Hospital In Botswana Research Articles

Occupational Stress among Nurses in Referral Hospitals in Botswana: Controlling the Risk to Health

The prevalence of occupational stress among nurses is an endemic problem. This study was undertaken on an academic journey to determine the current levels of occupational stress among nurses in referral hospitals in Botswana. The study used a cross-sectional design aimed at determining the prevalence of occupational stress among nurses in selected referral hospitals. The study was carried out in three referral hospitals, namely- Princess Marina hospital, Nyangabgwe referral hospital, and Sabrana psychiatric hospital. Purposive sampling was used to select the nurses as well as management with the required and relevant experiences. A semi-structured questionnaire was used to get responses from nurses and the management in referral hospitals. The data was sourced from different departments/ units in the referral hospitals. From a total of 98 study participants, 43.8 percent of nurses reported stressful irritable/angry at work. Less than one-third, 30.6% of respondents, reported that they were sometimes not able to sleep due to the fact they normally have to work in different departments/units in referral hospitals. Results from the study show that respondents are very often not coping with what they had to do and are not able to control important things (like work may be) in their lives, respectively statistically significant (p = 0.021< 0.05) and (p = 0.038 < 0.05. A significant percentage of respondents reported occupational stress that is influenced by environmental factors like working in different departments and pressure from work. Keywords- Endemic, Nurses, Occupational stress, Prevalence, Purposive sampling, Stress.

The barriers and facilitators of HIV-exposed infant testing as perceived by HIV-positive mothers in Botswana: A qualitative study.

BackgroundDespite high rates of HIV testing and enrolment of HIV-positive pregnant women on antiretroviral therapy in Botswana, coverage for HIV-exposed infant (HEI) testing remains suboptimal. Many factors can contribute to suboptimal HEI testing rates, but they have seldom been thoroughly investigated in Botswana. Therefore, the aim of this study was to explore the experiences and perspectives of HIV-positive mothers on the barriers and facilitators of HEI testing to inform interventions to promote HEI testing in Botswana.MethodsWe conducted focus group discussions (FGDs) with HIV-positive mothers who gave birth in 2016 at the three largest public hospitals in Botswana. FGDs were held in Maun, Francistown, and Gaborone from September 2019 to March 2020. The maximum variation sampling method was used to select the participants using information that was abstracted from birth registers and other medical records at the study sites. Mothers were asked to describe their HEI testing experiences, what made it easy or difficult for them to return the HEI for testing, and what needs to be done to improve HEI testing in Botswana. A thematic approach was used to analyse the data.ResultsFifteen FGDs with 142 mothers (aged 21–52 years) were held. Participants identified several facilitators to HEI testing, including a mother with adequate knowledge of PMTCT, intensive tracking of HEI by healthcare workers (HCWs), positive attitudes of HCWs toward clients, and social support from significant others. Staff shortages at health care facilities, frequent stock-outs of HIV test kits, fear of stigma, fear of positive test results for the child, and transportation challenges were identified as key barriers to HEI testing. Increasing staffing at healthcare facilities, having adequate supplies of HIV test kits, enhanced HEI tracking, easing access to HEI testing services in rural areas, and providing quality PMTCT education were among the proposed interventions to promote HEI testing.ConclusionOptimizing HEI testing in Botswana will require multi-level interventions at the policy, health system, community, interpersonal, and individual levels.

Assessment of surgical care capacity at non-tertiary hospitals in Botswana

Background: Most low- and middle-income communities (LMICs) live in rural areas and are served mainly by primary and district hospitals. This study seeks to geographically map these hospitals and measure their surgical care capacity in Botswana. Methods: This 3-month cross-sectional observational study was conducted at the Department of Surgery, University of Botswana. Google Map was used to map hospitals geographically. The PIPES (personnel, infrastructure, procedures, equipment, and supplies) tool was used to assess the surgical care capacity of hospitals. This tool was developed by Surgeons Overseas to quantify surgical capacity in low-resource settings. Consent was obtained. Results: Nine districts and ten primary hospitals were assessed. The distance from settlements to the nearest healthcare facility in sparsely populated areas was relatively larger, making timely healthcare access potentially problematic. Intensive care services were unavailable except at three hospitals. None of the hospitals had full blood bank services. X-ray and ultrasound machines and basic supplies were available at over 90% of the hospitals. Conclusion: There was a general lack of surgical care specialists. Hospitals with a full complement of surgical care specialists had relatively higher PIPES indices. We recommend investing in deploying specialized surgical care providers to primary and district hospitals.

Strategies to Enhance the Resilience of Nurse Managers

Nurse managers are often exposed to workplace stressors, thus it becomes necessary to enhance their resilience which will enable them to withstand workplace adversity. The purpose of the current study was to develop strategies that can enhance the resilience of nurse managers. A purposive sample of 49 nurse managers working in the general wards of 11 public hospitals in Botswana was undertaken. The study was done in two phases. Phase 1 of the study entailed the empirical phase that followed a concurrent mixed methods research (MMR) design, which included both quantitative and qualitative components in a single study at the same time. In Phase 2, the findings from the empirical phase, as well as the theoretical data, were utilised to develop a conceptual framework and strategies to enhance the resilience of nurse managers. The Kumpfer resilience model was used to guide the development of the conceptual framework, and a logic model further assisted with the development of strategies. The study identified the following main strategies that can enhance the resilience of nurse managers, namely: leadership development; building support systems; life skills development; and resource availability. The strategies should be utilised by nurse managers and senior management to enhance the resilience of nurse managers in order to facilitate the delivery of quality nursing services and patient care.

Health-related reasons patients transfer from a clinic or health post to the Emergency Department in a District Hospital in Botswana.

IntroductionRural health clinics in low-resource settings worldwide are usually staffed with health care workers with limited knowledge and skills in managing acute emergencies. The Emergency Centre (EC) at the district hospital or primary hospital serves as an entry point for patients with diverse medical needs from health posts and community clinics. The study described the socio-demographic characteristics, primary diagnosis, and disposition of patients transferred from the clinics and health posts to the district hospital in the Kweneng district.MethodThis study is a chart audit of the triage sheets and admitting medical records (Botswana Integrated Patient Management System, IPMS) conducted for the period June through to December 2020. Descriptive statistics were used to analyze the quantitative data. Frequencies, percentages, and measures of central tendency were calculated using the software, SPSS version 27.ResultsA total of 1565 charts were reviewed; 56% (n = 877) were females and 43.5% (n = 681) were males. Half of the patients presenting to the EC ranged from ages 21 to 50, with a mean age of 36.49. The most frequently reported reason for referral was “trauma,” (23.5%, n = 368) whereas the second common reason for referral was abortion-related complications (14.2%, n = 222). The highest admissions were from abortion-related complications (20.2%, n = 169). Most patients’ transfers were from clinics and health posts outside Molepolole (59.4%, n = 930). More than half of the patients (64.2%, n = 537) transferred from outside Molepolole were admitted than discharged from the EC.DiscussionOur study has shown significant transfers to a higher facility for emergency care. The higher number of transfers are trauma-related cases, whereas most patients were admitted for abortion-related complications indicating the need for skill-building in trauma care and management of abortions.

Resilience of Nurse Managers in Botswana Hospitals

Resilience of Nurse Managers in Botswana Hospitals

Carbapenem-resistant Acinetobacter baumannii at a tertiary-care hospital in Botswana: Focus on perinatal environmental exposures

Background: Bloodstream infections (BSIs) due to carbapenem-resistant Acinetobacter baumannii (CRAB) are difficult to treat and are associated with high mortality, particularly in neonates. Healthcare-associated CRAB infections have been linked to environmental reservoirs and are associated with seasonal clustering. CRAB outbreaks are being reported more frequently in sub-Saharan Africa, but published reports from this region that incorporate comprehensive surveillance data and environmental investigations are rare. Methods: We reviewed microbiology surveillance records at a 530-bed, public, tertiary-care hospital in Botswana from January 1 to December 13, 2021, and we collected data regarding age, specimen type, and onset date for all cultures from unique patients growing Acinetobacter spp. An automated blood-culture system was used for organism detection, manual biochemical tests were used for identification, and disc and agar diffusion methods were used for antimicrobial sensitivity testing. During this time, we conducted 4 point-prevalence environmental sampling surveys at this hospital’s 36-bed neonatal unit from January through June 2021 in addition to 3 neonatal CRAB cluster investigations. Environmental samples from surfaces, hands of caregivers and healthcare workers, and equipment were collected using flocked swabs. Extended-spectrum β-lactamase–producing organisms from environmental samples were identified using selective and differential chromogenic media (CHROMagarTM ESBL). Results: Overall, 48 Acinetobacter infections were identified, including 28 BSIs (among 3,699 blood cultures processed, approximately one-third of which were from neonates). More than half of cases were perinatal, which included 16 neonatal BSIs (median age, 4 days; case fatality rate, 56%), and 1 fatal case of postpartum sepsis in a 37-year-old mother. Among isolates tested, 35 (92%) of 38 demonstrated carbapenem resistance. Treatment information was not available for all neonatal patients, but delays in appropriate antimicrobial therapy were cited in all fatal cases. Most neonatal CRAB cases clustered in time and space (Fig. 1). For example, 15 (71%) of 21 neonatal cases occurred in the same unit and same week as another case. In the neonatal unit, CRAB clusters were associated with increased Acinetobacter recovery during environmental point-prevalence surveys (Fig. 1). Acinetobacter contamination was identified on feeding equipment (breast pumps, feeding tubes), respiratory equipment (suction machines or catheters, ventilator humidifiers), and hands of caregivers and healthcare workers. Conclusions: We report hyperendemic rates of CRAB infections with evidence of spatotemporal clustering, especially among neonates. Higher CRAB incidence coincided with increased Acinetobacter recovery during environmental sampling. We identified plausible transmission vehicles (respiratory or feeding devices, hands) in the neonatal care environment highlighting the value of environmental sampling to support CRAB investigations and reinforcing the importance of comprehensive and consistent disinfection practices, especially in resource-limited settings where equipment is shared or reused.Funding: NoneDisclosures: None

Cross-sectional trends in HIV prevalence among pregnant women in Botswana: an opportunity for PrEP?

IntroductionYoung women in sub‐Saharan Africa are at particularly high risk of HIV acquisition. Recent shifts towards “test and treat” strategies have potential to reduce transmission in this age group but have not been widely studied outside of clinical trials. Using data from nationwide surveillance among pregnant women in Botswana, where a “test and treat” program was implemented in 2016, we describe trends in HIV prevalence over time and highlight opportunities for targeted prevention.MethodsThe Tsepamo study abstracted data from obstetric records of all women delivering at eight government hospitals in Botswana between 2015 and 2019, accounting for 45% of all births in the country (n = 120,755). We used a stratified analysis to identify prevalence trends and evaluated decreases in HIV prevalence over time using the Cochrane–Armitage test for linear trend. A multivariable logistic regression analysis was also performed to identify factors associated with declines in HIV prevalence.ResultsOverall HIV prevalence was 24.1% among 120,755 women who delivered during the study period. Prevalence differed by site of delivery, ranging from 16.1% to 28.2%, and increased markedly with age. Lower educational attainment (adjusted odds ratio [aOR] = 3.28; 95% confidence interval [CI] 3.07–3.50) and being unmarried (aOR = 1.98; 95% CI 1.88–2.08) were associated with HIV infection. HIV prevalence was 10.0% with a first pregnancy, 21.0% with a second and 39.2% with a third or greater (aOR = 2.20; for any prior pregnancy; 95% CI 2.10–2.29). The same age‐adjusted trends were seen when data were limited to women aged 15–24, with a two‐ to three‐fold increase in HIV prevalence between a first and third pregnancy. Prevalence decreased linearly during the 5‐year study period from 25.8% to 22.7% (p <0.001). Among age‐specific strata, the greatest absolute decline occurred in those aged 35–39, with an 8.7% absolute decrease in HIV prevalence from 2015 to 2019. Minimal declines were seen in those 15–24, with a decrease of only 1.5% over the same period.ConclusionsWhile overall trends in Botswana show HIV prevalence declining among pregnant women, prevalence among the youngest age group has remained stagnant. Preventative interventions utilizing pre‐exposure prophylaxis should be prioritized during the high‐risk period surrounding a woman's first pregnancy.

Characterizing the bioburden of ESBL-producing organisms in a neonatal unit using chromogenic culture media: a feasible and efficient environmental sampling method

IntroductionInfections due to extended spectrum beta-lactamase producing organisms (ESBL) have emerged as the leading cause of sepsis among hospitalized neonates in Botswana and much of sub-Saharan Africa and south Asia. Yet, ESBL reservoirs and transmission dynamics within the neonatal intensive care unit (NICU) environment are not well-understood. This study aimed to assess the efficiency and feasibility of a chromogenic-culture-media-based environmental sampling approach to characterize the ESBL bioburden within a NICU.MethodsA series of four point-prevalence surveys were conducted at a 36-bed NICU at a public tertiary referral hospital in Botswana from January-June 2021. Samples were collected on 4 occasions under semi-sterile technique using 1) flocked swabs & templates (flat surfaces); 2) sterile syringe & tubing (water aspiration); and 3) structured swabbing techniques (hands & equipment). Swabs were transported in physiological saline-containing tubes, vortexed, and 10 µL was inoculated onto chromogenic-agar that was selective and differential for ESBL (CHROMagar™ ESBL, Paris, France), and streaking plates to isolate individual colonies. Bacterial colonies were quantified and phenotypically characterized using biochemical identification tests.ResultsIn total, 567 samples were collected, 248 (44%) of which grew ESBL. Dense and consistent ESBL contamination was detected in and around sinks and certain high-touch surfaces, while transient contamination was demonstrated on medical equipment, caregivers/healthcare worker hands, insects, and feeding stations (including formula powder). Results were available within 24–72 h of collection. To collect, plate, and analyse 50 samples, we estimated a total expenditure of $269.40 USD for materials and 13.5 cumulative work hours among all personnel.ConclusionsUsing basic environmental sampling and laboratory techniques aided by chromogenic culture media, we identified ESBL reservoirs (sinks) and plausible transmission vehicles (medical equipment, infant formula, hands of caregivers/healthcare workers, & insects) in this NICU environment. This strategy was a simple and cost-efficient method to assess ESBL bioburden and may be feasible for use in other settings to support ongoing infection control assessments and outbreak investigations.

The Prevalence, Intensity, Assessment, and Management of Acute Pain in Hospitalized Children in Botswana

BackgroundThere is very limited clinical and observational data on acute pain experienced by children in sub-Saharan Africa. AimsTo report the prevalence and intensity of acute pain, pain management practices, and describe associations between acute pain outcomes, children’s and parents or guardian’s demographics in hospitalized children aged 2 months to 13 years in Botswana. DesignA descriptive correlational prospective observational study using five repeated cross-sectional samples. SettingsTwo referral hospitals in Botswana. ParticipantsThe sample size included 308 children and 226 parents or guardians. Data were collected between November 2018 and February 2019 from children, their parents or guardians (<7 years child), and the health record for pain documentation and treatment. Measures: Pain was measured using Faces Pain Scale-Revised for children ≥7 years, revised Face, Legs, Activity, Cry, Consolability scale for children <7 years and numeric rating scale for parents or guardians. ResultsThere are 1,290 data points for children of which 1,000 were children <7 years and 999 data points for parents or guardians of children <7 years were used in analysis. Fifty percent of children <7 years were in pain using the revised Face, Legs, Activity, Cry, Consolability scale, whereas parents indicated 46% to be in pain. The pain prevalence for children ≥7 years was estimated at 54%. Pain was documentated at a rate of 54 % on the health records. Acetaminophen was most common analgesic across all age groups. Univariate associations of child <7 years pain intensity was statistically significant (p ≤ .05) for weight, diagnosis, residence, and parent relationship. Parents reported pain intensity was statistically significant (p ≤ .05) for child sex, weight, diagnosis, residence, surgery, parent or guardian age and education. Only age and surgery were significant for children ≥7 years. ConclusionsAcute pain prevalence and intensity among hospitalized children in Botswana is low.

Predictors of cesarean delivery in public referral hospitals in Botswana: a case control study

INTRODUCTION: Globally there is concern of rising cesarean delivery trend over the decades from a world average of 6.7% in 1990 to a high of 19.1% in 2014. Similarly, predictors of the cesarean delivery have been documented in other parts of the world, but there is paucity of evidence of those in Botswana. This study therefore aims to determine socio-demographic, obstetrics predictors as well as common indications for cesarean delivery in public referral hospitals in Botswana. METHODS: a case control study was conducted that involved retrospective review of 672 (112 cases:223 for each facility) patient´s medical records, hospital delivery registers and theater records from 01/01/2018 to 31/12/2018. Multivariate logistic regression modelling was applied using SPSS 24 to determine association between independent predictors and cesarean section. RESULTS: logistic regression analysis found out the following; women who were referred from other facilities (AOR=2.551; C.I=1.686 - 3.861), history of previous cesarean delivery (aOR=15.840; C.I 8.826 - 28.430), delivered with fetal birth weight of over 4000 grams (AOR=4.420; C.I 1.303 - 14.997), attended antenatal clinics less than four times during the index pregnancy (AOR=2.584; C.I 1.708 - 3.908), unemployed (AOR=1.619; C.I1.066 - 2.458) as well as those whose moment of delivery was at night (AOR=1.511; C.I 1.004 - 2.275). There was no statistically significant association between HIV serostatus and cesarean delivery. The most common indication for cesarean delivery was the previous cesarean delivery at 29.5%. CONCLUSION: predictors of cesarean delivery were identified as birth weight over 4000 grams, history of previous Cesarean delivery, unemployed status as well referral cases from other facilities.

Accuracy of Pathologic Diagnosis in Patients With Lymphoma and Survival: A Prospective Analysis From Botswana.

PURPOSEWith intense HIV epidemics, southern African countries have a high burden of classic Hodgkin lymphoma (CHL) and non-Hodgkin lymphoma (NHL). However, suboptimal access to pathology resources limits subtype classification. We sought to assess the diagnostic accuracy of specimens classified as lymphoma and to determine association between discordant pathologic diagnosis and overall survival.METHODSSeventy patients with CHL or NHL and treated at three Botswana hospitals from 2010 to 2016 were analyzed. Local pathologic assessment relied primarily on morphology. All cases underwent secondary US hematopathology review, which is considered gold standard.RESULTSThe median follow-up was 58 months. The overall reclassification rate was 20 of 70 cases (29%). All 20 CHL cases were correctly classified in Botswana, and mixed cellularity was the most common subtype, diagnosed in 11 (55%) cases. Of 47 confirmed NHL cases, diffuse large B-cell lymphoma was the final US diagnosis in 28 cases (60%), another aggressive B-cell NHL in nine (19%), an indolent B-cell NHL in six (13%), and T-cell NHL in four (9%). Common types of diagnostic discordance included NHL subtype reclassification (11 of 20, 55%) and CHL reclassified as NHL (7 of 20, 35%). Concordant versus discordant diagnosis after secondary review was associated with improved 5-year overall survival (60.1% v 26.3%, P = .0066). Discordant diagnosis was independently associated with increased risk of death (adjusted hazard ratio 2.733; 95% CI, 1.102 to 6.775; P = .0300) even after stratifying results by CHL versus NHL.CONCLUSIONIn this single prospective cohort, discordant pathologic diagnosis was associated with a nearly three-fold increased risk of death. Limited access to relatively basic diagnostic techniques impairs treatment decisions and leads to poor patient outcomes in low-resource countries.

Prevalence and Factors Associated with Microalbuminuria in Pediatric Patients with Type 1 Diabetes Mellitus at a Large Tertiary-Level Hospital in Botswana.

IntroductionMicroalbuminuria is considered the earliest sign of diabetic nephropathy among patients with type 1 diabetes mellitus (T1DM). The prevalence of microalbuminuria among African children with T1DM is reported to be high, yet its prevalence and population-specific risk factors in Botswana are not known.AimThis study aimed to determine the prevalence of microalbuminuria among children and young adults with T1DM in Botswana and identify factors associated with microalbuminuria in this population.MethodsA retrospective cross-sectional study was conducted on 127 T1DM patients aged <24 years followed at a pediatric endocrinology clinic in Botswana from 2010 to 2017. Clinical, laboratory, and demographic data were collected using chart review and patient surveys. Descriptive statistics were reported as mean and standard deviation for continuous variables, and frequency and percentage for categorical variables. Prevalence of microalbuminuria was calculated as a simple proportion. Group comparison was done using two-sample independent t-test, X2-test, or Fisher’s exact test and logistic regression to assess for associations. Level of significance was set at p<0.05.ResultsThere were a total of 71 (55.9%) females. The mean age was 18.7 (±5) years and mean duration of T1DM was 6.6 (±4.6) years. Most study participants were of African descent. The prevalence of microalbuminuria was 28.3%. Group comparison revealed gender (p= 0.040), duration of diabetes (p= 0.002), systolic blood pressure (p=0.003), baseline glycated hemoglobin (HbA1c) (p=0.009) and Tanner’s stage (p=008) to be significantly associated with microalbuminuria. On binary logistic regression, only gender (p=0.039) and baseline HbA1c (p=0.039) were independently associated with the presences of microalbuminuria.ConclusionThis study identified a high prevalence of microalbuminuria among children and young adults with T1DM in Botswana and reaffirms the importance of early detection, glycemic control, and regular screening to prevent diabetic nephropathy.

Seroprevalence and risk factors of hepatitis B, C and D virus infection amongst patients with features of hepatitis in a referral hospital in Botswana: A cross-sectional study.

Viral hepatitis is a major global health problem. There is a paucity of data from Botswana on the seroprevalence of markers of hepatitis. The objective of the study was to determine the seroprevalence and risk factors of hepatitis B virus (HBV), hepatitis D virus (HDV) and hepatitis C virus (HCV) infections in patients with clinical features of hepatitis and/or altered liver function tests. This cross-sectional study was done at Princess Marina Hospital (PMH) in Gaborone, Botswana, from February 2015 to July 2016. It involved 328 adult patients with any of the following: jaundice, history of liver disease and/or increased serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), and serum bilirubin of > 2 times the upper limit of normal (ULN). Active or chronic active hepatitis (hepatitis B surface antigen [HBsAg] positive) was identified in 46.7% of patients. Antibodies to HDV infection were detected in 4.6% of the HBsAg-positive patients and antibodies to HCV infection in 4.3% of the study patients. Immunity against HBV infection was noted in 34.5% of patients. Human immunodeficiency virus (HIV) co-infection was self-reported by 42.7% of HBsAg-positive patients with known HIV status. High prevalence rate of HBV, HCV, HDV infection and HIV co-infection was observed in patients with liver disease attending PMH.

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.&#x0D; Objectives: This study explored experiences of Health Care Workers on Emergency Obstetrics Care (EMOC) in-service training and its effect on maternal mortality.&#x0D; Methods: Descriptive qualitative study design was conducted using in-depth interviews and focus group discussions. Par- ticipants 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.&#x0D; 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.&#x0D; Conclusion: Strengthening health education at health facility levels, stakeholders’ involvement; and prioritising EMOC in-service training are necessary in reducing the national maternal mortality.&#x0D; Keywords: Maternal mortality; health care workers; EMOC, in-service training.

Health care workers experiences in emergency obstetric care following implementation of an in-service training program: case of 2 Referral Hospitals in Botswana.

Maternal mortality rate remains a challenge in many developing countries. This study explored experiences of Health Care Workers on Emergency Obstetrics Care (EMOC) in-service training and its effect on maternal mortality. 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. 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. Strengthening health education at health facility levels, stakeholders' involvement; and prioritising EMOC in-service training are necessary in reducing the national maternal mortality.

O36: DEVELOPING A TRAUMA REGISTRY IN A MIDDLE INCOME COUNTRY – BOTSWANA

Abstract 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 mainly involved stakeholder consultations on existing data collection tools. 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 is collected using hard copy forms and some of this data is 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 is also partially stored as hard copies and some data is 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. Keywords Trauma registry, Injury registry, Road Traffic Accident Trauma Registry, Road Traffic Crushes Registry, Road Accident Registry. SYSTEMATIC REVIEWS

Timelines to Cervical Cancer Diagnosis and Treatment at a Tertiary Hospital in Botswana.

PurposeTo describe the timelines leading to presentation, diagnosis and definitive treatment among cervical cancer patients at a tertiary treatment center in Botswana.Patients and MethodsThis was a retrospective study that evaluated timelines to diagnosis and linkage to definitive treatment among cervical cancer patients in Botswana. Medical records of 149 patients admitted at Princess Marina Hospital (PMH) from 2012 to 2014 were reviewed from August 2016 to February 2017. Data collected included socio-demographics, stage of disease at presentation, symptom duration at presentation, diagnosis to definitive treatment interval and treatment outcomes on discharge. STATA 12 was used for data analysis. Frequencies and percentages were used to analyse and present the data. This paper is limited to the analysis of records with documented duration of symptoms, histology turnaround time and the diagnosis to treatment interval.ResultsThe median duration of symptoms at presentation (N= 80) was 120 days (range 1–1290). Women who were HIV seropositive, of secondary level education or higher, below 50 years and those with cervical cancer screening history reported shorter duration of symptoms at presentation. Median histopathology turnaround time (N=123) was 27 days (range 3–274), median diagnosis to definitive chemoradiation interval (N=81) was 89 days (range 16–305) while median waiting time for surgery (N=7) was 60 days (range 29–279). Overall, the patients’ journey from the community to definitive treatment was about six months.ConclusionDelayed cervical cancer diagnosis and treatment is multifactorial and entails a complex interplay between patient health-seeking behavioural patterns, robustness of the patient referral and follow-up mechanisms, availability of prompt histopathology services and relay of results, and timely linkage to definitive care. Prioritization of strategies to address hurdles in all these aspects will not only reduce waiting times but also ensure timely management and improved outcomes among patients with cervical cancer.

769. Mortality Among Inpatients After the Initiation of ‘Treat All’ With Dolutegravir in Botswana

BackgroundBotswana was the first African country to implement a ‘treat all’ dolutegravir (DTG)-based treatment program for all adults. We studied whether this transition made a short-term impact on inpatient mortality among people living with HIV (PLWHIV).MethodsFrom Dec 2015-Nov 2017, data were collected prospectively on all patients admitted to the medical wards of a district hospital in Botswana. Tenofovir/emtricitabine/efavirenz (TDF/FTC/EFV) was the first-line recommended antiretroviral treatment (ART) regimen for all ART-naïve adults with CD4 < 350 until May 2016, when it was replaced by TDF/FTC/DTG without CD4 restriction (‘treat all’). Multivariable logistic regression was used to compare mortality by ART regimen.ResultsOf 1,969 patients admitted, 41.5% were PLWHIV and of these 62.9% were on ART prior to admission. Before ‘treat all’, 160 (58.0%) of 276 PLWHIV were on ART prior to admission, and post-implementation 354 (65.4%) of 541 PLWHIV were on ART prior to admission (p=0.01). Among 315 patients on EFV-based ART and 85 on DTG-based ART prior to admission, demographics were similar (Table 1), except for more recent ART initiation with DTG, and lower median CD4 cell count with DTG (256 vs. 339 cells/mm3). Tuberculosis (TB) and community acquired pneumonia were the leading causes of hospitalization for both regimens. Death occurred in 178 (21.8%) PLWHIV, including 29% not on ART and 19% on any ART (p=0.003). Overall, 38% who initiated ART < 3 months prior to admission died (23.7% DTG, 48.8% EFV), and 36% with CD4 cell count < 50 cells/mm3 died (42.9% DTG, 30.8% EFV). Fewer deaths occurred among those on EFV (18%) compared with those on DTG (27%). However, controlling for CD4 count and timing of ART start, the risk of mortality among those on DTG and EFV was similar (aRR 1.08, 95% CI 0.62, 1.87). TB was the leading cause of death (40.1% off ART, 31.8% on DTG, 22.2% on EFV).Table 1. Demographics, clinical characteristics, and outcomes of people living with HIV (PLWHIV) admitted to Scottish Livingstone Hospital, stratified by ART regimen prior to admission. ConclusionWe found no improvement in inpatient mortality among PLWHIV during the shift to ‘treat all’ with DTG-based ART in Botswana. Decreasing high inpatient HIV mortality will require increased testing in the community to detect and treat PLWHIV prior to disease progression, and improved screening for opportunistic infections.Disclosures All Authors: No reported disclosures

What happens when registered nurses are caring for patients with tracheostomies in the ward of a referral hospital in Botswana?

BackgroundTracheostomy is the opening where the tracheostomy tube is inserted to create an artificial airway when a patient requires respiratory support. Nurses caring for patients with tracheostomies are expected to be familiar with current guidelines on routine care and the emergency management of complications. The researcher has observed that when arrangements are being made to transfer patients with tracheostomies from the intensive care unit to the ward, the registered nurse in the ward often try to delay the transfer, frequently refuse to care for patients, or try to avoid any activities around patients. ObjectivesTo explore and describe the lived experiences of registered nurses regarding their caring for patients with tracheostomies. Methods and sampling techniquesA qualitative, exploratory, descriptive and contextual research design, using a descriptive phenomenological approach, was implemented. A purposive sample of ten participants who volunteered and participated signed the informed consent. Individual, in-depth interviews were conducted and analysed using Giorgi’s five-step method for descriptive data analysis. ResultsThe central theme revealed caring as empowering although challenging in an enabling therapeutic milieu. Caring, as a nurse’s duty, featured prominently. Two main themes emerged. Caring in an enabling therapeutic milieu experienced as caring for the whole person, caring for patients as their professional duty and empowerment in their nursing care. Caring in a disenabling therapeutic milieu experienced as caring for patients as a clinical challenge, incompetent to care for patients effectively related to inadequate knowledge and skills, inadequate equipment and human resources and caring in a non-conducive therapeutic environment.