Medicine

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    Neonatal pain management practices by health care professionals at Nyangabgwe and Princess Marina hospitals, Francistown and Gaborone, Botswana.
    (The University of Zambia, 2025) Difsele, Barulaganye
    Neonatal pain management remains a global challenge, particularly in low- and middle-income countries such as Botswana, due to inadequate resources, training, and evidence-based practice. Despite all neonates experiencing pain, with preterm babies being especially vulnerable, pain assessment and management are often overlooked, potentially leading to adverse short- and long-term outcomes. The main objective of this study was to assess neonatal pain management practices among healthcare professionals in the Neonatal Intensive Care Units of Nyangabgwe Referral Hospital (NRH) and Princess Marina Hospital (PMH) in Gaborone and Francistown towns of Botswana. This study used a descriptive cross-sectional design. The study included 110 healthcare professionals, all of whom were enrolled into the study by census method. The data were collected using an online questionnaire with validated items of the Likert scale. The collected data was exported into Excel 2013 for cleaning. The data was further imported into Stata version 18 for analysis using descriptive and inferential statistics. Chi-square, Fisher’s exact and binary logistic regression tests were used to statistically analyse the data. A confidence interval of 95% with a significance level of 5% was set. The results showed that 87 (79%) of the participants demonstrated good neonatal knowledge of pain management practices. The final analysis using binary logistic regression identified key predictors of good practice. Participants categorized as knowledgeable had 6 times odds of practicing good neonatal pain management practices compared to those not knowledgeable (AOR = 6.34; 95% CI: 0.10-22.7, p < .001). Participants with formal training in neonatal pain management had about 4 times odds of having good neonatal pain management practices compared to those who did not receive training (AOR= 3.974, 95%, CI: 0.37-1.82, p = .046) . Those who reported the presence of protocols in the Neonatal Intensive Care Units (NICUs) also had more than 1 times odds of having good neonatal pain management practices (AOR= 1.132; 95% CI: 0.12-1.02, p = .012). Non-Christian participants had 23% odds of having good neonatal pain management practices, while Christians had 76.9% odds of having good neonatal pain management practices (AOR= 0.231, 95%, CI:0.98-1.25, p = .002). Non-pharmacological interventions also mattered with respondents using non-pharmacological interventions to manage pain in neonates having better practices than those not using them (AOR= 6.863, 95%, CI: 0.001-63.2, p = .27). These results suggest that knowledge, training and adherence to protocols are crucial for improving neonatal pain management. The study highlights critical gaps in neonatal pain management practices in Botswana. The study recommends revising curricula, enhancing interdisciplinary training, and advocating for updated policies and protocols to improve assessment, documentation, and overall neonatal pain management practices. Keywords: Infant, newborn, Botswana, pain management, hospitals, Health care professionals.
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    Utilisation of the female condom by women in Chainda catchment area of Lusaka district, Zambia
    (The University of Zambia, 2025) Shankwaya, Modrine
    The female condom is a dual protection tool for both prevention of HIV/ AIDs transmission and unwanted or unplanned pregnancies. The female condom is one of several overlooked and underused reproductive health technologies having the potential to expand choice in family planning and prevention of Human Immunodeficiency Virus and sexually transmitted infections programmes. Nursing staff at Chainda health centre in Lusaka conduct health education on all family planning services at the clinic and in the community during outreach activities. However, data from Lusaka district health office (LDHO) show that female condom utilisation is very low in comparison to other family planning methods. The aim of this study was to determine factors associated with utilisation of the female condom among women in Chainda catchment area. A mixed method study design was used for this study. A semi structured questionnaire was used to collect quantitative data, while two focused group discussions (FGDs) were used to collect qualitative data. Statistical Package for Social Sciences (SPSS) version 23 was used for quantitative data analysis, and content analysis was used to analyse qualitative data. Chi square was used to test the association between the dependent and independent variables at 0.05 level of significance. The study population comprised of 384 randomly selected women, aged 15 to 49 years, living in Chainda catchment area of Lusaka district, and accessing health services from the health facility. Chainda catchment area was selected using purposive sampling, due to its dense and diverse population, being an accessible health facility, due to prior research indicating specific health concerns, established community engagement, relevant socioeconomic conditions, logistical ease, and alignment with funding or collaborative interests. These factors made it an ideal location for studying women's health and service utilisation. The findings were that 31% of the respondents exhibited high knowledge of the female condoms while 41% had moderate knowledge, and 28% had low knowledge. The findings also showed that 90% of the respondents agreed to female condoms being available all the time, while 10% said the commodity was not available at all times. A small proportion (14%) of respondents had positive attitudes towards female condom utilisation, while 86% had negative attitudes. The association between knowledge and utilisation of female condoms was statistically significant with p <0.0001. The association between availability and utilisation of the female condom was also statistically significant (p=0.00). The association between attitudes and utilisation of the female condom was not statistically significant (p=0.447). Three themes (i) Knowledge about female condoms, (ii) Use of female condoms and (iii) Experiences of using female condoms emerged from the qualitative data. (iv) Availability of female condom and (v) where can one get a female condom? Although female condoms are widely available, their utilisation remains low. Thus, the findings of the dissertation underscore the need for targeted education and awareness campaigns in the catchment area. Key words: Female condom, Women, Utilisation, Catchment area
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    Experiences of mothers with premature babies admitted in neonatal intensive care unit at Princess Marina hospital Gaborone, Botswana.
    (The University of Zambia, 2025) Mpofu, Pepechua
    Preterm birth is a major concern contributing significantly to the world's neonatal mortality. It is stressful and associated with many emotional crisis among mothers of preterm babies. This study explored the experiences of mothers with premature babies admitted to Neonatal Intensive Care Unit (NICU) at Princess Marina Hospital (PMH) in Gaborone, Botswana. The study utilised Qualitative phenomenological descriptive design. Twelve mothers of premature babies were purposively sampled. In-depth interview guide was used to collect data on mothers of preterm babies aged 20-40 years. Audio recorded in-depth interviews were transcribed verbatim, those in Setswana were translated to English. Data was analysed inductively using Braun and Clarke thematic analysis, with the aid of Nvivo` 15 software for codes generation, which were organised into subthemes and themes manually. The study uncovered an intricate journey noticeable by the interchange periods of sadness, disappointment, excitement, fear and anxiety of losing their babies with paucity in emotional and psychological support, inadequate rest and lack of information. Mothers yearned for bonding and interaction with their babies. Misinformation about the baby`s demise and baby swapping compounded their difficult journey. Despite these challenges, mothers of premature babies remained optimistic about their babies, showing the resilience amidst the complexities of prematurity. Mothers expressed divided opinions on their interaction with the NICU staff, variability in hospital care and support and perceived the need for increased resources in NICU. The findings underscores the necessity for a comprehensive interventions to overcome the physical, emotional, psychological and social burdens experienced by mothers of preterm babies, ensuring mothers are informed, quality health care and aid in reducing the neonatal morbidities and mortalities in NICU. Recommendations include review of the NICU guidelines for all mothers of premature babies admitted to NICU to be routinely referred to a psychologist. Integration of holistic approach to address the needs of mothers, babies and their families. Implementation of in service training programs of NICU staff to enhance the provision of educational and emotional support to mothers.Prioritisation and mobilisation of resources in NICU. Keywords: Mothers of premature babies, experiences, Neonatal intensive care Unit, perceptions.
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    HIV diagnosis during pregnancy: stress, coping strategies and experiences of women at selected health facilities in Lusaka district, Zambia.
    (The University of Zambia, 2024) Sianchapa, Brenda Nambala
    Background: A diagnosis of HIV usually causes stress in the affected individual because of its lack of cure. In an effort to eliminate mother-to-child transmission (eMTCT) of HIV, pregnant women have to undergo HIV testing during antenatal care. Pregnancy is a sensitive and stressful state as the body of the pregnant woman has to make adjustments throughout in order to maintain the pregnancy and prepare for labour and delivery; and the puerperium. A diagnosis of HIV during pregnancy therefore adds on to this stress. A pregnant woman who is diagnosed HIV positive requires assistance in order to cope positively with the HIV diagnosis and its effects. When positive coping strategies are used, the levels of stress begin to dissipate. Study aim: The study aimed to ascertain the stress levels, coping strategies and experiences of women diagnosed HIV positive during pregnancy at selected Health facilities in Lusaka district, Zambia Methods: A longitudinal mixed methods design was used to collect panel data in 3 stages. Stage 1 of the study was done during the participants’s second antenatal visit at around 14-20 weeks gestation, stage 2 was done at around 28-32 weeks’gestation and stage 3 was done at six weeks postdelivery. The quantitative arm used a longitudinal analytical design, while the qualitative arm used a descriptive cross-sectional design. The study population were pregnant women who tested HIV positive for the first time during their current pregnancy, and 100% enumeration was used to select 110 participants for the quantitative data, and out of these, purposive sampling was employed to select 17 participants, for the qualitative data collection. The Perceived Stress Scale (PSS) and Coping Strategy Indicator (CSI) were used to collect quantitative data on the levels of stress and the coping strategies used respectively. The stress levels were measured during all the 3 stages of the study and the coping strategies were categorised during stage 2 and 3 of the study. Stress levels were categorised into high, moderate or low, while coping strategies were either problem focused or emotion focused. The problem focused coping was subdivided into problem focused (problem solving) and problem focused (seeking social support). Quantitative data analysis was conducted using the Statistical Package for Social Sciences (SPSS) Version 26. Descriptive statistics were used to report participants’ demographic characteristics as well as the levels of stress and coping strategies that they used at each assessment period. A Wilcoxon matched pairs signed rank test tested for differences in stress levels at Stages 1 and 2 of the study, and Kruskal-Wallis test determined the relationship between the coping strategy used and the stress levels. Post hoc comparisons were conducted using Mann-Whitney tests to compare the differences in stress levels among the coping strategies that were used. Qualitative data were collected using a semi structured interview schedule during stage 3 of the study and were analysed manually, using the Braun and Clarke 6-phase coding framework for thematic analysis, which included; familiarisation, coding, generating themes, reviewing themes, defining and naming themes, and writing up. Findings: The major findings revealed that 57.3%, 65.6%, and 37.5% of the participants had moderate levels of stress at stages 1, 2 and 3 of the study respectively. This was followed by those who had high levels of stress (26.4%, 14.4 and 12.5%) at stages 1, 2 and 3 of the study respectively. Over half (54.5 and 62.5%) of participants utilised problem focused (problem solving) coping strategy at stages 2 and 3 of the study respectively. There was a statistically significant median difference between the perceived stress scale (stage 1) and perceived stress scale (stage 2). We therefore rejected the null hypothesis and concluded that the difference between the rank totals of 34.91 (A), 30.71 (B) and 46.43 (C) were significant, H (2, n=73(=6.75, p=.034. There was a statistically significant association between the coping strategy and the levels of stress at stage 2 of the study (p=.001). Post hoc comparisons were conducted using Mann- Whitney tests with a Bonferroni adjusted alpha level of .016 (0.05/3). The difference between the Problem solving group and the seeking social support group was statistically significant (z=-21.252, p=.002), Problem solving group and Emotion focused group (z=-33.327, p=.001). Kruskal Wallis test revealed a statistically significant association between stress levels and Health facility at Stage 1 (p=.038). Post hoc comparisons using Mann Whitney tests with a Bonferroni adjusted alpha level of .016 (0.05/3) were conducted and revealed a statistically significant difference between the Kanyama and the George group (z=24.638, p=.038). There was also a statistically significant association between participant’s age and stress levels at both stage 1 and 2 of the study (U=627.000, p=.012 at stage 1 and U=498.500, p=.015 at stage 2). Thematic analysis was conducted on qualitative data and 8 themes emerged which explained the participants’ experiences. Among them were; stress of an HIV diagnosis, ART adherence, disclosure of an HIV diagnosis, staff behaviour, mother baby interaction, and resilience and moving on. Conclusion: The study revealed that women who are diagnosed with HIV during pregnancy experience stress, and the coping strategy that they utilise determines the increase or reduction of the stress levels. The study recommends the use of the Perceived Stress Scale, and Coping Strategy Indicator at every antenatal and postnatal visit for women diagnosed HIV positive during pregnancy. This will help to identify those who are stressed and enable individualised care to help them to cope; and those using maladaptive coping, to help them employ coping strategies that can help them deal with the stress. Key words: stress, HIV diagnosis in pregnancy, coping strategy, mother-baby bonding
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    Prevalence of hypothermia and associated factors among neonates admitted to special care nursery at Raleigh Fitkin Memorial hospital, Manzini, Eswatini.
    (The University of Zambia, 2025) Mabuza, Ncanele Nokukhanya
    Neonatal hypothermia is an abnormal thermal state in which the neonate’s body temperature is less than 36.5 ̊ C. It remains a critical concern particularly in resource limited settings, contributing significantly to neonatal morbidity and mortality. While neonatal hypothermia is well documented globally, there is inadequate local data on its prevalence and contributing factors in Eswatini’s healthcare settings. This gap in knowledge limits targeted interventions for addressing hypothermia in the region. This study aimed to assess the prevalence of neonatal hypothermia and its associated factors among neonates admitted to the Special Care Nursery (SCN) of Raleigh Fitkin Memorial Hospital (RFMH) in Eswatini. A descriptive cross sectional study was conducted with 274 participants, consisting of 137 neonates and 137 mothers, admitted to the Special Care Nursery (SCN). Data were collected using a structured questionnaire and checklist, as well as through the medical records of the neonates. The body temperatures of the neonates were measured on admission and 24 hours post-admission. Data analysis was performed using SPSS version 26. Chi-square tests were applied to assess associations between categorical variables and hypothermia, with Fisher’s exact test used where necessary. Binary logistic regression analysis was used to identify independent variables significantly associated with neonatal hypothermia. The prevalence of neonatal hypothermia among the study participants was 69.3%. The analysis revealed several significant associations. Premature infants (28 – <37 weeks gestation) were more likely to be hypothermic compared to full-term infants (≥37 weeks gestation) (AOR = 3.34, p = 0.014). Additionally, delayed initiation of breastfeeding (beyond the first hour post-delivery) was strongly associated with increased likelihood of hypothermia (AOR = 0.203, p < 0.001). Neonates not born at RFMH also had a higher risk of hypothermia (AOR = 0.096, p = 0.025), as did those with low Apgar scores (<7) (AOR = 0.222, p = 0.017). The study found a high prevalence of neonatal hypothermia (69.3%) in the SCN of Raleigh Fitkin Memorial Hospital, with key factors including prematurity, delayed breastfeeding initiation, low Apgar scores, and environmental influences. These findings emphasize the need for targeted interventions, such as improved thermal protection, timely breastfeeding, enhanced neonatal care protocols and contributes to the limited local data on hypothermia, informing health policy and efforts to reduce neonatal mortality in Eswatini. Key words: Prevalence, Neonatal hypothermia, associated factor