Hospital In Botswana Research Articles

Workplace stressors and their impact on the nurse managers role

Background: Nursing is one of the professions that is known to expose its members to stress. Additionally, nurse managers work in complex health care environments that expose them to a substantial amount of stress. Workplace stressors have a negative impact on the nurse managers’ performance. Objective: To explore workplace stressors and their impact on the nurse managers’ role. Methodology: The study followed a qualitative exploratory inquiry. Participants were nurse managers working in 11 public hospitals in Botswana. A total of 49 nurse managers participated in this study. A semi-structured interview guide was used to collect data through written narratives. Emerging themes were identified through the use of thematic analysis. Results: The study identified 6 themes that outlined workplace stressors as experienced by nurse managers as follows: shortage of resources; lack of managerial and leadership skills; lack of progression; lack of support from supervisors; staff indiscipline, and nature of work. Participants perceived that exposure to workplace stressors resulted in low morale, customer complaints, and compromised quality of care. Conclusions: The study revealed that nurse managers were exposed to various workplace stressors in the healthcare environment. It was identified that the stress impacted negatively on the quality of care delivered to patients.

Temporal decreases in pathogen colonization and infection among hospitalized neonates following routine skin antisepsis with chlorhexidine gluconate: Botswana 2022 – 2023

Background: Multidrug-resistant Gram-negative bacteria are a major cause of sepsis among hospitalized neonates globally. Aqueous chlorhexidine gluconate (CHG) skin antisepsis has been shown to be safe for use in infants; however, its sustained effectiveness in preventing Gram-negative pathogen colonization, bloodstream infection (BSI), and mortality is unclear. Methods: We conducted a period prevalence survey, with 26 sampling events over 12 months (18 October 2022 – 31 October 2023) at a 33-bed neonatal unit in a tertiary public hospital in Botswana where ESBL-producing Klebsiella pneumoniae and carbapenem-resistant Acinetobacter baumannii are leading causes of BSI. Perirectal and periumbilical skin swabs were collected every two weeks from all inpatients. Swabs were inoculated onto chromogenic media selective and differential for extended-spectrum beta-lactamase producing Enterobacterales (ESBL-E) and Acinetobacter spp. (CHROMagar™ ESBL, Acinetobacter). Colonization status was determined based on culture growth and colony morphology. Contemporaneous data on all-cause mortality and BSI were abstracted from routine surveillance records. Pre- and post-CHG prevalences were compared using a simple Chi-square test. During the surveillance period, an outbreak of K. pneumoniae linked to contaminated multi-use vials was detected, thus BSIs and deaths during the outbreak period (2 February–6 April, 2023) were excluded. In February 2023, the hospital infection prevention and control (IPC) team introduced twice-weekly whole-body cleansing with commercially available 2% aqueous CHG, performed by caregivers and healthcare workers on neonates >24 hours old and weighing ≥1 kg until discharge. Results: There were significant decreases in ESBL-E and Acinetobacter skin and perirectal colonization following the CHG intervention (Table 1; Figure 1). After the CHG intervention, the incidence of Acinetobacter BSIs declined significantly and there was a trend toward a decline in other BSIs and mortality. No adverse events associated with CHG were reported. Conclusions: Twice-weekly CHG application was temporally associated with significant reductions in neonatal ESBL-E and Actinetobacter skin and perirectal colonization and Acinetobacter BSI. This analysis was limited by a short pre-intervention surveillance period and thus may have been influenced by confounders such as seasonality, and intensified IPC efforts following the outbreak. Analysis of the routine CHG use in other settings and over longer surveillance periods are needed to better understand its effectiveness as an IPC strategy in settings where neonatal sepsis incidence is high. Table 1. Colonization prevalence, BSI incidence, and mortality surrounding introduction of CHG skin cleansing in a neonatal unit, 18 October 2022 – 31 October 2023.

Neuropsychiatric Manifestations of Tuberous Sclerosis in a young adult male in a Psychiatry Hospital in Botswana: a case report

IntroductionTuberous sclerosis complex (TSC) is a disorder that affects multiple systems and was first described in 1880. Its symptoms include seizures, intellectual disability, and adenoma sebaceum. TSC is caused by mutations in the TSC1 and TSC2 genes and is inherited in an autosomal dominant manner.ObjectivesThis report highlights a case of a patient with an unusual psychological presentation evaluated in a psychiatric hospital.MethodsThe patient presented with psychotic features and abnormal behavior. A physical examination showed neurocutaneous lesions. After assessment a diagnosis of Tuberous sclerosis complex was confirmed through MRI Brain and genetic testing. Some of his relatives also showed similar neuropsychiatric symptoms.ResultsTuberous sclerosis complex is diagnosed based on TSC Clinical Consensus Group guidelines of 2012. Our patient fulfilled 4 of the major criteria and genetic testing also yielded a pathogenic variant. A TAND checklist (TSC-Associated Neuropsychiatric Disorders) is used to guide clinicians on areas to prioritize when managing TSC patients.Image:Image 2:Image 3:ConclusionsGiven that psychiatry may be the first contact for TSC patients, especially in low-resource settings. Patients referred to psychiatry, therefore, need to be thoroughly examined to exclude neuropsychiatric disorders, and a multidisciplinary team approach is vital in investigating and managing these cases.Disclosure of InterestNone Declared

Burden and Severity of Injuries at the Emergency Department of a Tertiary Hospital in Botswana- Princess Marina Hospital

Purpose: Injuries constitute a leading and growing cause of emergency department (ED) visits in sub-Saharan Africa. Characteristics of ED injury patients have been well-described in many parts of the world; however, data remain scarce throughout Africa, Botswana included. We aimed to describe in detail injury-related ED visits at an urban public referral hospital in Botswana.
 Methodology: We conducted a retrospective chart review of all patients who presented to Princess Marina Hospital in Gaborone, Botswana, over a period of 4 randomly selected consecutive months. Demographic data, injury mechanism, type, severity and ED disposition were abstracted from the medical record into a Microsoft Access database designed for this study. Study variables were analyzed with summary statistics for frequencies, percentages, means, medians and relationships using SPSS. Injury severity was calculated for each patient using the modified Kampala Trauma Score.
 Results: 6715 ED visits occurred during the study period, and 1709 (25.5%) were injury related. Of these, 63.9% were male, 24.7% <14 years old, 6.7% age 14-19, 49.1% 20-40, and 19.5% >40. 35.9% were due to falls, 23.6% assault and 18.8% road traffic crashes. 40.5% isolated soft tissue injuries, 34.7% isolated extremity injuries, 9.4% multiple injuries and 5.3% head and neck injuries. Kampala Trauma Score II (KTS) was available for 76% of patients. 1.7% scored ≤6, 5.9% 7-8, and 92.4% 9-10. For patients with KTS ≤6, 18% died in the ED, 82% were admitted and 0% discharged home. For KTS 7-8, 0% died, 93.5% were admitted, 6.5% were discharged home. For KTS II 9-10, 0% died, 26% were admitted, 74% were discharged home.
 Unique Contribution to Theory, Practice and Policy: This study is among the first in Botswana to assess the burden of injuries using a validated injury severity scoring tool. Based on the study findings and applicability of the KTS II in our setting, we recommend that PMH ED incorporates and promotes a severity scoring system to help in planning and resource allocation. PMH ED receives many low acuity injuries therefore improving the availability of basic resources in local clinics may reduce overcrowding. Future studies should aim to involve multiple centers to get a true representation of injury burden in Botswana.

Burnout and associated factors among nurses in psychiatric and general tertiary hospitals in Botswana: A cross-sectional study.

Research has consistently documented that nurses are at a higher risk for developing burnout syndrome due to the nature of their jobs. The high prevalence of burnout among nursing staff negatively affects healthcare delivery. Nurses experiencing burnout cannot provide quality care or actively participate in health promotion, and those experiencing emotional exhaustion are unlikely to be able to tend to the emotional needs of patients. The study aimed to determine the prevalence and factors associated with burnout syndrome among nursing staff in Botswana referral general and psychiatric hospitals. A cross-sectional survey was conducted among 249 nursing staff working in a referral psychiatric and general hospital. The job satisfaction survey, Maslach burnout inventory, and the OCEAN-20 were used to assess job satisfaction, burnout occurrence, and personality traits, respectively. A researcher-designed sociodemographic questionnaire was used to capture demographic data. Variables identified to be associated with burnout on bivariate analyses were entered into a regression analysis to determine to what extent these factors predicted burnout. The prevalence of emotional exhaustion, depersonalization, and reduced personal accomplishment was 65.7%, 56.9%, and 54%, respectively. Being in a general hospital, neuroticism, poor operating condition, and poor communication predicted emotional exhaustion, R 2 = 28%, F (9, 229) = 9.937, p < 0.001. Depersonalization was predicted by neuroticism and poor operating conditions, R 2 = 17%, F (9, 229) = 4.709, p < 0.001. Reduced personal achievement was significantly predicted by the number of people in the household, time at the current hospital, agreeableness, and nature of work, R 2 = 21%, F (7, 203) = 7.875, p < 0.001. Our findings highlight the need for interventions to be developed to address burnout among nursing staff to optimize healthcare delivery.

Clinical Characteristics, Pathological Features and Treatment Outcomes of Children With Nephrotic Syndrome at Princess Marina Hospital, Botswana.

Objective. Despite the remarkable progress made in the understanding and treatment of childhood nephrotic syndrome (NS), a lot is still unknown about its epidemiology in many African countries. This study sought to determine the clinicopathological features and treatment outcomes of children with NS at the largest tertiary hospital in Botswana. Methods. A retrospective study of 26 children with NS treated from 2009 to 2014 was conducted. Results. Mean age at presentation was 5.96 ± 3.06. Hematuria was found in 92.3%, low C3 in 26.7%, high creatinine in 19.2% and hypertension in 46.2% of the patients. 92.3% had primary NS out of which 23.1% had familial NS. HIV, tuberculosis and hepatitis B infections were diagnosed in 3.85%, 9.09% and 4.16% respectively. 69.2% had steroid-resistant nephrotic syndrome, focal segmental glomerulosclerosis (SRNS-FSGS). Conclusion. The frequency of primary SRNS-FSGS and familial SRNS appears to be much higher in Botswana highlighting the possibility of genetic causes.

Regional anaesthesia practice in public hospitals in Botswana: A cross-sectional study.

Little is known about the regional anesthesia practice in low resources settings (LRS). The aim of this study was to describe the regional anesthesia capacity, characteristics of regional anesthesia practice, and challenges and solutions of practicing safe regional anesthesia in public hospitals in Botswana. This was a cross-sectional survey of anesthesia providers working in public hospitals in Botswana. A purposive sampling method of public hospitals was used to achieve representation of different hospital levels across Botswana. Paper-based questionnaires were sent to anesthesia providers from selected hospitals. Descriptive statistics were used for analysis. Questionnaires were distributed to 47 selected anesthesia providers from selected hospitals; 38 (80.9%) were returned. Most participants were nurse anesthetists and medical officers (57.8%). All hospitals perform spinal anesthesia; however, other regional techniques were performed by a small number of participants in one referral hospital. Most hospitals had adequate regional anesthesia drugs and sedation medications, however, most hospitals (except one referral hospital) lacked ultrasound machine and the regional anesthesia kit. The common challenges reported were lack of knowledge and skills, lack of equipment and supplies, and lack of hospital engagement and support. Some solutions were proposed such as regional anesthesia training and engaging the hospital management to get resources. The results of this study suggest that spinal anesthesia is the most common regional anesthesia technique performed by anesthesia providers working in public hospitals in Botswana followed by few upper limb blocks. However, most public hospitals lack enough training capacity, equipment, and supplies for regional anesthesia. More engagement of the hospital management, investment in regional anesthesia resources, and training are needed in order to improve the regional anesthesia capacity and provide safe surgery and anesthesia in Botswana.

Do regular morbidity and mortality conferences reduce preventable death rates? Our experience at Princess Marina Hospital

Summary Background The role of morbidity and mortality conferences (M&amp;MC) in surgical departments is to provide education and improve patient care. However, there is sparse evidence in the literature that M&amp;MCs reduce preventable deaths. Therefore, this study aimed to assess the impact of routine M&amp;MC on reducing the preventable death rate over 4 years at a tertiary hospital in Botswana. Methods This study used a quantitative research methodology. In this retrospective audit of the M&amp;MC data, we collected all mortality data for the surgery department from the time the database started, July 2016, to December 2019. The department adopted and adapted the criteria and definitions of preventability based on the World Health Organization (WHO) guidelines for trauma quality improvement programs. We used the Pearson correlation statistic to evaluate the correlation between the time (years) since the start of routine M&amp;MC and the preventable death rate. Ethical approval for the study was obtained. Results There were 4660 registered admissions from July 2016 to December 2019. Of these, 267 deaths were recorded, resulting in a crude mortality rate of 6%. Overall, the department considered 23% (61/267) of the deaths as preventable. A strong linear correlation (R2 = 0.982, p = 0.009) was found between the preventable death rate and time (years) since the commencement of routine M&amp;MC. Trauma was the leading cause of preventable deaths (24.6%, 15/61). Conclusion Our findings suggest that routine M&amp;MCs have the desired effect of reducing preventable death rates. Further studies are required to investigate this observed effect.

Surgical Results in Neurotraumatology in a Hospital in Botswana

Objective: To describe the surgical results in patients operated on for traumatic brain injury in a hospital in Botswana. Methods: Observational, descriptive, cross-sectional study, in the period from January 2023 to August 2023, at the Nyangabgwe Referal Hospital in Botswana. The sample under study consisted of 50 patients. General and specific variables of the traumatic Brain injury were analyzed. Results: The average age was 40.8 years, with a predominance of males (86%), the most frequent cause of head trauma was aggression (50%), chronic subdural hematoma predominated (36%), with intrahospital pneumonia being the complication more frequent (10%), mortality was 12%. Conclusions: Traumatic brain injury is a health problem in Botswana, it behaves with an incidence and prevalence that rises despite the small population of the country. Surgical results of a heterogeneous group of pathologies secondary to TBI were described.

Pulmonary hemorrhage and associated risk factors among newborns admitted to a tertiary level neonatal unit in Botswana.

Pulmonary hemorrhage (PH) is a life-threatening complication seen in very sick newborns with high morbidity and mortality. There is little data on the incidence, risk factors, and ultimate survival of newborns with pulmonary hemorrhage in sub-Saharan countries, where the healthcare provision and facility differ in many ways compared to high-income countries. Hence, this study aimed to determine the incidence, identify the risk factors, and describe the outcome of pulmonary hemorrhage in newborns in a low middle income country setting. A cohort study with prospective data collection was conducted in a public, tertiary-level hospital in Botswana, the Princess Marina Hospital (PMH). All newborns admitted to the neonatal unit from 1 January 2020 to 31 December 2021 were included in the study. Data were collected using a checklist developed on the RedCap database (https//:ehealth.ub.ac.bw/redcap). The incidence rate of pulmonary hemorrhage was calculated as the number of newborns who had pulmonary hemorrhage per 1,000 newborns in the 2-year period. Group comparisons were made using X2 and Student's t-tests. Multivariate logistic regression was used to identify risk factors independently associated with pulmonary hemorrhage. There were 1,350 newborns enrolled during the study period, of which 729 were male newborns (54%). The mean (SD) birth weight was 2,154(±997.5) g, and the gestational age was 34.3 (±4.7) weeks. In addition, 80% of the newborns were delivered in the same facility. The incidence of pulmonary hemorrhage was 54/1,350 {4% [95% CI (3%-5.2%)]} among the newborns admitted to the unit. The mortality rate in those diagnosed with pulmonary hemorrhage was 29/54 (53.7%). Multivariate logistic regression identified birth weight, anemia, sepsis, shock, disseminated intravascular coagulopathy (DIC), apnea of prematurity, neonatal encephalopathy, intraventricular hemorrhage, mechanical ventilation, and blood transfusion as risk factors independently associated with pulmonary hemorrhage. This cohort study identified a high incidence and mortality rate of pulmonary hemorrhage in newborns in PMH. Multiple risk factors, such as low birth weight, anemia, blood transfusion, apnea of prematurity, neonatal encephalopathy, intraventricular hemorrhage, sepsis, shock, DIC, and mechanical ventilation, were identified as independently associated risk factors for PH.

Four-year overall surgical mortality rate at Princess Marina Hospital, a tertiary hospital in Botswana.

Improving surgical mortality rates is a global priority, as they measure the success of surgical care systems. There is no data on Botswana's overall surgical mortality rate. Therefore, this study set out to evaluate the overall mortality rate in a surgical department at Princess Marina Hospital, a tertiary hospital in Botswana. This study is a single-center quantitative and retrospective study conducted in the surgical department at Princess Marina Hospital from August 2016 to December 2019. The Department of Surgery at Princess Marina Hospital keeps a prospectively updated database for quality assurance, which started in August 2016. The study received ethical approval. We included all patients older than 12 years admitted to the surgical department. Our adults surgical wards admit patients who are older than 12 years. This study collected all mortality data and determined the overall mortality rate as a percentage of surgical admissions. We retrieved 4660 admissions. The mean age was 56 (standard deviation=20.1). 66% (3083/4660) were operated. Out of the 4660 admissions, 267 deaths were registered, giving an overall mortality rate of 6%. The overall postoperative mortality rate was 3.63%(112/3083), and the non-operatively managed patient mortality rate was 9.83% (155/1577). Overall, malignancies were the leading cause of death, at 49.1%(131/267), followed by trauma at 22.1% (59/267). The 4-year overall surgical mortality rate at Princess Marina Hospital was 6%. The mortality rate of the nonoperatively managed patients was more than twice as high as the postoperative mortality rate. Overall, malignancies were the leading cause of death, followed by trauma.

Provider perspectives on antiretroviral therapy adherence among psychiatric inpatients in Botswana

Background: Optimal adherence to antiretroviral therapy (ART) is crucial for the effective management of HIV. Mental disorders often co-occur with HIV infection which often compromises ART adherence. Little is known about ART adherence in psychiatric settings in sub-Saharan Africa. Aims: This study aimed at exploring the health care providers’ perspectives on ART adherence among psychiatric inpatients. The study further assessed the facilitators and strategies enhancing ART adherence in hospitalised psychiatric patients. Methods: In-depth interviews were conducted with 25 health care providers at the Sbrana Psychiatric Hospital in Botswana. Interviews were focused on barriers and facilitators to psychiatric inpatients’ adherence to ART, and strategies and recommendations to support adherence. Data were manually analysed using a thematic analysis approach. Results: Key barriers were lack of insight, HIV-related stigma, lack of HIV-related knowledge, antiretroviral side effects and delays in re-initiating ART. Facilitators of ART adherence included motivation to be discharged from the hospital, fear of being sick, peer support, longer duration of hospitalisation, good provider-patient relationships, good diet, privacy and confidentiality and a single-tablet regimen. Health care providers described the various strategies currently used to support adherence, including directly observed therapy and family support, and recommended potential approaches to enhance psychiatric inpatient adherence to ART, including the use of injectable antiretrovirals and the introduction of halfway house centres. Conclusions: Findings from this study revealed unique insights into the numerous factors that influence ART adherence among psychiatric inpatients, and underscore the need to implement tailored strategies to support ART adherence in this population with complex health needs.

Provision of HIV services to psychiatric inpatients in Botswana: Challenges and recommendations.

The high prevalence of HIV among psychiatric inpatients is well-documented, yet little is known about the provision of HIV services for these patients. This qualitative study aimed to explore and understand healthcare providers' challenges with providing HIV services to psychiatric inpatients. This study was conducted at the national psychiatric referral hospital in Botswana. The authors conducted in-depth interviews with 25 healthcare providers serving HIV-positive psychiatric inpatients. Data analysis was performed using a thematic analysis approach. Healthcare providers reported challenges with transporting patients to access off-site HIV services, longer waiting periods for antiretroviral therapy (ART) initiation, patient confidentiality, fragmented services for treatment of comorbidities, and a lack of patient data integration between the national psychiatric referral hospital and other facilities such as the Infectious Diseases Care Clinic (IDCC) at the nearby district hospital. Providers' recommendations for addressing these challenges included the establishment of an IDCC at the national psychiatric referral hospital, connecting the psychiatric facility to the patient data management system to ensure integration of patient data, and provision of HIV-related in-service training to nurses. Psychiatric healthcare providers advocated for on-site integration of care for psychiatric illness and HIV among inpatients to address the challenges of ART provision. The findings suggest the need to improve the provision of HIV services in the psychiatric hospitals in order to ensure better outcomes for this often-overlooked population. These findings are useful in improving clinical practice for HIV in psychiatric settings.

The prevalence of substance use disorders and associated characteristics among patients admitted to a psychiatric hospital in Botswana.

Substance use disorders (SUDs) have increased substantially across the globe, and has become one of the world's most significant public health and socioeconomic challenge. This study examined the prevalence and patterns of substance use disorders among patients admitted to the main psychiatric hospital in Botswana, the Sbrana Psychiatric Hospital. This was a cross-sectional study of patients admitted to a major psychiatric hospital in Botswana. SUDs were assessed using the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) v13.0. Bivariate analysis was conducted to determine the association between socio-demographic characteristics and SUDs. Multivariate logistic regression was used to control for confounders. The final analysis involved 101 patients. Participants ranged in age from 18-60 years, and over half (59.4%) were male. The majority of participants (85.1%) had used potentially addicting substances at least once during their lifetime, with 63.4% having current substance use disorders. The most frequently used substances were tobacco, cannabis, alcohol, and cocaine at 58.4%, 42.6%, 34.7% and 12.8% respectively. SUDs were more common among participants who were male, ages 18-35 years, single, had a tertiary education, or were unemployed. There is a high prevalence of substance use and SUDs among psychiatric patients in Botswana. Screening for and interventions to manage SUDs should be part of routine care at psychiatric health care facilities in this country. Consideration should be given to the screening of all patients admitted to psychiatric hospitals in Botswana for SUDs using the ASSIST.

Prevalence and Associated Risk Factors of Anemia Among Hospitalized Children in a Tertiary Level Hospital in Botswana.

Anemia is a global health concern and has been associated with long term cognitive and behavioral adverse effects. A cross sectional study was conducted to determine the prevalence of and risk factors for anemia in infants and children between 6 months to 5 years of age admitted to a tertiary hospital in Botswana. Baseline full blood count of every patient admitted during the study period was assessed to determine if anemia was present. Data were collected from patient's medical inpatient chart, electronic medical record (Integrated Patient Management System (IPMS)), and through interviewing parents and caregivers. Multivariate logistic regression model was used to identify risk factors of anemia. A total of 250 patients were included in the study. Prevalence of anemia in this cohort was 42.8%. There were 145 (58%) males. Of the patients with anemia, 56.1%, 39.2%, and 4.7% had mild, moderate, and severe anemia, respectively. Microcytic anemia consistent with iron deficiency was identified in 61 (57%) patients. Age was the only independent predictor of anemia. Children aged 24 months and more had a 50% lower risk of having anemia than their younger counterparts (odds ratio (OR) 0.52; 95% Confidence Interval (95% CI) 0.30 to 0.89). The findings of this study demonstrate anemia as a serious health concern in the pediatric population in Botswana.

Severity of illness and mortality among children admitted to a tertiary referral hospital in Botswana: A secondary data analysis of a prospective cohort study.

Data on triage practices of children admitted to Princess Marina Hospital in Gaborone, Botswana is limited. The inpatient triage, assessment, and treatment score was developed for low resource settings to predict mortality in children. We assess its performance among children admitted to Princess Marina Hospital and their demographic, clinical, and risk factors for death. This was a secondary data analysis of a prospective cohort study comprising 299 children ages 1 month to 13 years admitted June to September 2018. Descriptive statistics, bivariate analysis, and multivariate logistic regression were used. Sensitivity and specificity data were generated for the inpatient triage, assessment, and treatment score. Thirteen children died (13/284, 4.6%). Comorbidity (adjusted odds ratio 4.0, p = 0.020) and high inpatient triage, assessment, and treatment score (adjusted odds ratio 5.0, p = 0.017) increased odds of death. The area under the receiver operating characteristic curve was 0.81. Using inpatient triage, assessment, and treatment cutoff of 4, the sensitivity, specificity, and likelihood ratio were 31%, 94%, and 5.0, respectively. Implementing the inpatient triage, assessment, and treatment score in low resource settings may improve identification, treatment, and evaluation of the sickest children.

Investigating the Effects of Occupational Stress on Nurses Working in Referral Hospitals in Botswana to Reduce Health Risk

The incidence of work stress among nurses is a persistent issue. This qualitative study was carried out to examine the problems that nurses experience in providing basic health care at Botswana referral hospitals. The study was presented as a qualitative research approach. Three referral hospitals: Princess Marina Hospital, Nyangabwe Referral Hospital, and Sabrana Psychiatric Hospital were chosen for this study. Ten management officers from the three referral hospitals with the necessary and appropriate experience were purposefully sampled in order to generate the required data via questionnaires and interviews. An inductive thematic data analysis was then used, the researchers attentively examined the data to uncover common themes and patterns that appear frequently. The intended study objectives were obtained by focusing on the preceding sampled data from management officers in referral hospitals: to identify challenges faced by nurses in the delivery of basic health care services and to recommend strategies that can be used to address challenges faced by nurses in the delivery of basic health care services. The overall findings of this study emphasized three themes that developed from the interviews: the obstacles faced by nurses in the delivery of essential health care services, which are: a lack of manpower, a lack of staff and accommodation, low wages, and a terrible working environment. The researchers finished by providing a conceptual model that may be employed as an intervention technique in the workplace to help with occupational stress. Keywords: Occupational Stress, Stressors, Stress, Nurses.

Prevalence of the metabolic syndrome and associated factors among inpatients with severe mental illness in Botswana: a cross-sectional study

IntroductionThe metabolic syndrome, a cluster of inter-related risk factors for cardiovascular diseases is highly prevalent among individuals with obesity and sedentary lifestyle. Chronic psychiatric disorders such as severe mental illness are associated with increased risk for cardiovascular diseases. We aimed to assess the prevalence and correlates of metabolic syndrome among inpatients with severe mental illness in a resource limited setting with high HIV prevalence.MethodsThis was a cross-sectional study among adult inpatients at a referral psychiatric hospital in Botswana. We used convenience sampling to enrol participants available at the time of the study. The National Cholesterol Education Program Adult Treatment Panel-III (NCEP-ATP III) criteria was used to define the metabolic syndrome. Data were analysed using descriptive statistics as well as multiple logistic regression modelling.ResultsA total of 137 participants were enrolled. Of these, 119 (87%) had complete data for the main analysis. The overall prevalence of metabolic syndrome was 22.6% (95% CI 15.9, 30.6) and did not differ significantly by gender or HIV status. Age was significantly associated with the risk of having the metabolic syndrome while gender, body mass index, HIV status, and days of moderate physical activity were not.ConclusionThere was a moderately high prevalence of metabolic syndrome. Thus, the management of individuals with severe mental illness in resource limited settings should include assessment of cardiovascular risk and target modifiable risk factors in this population. Consideration for the patient’s age should be made when rationalizing the limited resources available for assessing metabolic syndrome among patients with severe mental illness.

Cost-effectiveness of single, high-dose, liposomal amphotericin regimen for HIV-associated cryptococcal meningitis in five countries in sub-Saharan Africa: an economic analysis of the AMBITION-cm trial

HIV-associated cryptococcal meningitis is a leading cause of AIDS-related mortality. The AMBITION-cm trial showed that a regimen based on a single high dose of liposomal amphotericin B deoxycholate (AmBisome group) was non-inferior to the WHO-recommended treatment of seven daily doses of amphotericin B deoxycholate (control group) and was associated with fewer adverse events. We present a five-country cost-effectiveness analysis. The AMBITION-cm trial enrolled patients with HIV-associated cryptococcal meningitis from eight hospitals in Botswana, Malawi, South Africa, Uganda, and Zimbabwe. Taking a health service perspective, we collected country-specific unit costs and individual resource-use data per participant over the 10-week trial period, calculating mean cost per participant by group, mean cost-difference between groups, and incremental cost-effectiveness ratio per life-year saved. Non-parametric bootstrapping and scenarios analyses were performed including hypothetical real-world resource use. The trial registration number is ISRCTN72509687, and the trial has been completed. The AMBITION-cm trial enrolled 844 participants, and 814 were included in the intention-to-treat analysis (327 from Uganda, 225 from Malawi, 107 from South Africa, 84 from Botswana, and 71 from Zimbabwe) with 407 in each group, between Jan 31, 2018, and Feb 17, 2021. Using Malawi as a representative example, mean total costs per participant were US$1369 (95% CI 1314-1424) in the AmBisome group and $1237 (1181-1293) in the control group. The incremental cost-effectiveness ratio was $128 (59-257) per life-year saved. Excluding study protocol-driven cost, using a real-world toxicity monitoring schedule, the cost per life-year saved reduced to $80 (15-275). Changes in the duration of the hospital stay and antifungal medication cost showed the greatest effect in sensitivity analyses. Results were similar across countries, with the cost per life-year saved in the real-world scenario ranging from $71 in Botswana to $121 in Uganda. The AmBisome regimen was cost-effective at a low incremental cost-effectiveness ratio. The regimen might be even less costly and potentially cost-saving in real-world implementation given the lower drug-related toxicity and the potential for shorter hospital stays. European Developing Countries Clinical Trials Partnership, Swedish International Development Cooperation Agency, Wellcome Trust and Medical Research Council, UKAID Joint Global Health Trials, and the National Institute for Health Research. For the Chichewa, Isixhosa, Luganda, Setswana and Shona translations of the abstract see Supplementary Materials section.

Phenotypic and genotypic profiling reveals a high prevalence of methicillin-resistant Staphylococcus aureus isolated from hospitals, houseflies and adjacent informal food retailers in Botswana.

The increasing occurrence of methicillin-resistant Staphylococcus aureus (MRSA) in the environment, food and healthcare systems is a global public health concern. MRSA is reported to cause food poisoning, osteomyelitis and pyogenic infections of the skin, and consequently has been categorized as a high-priority pathogen by the World Health Organization. Here, we determined the presence of MRSA in clinical (n=56), food (n=150) and housefly samples (n=970) collected from two hospitals in Botswana. Characterization based on phenotypic (antimicrobial resistance, biofilm production) and genotypic (antimicrobial resistance genes and integrons) profiles were performed on all isolates. Of the total samples tested, 64 were positive for MRSA following conventional culture methods and PCR amplification of the mecA and mecC genes for confirmation of presumptive MRSA isolates. The confirmed isolates included 71 % (95 % CI 83.2-59.6) from clinical, 9 % (95 % CI 14--4.8) from food, and 1 % (95 % CI 1.6-0.4) collected from housefly samples. In total 89 % (n=57) isolates in the current study showed a multidrug resistance phenotype, among these, resistance to β-lactams and glycoside antibiotic classes were predominant. Genotypic characterization showed the domination of the blatem gene (95 %) followed by fox (63 %) and tetO (19 %) whilst vanA was only reported in 13 % of the isolates. Integrons were detected in 50 % (32/64) of the total MRSA isolates, and we report a high prevalence of etd gene, detected in 67 % (43/64) of the isolates followed by eta 38 % (24/64) whilst tsst-1 (3%) was the least detected genetic determinant. The genes etb and PVL were not detected in a ll the tested MRSA isolates. We provide the first report on the prevalence of MRSA isolated from the clinical-food-vector nexus harbouring biofilm and blatem genes, and antibiotic resistance profiles in Botswana. These results are significant for risk-assessment analysis and the development of improved MRSA infection prevention and control strategies.