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 – stakeholders' consultation and trauma registry prototype was designed. 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 are collected using hard copy forms and some of these data were 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 were also partially stored as hard copies and some data are 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.
PURPOSE Breast cancer patients, including patients living with HIV (PLWH), in sub-Saharan Africa experience a disproportionate burden of mortality. Adherence to treatment guidelines improves quality of care and survival outcomes. We therefore sought to study patient socioeconomic and cultural factors associated with treatment fidelity and how this may differ for PLWH in Botswana. METHODS This was a qualitative study design with deviance sampling of high and low fidelity patients who initiated treatment for stage I-III breast cancer. One-on-one phone interviews were conducted using semi-structured interviews, guided by the Theory of Planned Behavior. The final sample size was determined by thematic saturation. Transcribed interviews were double-coded and analyzed in NVivo using an integrated analysis approach. We maintained a kappa statistic of 0.8 between coders. RESULTS Fifteen high and 15 low fidelity patients were enrolled from August 25-December 15, 2020. Ten out of 30 of the cohort were PLWH. Barriers to treatment adherence included concerns about safety and efficacy of chemotherapy, lack of trust in the care team, lack of psychosocial support, financial toxicity, geographical inaccessibility, and other health-system barriers. Drivers and manifestations of stigma, including intersectional stigma of cancer fatalism in PLWH were identified as prominent barriers. Conversely, self-acceptance and de-stigmatization were identified as facilitators of treatment initiation. Additional facilitators included knowledge of curative intent, anticipated management of side effects, self-motivation, social support, and peer support. COVID-19 pandemic amplified existing socioeconomic barriers especially for patients with food insecurity and geographic inaccessibility. CONCLUSION The study identified multi-level modifiable patient and related health-system factors associated with treatment initiation and adherence. PLWH experienced unique barriers including intersectional stigma, which is a critical finding and warrants further evaluation. The facilitators in this study provide opportunities for leveraging existing strengths within the specific context to design multilevel implementation strategies to increase treatment fidelity of guideline concordant breast cancer therapy.
Introduction. Systemic treatment for breast cancer in Sub-Saharan Africa (SSA) is cost-effective. However, there is limited real-world data on the translation of breast cancer treatment guidelines into clinical practice in SSA. The study aimed to identify provider factors associated with adherence to breast cancer guideline-concordant care at Princess Marina Hospital (PMH) in Botswana. Methods. The Consolidated Framework for Implementation Research was used to conduct one-on-one semi-structured interviews with breast cancer providers at PMH. Purposive sampling was used, and sample size determined by thematic saturation. Transcribed interviews were double-coded and analyzed in NVivo using an integrated analysis approach.Results. Forty-one providers across eight departments were interviewed. There were variations in breast cancer guidelines used. Facilitators included a strong tension for change and a government-funded comprehensive cancer care plan. Common provider and health system barriers were lack of available resources, staff shortages and poor skills retention; lack of relative priority compared to HIV/AIDS, suboptimal interdepartmental communication and lack of a clearly defined national cancer control policy. Communitylevel barriers included accessibility and associated transportation costs. Participants recommended the formal implementation of future guidelines that involved key stakeholders in all phases of planning and implementation, strategic government buy-in, expansion of multidisciplinary tumor boards, leveraging non-governmental and academic partnerships, and setting-up monitoring, evaluation and feedback processes. Discussion. The study identified complex, multi-level factors affecting breast cancer treatment delivery in Botswana. These results and recommendations will inform strategies to overcome specific barriers in order to promote standardized breast cancer care delivery and improve survival outcomes. The Oncologist 2021;9999:• • Implications for Practice: To address the increasing cancer burden in low-and middle-income countries, resource-stratified guidelines have been developed by multiple international organizations to promote high quality guideline-concordant care. However, these guidelines still require adaptation in order to be successfully translated into clinical practice in the countries where they intend to be used. This study highlights a systematic approach of evaluating important contextual factors associated with the successful adaptation and implementation of resource-stratified guidelines in sub-Saharan Africa. In Botswana, there is a critical need for local stakeholder input to inform country-level and facility-level resources, cancer care accessibility and community-level barriers and facilitators.
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
Background and context: Routine collection of quality oncology data remains underprioritized in resource limited settings. For breast cancer (BC) care at Princess Marina Hospital (PMH) in Botswana, this hampers its use for oncology program evaluation and clinical research. The Peo Data Acquisition Core (DAC), part of a consortium for planning of a noncommunicable diseases center for research excellence in Southern Africa, engaged relevant stakeholders and departments at PMH to establish health care worker driven processes that support sustained improvements in the quality of routinely collected breast cancer data. Aim: Assess PMH BC care needs to support the improvement of routinely collected data. Strategy/Tactics: Conventional routine data quality assessments guide iterative identification of data quality gaps for improvement, but tend to consume additional human resources to implement and prioritize data quality over existing provider concerns. We undertook a holistic approach to identifying needs challenging the improvement of data routinely collected about PMH BC patients. Program/Policy process: A need assessment began with mapping of patient care process, capturing process steps, including subprocesses, actors, and an inventory of related data capture systems. The assessment also gathered care providers' perceptions of challenges to providing care as well as perceptions of the up-time of an existing electronic health record (EHR). Outcomes: BC patient management involves multiple care providers who attend to patients in different locations within the hospital. Except for EHR captured laboratory data, nearly all other documentation of patient care occurred through paper-based registers, diaries and general clinical forms. Providers indicated the overbooking of patient appointments and use of different formats to manage patient data as key challenges for them. EHR appointment scheduling components appear underutilized by providers, and a brief monitoring of provider perceptions of the EHR's speed and reliability suggests it is poorest in the mornings - at a time when providers are the busiest attending to patients. What was learned: Needs assessment findings suggest several opportunities to respond to provider recognized challenges through greater adoption of EHR usage. Establishment of a Quality Improvement (QI) group that champions improvements in routine BC data quality should integrate standardization of patient data formats and EHR centralized appointment booking. QI group composition should include both care providers and an EHR IT technician.
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