Developing the Botswana Primary Care Guideline: an integrated, symptom-based primary care guideline for the adult patient in a resource-limited setting

Billy M Tsima,1 Vincent Setlhare,1 Oathokwa Nkomazana2 1Department of Family Medicine and Public Health, 2Department of Surgery, Faculty of Medicine, University of Botswana, Gaborone, Botswana Background: Botswana’s health care system is based on a primary care model. Various national guidelines exist for specific diseases. However, most of the guidelines address management at a tertiary level and often appear nonapplicable for the limited resources in primary care facilities. An integrated symptom-based guideline was developed so as to translate the Botswana national guidelines to those applicable in primary care. The Botswana Primary Care Guideline (BPCG) integrates the care of communicable diseases, including HIV/AIDS and noncommunicable diseases, by frontline primary health care workers.Methods: The Department of Family Medicine, Faculty of Medicine, University of Botswana, together with guideline developers from the Knowledge Translation Unit (University of Cape Town) collaborated with the Ministry of Health to develop the guideline. Stakeholder groups were set up to review specific content of the guideline to ensure compliance with Botswana government policy and the essential drug list.Results: Participants included clinicians, academics, patient advocacy groups, and policymakers from different disciplines, both private and public. Drug-related issues were identified as necessary for implementing recommendations of the guideline. There was consensus by working groups for updating the essential drug list for primary care and expansion of prescribing rights of trained nurse prescribers in primary care within their scope of practice. An integrated guideline incorporating common symptoms of diseases seen in the Botswana primary care setting was developed.Conclusion: The development of the BPCG took a broad consultative approach with buy in from relevant stakeholders. It is anticipated that implementation of the BPCG will translate into better patient outcomes as similar projects elsewhere have done. Keywords: Botswana, primary care, guidelines, developmen

Knowledge, attitudes and practice of healthcare providers regarding contraceptive use in adolescence in Mahalapye, Botswana

Introduction: Adolescent pregnancy is a global public health problem, for which healthcare providers (HCPs) play a critical role to prevent unintended pregnancy. This study investigated the knowledge, attitude and practice (KAP) of HCPs towards the use of contraceptives in adolescents.Results: Of the 101 eligible for the study, 79.2% HCPs from the selected clinics and hospital responded. The majority (91.2%) of respondents felt confident to explain to adolescents how to use old contraceptive methods such as oral contraceptives or IUCD, less than half of the respondents (41.3%) were confident to explain how to use new contraceptive methods such as transdermal contraceptive patches or vaginal rings. Medical doctors felt more confident to prescribe new contraceptive methods compared with nurses, both vaginal rings (p-value = 0.0006) and transdermal contraceptive patches (p-value = 0.0003). More than two-thirds of the respondents disagreed that beliefs influenced their ability to offer contraceptive services to adolescents, half of the respondents strongly disagreed that it was morally wrong for adolescents to use contraceptives. Although three-quarters of respondents strongly agreed (median = 5, [IQR 5–6]) that they were comfortable with prescribing contraceptives to adolescents, only 23% of the respondents very much prescribed or always prescribed contraceptives to adolescents.Conclusion: Most of the HCPs prescribed contraceptives irregularly, and had limited knowledge about newer methods. To change HCPs’ KAP, in addition to continuing medical education (CME), the establishment of family planning clinics for adolescents and more undergraduate contraceptive teaching for medical and nursing students could result in the increased utilisation of contraceptive services by adolescents.</jats:p

Knowledge, attitudes and practice of healthcare providers regarding contraceptive use in adolescence in Mahalapye, Botswana

Introduction: Adolescent pregnancy is a global public health problem, for which healthcare providers (HCPs) play a critical role to prevent unintended pregnancy. This study investigated the knowledge, attitude and practice (KAP) of HCPs towards the use of contraceptives in adolescents.Results: Of the 101 eligible for the study, 79.2% HCPs from the selected clinics and hospital responded. The majority (91.2%) of respondents felt confident to explain to adolescents how to use old contraceptive methods such as oral contraceptives or IUCD, less than half of the respondents (41.3%) were confident to explain how to use new contraceptive methods such as transdermal contraceptive patches or vaginal rings. Medical doctors felt more confident to prescribe new contraceptive methods compared with nurses, both vaginal rings (p-value = 0.0006) and transdermal contraceptive patches (p-value = 0.0003). More than two-thirds of the respondents disagreed that beliefs influenced their ability to offer contraceptive services to adolescents, half of the respondents strongly disagreed that it was morally wrong for adolescents to use contraceptives. Although three-quarters of respondents strongly agreed (median = 5, [IQR 5–6]) that they were comfortable with prescribing contraceptives to adolescents, only 23% of the respondents very much prescribed or always prescribed contraceptives to adolescents.Conclusion: Most of the HCPs prescribed contraceptives irregularly, and had limited knowledge about newer methods. To change HCPs’ KAP, in addition to continuing medical education (CME), the establishment of family planning clinics for adolescents and more undergraduate contraceptive teaching for medical and nursing students could result in the increased utilisation of contraceptive services by adolescents

Contribution of Xpert^® MTB/RIF to tuberculosis case finding among pregnant women in Botswana

Setting: Seven health facilities with antenatal care (ANC) clinics in two districts near Gaborone, Botswana.Objectives: To determine 1) the prevalence of tuberculosis (TB) and HIV-TB co-infection in pregnancy, and 2) the sensitivities of symptomatic TB screening and Xpert testing against gold standard culture.Design: This was a cross-sectional study. Pregnant women were randomly enrolled and screened using TB symptoms. HIV status was determined from ANC clinics’ client records. Two sputum specimens were collected from all clients and each was tested using Xpert® and culture for Mycobacterium tuberculosis.Results: Of 407 cases, eight had one or more TB symptoms, and all tested negative with Xpert® and culture. Another two (0.5%, 95%CI 0.08–1.96) asymptomatic clients tested positive with both tests. The adjusted TB prevalence was higher than that of the general population (0.6% vs. 0.24%; P &lt; 0.001). The prevalence of TB among HIV-positive and HIV-negative clients was 1/69 (1.45%, 95%CI 0.29–2.61) and 1/336 (0.3%, 95%CI 0.23–0.83), respectively (Fisher’s exact test P = 0.312). Xpert® demonstrated a 100% sensitivity and 100% specificity, while symptom screening had 0.0% sensitivity and 98% specificity.Conclusions: TB prevalence among pregnant women was high and TB symptom screening had limited ability to detect TB. An alternative TB screening algorithm for pregnant women is urgently needed irrespective of TB symptoms.</jats:p

Are patient outcomes improved by models of professionally-led community HIV management which aim to be person-centred? A systematic review of the evidence

UNAIDS advocates person-centred care (PCC) for people living with HIV/AIDS (PLWHA) to improve outcomes and wellbeing. We appraised the evidence of person-centred models of community HIV care delivered or led by trained healthcare professionals and its impact on care outcomes. A systematic review was conducted in line with PRISMA guidance. Six electronic databases (CINAHL, Embase, PubMed, Medline, PsycINFO and Web of Science) were searched from January 1980 to April 2019. We included primary studies of any design of PCC models; for adults aged ≥15 years; that were delivered or led by trained HCP. Data were extracted including study location, design, quality, outcomes measured and effectiveness. Five out of 1393 studies met the inclusion criteria, of which four were from a high-income country and one a lower-middle income country. Of the PCC components (physical, psychological, social and spiritual wellbeing) delivered alongside HIV clinical management, one study delivered 2, two studies delivered 3 and two studies delivered all 4 components. This review highlights the lack of outcome evidence for person-centred HIV care, and of concurrent focus on all domains of concern for PLWHA within interventions. Clear articulation of the meaning, practice of PCC and implementation strategies are needed to meet policy recommendations.</p

Are mycotoxins relevant to be studied in health care environments?

Project EXPOsE, nº 23222 (02/SAICT/2016)Mycotoxins are fungi metabolites produced by specific fungal genera and although the reported evidence about the health effects there is still a gap about data in health care environments. This study aimed to investigate if mycotoxins presence should be monitored in health care facilities by searching for studies that reported fungal contamination by toxigenic fungi in different health care environments. The study involved a systematic search of available information/data published on PubMed during the period of 2010 until 31st December 2018. Among the 26 papers analyzed, only in two the Aspergillus genera were not reported as the most prevalent. Additionally, other genera also with toxigenic potential were observed, namely Fusarium and Penicillium. The information gathered with this review allowed to conclude about the importance to assess mycotoxins in health care environments. Moreover, the analytical methods used should allow detecting low concentrations and multiple mycotoxins.info:eu-repo/semantics/publishedVersio