Health in Botswana

The government of Botswana stresses primary healthcare with emphasis on disease prevention and healthy living. In 2013, about 25% of the population were infected with HIV/AIDS.[1]

The Princess Marina Hospital

Healthcare system

Botswana provides universal healthcare to all citizens through a public healthcare system, but privately run healthcare is also available. The government operates 98% of all medical facilities. Healthcare in Botswana is delivered through a decentralised model with primary healthcare being the pillar of the delivery system. Botswana has an extensive network of health facilities (hospitals, clinics, health posts, mobile stops) in the 27 health districts. In addition to an extensive network of 101 clinics with beds, 171 clinics without beds, 338 health posts and 844 mobile stops primary health care (PHC) services in Botswana are integrated within overall hospital services, being provided in the outpatient sections of all levels of hospitals. It is through these structures that a complement of preventive, promotive and rehabilitative health services as well as treatment and care of common problems are provided. For a general check-up, citizens are charged 5 pula, unless they are under five or over 65, in which case check-ups are free. The network of public hospitals is organized between primary hospitals, which function as general hospitals and equipped to deal with most diseases and immediate threats to health, district hospitals, which have more beds and are equipped to deal with more serious medical issues, and referral hospitals, which are highly advanced facilities equipped to deal with specialized problems. There are also two private hospitals in the country. The government pays for the treatment of patients referred abroad for medical procedures.[2][3][4]

In 2004, there were an estimated 241 nurses, 29 physicians and 2 dentists per 100,000 people. In 1995, 70% of the population had access to safe water and 55% of the population had access to sanitation. Public health teams conduct tuberculosis and malaria control campaigns.

Health status

Life expectancy

The average life expectancy (at birth) in Botswana was 65 years in 2015.[5]

Maternal and child health

In 2012 0.5 million (26%) of Botswana's estimated 2 million population were women of reproductive age; thus the total fertility rate was 2.6 in 2012.[6] The maternal mortality ratio (MMR) (maternal deaths per 100,000 live births) in Botswana was 129 in 2015; this is compared to almost double in 1990, when the MMR was 243 in 1990.[7] Between 1990 and 2015 there was a 47% decrease in maternal mortality, this is below the 75% reduction target of MDG 5.

In 2015, Botswana ranked 55 out of 193 in the world in child mortality rate; there was an average of 44 deaths per 1000 (this equates to 2000 children dying under the age of 5). Although high, this is an improvement from 1990 – when the child mortality rate was 54. Although Botswana's child mortality is relatively high, it is lower than most countries in Africa, which suggests that child well-being is higher in Botswana than in the majority of the continent.[5] Botswana is an upper middle income country with a small population.

The infant mortality rate in Botswana has also reduced over the last 15 years; in 1990 infant mortality rate was 42, and this has since decreased to 35 in 2015.

Contraception

According to UNFPA, 52.8%[8] of women were using modern contraceptives in 2016.

Endemic diseases

There is a high risk of malaria in the northern half of Botswana, including the Okavango Delta, from November to June. In 2013 there were 456 confirmed malaria cases reported; there were seven deaths from confirmed and probable cases of malaria.[9]

Infectious diseases

In 1990, the tuberculosis mortality rate was 97 deaths per 100,000 people. In 2015 the tuberculosis mortality rate was reduced by 76% to 22 deaths per 100,000; this means that Botswana achieved one of the targets for the 6th Millennium Development Goal.[10]

HIV/AIDS
Main article: HIV/AIDS in Botswana

At 22.2%, Botswana has the third highest HIV prevalence in the world, after Lesotho and Swaziland.[11] The HIV/AIDS prevalence was 37.30 per 100 adults in 2003. In 2013, about 25% of the population were infected with AIDS/HIV.[1] The HIV/AIDS incidence in Botswana was reduced by 62% between 1990 and 2015.

In 2001, there were approximately 350,000 people living with HIV/AIDS in the country. There were an estimated 33,000 deaths from AIDS in 2003. The rapid transmission of HIV/AIDS in Botswana has been due to three main factors: the position of women in society, particularly their lack of power in negotiating sexual relationships; cultural attitudes to fertility; and social migration patterns.

HIV and AIDS estimates in 2015:

  • People living with HIV: 350 000 [330 000 – 370 000]
  • Adults aged 15 to 49 prevalence rate: 22.2% [20.9–23.4%]
  • Adults aged 15 and over living with HIV: 340 000 [320 000 – 360 000]
  • Women aged 15 and over living with HIV: 190 000 [180 000 – 210 000]
  • Children aged 0 to 14 living with HIV: 8500 [7300 – 10 000]
  • Deaths due to AIDS: 3200 [2800 – 3600]
  • Orphans due to AIDS aged 0 to 17: 60 000 [51 000 – 66 000]

Diarrhea among under-5s

Diarrhea is defined as a waterborne disease which is caused by a variety of microorganisms. Individuals who are diagnosed with diarrhea would suffer from loose or watery stools at least three times a day or more frequently than normal compared with unaffected people.[12] At present, diarrhea remains one of the leading causes of the mortality and morbidity globally,[13] besides, it is identified as the second leading sources of mortality expect for pneumonia in under-5s,[12] leading to more deaths than HIV, measles and malaria integrated together in this age group.[14] It is further estimated by the World Health Organization (WHO) that approximately nine million children under the same age category die each year,[12] among which four billion cases are caused by diarrhea and 2.2 million are diarrhea-related, with the majority of young children coming from developing countries.[15]

The global influence of diarrhea is particularly serious in sub-Saharan Africa, largely due to the high HIV pandemic.[16] The prevention of diarrhea in this continent has become a public health challenge since its multiple sources of determinants, such as the insecurity of breastfeeding from HIV positive mothers, the unpredictability of climate changes and unqualified public hygiene preparation, thus highlighting the importance of understanding the nature of the disease and relevant strategies to address the issue.

Studies reveal that between 2006 and 2011, there are 171,280 cases of diarrhea in Botswana and they led to 1820 deaths among children under 5 years old.[16] This result is massive since the whole population in this country is only a little over 2,000,000[16] and it has one of the highest HIV prevalence in the world with an estimated national prevalence of 17.6% in 2008.[17] The situation has put the effected individuals under a vulnerable status to infectious disease and diarrhea disease in particular.

Malnutrition

In 2000, 10.7% of children under five years of age were considered underweight.[18]

References
  1. "HIV & Aids in Botswana". AVERT International HIV & Aids Charity. Retrieved 15 January 2013.
  2. The State of Nursing and Nursing Education in Africa: A Country-by-country Review, Sigma Theta Tau (2012)
  3. "Ministry Of Health & Wellness, Botswana". www.moh.gov.bw.
  4. "Botswana:The Health System - AHO". www.aho.afro.who.int.
  5. "The State of the World's Children 2016". UNICEF. Retrieved 2017-09-08.
  6. "State of the World's Midwifery 2014 | UNFPA - United Nations Population Fund". www.unfpa.org. Retrieved 2017-09-08.
  7. "Maternal mortality country profiles". World Health Organization. Retrieved 2017-09-08.
  8. "UNFPA Botswana | Botswana introduces contraceptive implants". botswana.unfpa.org. Retrieved 2017-09-08.
  9. "GHO | By country | Botswana - statistics summary (2002 - present)". WHO. Retrieved 2017-09-10.
  10. WHO (2015)
  11. "HIV and AIDS in Botswana". AVERT. 2015-07-21. Retrieved 2017-09-10.
  12. Wardlaw, Tessa; Salama, Peter; Brocklehurst, Clarissa; Chopra, Mickey; Mason, Elizabeth (March 2010). "Diarrhoea: why children are still dying and what can be done". The Lancet. 375 (9718): 870–872. doi:10.1016/s0140-6736(09)61798-0. ISSN 0140-6736.
  13. Pr??ss-??st??n, Annette; Corval??n, Carlos (January 2007). "How Much Disease Burden can be Prevented by Environmental Interventions?". Epidemiology. 18 (1): 167–178. doi:10.1097/01.ede.0000239647.26389.80. ISSN 1044-3983.
  14. Fischer Walker, Christa L.; Aryee, Martin J.; Boschi-Pinto, Cynthia; Black, Robert E. (2012-01-03). "Estimating Diarrhea Mortality among Young Children in Low and Middle Income Countries". PLoS ONE. 7 (1): e29151. doi:10.1371/journal.pone.0029151. ISSN 1932-6203.
  15. Arvelo, Wences; Kim, Andrea; Creek, Tracy; Legwaila, Ketumetse; Puhr, Nancy; Johnston, Stephanie; Masunge, Japhter; Davis, Margarett; Mintz, Eric; Bowen, Anna (November 2010). "Case–control study to determine risk factors for diarrhea among children during a large outbreak in a country with a high prevalence of HIV infection". International Journal of Infectious Diseases. 14 (11): e1002–e1007. doi:10.1016/j.ijid.2010.06.014. ISSN 1201-9712.
  16. Popoola, Tosin; Mchunu, Gugu (May 2015). "Application of PRECEDE-PROCEED model to tackle problems identified with diarrhoea burden among under-5s in Botswana". International Journal of Nursing Practice. 21: 67–70. doi:10.1111/ijn.12328. ISSN 1322-7114.
  17. Alexander, KA; Blackburn, JK (2013-08-26). "Overcoming barriers in evaluating outbreaks of diarrheal disease in resource poor settings: assessment of recurrent outbreaks in Chobe District, Botswana". BMC Public Health. 13 (1). doi:10.1186/1471-2458-13-775. ISSN 1471-2458.
  18. "GHO | By category | Children aged". WHO. Retrieved 2017-09-10.
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