BackgroundCommunity home-based care is the Botswana Government's preferred means of providing care for people living with HIV (PLHIV). However, primary (family members) or volunteer (community members) caregivers experience poverty, are socially isolated, endure stigma and psychological distress, and lack basic care-giving education. Community home-based care also imposes considerable costs on patients, their caregivers and families in terms of time, effort and commitment. An analysis of the costs incurred by caregivers in providing care to PLHIV will assist health and social care decision makers in planning the most appropriate ways to meet future service needs of PLHIV and their caregivers.MethodsThis study estimated the cost incurred in providing care for PLHIV through a stratified sample of 169 primary and volunteer caregivers drawn from eight community home-based care groups in four health districts in Botswana.ResultsThe results show that the mean of the total monthly cost (explicit and indirect costs) incurred by the caregivers was $(90.45 ± 9.08) while the mean explicit cost of care giving was $(65.22 ± 7.82). This mean of the total monthly cost is about one and a half times the caregivers' mean monthly income of $66.00 (± 5.98) and more than six times the Government of Botswana's financial support to the caregivers. In addition, the cost incurred per visit by the caregivers was $15.26, while the total expenditure incurred per client or family in a month was $184.17.ConclusionsThe study, therefore, concludes that as the cost of providing care services to PLHIV is very high, the Government of Botswana should substantially increase the allowances paid to caregivers and the support it provides for the families of the clients. The overall costs for such a programme would be quite low compared with the huge sum of money budgeted each year for health care and for HIV and AIDS.

Objective: To assess the menopausal perceptions and experiences of older women from selected sites in Botswana. Design: This study used snowball sampling to recruit 444 older women in four health districts of Botswana. Trained research assistants administered a structured questionnaire to determine respondents' menopausal symptoms, perceptions and knowledge of menopause and sexual experiences. Multiple logistic regression procedures were used to evaluate the association of socio-demographic characteristics with knowledge of menopause and factor analysis was used to cluster menopausal symptoms. Results: Participants had low levels of knowledge and awareness of menopause. The three most common changes identified were weakening of bones (78%), changes in sex drive (69.6%), and difficulty working (56.2%). The majority of respondents perceived menopause as freedom from menstrual cycles (85%) and cost saving (65%). Employment status was significantly associated with knowledge of menopause. The mean age at menopause was 48.9 years. With an average life expectancy of 54.5 years, there remains about 6 years of postmenopausal life. Recommendation: Public health care systems in and beyond Botswana should mobilize resources and take measures to improve older women's awareness and knowledge about menopause-related changes through educational training and guidance to maintain active, healthy lives.

Objective: This study explored the challenges that older women from selected sites in Botswana face in accessing services that address sexual and reproductive health (SRH) and family planning (FP) needs.Design, setting and subjects: Two rural and two urban health districts were randomly selected for the study. A statistically determined sample of 454 older women was allocated to the different districts (strata), using probability proportional to size. Outcome measures:The study estimated the percentage use of sexual and reproductive health services (including family planning services), unmet need for family planning and factors inhibiting use of these services.Results: The study revealed that 25% of the older women used some type of FP method. Of this number, 67.9% were aged 50-59 years, 17.4% 60-69 years, 10.1% 70-79 years, and 72% had unmet needs for FP. The older women used natural FP methods mainly. The main SRH services used by them were screening for human immunodeficiency virus/acquired immune deficiency syndrome, sexually transmitted infections and cervical cancer. Obstacles to accessing SRH and FP services were found to include illiteracy, lack of education, financial constraints, a perception that healthcare planners limited SRH needs to antenatal and obstetrical services, a cultural reluctance to discuss SRH in public and domestic issues. Conclusion:The study recommends comprehensive public health education for older women on human sexuality and fertility, contraceptive use, access to services, effective training programmes for healthcare providers on how to deal with older women's issues and better access to STI and cervical cancer screening services.Peer reviewed.

Background: The healthcare of Batswana (citizens of Botswana) as indicated in the country's Vision 2016 is one of the top priorities of the government of Botswana, yet Botswana's National Health Policy, the Immigration Policy and the National Sexual and Reproductive Health Programme Framework all are silent on the obligations of the government to provide health services to the immigrant and refugee population. In view of the high prevalence of HIV/AIDS in Botswana, South Africa and other sub-Saharan countries, it is critical that reproductive health services be as affordable and accessible for the immigrants and refugees as they are for other residents in Botswana. This study measured the views of the primary healthcare providers in Botswana on the perceived reproductive health needs of immigrants and refugees and the availability and accessibility of reproductive healthcare services to the immigrant and refugee populations in the country. This information will be important for policy makers, the government of Botswana and the private sector to shape intervention measures to assist immigrants and refugees in seeking and accessing the desired reproductive health services. Methods: The study targeted all 4 667 medical doctors and nurses who were serving in various hospitals and clinics in 23 health districts of Botswana as at June 2005 when this study was conducted. Using NCS Pearson statistical software, the sample size for the study was determined to be 851. This estimated sample size was allocated to the 23 health districts (strata) using probability proportional to size (PPS). Having obtained the sample size for each district, the healthcare providers to be interviewed from each health district were selected randomly and in proportion to the number of doctors and nurses in each district. Questionnaires were administered to these healthcare providers by research assistants, who explained the purpose of the study and obtained informed consent. The questionnaires were coded to ensure the anonymity of the respondents. It contained questions about the healthcare providers' demographic characteristics, their opinions on the reproductive health needs of immigrants and refugees, and their views on factors that influence the accessibility of these services to immigrants and refugees. Data were collected from 678 doctors and nurses (about 80% of the targeted sample). Results: The majority of the healthcare providers indicated that the most important reproductive health needs of the immigrants and refugees, namely pregnancy-related services (prenatal, obstetrics, postnatal conditions), treatment for sexually transmitted infections (STIs), HIV/AIDS treatment and counselling and family planning were not different from those of the locals. However, some major differences noted between the local population and the foreigners were (i) that antiretroviral (ARV) treatment and prevention of mother-to-child-transmission (PMTCT) programmes were never accessible to the non-citizens; and (ii) that while treatments and other health se...

Purpose – This paper aims to look at Botswana women entrepreneurs involved in informal cross-border trade (ICBT). It addresses the following questions: What is the nature of the entrepreneurship activities that the women engage in, the funding sources and profitability of the businesses? How has the business helped to enhance women’s economic empowerment? What are the factors that influence participation of women in these businesses and their challenges? Design/methodology/approach – The study used both qualitative and quantitative methods in studying the challenges faced by Botswana women entrepreneurs in ICBT. A sample of 319 women were identified for study using a combination of the systematic sampling method and snowball techniques. Questionnaires were administered on the sampled women by trained research assistants. In addition, key informant interviews and focus group discussion were conducted on selected women entrepreneurs and key personnel from the Ministry of Trade and Industry, Customs and Immigration Offices at the border posts. Findings – The study revealed that the majority of the women (67 per cent) were under 35 years of age, 69 per cent had very little education (senior secondary certificate and below), 41 per cent were unemployed and 44 per cent were single (never married). The women traded mainly in agricultural products and industrial goods. Raising income for the families (49 per cent) ranked highest as the push factor for the women entrepreneurs. The average monthly profit made by the women was P5916.77 ± 409.86 (US$657.42 ± 45.54). The major constraints faced by the women traders were delays at the borders, long hours of travel, time away from their homes and stiff completion with other traders. ICBT was shown to be highly profitable for the women entrepreneurs, with gross profit margin on imported goods at 59.5 per cent. Research limitations/implications – The study limitations included fear that the research assistants are agents of the income tax department disguised as researchers and that the collected information may be passed on to government authorities for the purpose of taxation. It was not possible to evaluate the impact of these feelings by the respondents on the responses. However, “anonymity” was the best strategy for getting information. They were assured in the consent form and orally that information provided was not going to be divulged to any other sources and that the questionnaire does not contain anybody’s personal information which could be used to track the person. Notwithstanding these limitations, the study design was appropriate for the purpose of the research. The instrument was adequate as can be seen from the high values of the Cronbach’s alpha coefficient (0.90) and knowledgeable research assistants who collected the data under the supervision of the authors. Practical implications – The women entrepreneurs were able to generate substantial incomes and profits that enabled them to improve the livelihood of the families and empowered them to t...