The experience of traumatic brain injury in Botswana

Traumatic Brain Injury (TBI) is commonly associated with a number of physical, cognitive and behavioral changes, which have a significant, long-term impact on peoples’ ability to perform previous life roles. The consequences of TBI also impact on caregivers and families. The outcomes of TBI have been well documented in Western cultures, but much less so in non-Western countries. Whilst there is some evidence that cultural background and beliefs affect responses to TBI and outcome, the knowledge base is inadequate in low and middle-income countries where health services and socioeconomic factors are different from those of high income industrialised nations. More relevant to this current study, there are issues unique to Botswana, which have not received research attention. There is currently no information regarding the specific needs of people with TBI in Botswana, whose care and outcomes may be influenced by socio-cultural factors, economic factors, the country’s small population, lack of infrastructure, and the recency of development. Accordingly, in this doctoral thesis I aimed to: examine the cultural understandings and impact of injury on people with TBI in Botswana, including problems of a practical, vocational, social and psychological nature. Specifically, in this study I first explored the experiences of brain injury from the perspectives of individuals with TBI, their caregivers, and healthcare professionals. Treatment practices received by individuals with TBI and their caregivers’ experience within the healthcare system and local community were also examined. Second, I explored the beliefs about TBI amongst people who had sustained injury, their families, and healthcare workers involved in their care. I also explored the experiences of family caregivers of people with TBI and examined their psychological functioning. To gather this data, I employed a qualitative mixed-methods approach using semi structured interviews and questionnaires. Participants (people with moderate to severe TBI, caregivers and health care workers) were recruited from the two tertiary hospitals in the two capital cities, Francistown and Gaborone and data from a total of 71 participants were utilised in the studies. Results indicated that assault was a major cause of TBI in Botswana, along with motor vehicle accidents. Participants experienced a range of cognitive, sensory, emotional and behavioural effects of their injuries and they had numerous physical limitations largely consistent with those commonly associated with TBI. These consequences of TBI led to associated ongoing difficulties in areas such as education and employment and social and psychological functioning. Further, the common perceptions of the etiology of TBI among patients and their family caregivers was that TBI was associated with supernatural forces or witchcraft, bad luck, and the will of God. The study also revealed that for many participants, the quality of care received, both in and out of hospital, was low and there was limited knowledge and information provided about TBI, what to expect and how to care for the individual. This appeared to be associated with several factors including insufficient healthcare staff, language barriers, inadequate hospital services, a lack of training, and limited resources. The study further revealed that caregiving in the Botswana context creates a significant burden, for caregivers, with many having difficulty meeting the needs of their injured relatives. Caregivers of participants who were more dependent in activities of daily life tended to be very distressed, experiencing significant levels of depression and anxiety. Other factors that impacted negatively on caregivers’ wellbeing included growing social isolation, financial difficulty and a lack of support from distant relatives and friends. Despite the numerous challenges that caregivers faced, it was clear from this study that Batswana have a strong sense of family and strong community ties as well as faith in God. These mediators had a positive influence on their adjustment and participants with TBI and their families generally coped well and showed immense resilience in the face of adversity. Caregiving therefore resulted in certain reported positive effects for many families and brought families together. This research has highlighted some specific cultural, economic and social factors, which influence the experience of TBI in Botswana. There is clearly a need to improve communication, support and rehabilitation services. In addition to providing valuable feedback in formulating policies, the study findings can potentially contribute to the development of intervention programs at community, district and national levels. The study findings will provide the basis for development of culturally sensitive educational resources for people with TBI, their families and health professionals in Botswana

The 2022 symposium on dementia and brain aging in low‐ and middle‐income countries: Highlights on research, diagnosis, care, and impact

Two of every three persons living with dementia reside in low‐ and middle‐income countries (LMICs). The projected increase in global dementia rates is expected to affect LMICs disproportionately. However, the majority of global dementia care costs occur in high‐income countries (HICs), with dementia research predominantly focusing on HICs. This imbalance necessitates LMIC‐focused research to ensure that characterization of dementia accurately reflects the involvement and specificities of diverse populations. Development of effective preventive, diagnostic, and therapeutic approaches for dementia in LMICs requires targeted, personalized, and harmonized efforts. Our article represents timely discussions at the 2022 Symposium on Dementia and Brain Aging in LMICs that identified the foremost opportunities to advance dementia research, differential diagnosis, use of neuropsychometric tools, awareness, and treatment options. We highlight key topics discussed at the meeting and provide future recommendations to foster a more equitable landscape for dementia prevention, diagnosis, care, policy, and management in LMICs. Highlights: Two‐thirds of persons with dementia live in LMICs, yet research and costs are skewed toward HICs. LMICs expect dementia prevalence to more than double, accompanied by socioeconomic disparities. The 2022 Symposium on Dementia in LMICs addressed advances in research, diagnosis, prevention, and policy. The Nairobi Declaration urges global action to enhance dementia outcomes in LMICs

Dementia in Latin America : paving the way towards a regional action plan

Regional challenges faced by Latin American and Caribbean countries (LACs) to fight dementia, such as heterogeneity, diversity, political instabilities, and socioeconomic disparities, can be addressed more effectively grounded in a collaborative setting based on the open exchange of knowledge. In this work, the Latin American and Caribbean Consortium on Dementia (LAC-CD) proposes an agenda for integration to deliver a Knowledge to Action Framework (KtAF). First, we summarize evidence-based strategies (epidemiology, genetics, biomarkers, clinical trials, nonpharmacological interventions, networking and translational research) and align them to current global strategies to translate regional knowledge into actions with transformative power. Then, by characterizing genetic isolates, admixture in populations, environmental factors, and barriers to effective interventions and mapping these to the above challenges, we provide the basic mosaics of knowledge that will pave the way towards a KtAF. We describe strategies supporting the knowledge creation stage that underpins the translational impact of KtAF

Global Perspectives on Brief Cognitive Assessments for Dementia Diagnosis.

BackgroundTimely diagnosis of dementia is a global healthcare priority, particularly in low to middle income countries where rapid increases in older adult populations are expected.ObjectiveTo investigate global perspectives on the role of brief cognitive assessments (BCAs) in dementia diagnosis, strengths and limitations of existing measures, and future directions and needs.MethodsThis is a qualitative study of 18 dementia experts from different areas of the world. Participants were selected using purposeful sampling based on the following criteria: 1) practicing in countries with projected growth of older adult population of over 100%by 2050; 2) expertise in dementia diagnosis and treatment; 3) involvement in clinical practice and training; and 4) recognition as a national dementia expert based on leadership positions within healthcare system, research, and/or policy work. Participants were individually interviewed in their language of choice over secure videoconference sessions. Interviews were analyzed by a multidisciplinary team using theme identification approach.ResultsFour domains with subthemes emerged illustrating participants' perspectives: 1) strengths of BCAs; 2) limitations of BCAs; 3) needs related to the use of BCAs; and 4) characteristics of an ideal BCA. While most experts agreed that BCAs were important and useful for dementia diagnosis, the themes emphasized the need for development and validation of novel measures that are sensitive, psychometrically sound, and culturally appropriate.ConclusionBCAs are important for guiding diagnosis and care for dementia patients. Findings provide a roadmap for novel BCA development to assist in diagnostic decision making for clinicians serving a rapidly growing and diverse dementia population

Facilitators and Barriers to Dementia Assessment and Diagnosis: Perspectives From Dementia Experts Within a Global Health Context.

ObjectivesDementia poses one of the greatest global health challenges, affecting 50 million people worldwide. With 10 million new cases each year, dementia is a growing burden, particularly in low- and middle-income countries (LMIC). This study aimed to identify the facilitators and barriers to providing quality dementia assessment and care in LMICs from a global health perspective.Methods/designA qualitative semi-structured interview study with 20 dementia expert healthcare providers from 19 countries. To be included, providers had to: practice dementia assessment or care in LMICs where the population over age 60 is projected to more than double by 2050 and be recognized as a leading dementia expert in the region based on position, research publications, and/or policy leadership. Interviews were analyzed by a multidisciplinary team of researchers using thematic analysis.ResultsBarriers to dementia assessment and care included stigma about dementia, poor patient engagement in and access to healthcare, inadequate linguistic and cultural validation, limited dementia capable workforce, competing healthcare system priorities, and insufficient health financing. Facilitators included the rise in dementia awareness campaigns, dementia training for general practitioners, availability of family support and family caregivers, and national and international collaborations including coordinated policy efforts and involvement in international research initiatives.ConclusionsFindings from this study provide insights for prioritizing dementia assessment and care capacity-building in LMICs as a global health priority and for tailored public health approaches to strengthen dementia assessment and care at the individual, community, national, and multi-national levels

Dementia in Africa: Current evidence, knowledge gaps, and future directions

In tandem with the ever-increasing aging population in low and middle-income countries, the burden of dementia is rising on the African continent. Dementia prevalence varies from 2.3% to 20.0% and incidence rates are 13.3 per 1000 person-years with increasing mortality in parts of rapidly transforming Africa. Differences in nutrition, cardiovascular factors, comorbidities, infections, mortality, and detection likely contribute to lower incidence. Alzheimer's disease, vascular dementia, and human immunodeficiency virus/acquired immunodeficiency syndrome-associated neurocognitive disorders are the most common dementia subtypes. Comprehensive longitudinal studies with robust methodology and regional coverage would provide more reliable information. The apolipoprotein E (APOE) ε4 allele is most studied but has shown differential effects within African ancestry compared to Caucasian. More candidate gene and genome-wide association studies are needed to relate to dementia phenotypes. Validated culture-sensitive cognitive tools not influenced by education and language differences are critically needed for implementation across multidisciplinary groupings such as the proposed African Dementia Consortium

Dementia in Africa: Current evidence, knowledge gaps, and future directions

International audienceIn tandem with the ever-increasing aging population in low and middle-income countries, the burden of dementia is rising on the African continent. Dementia prevalence varies from 2.3% to 20.0% and incidence rates are 13.3 per 1000 person-years with increasing mortality in parts of rapidly transforming Africa. Differences in nutrition, cardiovascular factors, comorbidities, infections, mortality, and detection likely contribute to lower incidence. Alzheimer's disease, vascular dementia, and human immunodeficiency virus/acquired immunodeficiency syndrome-associated neurocognitive disorders are the most common dementia subtypes. Comprehensive longitudinal studies with robust methodology and regional coverage would provide more reliable information. The apolipoprotein E (APOE) ε4 allele is most studied but has shown differential effects within African ancestry compared to Caucasian. More candidate gene and genome-wide association studies are needed to relate to dementia phenotypes. Validated culture-sensitive cognitive tools not influenced by education and language differences are critically needed for implementation across multidisciplinary groupings such as the proposed African Dementia Consortium