Barriers to Prostate Cancer Screening by Men in Sub-Saharan Africa: An Integrated Review.

PURPOSE: The aim of this integrative review was to synthesize findings of the published studies on barriers to prostate cancer screening by men in sub-Saharan Africa. DESIGN AND METHOD: Five-step Cooper integrative methodology guided this review. Electronic databases, including the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, EBSCOHOST, MEDLINE, ProQuest, and PsycINFO, were searched using specific search terms in combinations to identify relevant articles for the review. Through this process, 83 articles were retrieved and evaluated for duplications and relevance of titles, abstracts, and content. Seventeen articles met the inclusion criteria and were judged to be methodologically adequate. These articles were published between 2008 and 2018. FINDINGS: Studies that met the inclusion criteria were from seven sub-Saharan countries, including Burkina Faso (n = 1), Ghana (n = 1), Kenya (n = 2), Namibia (n = 1), Nigeria (n = 8), South Africa (n = 3), and Uganda (n = 1). The most common barrier was lack of knowledge, followed by perceptions, attitudes, and beliefs that hindered screening and testing for prostate cancer. CONCLUSIONS: The findings from the integrative review suggest that individuals with low levels of education tend to lack knowledge, cannot comprehend information, and are mistrustful about prostate cancer screening. Low socio-economic status was also associated with poor prostate screening and testing uptake. CLINICAL RELEVANCE: Evidence from this review demonstrates that lack of knowledge is a major barrier for prostate screening among men in many parts of sub-Saharan Africa.

Integrated Review of Barriers to Cervical Cancer Screening in Sub-Saharan Africa.

PURPOSE: The aim of this study was to review published studies to identify and describe barriers to Papanicolaou (Pap) smear screening among women in sub-Saharan Africa. DESIGN AND METHODS: Guided by Cooper's integrative review methodology, studies published between 2006 and 2015 were identified by searching electronic databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, MEDLINE, ProQuest, and PsycINFO using specified search terms. Using this strategy, 224 articles were identified and screened for duplication and by reading titles, abstracts, and full texts. Seventeen articles met the inclusion criteria and were appraised using relevant tools for qualitative and quantitative designs. No relevant articles published in 2006, 2007, and 2014 were found. FINDINGS: All 17 articles had good methodological quality and were included in the review. The studies were from 10 sub-Saharan countries and from different settings. Content analysis of the data revealed three major themes coded as client, provider, and system barriers. The most common client barriers were lack of knowledge and awareness about Pap smear screening, fear of cancer, belief of not being at risk for cervical cancer, and that a Pap smear is not important unless one is ill and cultural or religious factors. Provider barriers were failure to inform or encourage women to screen. Major system barriers were unavailability and inaccessibility of the Pap test. CONCLUSIONS: The review provided evidence of barriers to Pap smear screening among sub-Saharan women. Although there were some variations from country to country, sub-Saharan countries share similar constraints to Pap smear screening. These findings have important implications for practice and policy. CLINICAL RELEVANCE: Understanding the client, provider, and system barriers to cervical cancer screening could guide development of effective interventions.

A root-cause analysis of maternal deaths in Botswana: towards developing a culture of patient safety and quality improvement.

BACKGROUND: In 2007, 95% of women in Botswana delivered in health facilities with 73% attending at least 4 antenatal care visits. HIV-prevalence in pregnant women was 28.7%. The maternal mortality ratio in 2010 was 163 deaths per 100,000 live births versus the government target of 130 for that year, indicating that the Millennium Development Goal 5 was unlikely to be met. A root-cause analysis was carried out with the aim of determining the underlying causes of maternal deaths reported in 2010, to categorise contributory factors and to prioritise appropriate interventions based on the identified causes, to prevent further deaths. METHODS: Case-notes for maternal deaths were reviewed by a panel of five clinicians, initially independently then discussed together to achieve consensus on assigning contributory factors, cause of death and whether each death was avoidable or not at presentation to hospital. Factors contributing to maternal deaths were categorised into organisational/management, personnel, technology/equipment/supplies, environment and barriers to accessing healthcare. RESULTS: Fifty-six case notes were available for review from 82 deaths notified in 2010, with 0-4 contributory factors in 19 deaths, 5-9 in 27 deaths and 9-14 in nine. The cause of death in one case was not ascertainable since the notes were incomplete. The high number of contributory factors demonstrates poor quality of care even where deaths were not avoidable: 14/23 (61%) of direct deaths were considered avoidable compared to 12/32 (38%) indirect deaths. Highest ranking categories were: failure to recognise seriousness of patients' condition (71% of cases); lack of knowledge (67%); failure to follow recommended practice (53%); lack of or failure to implement policies, protocols and guidelines (44%); and poor organisational arrangements (35%). Half the deaths had some barrier to accessing health services. CONCLUSIONS: Root-cause analysis demonstrates the interactions between patients, health professionals and health system in generating adverse outcomes for patients. The lessons provided indicate where training of undergraduate and postgraduate medical, midwifery and nursing students need to be intensified, with emphasis on evidence-based practice and adherence to protocols. Action plans and interventions aimed at changing the circumstances that led to maternal deaths can be implemented and re-evaluated.

Integration of HIV care into maternal health services: a crucial change required in improving quality of obstetric care in countries with high HIV prevalence.

BACKGROUND: The failure to reduce preventable maternal deaths represents a violation of women's right to life, health, non-discrimination and equality. Maternal deaths result from weaknesses in health systems: inadequate financing of services, poor information systems, inefficient logistics management and most important, the lack of investment in the most valuable resource, the human resource of health workers. Inadequate senior leadership, poor communication and low staff morale are cited repeatedly in explaining low quality of healthcare. Vertical programmes undermine other service areas by creating competition for scarce skilled staff, separate reporting systems and duplication of training and tasks. DISCUSSION: Confidential enquiries and other quality-improvement activities have identified underlying causes of maternal deaths, but depend on the health system to respond with remedies. Instead of separate vertical programmes for management of HIV, tuberculosis, and reproductive health, integration of care and joint management of pregnancy and HIV would be more effective. Addressing health system failures that lead to each woman's death would have a wider impact on improving the quality of care provided in the health service as a whole. More could be achieved if existing resources were used more effectively. The challenge for African countries is how to get into practice interventions known from research to be effective in improving quality of care. Advocacy and commitment to saving women's lives are crucial elements for campaigns to influence governments and policy -makers to act on the findings of these enquiries. Health professional training curricula should be updated to include perspectives on patients' rights, communication skills, and integrated approaches, while using adult learning methods and problem-solving techniques. SUMMARY: In countries with high rates of Human Immunodeficiency Virus (HIV), indirect causes of maternal deaths from HIV-associated infections now exceed direct causes of hemorrhage, hypertension and sepsis. Advocacy for all pregnant HIV-positive women to be on anti-retroviral therapy must extend to improvements in the quality of service offered, better organised obstetric services and integration of clinical HIV care into maternity services. Improved communication and specialist support to peripheral facilities can be facilitated through advances in technology such as mobile phones.

Male involvement in child care activities: a review of the literature in Botswana.

Engaging men as partners in childrearing is critical because of the positive aspects on the child's development and reduction of childhood illnesses. The paper presents findings from a literature review whose aim was to assess the extent to which males are involved in child care activities. Findings revealed a limited number of studies conducted in the area of male involvement. Sociocultural factors have a negative influence on men's participation on child care activities. In addition, some laws were prohibitive to male involvement. It was difficult to assess the extent to which males were involved due to inadequate data collection tools. Recommendations include a study on male involvement, review of the existing Sexual and Reproductive Health data collection tools, development of a policy on paternity leave, strengthening training on male involvement; community sensitization on cultural stereotypes and harmonization of customary and common laws.

Cultural considerations in theories of adolescent development: a case study from Botswana.

Western studies of adolescent development are beginning to corporate not only the traditional ideas of nature and nurture, but also contextual factors such as culture, ecology and historical time. This article explores how adolescent development is influenced by both a specific culture (Botswana) and a specific ecological situation (the rampant HIV pandemic in that country). A case study of late adolescents living in this pandemic in Botswana helps broaden our traditional views of adolescent development.

Using qualitative methods for course evaluation: a case study from Botswana.

This article is a report of a qualitative evaluation of a course on human immunodeficiency virus/acquired immunodeficiency syndrome carried out jointly by faculty from Botswana and the United States at a university in Botswana. It demonstrates the importance of both international nurse educator expertise in impacting a major pandemic and the use of qualitative methods for course evaluation.