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A Bochdalek hernia (BH) occurs when abdominal contents herniate through the postero-lateral segment of the diaphragm. The right side is affected considerably less commonly than the left. Most BHs present are diagnosed early in life, with some element of cardio-respiratory distress. Rarely, hernias that remain clinically silent until adulthood when they present as life-threatening surgical emergencies. We report a case 35 year old female who emergency exploratory laparotomy for a complete mechanical bowel obstruction. At surgery the redundant transverse colon was twisted and incarcerated within the right hemithorax, creating a closed loop obstruction. The right colon, appendix, terminal ilium, and three accessories right liver lobes were also dragged into the right thoracic cavity. After reducing the hernia, the diaphragmatic defect was primarily repaired with non-absorbable suture. The redundant transvers colon which had been compromised was resected and primary end-to- end anastomosis was carried out. Incidental appendectomy was done. The patient was sent into ICU for post-operative monitoring. She made an uneventful recovery and remains asymptomatic at nine month follow-up. I discuss what i believe to be the first case report of complicated right diaphragmatic hernia in Botswana, associated with another congenital mal-formation (accessories hepatic lobes, partial mal-rotation, and redundant transvers colon) in adult.

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Congenital intestinal malrotation is a gastrointestinal anomaly whose most serious complication is midgut volvulus. More commonly, it presents as an incidental finding at laparotomy, or as a finding on diagnostic imaging (Ultrasound, CT, Upper GI contrast study). Most patients are diagnosed in childhood. Laparoscopic Ladd's procedure is an accepted alternative to Laparotomy in children but has not been well-studied in adult. We present the case of this unexpected finding in a patient 38 years old, during emergency laparotomy for mechanical intestinal obstruction. Intra-operative findings included intestinal malrotation with small bowel volvulus. The terminal ilea and cecum were gangrenous on the basis of ischemic necrosis. A limited right hemycolectomy and primary end-to- end anastomosis was performed.

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Background Similar to many low- and middle-income countries, Botswana has identified eHealth as a means of improving health care service provision and delivery. The National Malaria Programme (NMP) in Botswana has implemented the District Health Information System version 2 (DHIS2) to support timely malaria case reporting across its 27 health districts; however, the implementation of an eHealth system is never without challenges. Barriers to the implementation of eHealth innovations within health care settings may arise at the individual or organizational levels. As such, the evaluation of user perceptions of the technology is an important step that can inform its sustainable implementation. The DHIS2 was implemented without evaluating user perceptions beforehand; therefore, the Botswana Ministry of Health and Wellness was uncertain about the likelihood of acceptance and use of the platform. Objective We aimed to determine the acceptance of the DHIS2 platform by the NMP in Botswana to gauge whether adoption would be successful. Methods The study’s design was informed by constructs of the technology acceptance model. A survey, with items assessed using a 7-point Likert scale, and focus group discussions were undertaken with DHIS2 core users from 27 health districts and NMP personnel at the Ministry of Health and Wellness. The web-based survey was administered from August 3, 2020 to September 30, 2020. Results Survey participants were core users (n=27). Focus group participants were NMP personnel (n=5). Overall, participants’ survey responses (frequently occurring scores of 7) showed their confidence in the DHIS2 platform for case-based surveillance of malaria; however, participants also noted some organizational issues that could compromise user acceptance of the DHIS2 platform. Conclusions Participants’ responses indicated their acceptance of the DHIS2 platform; however, the consideration of factors related to organizational readiness could further enhance successful acceptance, and consequently, successful adoption of the platform by the malaria program in Botswana.

Purpose Seeking to leverage on benefits of personal mobile device use, medical schools and healthcare facilities are increasingly embracing the use of personal mobile devices for medical education and healthcare delivery through bring-your-own-device (BYOD) policies. However, empirical research findings that could guide the development of BYOD policies are scarce. Available research is dominated by studies that were guided by technocentric approaches, hence seemingly overlooking the complexities of the interactions of actors in mobile device technologies implementation. The purpose of this study was to use the actor–network theory to explore the potential role of a BYOD policy at the University of Botswana’s Faculty of Medicine. Design/methodology/approach Purposive sampling was used to select the participants and interviews, focus group discussions, observations and document analysis were used to collect data. Data were collected from 27 participants and analysed using grounded theory techniques. Emerging themes were continually compared and contrasted with incoming data to create broad themes and sub-themes and to establish relationships or patterns from the data. Findings The results suggest that the potential roles for BYOD policy include promoting appropriate mobile device use, promoting equitable access to mobile devices and content, and integrating mobile devices into medical education, healthcare delivery and other institutional processes. Research limitations/implications BYOD policy could be conceptualized and researched as a “script” that binds actors/actants into a “network” of constituents (with shared interests) such as medical schools and healthcare facilities, mobile devices, internet/WiFi, computers, software, computer systems, medical students, clinical teachers or doctors, nurses, information technology technicians, patients, curriculum, information sources or content, classrooms, computer labs and infections. Practical implications BYOD is a policy that seeks to represent the interests (presents as a solution to their problems) of the key stakeholders such as medical schools, healthcare facilities and mobile device users. BYOD is introduced in medical schools and healthcare facilities to promote equitable access to mobile devices and content, appropriate mobile device use and ensure distribution of liability between the mobile device users and the institution and address the implication of mobile device use in teaching and learning. Originality/value The BYOD policy is a comprehensive solution that transcends other institutional policies and regulations to fully integrate mobile devices in medical education and healthcare delivery.

Introduction Globally, the amount of research on the outcomes of pediatric tuberculosis (TB) is disproportionately less than that of adult TB. The diagnosis of paediatric TB is also problematic in developing countries. The aim of this study was to describe the outcomes of pediatric TB in Botswana and to identify the factors associated with unfavorable outcomes. Methods This was a retrospective analysis of pediatric TB outcomes in Botswana, over a 12-year period from January 2008 to December 2019. Treatment success (treatment completion or cured) was considered a favorable outcome, while death, loss to follow-up and treatment failure were considered unfavorable outcomes. Program data from drug-sensitive TB (DS-TB) cases under the age of 15 years were included. Sampling was exhaustive. Binary logistic regression was used to determine the factors associated with unfavorable outcomes during TB treatment. A p value of < 0.05 was considered a statistically significant association between the predictor variables and unfavorable outcomes. Results The data of 6,004 paediatric TB cases were extracted from the Botswana National TB Program (BNTP) electronic registry and analyzed. Of these data, 2,948 (49.4%) were of female patients. Of the extracted data, 1,366 (22.8%) were of HIV positive patients and 2,966 (49.4%) were of HIV negative patients. The rest of the data were of patients with unknown HIV status. Pulmonary TB accounted for 4,701 (78.3%) of the cases. Overall, 5,591 (93.1%) of the paediatric TB patient data showed treatment success, 179 (3.0%) were lost to follow-up, 203 (3.4%) records were of patients who died, and 31 (0.5%) were of patients who experienced treatment failure. The factors associated with unfavorable outcomes were positive HIV status (AOR 2.71, 95% CI: 2.09–3.52), unknown HIV status (AOR 2.07, 95% CI: 1.60–2.69) and retreatment category (AOR 1.92, 95% CI: 1.30–2.85). Compared with the 0–4 years age category, the 5–9 years (AOR 0.62, 95% CI: 0.47–0.82) and 10–14 years (AOR 0.76, 95% CI: 0.60–0.98) age categories were less likely to experience the unfavorable outcomes. Conclusion This study shows a high treatment success rate among paediatric TB cases in Botswana. The government under the National TB Program should maintain and consolidate the gains from this program. Public health interventions should particularly target children with a positive or unknown HIV status, those under 5 years, and those who have been previously treated for TB.