Experiences of accessing healthcare services by people with hearing loss/impairment (deaf) in sub-Saharan Africa: An integrative review.

PURPOSE: The aim was to review published articles to identify experiences of people with hearing loss/impairment accessing healthcare services in sub-Saharan Africa. DESIGN AND METHOD: The study was guided by Cooper's integrative review methodology. Articles published between 2010 and 2020 were identified through electronic databases. The search included: Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, EBSCOHOST, MEDLINE, and Psyc INFO and using specific search terms. Ninety-one (91) articles were identified and screened for eligibility, and only seven articles were appraised using relevant tools for qualitative and quantitative designs. FINDINGS: The articles that met the inclusion criteria were from the following sub-Saharan countries: Ghana (n = 2) South Africa (n = 3) Uganda (n = 1) and Zimbabwe (n = 1). Review analysis revealed seven (7) major themes categorized as: communication, lack of knowledge, discrimination, financial problem, healthcare workers' attitudes, and a lack of autonomy, security and privacy issues. CONCLUSION: The review provides evidence that indicate the challenges faced by people with hearing loss/impairment in sub-Saharan Africa. Studies suggest that communication, lack of knowledge; financial problems, lack of autonomy and privacy, and a perception of being discriminated against were major impediments in accessing healthcare service. Undesirable attitudes were also a hindrance for healthcare access. CLINICAL RELEVANCE: Communication is a major impediment in accessing healthcare for the hearing impaired people residing in sub-Saharan Africa.

High Levels of Post-Abortion Complication in a Setting Where Abortion Service Is Not Legalized.

BACKGROUND: Maternal mortality due to abortion complications stands among the three leading causes of maternal death in Botswana where there is a restrictive abortion law. This study aimed at assessing the patterns and determinants of post-abortion complications. METHODS: A retrospective institution based cross-sectional study was conducted at four hospitals from January to August 2014. Data were extracted from patients' records with regards to their socio-demographic variables, abortion complications and length of hospital stay. Descriptive statistics and bivariate analysis were employed. RESULT: A total of 619 patients' records were reviewed with a mean (SD) age of 27.12 (5.97) years. The majority of abortions (95.5%) were reported to be spontaneous and 3.9% of the abortions were induced by the patient. Two thirds of the patients were admitted as their first visit to the hospitals and one third were referrals from other health facilities. Two thirds of the patients were admitted as a result of incomplete abortion followed by inevitable abortion (16.8%). Offensive vaginal discharge (17.9%), tender uterus (11.3%), septic shock (3.9%) and pelvic peritonitis (2.4%) were among the physical findings recorded on admission. Clinically detectable anaemia evidenced by pallor was found to be the leading major complication in 193 (31.2%) of the cases followed by hypovolemic and septic shock 65 (10.5%). There were a total of 9 abortion related deaths with a case fatality rate of 1.5%. Self-induced abortion and delayed uterine evacuation of more than six hours were found to have significant association with post-abortion complications (p-values of 0.018 and 0.035 respectively). CONCLUSION: Abortion related complications and deaths are high in our setting where abortion is illegal. Mechanisms need to be devised in the health facilities to evacuate the uterus in good time whenever it is indicated and to be equipped to handle the fatal complications. There is an indication for clinical audit on post-abortion care to insure implementation of standard protocol and reduce complications.

A root-cause analysis of maternal deaths in Botswana: towards developing a culture of patient safety and quality improvement.

BACKGROUND: In 2007, 95% of women in Botswana delivered in health facilities with 73% attending at least 4 antenatal care visits. HIV-prevalence in pregnant women was 28.7%. The maternal mortality ratio in 2010 was 163 deaths per 100,000 live births versus the government target of 130 for that year, indicating that the Millennium Development Goal 5 was unlikely to be met. A root-cause analysis was carried out with the aim of determining the underlying causes of maternal deaths reported in 2010, to categorise contributory factors and to prioritise appropriate interventions based on the identified causes, to prevent further deaths. METHODS: Case-notes for maternal deaths were reviewed by a panel of five clinicians, initially independently then discussed together to achieve consensus on assigning contributory factors, cause of death and whether each death was avoidable or not at presentation to hospital. Factors contributing to maternal deaths were categorised into organisational/management, personnel, technology/equipment/supplies, environment and barriers to accessing healthcare. RESULTS: Fifty-six case notes were available for review from 82 deaths notified in 2010, with 0-4 contributory factors in 19 deaths, 5-9 in 27 deaths and 9-14 in nine. The cause of death in one case was not ascertainable since the notes were incomplete. The high number of contributory factors demonstrates poor quality of care even where deaths were not avoidable: 14/23 (61%) of direct deaths were considered avoidable compared to 12/32 (38%) indirect deaths. Highest ranking categories were: failure to recognise seriousness of patients' condition (71% of cases); lack of knowledge (67%); failure to follow recommended practice (53%); lack of or failure to implement policies, protocols and guidelines (44%); and poor organisational arrangements (35%). Half the deaths had some barrier to accessing health services. CONCLUSIONS: Root-cause analysis demonstrates the interactions between patients, health professionals and health system in generating adverse outcomes for patients. The lessons provided indicate where training of undergraduate and postgraduate medical, midwifery and nursing students need to be intensified, with emphasis on evidence-based practice and adherence to protocols. Action plans and interventions aimed at changing the circumstances that led to maternal deaths can be implemented and re-evaluated.

Male involvement in child care activities: a review of the literature in Botswana.

Engaging men as partners in childrearing is critical because of the positive aspects on the child's development and reduction of childhood illnesses. The paper presents findings from a literature review whose aim was to assess the extent to which males are involved in child care activities. Findings revealed a limited number of studies conducted in the area of male involvement. Sociocultural factors have a negative influence on men's participation on child care activities. In addition, some laws were prohibitive to male involvement. It was difficult to assess the extent to which males were involved due to inadequate data collection tools. Recommendations include a study on male involvement, review of the existing Sexual and Reproductive Health data collection tools, development of a policy on paternity leave, strengthening training on male involvement; community sensitization on cultural stereotypes and harmonization of customary and common laws.

Development and evaluation of an international, interdisciplinary palliative care workshop in Botswana.

AIM: This paper reports the development and evaluation of an interdisciplinary, international palliative care workshop presented in Gaborone, Botswana. METHOD: A 5-day workshop was held in June 2009 at the University of Botswana. Clinicians, faculty, and students from throughout Botswana were invited to attend at no cost. Participants included nurses, social workers, physicians, pharmacists, chaplains and volunteers. Learning activities included lectures, case studies, and group discussion. RESULTS: Evaluation indicated high satisfaction with the workshop and significant, though modest, gains in knowledge and self-evaluation of palliative care skills. Discussion revealed important clinical issues for attendees and underscored the need to coordinate national efforts to enhance palliative care in Botswana. CONCLUSION: The international collaborative palliative care workshop increased the knowledge and commitment of attendees. Additional collaborative efforts to educate providers, coordinate care, and change policies and practices are needed to integrate palliative care fully into health care in Botswana.