Prevalence of late antenatal care booking among pregnant women attending public health facilities of Kigamboni Municipality in Dar es Salaam region, Tanzania.

Background: Good care during pregnancy is important for the health of mothers and development of the unborn baby. The study determined the prevalence and factors associated with late ANC booking among pregnant women at health facilities in Kigamboni Municipality in Dar es Salaam, Tanzania. Methods: This was an analytical cross-sectional study among pregnant women attending ANC services during second and third trimester in the selected health facilities. The study recruited 204 through convenient sampling. Multi-stage cluster sampling was used to select health facilities. A Standardised questionnaire was used to collect information through face-to-face interviews. Data was analysed using SPSS version 25.0. Proportions were used to estimate the magnitude of late ANC booking while bivariate and multivariate analyses were performed to determine factors associated with the magnitude of late ANC booking. Results: Late ANC bookings were high 174 (85.3%) among pregnant women who attended clinic week 13 and later compared to those who attended earlier than 13 weeks 30 (14.7%). Factors associated with likelihood for late ANC booking during the initial visit included tertiary education [AOR= 10.174, 95%CI: 1.002-103.301] and primigravida [AOR=0.101, 95%CI: 0.170-0.605]. Conclusion: Majority of the pregnant women started ANC later than the recommended time. Health education provision at all community levels on the advantages and disadvantages of early and late ANC booking respectively should be strengthened.

Comparison on treatment outcomes of patients enrolled on anti-retroviral therapy at different levels of the health-care system in a high HIV/AIDS setting.

HIV/AIDS prevalence in Botswana is amongst the highest in the world and remains a significant public health problem. however, the introduction of anti-retroviral therapy (ART) lead to a significant reduction in morbidity and mortality. Decentralization of anti-retroviral therapy has improved access to treatment for people living with HIV. Treatment outcomes for patient initiated on treatment at different levels of care is unknown and this study seeks to compare treatment outcomes of patients enrolled on ART at different levels of the health care. This is a retrospective cross-sectional study that included review of data from January 2017 to December 2018. The study was conducted in 2 health districts in the country. Nine hundred and sixty (960) patient's record were included in analysis. More than half (63%) of patients were enrolled at primary care level while 37% were at tertiary level. Sixty one percent (n = 587) were female while 39% (n = 373) were males. There were no statistically significant differences in viral load suppression after 12 months of treatment between patients enrolled at tertiary level and primary care level, x2 = 0.75, p value = 0.56. Time to initiation was longer at tertiary (median = 126) compared to primary are level (median = 18), p < 0.001. We reccommend further decentralization of ART services to lower levels of the health care system to initiate PLWHIV early on treatment and improve their health outcomes and reduce transmission through treatment by prevention.

The Impact of China's Lockdown Policy on the Incidence of COVID-19: An Interrupted Time Series Analysis.

BACKGROUND: Policy changes are often necessary to contain the detrimental impact of epidemics such as those brought about by coronavirus disease (COVID-19). In the earlier phases of the emergence of COVID-19, China was the first to impose strict restrictions on movement (lockdown) on January 23rd, 2020. A strategy whose effectiveness in curtailing COVID-19 was yet to be determined. We, therefore, sought to study the impact of the lockdown in reducing the incidence of COVID-19. METHODS: Daily cases of COVID-19 that occurred in China which were registered between January 12th and March 30th, 2020, were extracted from the Johns Hopkins CSSE team COVID-19 ArcGIS® dashboards. Daily cases reported were used as data points in the series. Two interrupted series models were run: one with an interruption point of 23 January 2020 (model 1) and the other with a 14-day deferred interruption point of 6th February (model 2). For both models, the magnitude of change (before and after) and linear trend analyses were measured, and ß-coefficients reported with 95% confidence interval (CI) for the precision. RESULTS: Seventy-eight data points were used in the analysis. There was an 11% versus a 163% increase in daily cases in models 1 and 2, respectively, in the preintervention periods (p ≤ 0.001). Comparing the period immediately following the intervention points to the counterfactual, there was a daily increase of 2,746% (p < 0.001) versus a decline of 207% (p = 0.802) in model 2. However, in both scenarios, there was a statistically significant drop in the daily cases predicted for this data and beyond when comparing the preintervention periods and postintervention periods (p < 0.001). CONCLUSION: There was a significant decrease the COVID-19 daily cases reported in China following the institution of a lockdown, and therefore, lockdown may be used to curtail the burden of COVID-19.

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' involvement; and prioritising EMOC in-service training are necessary in reducing the national maternal mortality.

Gaps, Challenges, and Opportunities for Global Health Leadership Training.

Background: Global Health Leadership (GHL) programs are essential for training emerging health care professionals to be effective leaders. Synthesizing knowledge acquired through experience implementing GHL programs can inform future recommendations for GHL. Objective: To describe the lessons learned, highlighting gaps, challenges and opportunities, during implementation of two GHL capacity building programs, namely the Afya Bora Consortium Fellowship in Global Health Leadership and the Sustaining Technical and Analytic Resources (STAR) fellowship and internship program for global health professionals. Methods: A mixed methods case-comparison study was conducted, using qualitative data (expert opinion) collected from the Program Directors in order to understand the experiences of the two GHL programs. A structured response guide was used to assess the overall experience in GHL program implementation, operational challenges and reported gaps. Afya Bora and STAR have been implemented for 8 and 2.5 years respectively. Thus, the analysis reflects a snapshot of the two programs at different stages. Findings: The results reflect knowledge gained through extensive experience in implementing the two GHL programs. Afya Bora has trained 188 multi-disciplinary fellows, and 100% of the African fellows are engaged in leadership positions in government departments and non-governmental organizations (NGOs) in their countries. STAR has placed 147 participants (89 fellows and 58 interns) in more than 25 countries globally. Both programs were successful in strengthening south-south and north-south collaborations for a common goal of improving global health. Implementation of both fellowships identified room for improvement in operational procedures and financing of the programs, and highlighted knowledge and skills gaps, as well as challenges in sustainability of the training programs. Conclusions: Afya Bora and STAR have had significant impact and have contributed to changing the leadership landscape in global health. Future GHL programs should address sustainability in terms of financing, delivery modalities and domestic integration of knowledge.

Training Curriculum, Skills, and Competencies for Global Health Leaders: Good Practices and Lessons Learned.

Objectives: This paper aims to depict unique perspectives and to compare and contrast three leadership programs for global health in order to enable other training institutions to design impactful curricula. Methods: We purposively selected three global health training programs. We used a six-step curriculum development framework to systematically compare the curriculum process across programs and to identify best practices and factors contributing to the impact of each of these programs. Findings: All three fellowship programs undertook an intentional and in-depth approach to curriculum development. Each identified competencies related to leadership and technical skills. Each defined goals, though the goals differed to align with the desired impact of the program, ranging from improving the impact of HIV programming, supporting stronger global health program implementation, and supporting the next generation of global health leaders. All programs implemented the curriculum through an onboarding phase, a delivery of core content in different formats, and a wrap-up or endline phase. During implementation, each program also utilized networking and mentoring to enhance connections and to support application of learning in work roles. Programs faced overlapping challenges and opportunities including funding, strengthening partnerships, and finding ways to engage and support alumni. Conclusions: Local ownership of programs is critical, including tailoring curricula to the needs of specific contexts. Strong partnerships and resources are needed to ensure program sustainability and impact. Key Takeaways: Global health competencies and curricula should be linked to local health system needs and contexts where learners are working.Emphasizing both individualistic and collectivist approaches to learning is important in engaging and supporting diverse global health learners.Emphasizing mentorship and opportunities to apply learning in contexts where learners are working is important in order to provide support to learners as they work to integrate what they are learning into their professional roles and activities.Partnerships and resources-including donor support-are essential to implement and sustain robust leadership curricula and to provide opportunities for experiential and didactic learning.

Developing a trauma registry in a middle-income country - Botswana.

BACKGROUND: Botswana has a large burden of disease from injury, but no trauma registry. This study sought to design and pilot test a trauma registry at two hospitals. METHODS: A cross sectional study was piloted at a tertiary hospital and a secondary level hospital in Botswana. The study consisted of two stages: stage 1 - stakeholders' consultation and trauma registry prototype was designed. Stage 2 consisted of two phases: Phase I involved retrospective collection of existing data from existing data collection tools and Phase II collected data prospectively using the proposed trauma registry prototype. RESULTS: The pre-hospital road traffic accident data are collected using hard copy forms and some of these data were transferred to a stand-alone electronic registry. The hospital phase of road traffic accident data all goes into hard copy files then stored in institutional registry departments. The post-hospital data were also partially stored as hard copies and some data are stored in a stand-alone electronic registry. The demographics, pre-hospital, triage, diagnosis, management and disposition had a high percent variable completion rate with no significant difference between phases I and II. However, the primary survey variables in Phase I had a low percent variable completion rate which was significantly different from the high completion rates in phase II at both hospitals. A similar picture was observed for the secondary survey at both hospitals. CONCLUSION: Electronic trauma registries are feasible and data completion rate is high when using the electronic data registry as opposed to data collected using the existing paper-based data collection tools.

Applying the Haddon matrix conceptual model to guide motor vehicle crash injury research and prevention in Botswana.

INTRODUCTION: Little literature addresses the burden of injury in Botswana, including trauma from motor-vehicle crashes (MVCs). In response, the University of Botswana and the Botswana Ministry of Health and Wellness are collaborating with the University of Pennsylvania to enhance injury and trauma research capacity in Botswana. Here we describe this training program and a research exercise to identify opportunities to prevent, through future research and countermeasures, MVCs specifically in Botswana. METHODS: We initiated a mixed-methods study during a training module during the first two years of the program. The module introduced the Haddon matrix as a conceptual framework, and asked trainees to identify host, vector, and physical/social environment risk factors for MVCs that, if targeted, may lead to primary, secondary, or tertiary prevention. We conducted 10 photovoice elicitation interviews; results were thematically analyzed to further elucidate the context of MVCs in Botswana and potential countermeasures. RESULTS: Our process identified a range of ideas as barriers or facilitators to MVC prevention. The most commonly cited barriers were animals on the road, drunk or reckless driving, poor road quality, lack of road signs/traffic signals to orient drivers, and poor visibility (e.g., no street lighting; poor lighting on vehicles). Regarding primary prevention, participants identified features prior to the crash, across all matrix levels, as influencers of crashes in Botswana. Among these, several human factors (i.e., over-speeding; drunk driving) and environmental factors (i.e., livestock on road) were commonly mentioned as contributors to MVCs, as were cattle gates and traffic calming measures for prevention. CONCLUSION: Results of the Haddon matrix exercise proved useful for training burgeoning Batswana researchers to think conceptually about the occurrence of MVCs in Botswana and think creatively about targeting countermeasures for prevention. The exercise resulted in potential research questions for the trainees to pursue in mentored research of their own.

Transition of adolescents with intellectual disability from schools for learners with special educational needs: Parents views for the preparedness.

BACKGROUND: Studies on preparedness of parents of adolescents living with intellectual disabilities transitioning from school to adulthood are scarce in sub-Saharan Africa. This study explored views of parents on their preparedness to handle adolescents transitioning from special schools to adulthood. METHODS: Descriptive qualitative method was used to collect views of parents of adolescents with intellectual disability on their preparedness to handle transition of their children from school into community life. Content analysis was used to analyse the data. FINDINGS: Twelve female and two male participants expressed concerns on lack of transition plans, adolescent's future, culture and beliefs and inadequate community support. Views of parents of younger children and those of parents of older children were similar. CONCLUSION: Parents were unprepared for transition of their children from school to community life. Multidisciplinary approach including family involvement and community support is necessary to enhance the transition of adolescents with intellectual disability.

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

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.

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 & 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.

Antimicrobial utilization research and activities in Botswana, the past, present and the future.

A number of activities are ongoing to reduce AMR in Botswana by improving antimicrobial utilization across all sectors. However, there is a need to share experiences. With the objective of sharing these, the second one day symposium was held in the University of Botswana in October 2018 involving both private and public hospitals. In Lenmed Bokamoso hospital, ESKAPE organisms were associated with 50-90% of clinical infections; however, there was no correlation between healthcare associated infections (HAIs) and admission swab positivity with ESKAPE or ESBL isolates. Hang times, the time between a prescription and IV administration, were also discussed. At Nyangabwe Hospital, the prevalence of HAIs was 13.54%, 48.9% were laboratory confirmed of which 8.5% were blood stream infections (BSIs). The prevalence of different bacteria causing neonatal BSIs was also investigated. At Princess Marina Hospital, positive cultures were seen in 22.4% of blood cultures with contaminants comprising the majority. Several activities are ongoing in Botswana across sectors as a result of the findings and will be periodically reported to further improve antibiotic utilization.

Perceptions and attitudes towards acceptability of HIV self-testing among female sex workers in Selibe Phikwe, Botswana.

Background: Sub-Saharan Africa accounts for 71% of the global burden of HIV infection. For the general population of Botswana, the estimated HIV prevalence is 18.5%; for female sex workers it is 61.9%. This study explored and documented female sex workers' perceptions and attitudes towards the acceptability of HIV self-testing in Selibe Phikwe, north-eastern Botswana. Methods: Purposive convenience sampling and snowballing approaches were used to recruit 17 participants into the study which was carried out in collaboration with a community-based organisation, the Silence Kills Support Group. Two focus group discussions and five in-depth interviews were conducted. Information was collected on female sex workers' awareness of HIV self-testing, their willingness to use it, their preferred distribution model, and their preferred test kit. Themes and subthemes that emerged were interpreted based on the Integrated Behavioural Model. Results: HIV self-testing (HIVST) was not known to most participants. Participants expressed negative attitude towards HIVST due to a lack of knowledge and confidence to carry out self-testing independently. Participants preferred facility-based services and a blood test over HIVST. Inadequate post-test counselling and lack of assisted HIVST were among their major concerns. Raising community awareness of HIVST through education was suggested. Conclusion: Improving the uptake of HIVST will require community sensitization, the availability of counselling services, close follow-ups, and the introduction of assisted HIVST approaches.

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.

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.

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

Perceptions of adolescents and teachers on school-based sexuality education in rural primary schools in Uganda.

BACKGROUND: Evidence-based sexuality education programmes are a cornerstone in reducing adolescent sexual risk behaviours and promoting sexual health. Several initiatives aimed at reducing sexual and reproductive problems among adolescents have been done. These initiatives include life skill education and abstinence program. Despite these initiatives teen pregnancy, sexually transmitted diseases and abortion are still common among school going adolescents. OBJECTIVES: The purpose of this study was to explore the experiences and perceptions of adolescents and teachers regarding school-based sexuality education in rural primary schools. METHODS: A purposive sample was drawn from primary school-going adolescents aged 12-16 years and teachers aged 28-52 in four rural schools. Eleven audio taped individual interviews and eight focus group discussions were used to collect data. A constant comparison method of data analysis was applied by following the Strauss and Corbin (1998) analysis process of open, axial and selective coding to analyse textual qualitative data until themes, categories and sub-categories were identified and developed. RESULTS: Data analysis revealed that adolescents benefitted from School Based Sexuality Education but the implementation of programmes was undermined by physical and contextual factors such as challenges at national, institutional, community, family and individual levels. CONCLUSION: It is vital to review the teaching and learning resources and to fully integrate sexuality education into the formal school curriculum. A combined effort of major stakeholders including teachers, community leaders, adolescents, healthcare professionals and parents is needed for sexuality education among adolescents to succeed.

Ongoing initiatives to improve the use of antibiotics in Botswana: University of Botswana symposium meeting report.

BACKGROUND AND OBJECTIVE: There are ongoing initiatives in Botswana to enhance appropriate antibiotic use. The objective of this meeting was to discuss ongoing initiatives in Botswana since February 2016 to improve antibiotic use. Subsequently, use the findings to refine national and local action plans. METHOD: Presentation and review of ongoing initiatives. RESULTS: There was a high rate of antibiotic prescribing among ambulatory care patients in the public sector (42.7%) as well as for patients with upper respiratory tract infections in the private sector (72.9%). Prophylactic antibiotics were given to 73.3% of surgical patients to reduce surgical site infections (SSIs) in a leading tertiary hospital in Botswana; however, SSIs at 9% of patients can be reduced further with better timing of antibiotic prophylaxis. To date, 711 patients have been enrolled into the national point prevalence study. Highlighted concerns included limited ordering and use of sensitivity tests despite functional laboratories, as well as concerns with missed doses of antibiotics across most hospitals. CONCLUSION: A number of issues and concerns regarding antibiotic use were highlighted. Activities are ongoing across sectors to address identified concerns.