Sheila Shaibu

Socio-economic status and urbanization are linked to snacks and obesity in adolescents in Botswana

OBJECTIVE To describe patterns of food consumption associated with overweight/obesity (OW/OB) and their links to socio-economic status (SES) and urbanization. DESIGN A nationwide cross-sectional survey. SETTING Secondary schools in cities, towns and villages in Botswana, Africa. SUBJECTS A total of 746 adolescent schoolchildren. RESULTS OW/OB is associated with greater SES, city residence and a snack-food diet pattern. Students belonging to higher SES compared with those from a lower SES background reported significantly (P < 0·01) more daily servings of snack foods (1·55 v. 0·76) and fewer servings of traditional diet foods (0·99 v. 1·68) and also reported that they ate meals outside the home more often (90% v. 72%). Students in cities ate significantly (P < 0·01) more servings of snacks (1·69 v. 1·05 v. 0·51) and fewer servings of traditional foods (0·67 v. 1·52 v. 1·61) compared with those in urban and rural villages. The odds of OW/OB were increased 1·16-fold with a snack-food diet, a result that was diminished when controlled for SES. CONCLUSIONS These data suggest that nutritional transition occurs at different rates across urbanization and SES levels in Botswana. In cities, increasing the availability of fruit while reducing access to or portion sizes of snack items is important. Emphasis on continued intake of traditional foods may also be helpful as rural areas undergo economic and infrastructural development.

Ethical and Cultural Considerations in Informed Consent in Botswana

Reflections on my experience of conducting research in Botswana are used to highlight tensions and conflicts that arise from adhering to the western conceptualization of bioethics and the need to be culturally sensitive when carrying out research in ones own culture. Cultural practices required the need to exercise discretionary judgement guided by respect for the culture and decision-making protocols of the research participants. Ethical challenges that arose are discussed. The brokerage role of nurse educators and leaders in contextualizing western bioethics is emphasized.

Association between socioeconomic status indicators and obesity in adolescent students in Botswana, an African country in rapid nutrition transition.

The purpose of this study was to examine two separate socioeconomic status (SES) indicators of obesity in Botswana, an African country that has experienced rapid economic development and where the prevalence of human immunodeficiency virus/acquired immune deficiency syndrome is high.

Body Image Dissatisfaction Is Increased in Male and Overweight/Obese Adolescents in Botswana

Introduction. The purpose of this study was to examine linkages between obesity, physical activity, and body image dissatisfaction, with consideration of socioeconomic status (SES) and urbanization in adolescents in Botswana. Materials and Methods. A nationally representative, cross-sectional survey in 707 secondary school students included measured height and weight to determine overweight (OW) or obesity (OB) using World Health Organization standards; physical activity (PA) using the International Physical Activity Questionnaire; and body image satisfaction using the Body Ideals Questionnaire. SES was described by private school versus public school attendance. Results and Discussion. OW/OB students felt farther from ideal and greater dissatisfaction with their weight and body proportions than optimal weight students. Boys felt greater difference from ideal and more dissatisfaction with muscle tone, chest size, and strength than girls. Lower SES students and those from rural villages had more minutes of PA than higher SES or urban students. In this rapidly developing African country, these trends reflect the nutrition transition and offer opportunity to motivate OW/OB students and boys for PA as a health promotion obesity prevention behavior. Conclusions. As urbanization and improved SES are desirable and likely to continue, the public health system will be challenged to prevent obesity while preserving a healthy body image.

Building Trust and Relationships Between Patients and Providers: An Essential Complement to Health Literacy in HIV Care

&NA; Health literacy is important for access to and quality of HIV care. While most models of health literacy acknowledge the importance of the patient–provider relationship to disease management, a more nuanced understanding of this relationship is needed. Thematic analysis from 28 focus groups with HIV‐experienced patients (n = 135) and providers (n = 71) identified a long‐term and trusting relationship as an essential part of HIV treatment over the continuum of HIV care. We found that trust and relationship building over time were important for patients with HIV as well as for their providers. An expanded definition of health literacy that includes gaining a patients trust and engaging in a process of health education and information sharing over time could improve HIV care. Expanding clinical perspectives to include trust and the importance of the patient–provider relationship to a shared understanding of health literacy may improve patient experiences and engagement in care.

Stakeholders' Perceptions on Shortage of Healthcare Workers in Primary Healthcare in Botswana: Focus Group Discussions.

Background An adequate health workforce force is central to universal health coverage and positive public health outcomes. However many African countries have critical shortages of healthcare workers, which are worse in primary healthcare. The aim of this study was to explore the perceptions of healthcare workers, policy makers and the community on the shortage of healthcare workers in Botswana. Method Fifteen focus group discussions were conducted with three groups of policy makers, six groups of healthcare workers and six groups of community members in rural, urban and remote rural health districts of Botswana. All the participants were 18 years and older. Recruitment was purposive and the framework method was used to inductively analyse the data. Results There was a perceived shortage of healthcare workers in primary healthcare, which was believed to result from an increased need for health services, inequitable distribution of healthcare workers, migration and too few such workers being trained. Migration was mainly the result of unfavourable personal and family factors, weak and ineffective healthcare and human resources management, low salaries and inadequate incentives for rural and remote area service. Conclusions Botswana has a perceived shortage of healthcare workers, which is worse in primary healthcare and rural areas, as a result of multiple complex factors. To address the scarcity the country should train adequate numbers of healthcare workers and distribute them equitably to sufficiently resourced healthcare facilities. They should be competently managed and adequately remunerated and the living conditions and rural infrastructure should also be improved.

Adolescent Obesity Prevention in Botswana: Beliefs and Recommendations of School Personnel.

The study’s objectives were to gain school personnel’s (1) perceptions on diet, physical activity, body size, and obesity, (2) description of school food and physical activity practices, and (3) recommendations for programs to prevent adolescent obesity. The study took place in six junior secondary schools of varying socioeconomic status in Gaborone, Botswana. Using a qualitative descriptive design, semistructured interviews were conducted with key school personnel. Directed content analysis was used to summarize the findings. School personnel believed that obesity was an important problem. They felt that school food was unhealthy and that physical activity was provided insufficiently. Participants shared enthusiasm for a school-based health-promoting intervention that must be fun and include active engagement and education on healthy lifestyles for all students. Participants supported on-site food shop inventory changes and physical activity programs. Potential barriers listed were schools’ financial resources, interest of students, and time limitations of all involved.

Evidence-based nursing practice in Botswana: issues, challenges, and globalization

This paper presents developments in evidence-based nursing practice in Botswana, Africa. Issues pertaining to evidence-based practice in community health such as the role of research, the digital divide between African countries and developing countries, and evidenced-based nursing curricula are discussed. The role of globalization in capacity building in evidence-based practice is emphasized. Recommendations for addressing challenges faced by some African countries, including Botswana in implementing evidence-based nursing practice are made.

Factors influencing infant‐feeding choices selected by HIV‐infected mothers: Perspectives from Zimbabwe

AIM To assess factors influencing infant-feeding methods selected by HIV-infected mothers. METHODS A descriptive quantitative study was conducted among 80 mothers with babies aged 0-6 months who were randomly selected and interviewed. Descriptive statistics were used to summarize the findings. RESULTS Factors considered by women in choosing the infant-feeding methods included sociocultural acceptability (58.8%), feasibility and support from significant others (35%), knowledge of the selected method (55%), affordability (61.2%), implementation of the infant-feeding method without interference (62.5%), and safety (47.5%). Exclusive breast-feeding was the most preferred method of infant feeding. Disclosure of HIV status by a woman to her partner is a major condition for successful replacement feeding method, especially within the African cultural context. However, disclosure of HIV status to the partner was feared by most women as only 16.2% of the women disclosed their HIV status to partners. CONCLUSION The factors considered by women in choosing the infant-feeding option were ability to implement the options without interference from significant others, affordability, and sociocultural acceptability. Knowledge of the selected option, its advantages and disadvantages, safety, and feasibility were also important factors. Nurses and midwives have to educate clients and support them in their choice of infant-feeding methods.

School health: the challenges to service delivery in Botswana

This paper reports an evaluation of the implementation of the School Health Policy (SHP) in Botswana schools. Historically, school health originated with a concern for the number of children being excluded from school owing to communicable diseases. In 1999, the three ministries, Ministry of Health, Ministry of Education and Ministry of Local Government, developed the Botswana School Health Policy and Procedures Manual. The school health services are organized at national, district and local levels. The purpose of the evaluation was to explore how school health services were delivered in schools in Botswana. Data on current practices on school health were collected using observations, field notes and interviews of various school personnel in 27 schools located in the Gaborone district, and surrounding villages using the assessment guide in the SHP. Content analysis was used to analyse the data. Several challenges to implementing the school health policy were identified, for example, lack of human resources, lack of equipment supplies, lack of health knowledge among teachers, as well as organizational problems. This has budgetary implications for Botswana at both central and district levels. Commitment of all stakeholders in all ministries concerned would also improve the implementation of school health services.