BackgroundBotswana’s medical school graduated its first class in 2014. Given the importance of attracting doctors to rural areas the school incorporated rural exposure throughout its curriculum.AimThis study explored the impact of rural training on students’ attitudes towards rural practice.SettingThe University of Botswana family medicine rural training sites, Maun and Mahalapye.MethodsThe study used a mixed-methods design. After rural family medicine rotations, third- and fifth-year students were invited to complete a questionnaire and semi-structured interview. Data were analysed using descriptive statistics and thematic analysis.ResultsThe thirty-six participants’ age averaged 23 years and 48.6% were male. Thirty-three desired urban practice in a public institution or university. Rural training did not influence preferred future practice location. Most desired specialty training outside Botswana but planned to practice in Botswana. Professional stagnation, isolation, poorly functioning health facilities, dysfunctional referral systems, and perceived lack of learning opportunities were barriers to rural practice. Lack of recreation and poor infrastructure were personal barriers. Many appreciated the diversity of practice and supportive staff seen in rural practice. Several considered monetary compensation as an enticement for rural practice. Only those with a rural background perceived proximity to family as an incentive to rural practice.ConclusionThe majority of those interviewed plan to practice in urban Botswana, however, they did identify factors that, if addressed, may increase rural practice in the future. Establishing systems to facilitate professional development, strengthening specialists support, and deploying doctors near their home towns are strategies that may improve retention of doctors in rural areas.

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Purpose – Identifying and addressing poor nutritional status in school-aged children is often not prioritized relative to HIV/AIDS treatment. The purpose of this paper is to elucidate the benefits of integrating nutrition (assessment and culturally acceptable food supplement intervention) in the treatment strategy for this target group. Design/methodology/approach – The authors conducted a randomized, double blind pre-/post-intervention trial with 201 HIV-positive children (six to 15 years) in Botswana. Eligibility included CD4 cell counts < 700/mm3 (a marker for the severity of HIV infection), documented treatment with antiretroviral (ARV) drugs, and no reported evidence of taking supplemental food products with one or more added nutrients in the six-month period prior to the study. The intervention (12 months) consisted of two food supplements for ethical reason, one with a higher protein content, bean (bean-sorghum based) group (n=97) and a cereal (sorghum) group (n=104) both of which contained added energy- and micro- nutrients. Anthropometric and biochemical nutritional status indicators (stunting, wasting, underweight, skinfolds for fat and muscle protein reserves, and hemoglobin levels) were compared within and between the bean and the cereal groups pre- and post-intervention separately for children six to nine years and ten to 15 years. Findings – Older children (ten to 15 years) fared worse overall compared to those who were younger (six to nine years) children in anthropometric and protein status indicators both at baseline and post-intervention. Among children six to nine years, the mid arm circumference and blood hemoglobin levels improved significantly in both the bean and cereal groups (p < 0.01 and p < 0.05, respectively). Although the BMI for age z-score and the triceps skinfold decreased significantly in the bean group, the post-intervention subscapular skinfold (fat stores) was significantly higher for the bean group compared to the cereal group (p < 0.05). Among children ten to 15 years, both the bean and the cereal groups also showed improvement in mid arm circumference (p < 0.001), but only those in the bean group showed improvement in hemoglobin (p < 0.01) post-intervention. Originality/value – Similar significant nutritional status findings and trends were found for both food interventions and age within group pre- vs post-comparisons, except hemoglobin in the older children. Post-intervention hemoglobin levels for the type food supplement was higher for the “bean” vs the “cereal” food in the younger age group. The fact that all children, but especially those who were older were in poor nutritional status supports the need for nutrition intervention in conjunction with ARV treatment in children with HIV/AIDS, perhaps using a scaled up future approach to enhance desired outcomes.

PurposeThe purpose of this paper is to study the quality of porridge made from cereal legume composite flour and to compare with a porridge that it is traditionally eaten.Design/methodology/approachThe nutritional composition as well as protein, microbiological, and sensory quality of porridge from a sorghum bean composite flour was assessed and compared with sorghum porridge (SP) that is traditionally eaten in Botswana.FindingsResults indicated that the nutrient composition and the protein quality of the sorghum bean composite porridge were significantly higher than that of the SP. The majority of children and adults rated the sensory attributes of the sorghum composite porridge highly and adult consumers indicated willingness to buy it.Originality/valueThe study demonstrates that using traditionally consumed foods, which are culturally acceptable and low cost, such as sorghum and sugar beans, can improve nutritional and sensory attributes when composited. These composited foods can then be recommended as a sustainable supplementary food source to improve the nutritional status and health of vulnerable populations such as HIV+ children.