Rural Botswana Research Articles

P17-041-23 Household Food Insecurity Among the Indigenous San People in Rural Botswana

P17-041-23 Household Food Insecurity Among the Indigenous San People in Rural Botswana

Lived Experiences of Low-Income Unmarried Women in Rural Botswana: A Narrative Approach

The research explored the lived experiences of low-income single mothers, to understand the psychosocial life course pathways that might expose them to chains of risks. Studies have found a high prevalence of co-occurring poverty, single parenthood, unemployment, violence, and multiple life traumas among rural unmarried women. It is important to explore how single mothers are vulnerable to poverty and its many effects and how these factors heighten adverse experiences of unmarried rural women. Fifteen low-income unmarried Botswana mothers were purposively sampled. A narrative approach was used to collect data, allowing participants to share detailed lived experiences from childhood to adulthood. The study used a life course framework to explore the lived experiences, transitions, events, and trajectories of the women’s lives. Women’s narratives conveyed exposure to emotional, physical abuse and neglect in childhood; teenage pregnancy and the poverty connection; exposure to intimate partner violence; and multiple pregnancies and promised and suspended marriage. The study suggests that several life events and experiences have negatively influenced and skewed transitions and trajectories in the lives of low-income women. There is need for establishment of family policy and safety net programmes to cater for low-income mothers’ families.

Agrotourism as peripheral and ultraperipheral community livelihoods diversification strategy: Insights from the Okavango Delta, Botswana

The potential of agrotourism for livelihoods diversification in remote (peripheral) and extremely remote (ultraperipheral) traditional, agrarian communities is indeed a testament of its uniqueness to enhance rural entrepreneurship development, employment creation and poverty alleviation. In an arid environment such as Botswana's where traditional agricultural concerns are generally impeded by inclement weather conditions exacerbated by climate variability and change scenarios, identifying opportunities in challenges associated with livelihood activities might provide a better pathway for improving rural socio-economic wellbeing and development. Semi-structured interviews and a literature review were used to document the current status and evolution of agrotourism in rural Botswana; and identify the associated constraints and opportunities, which the subsector might offer emerging entrepreneurs. Major findings reveal that agrotourism activities are relatively new and still fledgling in the Okavango Delta, Botswana. While 4.8 percent of the initiatives investigated accounts for agrotourism initiatives that are fully and currently operational in the area, another 4.8 percent constitutes the business initiatives, which are still not fully operational. Findings also revealed that most agrotourism businesses in the Okavango Delta were challenged by inadequate capital outlays constituting an impediment to running a successful business. While bureaucratic bottlenecks associated with registering agrotourism projects is a challenge for some entrepreneurs, a few others are bedeviled by lack of market for their products. The relatively fledgling status of agrotourism in the area might offer a good business opportunity for potential entrepreneurs and the government to fully exploit the socio-economic benefits of the subsector and push a more sustainable environmental conservation agenda, respectively.

The Village, the Elephant, and the State: Land Access and Vulnerability in Rural Botswana

Throughout the world, people resettle to reduce vulnerability to potentially dangerous wildlife, including elephants. In turn, they may become subject to development policies and practices that can either exacerbate or alleviate their vulnerability. Our ethnographic study in the Okavango Delta of Botswana, where 18,000 elephants share territory with 16,000 people, examines how resettlement decisions and settlement policies impacted vulnerability to elephants. We found that people who came into regular conflict with elephants frequently relocated from cattleposts to villages. Although people historically resettled near family, in 2015 a newly introduced “first-come, first-served” residential plot allocation policy spatially separated families within the village, creating further vulnerability for households relying on kinship networks. We found that government planning that incorporates locally available strategies, such as the ability to access support from kinship networks, may reduce vulnerability for those forced to resettle by elephant encroachment on their land.

Effects of Moringa oleifera seeds on the physicochemical properties and microbiological quality of borehole water from Botswana

Abstract This study was conducted to determine the effects of Moringa oleifera seeds on the physicochemical properties and microbiological quality of borehole water collected from Thamaga village in Botswana. Borehole water samples were subjected to two different Moringa seed treatment methods: M. oleifera crushed seed powder and Moringa seed extract. Five treatment levels (0, 10, 20, 30, 40 g or mL extract) were used for each treatment method. Borehole water treated with Moringa seed extract had significantly lower (p < 0.05) total dissolved solids and conductivity as compared with water treated with crushed Moringa seed powder. However, borehole water treated with Moringa seed extract had significantly higher (p < 0.05) pH and total suspended solids as compared with water treated with crushed Moringa seed powder. Escherichia coli and total coliforms were completely inhibited by Moringa seed extract after 2 h of treatment at a concentration level of 40 mL extract. It was observed that Moringa seed extract at a concentration level of 40 mL was the most effective in treating borehole water compared with Moringa crushed seed powder. In conclusion, Moringa seed extract can be used as an alternative and affordable source of borehole water treatment in rural Botswana.

Predictors of mass psychogenic illness in a junior secondary school in rural Botswana: A case control study.

BackgroundIn March 2019, students at Lempu Secondary School in Kweneng District, Botswana displayed symptoms including headache, abnormal leg movements and difficulty walking. Within days, 133 students were admitted to Scottish Livingstone Hospital where mass psychogenic illness (MPI) was diagnosed.AimTo identify predictors of this illness.SettingKweneng West District, Botswana.MethodsThis was a case control study using interviewer-administered questionnaires. Cases were students who displayed MPI symptoms from the 2nd of March to the time of the interviews or who were admitted with MPI diagnosis. Analysis was restricted to female students. Logistic regression was used to generate odds ratios. A p value of < 0.05 was considered to demonstrate significant association between variables.ResultsInterviews were conducted with 142 cases and 202 controls. The median age was 15 years. Most of the cases (95.8%) were boarding girls. Residence in school campus (AOR 13.2), history of evaluation by psychologist and/or social worker (AOR 2.6), history of traumatic events (AOR 1.8), contact with sick peers (AOR 2.3) and contact with spiritual healer (AOR 2.0) were independent predictors of MPI. Additionally, perception of adequate security in the dormitories (AOR 0.3) and perception of poor lighting (AOR 6.8) were significant predictors of MPI amongst boarding girls.ConclusionThe outbreak in Lempu Community Junior Secondary School (CJSS) was typical of mass psychogenic illness affecting mainly boarding girls and was associated with psychological and environmental risk factors. Changing the boarding environment and continuous psychological support are key to preventing future outbreaks. Interventions should also target the identified risk factors.

A community-based evaluation of disability resources and inclusion practices in rural Botswana

BackgroundCommunity-based approaches to enhance the inclusion of persons with disabilities have proven effective; however, not much is known about cultural and contextual factors that influence the capacity of policy implementation and inclusion practices in rural Botswana. ObjectiveThe study evaluated local disability education and health resources in rural Botswana to develop a deeper understanding of cultural and contextual factors impacting inclusion practices. MethodResearchers used socio-demographic and qualitative research methods to conduct a comprehensive community-based needs assessment. Sampling techniques included maximum variation and snowball sampling. Thirty-two individuals participated in the study. Data were collected between June and August of 2019 through participant observation, in-depth interviews, and focus group discussions. An inductive thematic analysis was conducted by examining participants’ attitudes, perceptions, and experiences of community members with disabilities. ResultsFour primary themes emerged identifying factors that affect people living with disabilities in the rural community: (1) culture of vulnerability, (2) determinants of disability, (3) educational resources for persons with disabilities, and (4) effective systems integration. Findings suggested that while policies associated with disability at the government level are in place, disparities among rural communities’ hindered local responses to managing the needs of persons with disabilities. ConclusionsSocial, environmental, and physical barriers prevent the full implementation of policies that advocate for the rights of persons with disabilities in Botswana's rural settings. Increasing awareness of cultural and contextual factors may help community stakeholders facilitate inclusive practices in Botswana.

Depression: Determinants That Influence the Mental Health of Older People (60 Years +) in Botswana.

Correlates of depression in older people were explored in this study. The prevalence of depression was also calculated. Data were collected using a cross-sectional study stratified by district in urban and rural Botswana using the Patient Health Questionnaire. A snowballing technique was utilized to recruit older participants (N = 378; age = 71.8; SD = 9.1) with low to high incomes. Univariate and multivariate analyses were used to investigate the associations among demographics, individual, social, and environmental factors, and depression. The prevalence of depression and social impairment in older people was 7.8% and 20.6%. The correlates significantly associated with depression in Model 2 were education, income earned, resilience, and self-esteem (F (6, 358) = 19.5, p < .001; R2 = 23%) after adjusting for all influencing factors. Self-perceived health was associated with depression in Model 3 [F (11,340) = 12.5, p < .001; R2 = 28%]. In the final model, resilience, quality of life (QOL), and leisure were significantly associated with depression (p < .001), followed by anxiety, somatic symptoms, and social impairment (p < .05) [F (20,214) = 9.2, p < .001; R2 = 46%]. Findings provide preliminary information on the determinants of depression for further review by the research community. Stakeholders should also take cognizance of these correlates during their practice to curb depression in older people.

Undernutrition and Anemia Prevalence Among Indigenous San Women of Child-Bearing Age and Young Children in Rural Botswana

ObjectivesGlobally, Indigenous women and young children disproportionately face increased nutritional risks, which may have serious adverse health consequences. In Botswana, data is limited on the health and nutritional status of the San People, an Indigenous minority group primarily living in the Ghanzi District. This cross-sectional study aimed to assess the prevalence of anemia and undernutrition among San women and young children in Ghanzi District. MethodsWe recruited 367 mother-child pairs (women 15–49 years and children 6–59 months) from San households from nine randomly selected areas. A capillary blood sample was collected, and weight and height were measured in both mothers and children. Hemoglobin (Hb) concentration was measured using a hemoglobinometer (HemoCue, AB). As per global recommendations, Hb concentrations were adjusted for altitude, smoking (in women), and ethnicity. ResultsFifty-six % (n = 205/367) of women self-reported smoking in any form (rolled cigarettes or snuffing). Overall, adjusted anemia prevalence was 12% in non-pregnant women (Hb < 120 g/L), 26% in pregnant women (Hb < 110 g/L), and 42% in children (Hb < 110 g/L); but ranged widely based on the controversial factor of whether or not adjustments for ethnicity were applied (range of 6–26%, 22–30% and 35–68% prevalence, respectively). Thirty-nine % (n = 133/344) of non-pregnant women and 52% (n = 12/23) of pregnant women were underweight (BMI < 18.5 kg/m2). In children 6–23 months, 41% were underweight (weight-for-age z-score < -2SD), 13% were wasted (weight-for-height z-score < -2SD), and 65% were stunted (height-for-age z-score < -2SD); in children 24–59 months 57% were underweight, 13% were wasted and 66% were stunted. ConclusionsThe high prevalence of smoking among women, underweight status among pregnant women, and anemia, stunting, and wasting among children were of the highest public health concern and should be addressed in future health and nutrition programming. These findings will inform and guide targeted nutrition and health policies for the San People and potentially motivate more research with other Indigenous groups. Funding SourcesInternational Development Research Centre (Doctoral Research Award), Botswana International University of Science and Technology (Ph.D. Fellowship), and University of British Columbia (Public Scholar Initiative).

Anemia Prevalence and Anthropometric Status of Indigenous Women and Young Children in Rural Botswana: The San People.

In Botswana, there is limited data available on the health and nutritional status of the San People (also known as the Basarwa or Bushmen), an Indigenous minority group primarily living in the Ghanzi District. Our aim in this study was to assess anemia prevalence among and anthropometric indices of women and young children in Ghanzi District through a cross-sectional survey. We recruited 367 mother–child pairs (women 15–49 years and children 6–59 months) in nine randomly selected areas. A capillary blood sample was collected, and weight and height were measured. Hemoglobin (Hb) concentration was measured with use of a hemoglobinometer (HemoCue, AB), as per global recommendations. Overall, adjusted anemia prevalence was 12% in non-pregnant women (Hb < 120 g/L), 26% in pregnant women (Hb < 110 g/L), and 42% in children (Hb < 110 g/L), but it varied widely depending on whether or not the controversial factor of ethnicity was adjusted for (range of 6–26%, 22–30%, and 35–68% prevalence, respectively). Thirty-nine percent (n = 133/344) of non-pregnant women and 52% (n = 12/23) of pregnant women were underweight (BMI < 18.5 kg/m2). In children aged 6–23 months, 41% were underweight (weight-for-age z-score < −2 SD), 13% were wasted (weight-for-height z-score < −2 SD), and 65% were stunted (height-for-age z-score < −2 SD); in children aged 24–59 months, 57% were underweight, 13% were wasted, and 66% were stunted. Fifty-six percent (n = 205/367) of women self-reported smoking in any form (rolled cigarettes or snuffing). The high prevalence of smoking among women, underweight status among pregnant women, and anemia, stunting, and wasting among children is of the highest concern for public health and should be addressed in future health and nutrition programming.

Effect of a weekly SMS reminder on Adherence and Quality of Life among HIV/AIDS patients on ART in Rural Botswana, Prospective Cohort Study

Effect of a weekly SMS reminder on Adherence and Quality of Life among HIV/AIDS patients on ART in Rural Botswana, Prospective Cohort Study

Reducing the impact of climatological disasters in rural Botswana—Building disaster-resilient dwelling structures—A gendered perspective.

Reducing the impact of climatological disasters in rural Botswana—Building disaster-resilient dwelling structures—A gendered perspective.

Optimizing Antiretroviral Uptake in Rural Botswana: Advancing the World Health Organization’s Treat All Program

Botswana was the first African country to introduce free antiretroviral treatment (ART) to people living with human immunodeficiency virus (HIV), but today it has the third highest HIV prevalence rate (20.3 per 100 population) in the world. This study investigates the availability and accessibility of ART facilities in Botswana and the utilization of ART services in districts with high HIV prevalence and low percentages of ART uptake. Availability and accessibility are measured using Botswana’s ART site model and road network analysis. Microdata on HIV status from the Botswana AIDS Impact Survey IV (BAIS IV) survey, and patient data on antiretroviral (ARV) utilization is examined at the health district level. The results show the spatial mean centers of hierarchically clustered ART facilities within ART sites are strategically located in areas of high population density. Many rural people across the country travel more than three hours to ART services. Within five rural health districts there are substantial ART facility patient deficits. Future planning should focus on increasing ART services and road infrastructure in rural areas, ART uptake for men, and ART adherence in relation to circular migration and social stigmas in rural destinations to ensure the success of the Treat All Program in Botswana.

Co-opting cattle spaces: Women, cattle, and empowerment in Northwestern Botswana

This paper offers spatial insights on gender, development, and empowerment scholarship through a case study of women and cattle in Botswana exploring the interconnections between space, nature, material action, and subjectivities. Using women’s access to and interactions with cattle as an entry point, this paper demonstrates the value of including space in conceptualizations of empowerment. It particularly highlights how enacting cattle rearing activities in certain spaces impacts women’s pride and self-confidence, contributing to changes in subjectivities and gender/spatial ideologies. Subjectivities are both contested and reinforced through women’s actions in cattle spaces in rural Botswana, with certain activities being simultaneously empowering and disempowering. Broadly, this paper reveals the significance to empowerment initiatives of contextualizing asset acquisition in socio-spatial norms. Demonstrating the importance of space in empowerment research also has implications for gender mainstreaming policies.

Reflections on Positionalities in Social Science Fieldwork in Northern Botswana: A Call for Decolonizing Research

AbstractIn this article, two white, Western female researchers reflect on the methodological, ethical, and practical dilemmas experienced while conducting social science fieldwork in Botswana for their doctoral degrees. In addition, their shared research assistant examines her role as a social and cultural interlocutor, which was essential to the researchers’ successful navigation in their various field sites. Drawing on distinct but common experiences conducting research in northern and western regions of rural Botswana, the authors reflexively consider a series of interwoven issues tied to their positionalities: the disparity in benefits and return on research investment between the researcher and research participants; the nature of commodified or transactional relations, especially in an impoverished region highly dependent on foreign tourists; the complex nature of researcher–research assistant relationships; and the contradictory dynamics of being female researchers in a patriarchal society while also embodying privileges of whiteness and Western nationality. Building on these reflections, the authors engage with current debates in the social sciences to argue that researcher reflexivity is not an adequate end point and should result in engagement with ethical and epistemological questions regarding the decolonization of research practices more broadly.

Confidence and performance of health workers in cardiovascular risk factor management in rural Botswana: a cross-sectional study

Abstract Background Social and demographic changes in Botswana are resulting in an increased prevalence of cardiovascular disease (CVD). Providers, mostly nurses, in this setting have limited training in managing CVD risk and few opportunities for continued medical education. We aimed to evaluate providers' perceived confidence in managing CVD risk factors and describe management of patients with hypertension at public-sector clinics in a rural district of Botswana. Methods In this cross-sectional study, we invited public-sector health-care providers in 11 ambulatory clinics in the Kweneng East district of Botswana to complete an anonymous questionnaire survey. We used descriptive statistics to evaluate providers' confidence in managing CVD risk (a Likert scale from 1 [low confidence] to 5 [high confidence]). We used t tests to compare confidence levels between groups of providers and specific risk factors. Additionally, we interviewed patients and did chart reviews to assess how CVD risk factors were managed in 275 hypertensive patients at seven of the 11 sites surveyed. Uncontrolled hypertension was defined as ≥140/90 mm Hg (or ≥130/80 mm Hg in patients with diabetes) for an average of two blood pressure readings and CVD risk was defined using WHO guidelines. Findings Of 88 health care providers invited to participate, 44 registered nurses (80%), four family nurse practitioners (7%), and seven doctors (13%) completed the survey. Providers reported feeling significantly more comfortable managing hypertension than they did diabetes (3·73 vs 3·15; p Interpretation Public sector health-care providers in rural Botswana have low confidence in managing CVD risk factors. Although reported confidence was higher for management of hypertension than for diabetes, there were significant lapses in management of both diseases. CVD and diabetes account for 22% of all adult deaths in Botswana and it is imperative that training in management of these diseases is improved. To address low provider confidence and gaps in guideline-driven CVD prevention, we plan to implement an integrative training programme for health workers in the Kweneng East district of Botswana. Funding Hospital Medicine, Beth Israel Deaconess Medical Center.

ARV Adherence vs. Cultural Compliance: HIV/AIDS Drug Therapy and Decision-Making among PLWHA in Rural Botswana

ARV Adherence vs. Cultural Compliance: HIV/AIDS Drug Therapy and Decision-Making among PLWHA in Rural Botswana

Perceptions of Infertility as a Barrier to Cervical Cancer Screening in Rural Botswana: A Qualitative Study

Perceptions of Infertility as a Barrier to Cervical Cancer Screening in Rural Botswana: A Qualitative Study

Local attitudes towards tourism and conservation in rural Botswana and Rwanda

The establishment of protected areas is an accepted means of achieving biodiversity conservation and associated tourism development; yet, there is limited evidence of the relationship between the two and how this influences local communities’ attitudes to conservation and tourism. Joint venture models are one way to achieve these two outcomes. The African Wildlife Foundation conservation enterprise model aims to improve the quality of life of local communities and encourage positive local attitudes to conservation; yet, this has not been tested. This research adopted one-on-one structured questionnaire interviews to examine community and tourism lodge staff’s attitudes towards conservation of, and tourism in, protected areas in two case-study sites in rural Botswana and Rwanda. Findings indicate that at both case-study sites lodge staff and the local community were generally supportive of conservation, and had positive attitudes towards conservation and tourism.

Dynamics of local governance in natural resource conservation in the Okavango Delta, Botswana

There has been a shift in natural resource management worldwide. This paper describes how modern institutions and policies influence management and shape access to and utilization of resources by rural communities in the Okavango Delta, Botswana. It is rooted in the framework of adaptive co‐governance within social‐ecological systems, and employs a critical literature review to analyse access to and use of natural resources in rural Botswana. Prior to the establishment of community‐based natural resource management (CBNRM) in Botswana in 1989, resource governance was dominated by strong traditional institutions that were responsible for natural resource management and decision‐making. Contemporary natural resource governance is characterized by a bureaucratic system that invariably undermines the role of traditional institutions in natural resource governance. Findings indicate that policies and regulatory instruments deny rural communities adequate access to and utilization of resources available within their immediate environment. In spite of an orientation towards an anthropocentric approach to natural resource management (as in the case of CBNRM), the current governance system continues to undermine the inclusion of local resource users as legitimate stakeholders in the decision‐making process.