Epidemiology of hip fracture in Botswana

Summary A retrospective population-based survey in the Republic of Botswana determined the incidence of fractures at the hip over 3 years. The estimated number of such fractures nationwide for 2020 was 103 and is predicted to increase. Objective This article describes the epidemiology of hip fractures in the Republic of Botswana. Methods A retrospective patient chart review was conducted to identify from hospital registers the number of patients diagnosed with hip fracture in 2009, 2010, and 2011. Age- and sex-specific incidence of hip fracture was determined from which lifetime probabilities and future projections for hip fracture were calculated. Results The incidence of hip fracture was low and comparable to rates reported from Tunisia. The remaining lifetime risk of hip fracture at the age of 50 years in men and women was 1.4 and 1.1%, respectively. The incidence of hip fracture suggested that the estimated number of hip fractures nationwide in persons over the age of 50 years for 2020 was 103 and is predicted to increase by more than threefold to 372 in 2050. Conclusion The hip fracture rates can be used for healthcare planning. Additionally, these data can be used to create a FRAX model to help guide decisions about treatment

Postgraduate medical specialty training for Botswana: A successful innovative partnership with South Africa

Background. Sub-Saharan Africa has a significant shortage of healthcare providers, and educational collaborations are recommended as one of the crucial steps to increase the medical workforce.Objectives. To describe a successful innovative postgraduate medical specialisation programme involving two neighbouring African countries, Botswana and South Africa (SA).Methods. After lengthy consultative processes, a postgraduate training programme was approved between the University of Botswana and the Colleges of Medicine of SA (CMSA). This programme utilised a 4-year Master of Medicine (MMed) curriculum for consecutive training and examinations in both countries. Extensive collaborations with government and regulatory bodies in both countries were required to facilitate the programme.Results. Despite initial diverse challenges, the two countries continue to support the partnership, with 40 local doctors having graduated as medical specialists since 2014, and additional MMed programmes in development for Botswana.Conclusions. The University of Botswana and CMSA partnership model is a novel and sustainable cross-border collaboration with significant benefits for both health systems and individual trainees. It is possible to have a successful and high-quality specialisation programme without all the resources in place by being innovative and leveraging external partnerships and collaborations. This  partnership hopes to encourage other developing countries to explore similar association

Perceptions of physician leadership in Botswana

Background. Physician leadership is essential for the strengthening of health systems, especially in underserved settings such as sub-Saharan Africa. To be effective, leaders must be perceived as such by their community. It is unknown how perceptions of physician leadership in Botswana compare with those of the Canadian Medical Education Directives for Specialists (CanMEDS) Physician Competency Framework, which is used to shape the training of Botswana’s future physicians.Objective. To examine if the perceived competencies of physician leadership in Botswana are  specifically named in the CanMEDS Framework and thereby inform Botswana’s graduate medical education.Methods. We conducted focus groups discussions with nurses, interns, medical officers and specialists at Princess Marina Hospital and Nyangabgwe Referral Hospital. Key questions focused on describing the qualities of physician leadership. For data analysis we used inductive content coding and comparison with the CanMEDS frameworks.Results. Forty-eight clinicians participated and 111 unique codes were assigned to 503 comments.  Eighty-four per cent of comments corresponded to the CanMEDS 2005 competencies; many were  captured within the competencies of the medical expert (13.0%), communicator (17.8%), collaborator (15.6%), scholar (14.9%) and professional (31.3%) roles. About 5% of comments mapped to the draft CanMEDS 2015 update, and 11.5% were not specifically described in either version of CanMEDS, including charisma and decisiveness.Conclusion. The CanMEDS frameworks specifically address most of the competencies perceived as important for physician leadership in Botswana. Additional perceptions were identified that may require the attention of existing and aspiring physician leaders and their teachers to ensure they attain and maintain their effectiveness as leaders