Communities In Botswana Research Articles

Social, environment and climate change impacts on vector-borne diseases in arid areas of southern Africa

Social, institutional and environmental determinants of health have a major influence on the epidemiology of vector-borne diseases. This is exacerbated by climate change. We assessed the influence of these factors on malaria and bilharzia in vulnerable communities in Botswana, South Africa and Zimbabwe with a view to develop stakeholder-driven adaptation strategies. We adopted an ecohealth approach. Quantitative and qualitative data was collected through community and household surveys, epidemiological surveys, GIS and Remote Sensing tools and participatory rural appraisal workshops. Burden of malaria at one study location was very high in 2011 (218 DALYs) but reduced over years to 0.21 in 2015. An average of 8 working and 8 school days were lost due to malaria. We demonstrated the value of using the maxent model to determine snail habitat suitability with small data of presence-only sampling sites thus providing useful information for local bilharzia control programmes. Distance of homestead from piped water collection points, distance from open water sources, religion and toilet use were key determinants of a child being infected with bilharzia. Communities were aware of malaria and bilharzia and how the diseases may be influenced by climate factors. However, knowledge on transmission of the diseases was limited thus compromising community capacity to adequately adapt. Communities claimed that they could predict rainfall based on indicators such as insect and animal behavior and abundance of plants. Engagement between the communities and researchers was very high. Both bilharzia and malaria are public health problems at the study sites but their severity is variable as different control measures have been effected. Factors influencing transmission of the diseases and how climate change may exacerbate the problem were identified and have formed the basis for formulating community adaptation strategies.

Conservation of indigenous plants to support community livelihoods: the MGU – Useful Plants Project

Through the MGU – Useful Plants Project (2007–2015) led by the Royal Botanic Gardens Kew, high-quality seed collections and research information have been gathered on useful indigenous plants selected by communities in Botswana, Kenya, Mali, South Africa, and Mexico. Local communities were trained in seed conservation, plant propagation, and planting activities, while revenue generation was promoted directly through the sustainable use of plants and plant products and indirectly through wider environmental and cultural services. The success of this project was determined by its participative approach, involving local communities in plant conservation activities and using plant research to support it. However, the promotion of sustainable use and income generation highlighted issues that confirmed the importance of using a ‘holistic approach’ to address the objective of poverty reduction and contribute to improved livelihoods in the communities.

Protocol for a population-based molecular epidemiology study of tuberculosis transmission in a high HIV-burden setting: the Botswana Kopanyo study

IntroductionMycobacterium tuberculosis (Mtb) is transmitted from person to person via airborne droplet nuclei. At the community level, Mtb transmission depends on the exposure venue, infectiousness of the tuberculosis (TB) index...

Triggering the decision to undergo medical male circumcision: a qualitative study of adult men in Botswana

ABSTRACTIn 2007, the World Health Organization endorsed voluntary medical male circumcision (VMMC) as part of comprehensive HIV-prevention strategies. A major challenge facing VMMC programs in sub-Saharan Africa remains demand creation; there is urgent need for data on key elements needed to trigger the decision among eligible men to seek VMMC. Using qualitative methods, we sought to better understand the circumcision decision-making process in Botswana related to VMMC. From July to November 2013, we conducted 27 focus group discussions in four purposively selected communities in Botswana with men (stratified by circumcision status and age), women (stratified by age) and community leaders. All discussions were facilitated by a trained same-sex interviewer, audio recorded, transcribed and translated to English, and analyzed for key themes using an inductive content analytic approach. Improved hygiene was frequently cited as a major benefit of circumcision and many participants believed that cleanliness was directly responsible for the protective effect of VMMC on HIV infection. While protection against HIV was frequently noted as a benefit of VMMC, the data indicate that increased sexual pleasure and perceived attractiveness, not fear of HIV infection, was an underlying reason why men sought VMMC. Data from this qualitative study suggest that more immediate benefits of VMMC, such as improved hygiene and sexual pleasure, play a larger role in the circumcision decision compared with protection from potential HIV infection. These findings have immediate implications for targeted demand creation and mobilization activities for increasing uptake of VMMC among adult men in Botswana.

Assessing girls' HIV vulnerability: evidence from Botswana, Malawi and Mozambique.

Past research documents multiple factors associated with girls' susceptibility to human immunodeficiency virus transmission; yet a literature review found no systematic approach to measure vulnerability. This study characterized, developed and tested a set of indicators to measure girls' vulnerability, resulting in the vulnerable girls index (VGI). A quasi- experimental, separate-sample pre-/post-test design was used to test the index. Adolescent girls were randomly drawn for the pre-test (2277 respondents) and post-test (1418 respondents) from 16 purposively selected communities in Botswana, Malawi and Mozambique. The higher the VGI score-or the more vulnerable the girl-the more likely she was to report premarital sexual experience across the three countries and the more likely she was to report low agency to insist upon condom use in Botswana and Mozambique. The VGI can be used to assess girls' vulnerability levels across time and space for policy and programme planning purposes, and as part of programme evaluations.

Community Support and Adolescent Girls' Vulnerability to HIV/AIDS: Evidence From Botswana, Malawi, and Mozambique.

Girls are vulnerable to HIV in part because the social systems in which they live have failed to support and protect them. The goal of this research was to develop a viable supportive community index and test its association with intermediate variables associated with HIV risk across 16 communities in Botswana, Malawi, and Mozambique. This cross-sectional survey with separate samples randomly drawn in each country (2010) yielded a total sample of 1,418 adolescent girls (aged 11-18). Multilevel, multivariate logistic regression, while controlling for vulnerability, age, religion, and residence, found that an increase in supportive community index is positively associated with the odds of indicating improved community support for girls and with the confidence to refuse unwanted sex with a boyfriend across the three countries, as well as with self-efficacy to insist on condom use in Botswana and Mozambique. Program implementers and decision makers alike can use the supportive community index to identify and measure structural factors associated with girls' vulnerability to HIV/AIDS; this will potentially contribute to judicious decision making regarding resource allocation to enhance community-level, protective factors for adolescent girls.

Factors that influence support for community-based ecotourism in the rural communities adjacent to the Kgalagadi Transfrontier Park, Botswana

Community-based tourism (CBE) has become an important livelihood option for rural communities in Botswana. The growth of CBE has been facilitated via community-based natural resources management initiatives that have yielded positive and tangible benefits to some regions more than others. The south-western region of the country lacks the level of tourism development of other areas, but has the opportunity to capitalise via CBE based on Kgalagadi Transfrontier Park area. Given the paucity of information and research on CBEs in the region, there is a dire need for additional baseline data. This study empirically explored knowledge, concern, perceptions of and support for CBE among residents living adjacent to the Transfrontier Park. Data were collected via a semi-structured questionnaire among 746 households in 9 villages. Results highlight the diverse array of factors that were likely to influence residents' perception and support of CBE development in the area. In addition to descriptive analysis, two models were tested via hierarchical regression to examine the factors that influence residents' support for CBE development. Overall, four independent variables were important predictors of residents' CBE support with environmental being the most important factor followed by economic, socio-cultural, and knowledge of ecotourism. This study contributes to the emerging literature in the region, as well as assists policy-makers, planners, and other stakeholders with respect to what should be considered when assessing the communities for CBE development.

A survey of risk factors associated with hypertension in the adult population of Kang, Kgalagadi North, Botswana

Background: Sustainable and aggressive population-based programmes on hypertension awareness, prevention, treatment and control are key to the successful control of this epidemic. The objective of the study was to determine to what extent hypertension and risk factors for its development were prevalent in the Kang village community in Botswana, and specifically to assess its prevalence in the adult population and its relationship with high blood pressure, anthropometric measures and lifestyle factors, i.e. diet and the use of tobacco products and alcohol.Method: A population-based cross-sectional study was conducted on 161 adult residents of Kang aged 18 years and older from November to December 2008. A questionnaire adapted from the World Health Organization stepwise approach to the surveillance of chronic disease was used for the data collection. Results: The prevalence of hypertension in the adult population of Kang was found to be 32% (95% confidence interval: 25-40). There was no significant sex difference in the prevalence rate in men (28%) versus women (34%), (p = 0.59). Hypertension was more prevalent in the overweight group than in the normal-weight group (p = 0.3), in the obese group than in the normal-weight group (p = 0.002), and in the obese group than in the overweight group (p = 0.04). Conclusion: This study showed that hypertension affected almost a third of the adult population of Kang, and was significantly associated with overweight and obesity.

Safe male circumcision in Botswana: Tension between traditional practices and biomedical marketing

Botswana has been running Safe Male Circumcision (SMC) since 2009 and has not yet met its target. Donors like the US Centers for Disease Control and Prevention and Africa Comprehensive HIV/AIDS Partnership (funded by the Gates Foundation) in collaboration with Botswana's Ministry of Health have invested much to encourage HIV-negative men to circumcise. Demand creation strategies make use of media and celebrities. The objective of this paper is to explore responses to SMC in relation to circumcision as part of traditional initiation practices. More specifically, we present the views of two communities in Botswana on SMC consultation processes, implementation procedures and campaign strategies. The methods used include participant observation, in-depth interviews with key stakeholders (donors, implementers and Ministry officials), community leaders and men in the community. We observe that consultation with traditional leaders was done in a seemingly superficial, non-participatory manner. While SMC implementers reported pressure to deliver numbers to the World Health Organization, traditional leaders promoted circumcision through their routine traditional initiation ceremonies at breaks of two-year intervals. There were conflicting views on public SMC demand creation campaigns in relation to the traditional secrecy of circumcision. In conclusion, initial cooperation of local chiefs and elders turned into resistance.

A survey of risk factors associated with hypertension in the adult population of Kang, Kgalagadi North, Botswana

Background: Sustainable and aggressive population-based programmes on hypertension awareness, prevention, treatment and control are key to the successful control of this epidemic. The objective of the study was to determine to what extent hypertension and risk factors for its development were prevalent in the Kang village community in Botswana, and specifically to assess its prevalence in the adult population and its relationship with high blood pressure, anthropometric measures and lifestyle factors, i.e. diet and the use of tobacco products and alcohol.Method: A population-based cross-sectional study was conducted on 161 adult residents of Kang aged 18 years and older from November to December 2008. A questionnaire adapted from the World Health Organization stepwise approach to the surveillance of chronic disease was used for the data collection.Results: The prevalence of hypertension in the adult population of Kang was found to be 32% (95% confidence interval: 25-40). There was no significant sex difference in the prevalence rate in men (28%) versus women (34%), (p = 0.59). Hypertension was more prevalent in the overweight group than in the normal-weight group (p = 0.3), in the obese group than in the normal-weight group (p = 0.002), and in the obese group than in the overweight group (p = 0.04).Conclusion: This study showed that hypertension affected almost a third of the adult population of Kang, and was significantly associated with overweight and obesity.

PGIS Based Land Information Mapping and Map Updating to Support Rural Community Knowledge Building

AbstractThis paper outlines an approach developed to assist a rural community in Botswana to utilise Geographic Information Systems (GIS) to compile and update a village land parcels dataset. The work is based on a PhD research work which was carried out at a remote rural village, where participatory action research was employed. Participation is defined as learning and the Participatory Geographic Information Science (PGIS) framework was considered to be appropriate. The contention here is that community learning is a pre‐condition for successful implementation of human development interventions. The PGIS activity itself served mainly to anchor the learning of the creation of the database, the construction of knowledge and its contribution to improve individual household livelihoods. The rationale here is that the database design process can be devolved to ordinary language so that the attention is drawn more to the subsequent use of the data rather than to its compilation. Therefore the PGIS was envisaged as interacting objects and people, relations among them and the role of the containing space. It was also anticipated that in the process, the information would be conversed and the knowledge perceived, constructed and conceived. The basic essence of the PGIS approach was to use georeferenced digital colour aerial photographs and on screen digitizing (OSD) to create land parcels vectors and use the plotted land parcels as references to update the village plot layouts by measuring and scaling in the missing plots at the field. The GIS based mapping was preceded by entry and collaborative team building processes and basic training in computing, business process modeling, business calculations and business planning. This was followed by social survey focused on the poor and struggling members of the community. The produced PGIS artifact served to be the sink for all the produced data. The early conclusion that was drawn was that the PGIS serves as an effective instrument to help a rural community to create and construct knowledge and to strike the link with the political institutions that are intended to support citizens to improve their living standards.

Estimated age and gender profile of individuals missed by a home-based HIV testing and counselling campaign in a Botswana community.

IntroductionIt would be useful to understand which populations are not reached by home-based HIV-1 testing and counselling (HTC) to improve strategies aimed at linking these individuals to care and reducing rates of onward HIV transmission.MethodsWe present the results of a baseline home-based HTC (HBHTC) campaign aimed at counselling and testing residents aged 16 to 64 for HIV in the north-eastern sector of Mochudi, a community in Botswana with about 44,000 inhabitants. Collected data were compared with population references for Botswana, the United Nations (UN) estimates based on the National Census data and the Botswana AIDS Impact Survey IV (BAIS-IV). Analyzed data and references were stratified by age and gender.ResultsA total of 6238 age-eligible residents were tested for HIV-1; 1247 (20.0%; 95% CI 19.0 to 21.0%) were found to be HIV positive (23.7% of women vs. 13.4% of men). HIV-1 prevalence peaked at 44% in 35- to 39-year-old women and 32% in 40- to 44-year-old men. A lower HIV prevalence rate, 10.9% (95% CI 9.5 to 12.5%), was found among individuals tested for the first time. A significant gender gap was evident in all analyzed subsets. The existing HIV transmission network was analyzed by combining phylogenetic mapping and household structure. Between 62.4 and 71.8% of all HIV-positive individuals had detectable virus. When compared with the UN and BAIS-IV estimates, the proportion of men missed by the testing campaign (48.5%; 95% CI 47.0 to 50.0%) was significantly higher than the proportion of missed women (14.2%; 95% CI 13.2 to 15.3%; p<0.0001). The estimated proportion of missed men peaked at about 60% in the age group 30 to 39 years old. The proportions of missed women were substantially smaller, at approximately 28% within the age groups 30 to 34 and 45 to 49 years old.ConclusionsThe HBHTC campaign seems to be an efficient tool for reaching individuals who have never been tested previously in southern African communities. However, about half of men from 16 to 64 years old were not reached by the HBHTC, including about 60% of men between 30 and 40 years old. Alternative HTC strategies should be developed to bring these men to care, which will contribute to reduction of HIV incidence in communities.

A Case Study Evaluation of the Training Gaps among Palliative Caregivers in Botswana Community Home Based Care Programs (CHBC)

The aim of the present research is to evaluate the training gaps and challenges within the Botswana community home based care programs exemplified by an empirical case study. The study used qualitative paradigm; was exploratory in nature and used case study design; and entailed interviewing 82 palliative primary caregivers in 10 focus groups and five CHBC nurses on one-to-one in-depth interviews. An interview guide served as a data collection instrument for both the focus groups and the interviews. Findings indicated an array of training gaps and challenges such as: lack of a caregiver training arrangement in the CHBC program; inadequate training of the caregivers; caregivers' inadequate skills in handling and disposal of clinical waste; complaints of primary caregivers being discriminated in training in favour of for community caregivers. The CHBC program needs: a comprehensive caregiver training to increase caregivers' understanding of the care giving field generally; training of caregivers on gender mainstreaming, self-care, management of clinical waste, and in income generating activities. Balancing training opportunities between the palliative primary caregivers and community palliative caregivers (volunteers) has been found critical.

Impact of sampling density on the extent of HIV clustering.

Identifying and monitoring HIV clusters could be useful in tracking the leading edge of HIV transmission in epidemics. Currently, greater specificity in the definition of HIV clusters is needed to reduce confusion in the interpretation of HIV clustering results. We address sampling density as one of the key aspects of HIV cluster analysis. The proportion of viral sequences in clusters was estimated at sampling densities from 1.0% to 70%. A set of 1,248 HIV-1C env gp120 V1C5 sequences from a single community in Botswana was utilized in simulation studies. Matching numbers of HIV-1C V1C5 sequences from the LANL HIV Database were used as comparators. HIV clusters were identified by phylogenetic inference under bootstrapped maximum likelihood and pairwise distance cut-offs. Sampling density below 10% was associated with stochastic HIV clustering with broad confidence intervals. HIV clustering increased linearly at sampling density >10%, and was accompanied by narrowing confidence intervals. Patterns of HIV clustering were similar at bootstrap thresholds 0.7 to 1.0, but the extent of HIV clustering decreased with higher bootstrap thresholds. The origin of sampling (local concentrated vs. scattered global) had a substantial impact on HIV clustering at sampling densities ≥10%. Pairwise distances at 10% were estimated as a threshold for cluster analysis of HIV-1 V1C5 sequences. The node bootstrap support distribution provided additional evidence for 10% sampling density as the threshold for HIV cluster analysis. The detectability of HIV clusters is substantially affected by sampling density. A minimal genotyping density of 10% and sampling density of 50-70% are suggested for HIV-1 V1C5 cluster analysis.

Why We Drop Out of School: Voices of San School Dropouts in Botswana

Among San communities in Botswana, the rate of student disengagement from both primary and junior secondary school is an ongoing concern for educators. San learners leave school at all levels of primary and junior secondary education. Students who leave school have tended not to provide reasons as to why they are dropping out. This study investigated some of the reasons why San learners decided to drop out at primary and junior secondary school levels in the Central District in Botswana. In-depth interviews were undertaken with 20 former students living in five cattle-posts where the participants worked as cattle herders. The results indicate that some San drop out of school for reasons of survival, both within and outside school. The findings of the study offer insights into some of the issues that impede students within San communities in achieving their educational goals. Further, the findings could assist educational authorities in their review of current educational practices in Botswana so that that all citizens can be appropriately accommodated within the education system.

An exploratory analysis of community-based disability workers’ potential to alleviate poverty and promote social inclusion of people with disabilities in three Southern African countries

This article draws on accounts by community-based disability workers (CDWs) of their life and work experiences in resource-limited rural communities in Botswana, Malawi and South Africa. Using the World Health Organisation’s community-based rehabilitation (CBR) matrix and the United Nations’ Millennium Development Goals as analytic frameworks, the article explores CDWs’ potential to contribute to improving the lives and increasing the levels of social, economic and political inclusion of people with disabilities, their families and communities. The article argues that CDWs’ knowledge, experience and understanding of disability in resource-limited communities may constitute an important local resource for helping to address the inter-related effects of poverty and disability in developing countries.

A community survey of cardiovascular risk factors in an urban population in Botswana exploring potential for telemedicine

Summary Background This paper reports the findings of a pilot study undertaken in Gaborone, Botswana to investigate the feasibility of using screening to address hypertension. An international research team, consisting of members of the University of Melbourne, Australia, and the Institut de neurologie tropicale, Limoges, France, collaborated with researchers from the University of Botswana, Botswana, to develop the pilot study. Methods Sampling of inhabitants was carried out from consecutive households from the central location of the local Bontleng Health Clinic. Eligible participants were 18 years and over, present during data collection, and able to participate in a short questionnaire and physical examination. A total of 92 participants were consented and enrolled in the pilot study. Results The research study and team were received with enthusiasm and there was mutual respect by all involved in the study. Our study confirmed that the prevalence of hypertension in an urban Botswana population was around 30%, a figure that is comparable to other data from sub-Saharan Africa. The significant clinical correlates in our study population for hypertension were obesity and high salt intake. Only 37% of participants had been exposed to any education regarding raised blood pressure, cardiac disease or stroke. Conclusion While no single intervention has been shown to be effective the models of care need to be multidimensional and based on an integration of expertise. Long-term follow-up, training, quality assurance and support for local health workers is essential. The positive findings from the social evaluation component of the study indicate that the proposed model of integrated care benefit can from the strong social bonds and support already available in the Botswana community. The paper recommends a model of care that would be piloted in Botswana using a randomized control trial where the intervention group would receive an integrated Telemedicine-supported model of care with the control group receiving care as usual.

Constructing a Framework for the Use of Tests Within a Developing Nation’s School System

Interpretive participatory action research methods were used to assist the education community in Botswana, a developing nation, to identify a framework for the use of tests in the nation’s schools. User preferences for understanding important learner-related qualities through the use of tests were emphasized. Participant informants were educators and school counselors ( n = 1,221), learners ( n = 355), parents/guardians ( n = 162), and education program personnel from civic and multilateral agencies ( n = 47). The learners and school personnel were drawn from a nationally representative sample of 328 schools (49% primary and 51% secondary levels; 92% public and 8% private schools). Data on the components and content of a prospective framework were gathered using concept mapping and preference methods. The data were analyzed to construct a locally grounded test use framework appropriate to the Botswana school system. Findings suggest a test use framework spanning the following preferred assessment domains: learning readiness, aptitude, personal development, community norms, socialization, and guidance and counseling. Learners and their parents/guardians prefer that learners access test information first from their classroom teachers followed by guidance and counseling personnel. The use of a consensus-driven multilayered participatory action research consultative processes to develop a framework for test use with the education community has potential for replication in educational and other settings in other developing countries.

Phylogenetic relatedness of circulating HIV-1C variants in Mochudi, Botswana.

BackgroundDetermining patterns of HIV transmission is increasingly important for the most efficient use of modern prevention interventions. HIV phylogeny can provide a better understanding of the mechanisms underlying HIV transmission networks in communities.MethodsTo reconstruct the structure and dynamics of a local HIV/AIDS epidemic, the phylogenetic relatedness of HIV-1 subtype C env sequences obtained from 785 HIV-infected community residents in the northeastern sector of Mochudi, Botswana, during 2010–2013 was estimated. The genotyping coverage was estimated at 44%. Clusters were defined based on relatedness of HIV-1C env sequences and bootstrap support of splits.ResultsThe overall proportion of clustered HIV-1C env sequences was 19.1% (95% CI 17.5% to 20.8%). The proportion of clustered sequences from Mochudi was significantly higher than the proportion of non-Mochudi sequences that clustered, 27.0% vs. 14.7% (p = 5.8E-12; Fisher exact test). The majority of clustered Mochudi sequences (90.1%; 95% CI 85.1% to 93.6%) were found in the Mochudi-unique clusters. None of the sequences from Mochudi clustered with any of the 1,244 non-Botswana HIV-1C sequences. At least 83 distinct HIV-1C variants, or chains of HIV transmission, in Mochudi were enumerated, and their sequence signatures were reconstructed. Seven of 20 genotyped seroconverters were found in 7 distinct clusters.ConclusionsThe study provides essential characteristics of the HIV transmission network in a community in Botswana, suggests the importance of high sampling coverage, and highlights the need for broad HIV genotyping to determine the spread of community-unique and community-mixed viral variants circulating in local epidemics. The proposed methodology of cluster analysis enumerates circulating HIV variants and can work well for surveillance of HIV transmission networks. HIV genotyping at the community level can help to optimize and balance HIV prevention strategies in trials and combined intervention packages.

Impediments for the Uptake of the Botswana Government's Male Circumcision Initiative for HIV Prevention

Botswana remains one of the countries with high prevalence of HIV infection with a population prevalence rate of 17.6 in 2008. In 2009, the Ministry of Health launched male circumcision as an additional strategy to the already existing HIV preventive efforts. The purpose of this paper is to share what the participants of a survey to evaluate a short-term male circumcision communication strategy in seven health districts of Botswana reported as impediments for the program's uptake. Qualitative data were obtained from 32 key informants and 36 focus group discussions in 2011. Content analysis method was used to analyze data and to derive themes and subthemes. Although male circumcision was generally acceptable to communities in Botswana, the uptake of the program was slow, and participants attributed that to a number of challenges or impediments that were frustrating the initiative. The impediments were organized into sociocultural factors, knowledge/informational factors, and infrastructural and system factors.