Caregiving on the edge: the situation of family caregivers to older persons in Botswana

Little is known about the long-term care of older persons in Africa. In Botswana it is assumed that families care for their elderly relatives. Yet, the African family is undergoing change, due to more women entering the labour force and rural-to-urban migration of young adults in search of better employment opportunities. The purpose of this study was to explore the experiences of family caregivers to older persons in Botswana. A qualitative, grounded-theory methodology was used to interview 24 participants who were caring for an older person. The findings indicate that the caregivers are "living on the edge, as they struggle to meet basic survival needs. Implications of the findings for nursing practice, research and policy that address the plight of the caregivers are discussed

Resilience: Key Factors Associated With Resilience of Older People in Botswana

This study aims to determine key factors that predict resilience in older people. A cross-sectional design and quantitative methods were used for this study. Four districts were selected in Botswana using cluster random sampling. Data on resilience from 378 older adults aged 60 years+ [Mean Age (SD) = 71.1(9.0)] was collected using snowballing technique. Data on socio-demographics, protective and risk factors were also collected from urban and rural areas. CHAID (Chi-squared Automatic Interaction Detection) analysis was used to predict the strengths of the relationships among resilience and all predictor variables because the data were skewed. Five major predictor variables reached significance to be included in the model: depression, QOL, social impairment, education, and whether participants paid for services or accessed free services, along with high self-esteem (p \u3c .001), security, and self-efficacy (p \u3c .05). The presence of depression symptoms (χ2 = 23.7, p = .001, df = 1) and self-esteem (χ2 = 39.6, p \u3c .001) had the greatest influence on resilience. Older people with no depression symptoms but had low QOL still had social impairment (χ2 = 3.9, p \u3c .05). Older people with no depression symptoms had moderate to high QOL but had low resilience as a result of paying for services (χ2 = 7.4, p \u3c .02). Both protective and risk factors had a significant influence on resilience. Knowledge about the predictors of resilience in older people may assist stakeholders devise effective intervention, especially now with COVID-19 ravaging the country. Additionally, policies and programs inclined to assist older people may be established and implemented

Clinical experiences of RN to BScN nursing students in Kenyan universities

Introduction and objective: Clinical learning environments play a great role in nursing training as they allow nursing students to develop their clinical skills by combining cognitive, psychomotor and affective skills. Consequently, clinical learning environments enable nursing students to bridge the theory-practice gap. Fewer studies have examined the clinical experiences of RN to BScN students in Kenya. This paper is part of analytical memo of a larger PhD study that sought to explore and describe the support needs of RN to BScN students in Kenyan universities. The paper focuses on clinical experiences of RN to BScN students. Methods: Using a qualitative phenomenological approach, ten focus group discussions were conducted with 100 RN to BScN students, purposively sampled from four universities in Kenya. Data were analyzed using Tesch’s data analysis protocol. The article has adhered to Consolidated criteria for reporting qualitative studies. Results: The data on RN to BScN students’ clinical experience revealed two themes: curriculum challenges and practice environment and six sub-themes: redundant learning outcomes, redundant clinical assessments, not acknowledging prior learning, lack of clinical supervision, lack of learning resources and “an extra pair of hands”. Conclusions: The study findings highlight the need for review of clinical learning outcomes for the RN to BScN students in Kenya. The findings emphasize the need for collaborative partnerships between universities, clinical learning environments, nurse educators, and policy makers, to design of clinical learning outcomes relevant to RN to BScN students in Kenya

Maternal and newborn care during the COVID-19 pandemic in Kenya: re-contextualising the community midwifery model

Peripartum deaths remain significantly high in low- and middle-income countries, including Kenya. The COVID-19 pandemic has disrupted essential services, which could lead to an increase in maternal and neonatal mortality and morbidity. Furthermore, the lockdowns, curfews, and increased risk for contracting COVID-19 may affect how women access health facilities. SARS-CoV-2 is a novel coronavirus that requires a community-centred response, not just hospital-based interventions. In this prolonged health crisis, pregnant women deserve a safe and humanised birth that prioritises the physical and emotional safety of the mother and the baby. There is an urgent need for innovative strategies to prevent the deterioration of maternal and child outcomes in an already strained health system. We propose strengthening community-based midwifery to avoid unnecessary movements, decrease the burden on hospitals, and minimise the risk of COVID-19 infection among women and their newborns

Introduction of an Advanced Practice Nurse Program in Kenya: A New Era in Nursing Education

Purpose: The purpose of this presentation is to share the intra and interprofessional collaborative process of developing an Advanced Practice Nursing (APN) program to be offered in 2020 in Kenya, a low middle-income country. Methods: Engagement with stakeholders (students, clinicians, regulators and educators) affirmed the need for an APN program. Faculty from Schools of Nursing and Midwifery in three East African countries developed an APN curriculum with input from local and international agencies such as the Nursing Council of Kenya with linkages to the ICN, the Nursing Now Team and partner universities in the UK and USA. The curriculum was reviewed for relevance and cultural sensitivity. Christmals and Crous (2019) noted the importance of contextualizing the APN role to the specific country and healthcare systems. The development of collaborative frameworks between nursing and midwifery, and higher educational councils is important (Muraraneza, Mtshali, and Mukamana, 2017), therefore, feedback from the Council for Higher Education was sought and incorporated. The final document will be sent to external reviewers from partner universities prior to implementation in 2020. Limited resources and opposition from the medical profession have been reported as challenges to APN programs in Sub Saharan Africa (Christmals and Armstrong, 2019). To address these problems, the Liverpool John Moore University, UK, will host a six weeks’ capacity building program for East African faculty who will teach in this program. The program will be also offered in partnership with Family Medicine physicians and pharmacists and this will enhance interprofessional competencies (Monahan, Sparbel, Heinschel, Rugen, and Rosenberger, 2018). A workshop will be held in 2020 to share a common understanding of the program with all collaborative partners. The APN role is evolving globally and there is no consensus on the core competencies and its definition (Heale and Buckley, 2016). Kenya has no scope of practice for APN (East, Arudo, Loefler and Evans, 2014) and one will be developed. Results: An APN curriculum has been developed and is in the final stages of review prior to implementation in 2020. Anticipated challenges have been identified such as lack of resources among others, and strategies have been put in place to mitigate them. Conclusion: An APN program is pivotal to the realization of the Universal Health Coverage (UHC) as graduates of this program will be deployed in primary health care settings. The intra and interprofessional collaboration will strengthen both the program and partnerships (local and global) with mutual benefits for all involved

Knowledge, Attitudes, and Preparedness for Managing Pregnant and Postpartum Women with COVID-19 Among Nurse-Midwives in Kenya

Introduction: Globally, maternal morbidity and mortality have increased during the COVID-19 pandemic. Given the high burden of maternal and neonatal mortality in Kenya prior to COVID-19, front line health workers, including nurse-midwives, must be competent to ensure continued quality maternal services. Knowledge and awareness of COVID-19 transmission influence nurse-midwives risk perception and ability to implement prevention strategies. Objective: We examined nurse-midwives’ knowledge, attitudes, and preparedness in managing pregnant and postpartum women with COVID-19 in Kenya. Methods: A cross-sectional online survey was conducted among 118 nurse-midwives between July 2020 and November 2020. A 31-item survey comprising 15 knowledge, 11 attitude, and five preparedness questions was administered using SurveyMonkey. A link to the survey was distributed among nurse-midwives via email. Multiple logistic regression analysis was used to assess associations between the variables. A p-value \u3c.05 was considered statistically significant. Results: Eighty-five participants were included in the final analysis (response rate 72%). Most participants were female (n = 69, 81.2%), 52.9% (n = 45) worked in labor wards, and 57.6% (n = 49) worked in rural hospitals. Overall, 71% (n = 57) of par- ticipants had sufficient knowledge about managing COVID-19 in pregnant and postpartum women. However, only 63% were willing to receive COVID-19 vaccination. Nurse-midwives working in urban areas were 3.7 times more likely to have positive attitudes than those in rural areas (odds ratio 3.724, 95% confidence interval 1.042–13.31; p = .043). Conclusion: Nurse-midwives’ responses to the Kenyan government’s COVID-19 guidelines for managing and caring for pregnant women were inconsistent. Continued professional development for nurse-midwives is important to ensure they stay abreast of evolving COVID-19 guidelines for maternal health. Our findings also suggest vaccine hesitancy may be a hurdle for ongoing COVID-19 vaccination

Reorienting Nurturing Care for Early Childhood Development during the COVID-19 Pandemic in Kenya: A Review

In Kenya, millions of children have limited access to nurturing care. With the Coronavirus disease 2019 (COVID-19) pandemic, it is anticipated that vulnerable children will bear the biggest brunt of the direct and indirect impacts of the pandemic. This review aimed to deepen understanding of the effects of COVID-19 on nurturing care from conception to four years of age, a period where the care of children is often delivered through caregivers or other informal platforms. The review has drawn upon the empirical evidence from previous pandemics and epidemics, and anecdotal and emerging evidence from the ongoing COVID-19 crisis. Multifactorial impacts fall into five key domains: direct health; health and nutrition systems; economic protection; social and child protection; and child development and early learning. The review proposes program and policy strategies to guide the reorientation of nurturing care, prevent the detrimental effects associated with deteriorating nurturing care environments, and support the optimal development of the youngest and most vulnerable children. These include the provision of cash transfers and essential supplies for vulnerable households and strengthening of community-based platforms for nurturing care. Further research on COVID-19 and the ability of children’s ecology to provide nurturing care is needed, as is further testing of new ideas

The social, mental, and physical health impacts of the COVID-19 pandemic on people with HIV: protocol of an observational International Multisite Study

As the COVID-19 pandemic spread across the world, immunocompromised individuals such as people with HIV (PWH) may have faced a disproportionate impact on their health and HIV outcomes, both from COVID-19 and from the strategies enacted to contain it. Based on the SPIRIT guidelines, we describe the protocol for an international multisite observational study being conducted by The International Nursing Network for HIV Research, with the Coordinating Center based at the University of California, San Francisco (UCSF) School of Nursing. Site Principal Investigators implement a standardized protocol to recruit PWH to complete the study online or in-person. Questions address demographics; HIV continuum of care indicators; mental and social health; COVID-19 and vaccination knowledge, attitudes, behaviors, and fears; and overall outcomes.Results of this study will contribute to knowledge that can inform responses to future public health crises to minimize their impacts on vulnerable populations such as PWH

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Experiences of grandmothers caring for orphan grandchildren in Botswana

Purpose The purpose of the study was to identify the experiences of the grandparents who were taking care of orphan grandchildren in Botswana. Design A descriptive qualitative design was used to interview 12 grandmothers 60 years and older in a semi‐urban village in Botswana. Content analysis was used to analyze the data. Findings The ages of the grandmothers interviewed ranged from 60 to 80 years, while the number of orphans under their care ranged from 1 to 9 years. The themes that emerged included context of caregiving, acceptance of the caregiver role, consequences of caregiving, social support, and coping strategies. Although they accepted the caregiving role and appreciated the government assistance, it was fraught with difficulties. They reported very limited or no support from the extended family, and their health concerns compromised their financial circumstances. Conclusions Although the grandmothers accepted this role, it was described as difficult, and had profound consequences for them. Recommendations include comprehensive support for grandmothers and orphans that include psychological support and health promotion. Clinical Relevance Grandparents are an important support system of orphans in Botswana since there are very few orphanages. In order to support grandparents in this role, community health nurses need to provide comprehensive health promotion for grandmothers caring for orphans that includes support groups and multidisciplinary care teams to ensure that the grandmothers’ health is not neglected. Nurse educators should also include care of grandmothers caring for orphans in their curricula