Patterns of Skin Disease in the Context of a High Prevalence HIV Population in Botswana

Mosojane, Karen Itumeleng; Damiani, Gianfranco; Forrestel, Amy; Conic, Rosalynn R.Z.; Kovarik, Carrie L.; Williams, Victoria

doi:10.1016/j.det.2020.08.001

Cited by 3 publications

(9 citation statements)

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“…similarly found that the most common HIV-related neoplasm was KS. 12 It is important for clinicians to recognize these common HIVrelated skin conditions that may be the first manifestation of underlying immunosuppression and assist in early diagnosis or advancing HIV infection. Kaposi sarcoma was also the most common biopsy diagnosis in our study, likely due to relatively high HIV prevalence.…”

Section: Discussionmentioning

confidence: 99%

“…Botswana is one of the world's most sparsely populated countries with an estimated 2 million people 11 . In the public sector, access to healthcare is free for citizens, and the healthcare system has a tiered structure 12 . PMH is the largest tertiary referral hospital located in Gaborone, Botswana's capital.…”

Section: Introductionmentioning

confidence: 99%

“…11 In the public sector, access to healthcare is free for citizens, and the healthcare system has a tiered structure. 12 PMH is the largest tertiary referral hospital located in Gaborone, Botswana's capital. In addition to many public health threats, Botswana has experienced a severe generalized HIV epidemic, with an HIV prevalence still over 20%.…”

mentioning

confidence: 99%

“…However, Botswana was the first country to offer free antiretroviral therapy, and it is estimated that approximately 83% of the HIV population are on antiretroviral therapy. 12 Changes in the population living with HIV in Botswana affect the skin diseases that present in the clinics.…”

mentioning

confidence: 99%

“…13,14 The few studies that have described patterns of skin diseases in Botswana have focused mainly on adults. 12,15,16 Our study aims to understand the skin disease patterns seen in children in Botswana, with a goal of informing dermatological policy development, training, and resource allocation for the pediatric population. 2 2 | METHODS…”

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confidence: 99%

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Skin conditions among pediatric dermatology outpatients in Botswana

Sethomo

Williams

Tladi

et al. 2022

Pediatric Dermatology

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Background An understanding of the prevalence patterns of skin diseases in children in Botswana is needed to guide national dermatological policy development, training, and resource allocation to improve patient care. Objective To describe local skin disease patterns in children aged 0–18 years presenting for dermatologic care in Botswana. Methods A retrospective review of records from 1st January 2011 to 31st December 2016 was conducted at the outpatient dermatology clinic of Princess Marina Hospital (PMH) in Gaborone, Botswana and outreach clinic sites. Results There were 4413 pediatric visits constituting 18.6% of all dermatology visits. There was a slight male predominance of 1.2:1. The majority of disorders were noninfectious 80.1% (3537/4413) versus infectious 14.6% (645/4413), with 5.2% (231/4413) unclassified. In the noninfectious category, two‐thirds were inflammatory, followed by disorders of nails, skin appendages, and pigmentary disorders. Atopic dermatitis was the most common inflammatory disorder. Over half of infectious skin diseases were viral, followed by fungal and bacterial disorders. In the HIV‐related disorders, the majority were verrucae 94% (108/115) followed by Kaposi sarcoma. The nine most common skin diagnoses accounted for close to 70% of all skin diseases seen at the clinic, and these included atopic dermatitis (almost half of all cases), followed by verruca, acne, and vitiligo. Conclusion There is a high burden of skin disorders in children in Botswana. In our cohort, a small number of skin conditions made up the vast majority of pediatric diagnoses. This information can be used to guide dermatology training and resource allocation to better manage these common diseases.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Skin conditions among pediatric dermatology outpatients in Botswana

Sethomo

Williams

Tladi

et al. 2022

Pediatric Dermatology

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Evaluating the Feasibility and Acceptance of a Mobile Clinical Decision Support System in a Resource-Limited Country: Exploratory Study

Ndlovu¹,

Stein²,

Gaopelo³

et al. 2023

JMIR Form Res

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Background In resource-limited countries, access to specialized health care services such as dermatology is limited. Clinical decision support systems (CDSSs) offer innovative solutions to address this challenge. However, the implementation of CDSSs is commonly associated with unique challenges. VisualDx—an exemplar CDSS—was recently implemented in Botswana to provide reference materials in support of the diagnosis and management of dermatological conditions. To inform the sustainable implementation of VisualDx in Botswana, it is important to evaluate the intended users’ perceptions about the technology. Objective This study aims to determine health care workers’ acceptance of VisualDx to gauge the feasibility of future adoption in Botswana and other similar health care systems. Methods The study’s design was informed by constructs of the Technology Acceptance Model. An explanatory, sequential, mixed methods study involving surveys and semistructured interviews was conducted. The REDCap (Research Electronic Data Capture; Vanderbilt University) platform supported web-based data capture from March 2021 through August 2021. In total, 28 health care workers participated in the study. Descriptive statistics were generated and analyzed using Excel (Microsoft Corp), and thematic analysis of interview transcripts was performed using Delve software. Results All survey respondents (N=28) expressed interest in using mobile health technology to support their work. Before VisualDx, participants referenced textbooks, journal articles, and Google search engines. Overall, participants’ survey responses showed their confidence in VisualDx (18/19, 95%); however, some barriers were noted. Frequently used VisualDx features included generating a differential diagnosis through manual entry of patient symptoms (330/681, 48.5% of total uses) or using the artificial intelligence feature to analyze skin conditions (150/681, 22% of total uses). Overall, 61% (17/28) of the survey respondents were also interviewed, and 4 thematic areas were derived. Conclusions Participants’ responses indicated their willingness to accept VisualDx. The ability to access information quickly without internet connection is crucial in resource-constrained environments. Selected enhancements to VisualDx may further increase its feasibility in Botswana. Study findings can serve as the basis for improving future CDSS studies and innovations in Botswana and similar resource-limited countries.

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Evaluating the Feasibility and Acceptance of a Mobile Clinical Decision Support System in a Resource-Limited Country: Exploratory Study (Preprint)

Ndlovu¹,

Stein²,

Gaopelo³

et al. 2023

Preprint

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BACKGROUND The health workforce in Botswana consists mainly of medical officers and primary care nurses working in remote areas with limited training and insufficient reference materials to support diagnosis and management of diseases in dermatology and other subspecialties. This suggests a need for clinical decision support tools for these healthcare providers. VisualDx, is among well-established mobile clinical decision support systems offering a promising solution with documented benefits. However, implementation of eHealth systems is commonly associated with challenges. To inform sustainable implementation of VisualDx in Botswana, it is important to evaluate intended users’ perceptions of the technology. OBJECTIVE This study aims to determine healthcare workers acceptance of VisualDx to gauge feasibility of future adoption in Botswana and other similar healthcare systems. METHODS The study's design was informed by constructs of the technology acceptance model. A convergent mixed methods feasibility study involving surveys and semi-structured interviews was conducted. The Research Electronic Data Capture platform supported online data capture from March 2021 through August 2021. Twenty-eight healthcare workers participated in the study. Descriptive statistics were generated and analyzed using Excel and thematic analysis of interview transcripts performed using Delve. RESULTS All survey participants (n=28) expressed interest in using mHealth technology to support their work. Prior to VisualDx, participants referenced textbooks, journal articles, and Google search engines. Overall, participants' survey responses showed their confidence on VisualDx (94.7%); however, some barriers were noted. Frequently used VisualDx features included generating a differential diagnosis through manual entry of patient symptoms (48.5%) or using the artificial intelligence feature to analyze skin conditions (22.0%). Seventeen (60.7%) survey participants were also interviewed, and 4 thematic areas derived. CONCLUSIONS Participants' responses indicated acceptance of VisualDx. The ability to access information quickly without internet connection is crucial in resource constrained environments. Select enhancements to VisualDx may further increase its feasibility in Botswana.

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Patterns of Skin Disease in the Context of a High Prevalence HIV Population in Botswana

Cited by 3 publications

References 32 publications

Skin conditions among pediatric dermatology outpatients in Botswana

Skin conditions among pediatric dermatology outpatients in Botswana

Evaluating the Feasibility and Acceptance of a Mobile Clinical Decision Support System in a Resource-Limited Country: Exploratory Study

Evaluating the Feasibility and Acceptance of a Mobile Clinical Decision Support System in a Resource-Limited Country: Exploratory Study (Preprint)

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