposait sur un simple échantillonnage aléatoire à plusieurs degrés. Un questionnaire structuré a été utilisé pour collecter des données sur les adolescents âgés de 15 – 19 ans. La distribution de fréquence des variables dépendantes et indépendantes a été calculée et les rapports de cotes ont été calculés pour déterminer l'association entre les variables. La plupart des participants étaient issus de familles pauvres et illettrées. Un peu plus de la moitié d'entre eux avaient entendu parler de la santé sexuelle et de la reproduction et la connaissance de la contraception d'urgence était limitée. Environ 80% des filles qui étaient enceintes ont mis fin à leur grossesse par un avortement et les discussions entre parents et adolescents sur les questions de sexualité ont été médiocres. Un effort visant à responsabiliser les adolescents et les communautés en matière de santé sexuelle et de la reproduction est nécessaire; les programmes universitaires devraient être revus et les établissements de santé devraient être engagés pour dispenser une éducation sexuelle. Mots-clés: Adolescents, connaissances, communication sur la santé sexuelle et de la reproduction

Malaria, burden, HIV, Poor countries, Research Infrastructure, Tazania

Developing countries carry 90% of the global burden\ud of disease. Infections such as malaria and HIV are\ud debilitating their economies by killing the young and\ud economically productive workforce. Research is essen­\ud tial for health development, yet less than 10% of the\ud annual global expenditure on health research is\ud allocated to addressing developing countries' prob­\ud lems.1 Poor countries must face this challenge seriously.\ud It is essential that they create strong national research\ud infrastructures so that they can define priorities for\ud health research priorities; influence national, regional,\ud and global health agendas; and lobby for a more equi­\ud table allocation of resources. This paper discusses\ud some of the barriers to establishing coordinated health\ud research programmes in developing countries and\ud describes how Tanzania has developed a new research\ud model to try and overcome these

Factors Influencing Women’s Preferences for Places to Give Birth in Addis Ababa, Ethiopia

The main aim of this study was to examine factors determining women’s preference for places to give birth in Addis Ababa, Ethiopia. A quantitative and cross-sectional community based study design was employed. Data was collected using structured questionnaire administered to 901 women aged 15–49 years through a stratified two-stage cluster sampling technique. Multinomial logistic regression model was employed to identify predictors of delivery care. More than three-fourth of slum women gave birth at public healthcare facilities compared to slightly more than half of the nonslum residents. Education, wealth quintile, the age of respondent, number of children, pregnancy intention, and cohabitation showed net effect on women’s preference for places to give birth. Despite the high number of ANC attendances, still many pregnant women especially among slum residents chose to deliver at home. Most respondents delivered in public healthcare institutions despite the general doubts about the quality of services in these institutions. Future studies should examine motivating factors for continued deliveries at home and whether there is real significant difference between the quality of maternal care service offered at public and private health facilities

Cutaneous leishmaniasis a neglected tropical disease: community knowledge, attitude and practices in an endemic area, Northwest Ethiopia

Abstract Background Cutaneous leishmaniasis is one of the neglected tropical diseases in the Ethiopian highlands and studies on assessment of knowledge, attitude and practice of the community in endemic areas are scanty. The study aimed to assess the knowledge, attitude towards cutaneous leishmaniasis and treatment seeking practices in people living in the endemic highlands areas in the Northwest, Ethiopia and to provide evidence-based information to guide development of appropriate interventions to reduce the impact of cutaneous leishmaniasis on communities. Methods Quantitative cross-sectional study was conducted in cutaneous leishmaniasis endemic districts (woredas) using a semi structured questionnaire. Households were randomly selected according to probability proportional to size of households in each enumeration area. Systematic random sampling of eligible households was based on the number of households recorded during listing of households. Descriptive statistics was used to describe numerical data, organise and summarise the data in a manner that gave meaning to the numerical form. Frequency tables were used to show descriptive analysis and regression analysis was used to determine correlation between variables. Results Majority of respondents 321(78.7%) lived in rural areas, age ranged between 18 and 85 years and most were farmers. Illiteracy was high (47.6%) among respondents and majority 358(87.8%) had seen patients with CL. Less than quarter (21.6%) had heard about sand flies and knowledge on the peak transmission period was low (46.3%). About 192 (47.1%) of the respondents indicated disfiguring lesions were the major clinical presentations, less than half 55(27.5%) of urban residents believed CL was treatable compared to 145(72.5%) of rural residents (P < 0.001). Traditional medicines were indicated as best treatment option by 209(51.2%) compared to 114(27.9%) for modern treatment. Major factors influencing treatment options included accessibility to treatment facilities, distance and short duration of treatment. Participants expressed negative experiential attitude and perceived control towards modern treatment because of inaccessibility and distance from where modern treatment is provided. Conclusion Priority should be given to primary prevention and appropriate awareness campaigns on lesion recognition. Information on modern treatment should be intensified

Health care workers experiences in emergency obstetric care following implementation of an in-service training program: case of 2 Referral Hospitals in Botswana

Background: Maternal mortality rate remains a challenge in many developing countries. Objectives: This study explored experiences of Health Care Workers on Emergency Obstetrics Care (EMOC) in-service training and its effect on maternal mortality. Methods: Descriptive qualitative study design was conducted using in-depth interviews and focus group discussions. Participants were EMOC trained midwives and doctors purposively selected from the 2 referral hospitals in the country. Data were transcribed verbatim, coded, and analysed using Grounded Theory approach. Results: Four themes emerged including training, EMOC implementation, maternal death factors and EMOC prioritisation. The duration of training was viewed inadequate but responsiveness to and confidence in managing obstetric emergencies improved post EMOC training. Staff shortage, HCWs non-adherence and negative attitude to EMOC guidelines; delays in instituting interventions, inadequate community involvement, minimal or no health talk to women and their partners and communities on sexual reproductive matters and non-prioritisation of EMOC by authorities were concerns raised. Conclusion: Strengthening health education at health facility levels, stakeholders\u2019 involvement; and prioritising EMOC in-service training are necessary in reducing the national maternal mortality

Maternal mortality trends at the Princess Marina and Nyangabwe referral hospitals in Botswana

Despite the fact that about 94% of pregnant women attend ANC, 95% deliver at health facilities and 99% deliveries are assisted by skilled birth attendants in Botswana, the national Maternal Mortality Rate is still high. Objectives: To determine the trend of MMR at Princess Marina and Nyangabwe referral hospitals before and after EMOC training. Methods: Retrospective longitudinal quantitative study design was used to collect data on maternal deaths. Demographic characteristics, maternal death causes, gestation at ANC registration and pregnancy risks were collected for the period before EMOC training and after training, analysed and compared. Descriptive statistics and frequency tables were used. Findings: Maternal deaths were 33 and 41 before and after EMOC training respectively. Majority of the maternal deaths, 78.8% and 70.7% before and after EMOC training respectively occurred among young women in the reproductive ages. Eclampsia was the commonest cause of maternal death before EMOC between training &amp; and 58% and 66% of maternal deaths before and after EMOC training respectively occurred among women who had attended ANC services four or more times. Conclusion: Maternal deaths at the hospitals remained similar during the two periods. Qualitative studies are needed to determine why EMOC training has not resulted in significant reduction in MMR in Botswana. DOI: https://dx.doi.org/10.4314/ahs.v19i2.5 Cite as: Nkhwalume L, Mashalla Y. Maternal mortality trends at the Princess Marina and Nyangabwe referral hospitals in Botswana. Afri Health Sci.2019;19(2): 1833-1840. https://dx.doi.org/10.4314/ahs.v19i2.

Integrated management of HIV/NCDs: knowledge, attitudes, and practices of health care workers in Gaborone, Botswana

Background: The epidemiologic transition and double disease burden from chronic infections and Non-communicable diseases (NCDs) worldwide requires re-engineering of healthcare delivery systems. Healthcare workers (HCWs) need to adapt to new integrated disease management approaches and change from current disease-specific management. Objectives: The study aimed to determine HCWs knowledge, capacity and skills for management of NCDs among HIV patients and their attitudes towards integrated HIV/NCDs disease management approaches for future clinical practice. Methods: Descriptive cross-sectional survey among HCWs attending to HIV patients at selected government facilities. Results: One hundred out of 105 responses were analysed. Only 6% could fully define NCDs. Awareness levels of NCDs were high: Diabetes and hypertension 98%; cancer 96%; cardiovascular diseases 86%. However, 11.8% and 58% classified HIV and malaria respectively as NCDs. Most respondents (88%) believe that integrating HIV/NCDs care would be good use of resources while 62% disagreed with current separate facility management of HIV patients with NCDs. Over 60% routinely screened HIV patients for NCDs risk factors: Smoking (87.2%), alcohol (90.8%), diet (84.9%) and physical activity (73.5%). Conclusion: There were gaps in detailed knowledge on NCDs, but positive attitude towards routine primary care integrated HIV/NCDs management, showing likely support for implementation of such policy.Keywords: Non-communicable diseases, knowledge, attitude, HIV, integration