http://hdl.handle.net/10311/237 2026-07-11T06:35:30Z 2026-07-11T06:35:30Z Adewole, I.F. Abauleth, Y.R. Adoubi, I. Amorissani, F. Anorlu, R.I. Awolude, O.A. Botha, H. Byamugisha, J.K. Cisse, L. Diop, M. Doh, S. Fabamwo, A.O. Gahouma, D. Galadanci, H.S. Githanga, D. Magure, T.M. Mabogunje, C. Mbuthia, J. Muchiri, L.w. Ndiaye, O. Nyakabau, A.M. Ojwang, S.B.O. Ramogola-Masire, D. Sekyere, O. Smith, T.H. Taulo, F.O.G. Wewege, A. Wiredu, E. Yarosh, O. http://hdl.handle.net/10311/2181 2021-10-08T00:00:47Z 2013-01-01T00:00:00Z

Consensus recommendations for the prevention of cervical cancer in sub-Saharan Africa Adewole, I.F.; Abauleth, Y.R.; Adoubi, I.; Amorissani, F.; Anorlu, R.I.; Awolude, O.A.; Botha, H.; Byamugisha, J.K.; Cisse, L.; Diop, M.; Doh, S.; Fabamwo, A.O.; Gahouma, D.; Galadanci, H.S.; Githanga, D.; Magure, T.M.; Mabogunje, C.; Mbuthia, J.; Muchiri, L.w.; Ndiaye, O.; Nyakabau, A.M.; Ojwang, S.B.O.; Ramogola-Masire, D.; Sekyere, O.; Smith, T.H.; Taulo, F.O.G.; Wewege, A.; Wiredu, E.; Yarosh, O. Cervical cancer is the second most common cancer and the leading cause of cancer-related death in women in sub-Saharan Africa. It is estimated that more than 200 million females older than 15 years are at risk in this region. This paper highlights the current burden of cervical cancer in sub-Saharan Africa, reviews the latest clinical data on primary prevention, outlines challenges in the region, and offers potential solutions to these barriers. Based on these factors, clinical recommendations for the prevention of cervical cancer from the sub-Saharan African Cervical Cancer Working Group expert panel are presented. Editorial assistance was provided by Dr Ian Seymour and Dr Tim Blackstock from Wells Healthcare Communications, funded with support from GSK. The authors take full responsibility for the content of this manuscript.

2013-01-01T00:00:00Z DiAngi, Yumi Taylor Panozzo, Catherine A. Ramogola-Masire, Doreen Steenhoff, Andrew P. Brewer, Noel T. http://hdl.handle.net/10311/2178 2021-10-07T00:00:46Z 2011-10-25T00:00:00Z

A cross-sectional study of HPV vaccine acceptability in Gaborone, Botswana DiAngi, Yumi Taylor; Panozzo, Catherine A.; Ramogola-Masire, Doreen; Steenhoff, Andrew P.; Brewer, Noel T. Background Cervical cancer is the most common cancer among women in Botswana and elsewhere in Sub-Saharan Africa. We sought to examine whether HPV vaccine is acceptable among parents in Botswana, which recently licensed the vaccine to prevent cervical cancer. Methods and Findings We conducted a cross-sectional survey in 2009, around the time the vaccine was first licensed, with adults recruited in general medicine and HIV clinics in Gaborone, the capital of Botswana. Although only 9% (32/376) of respondents had heard of HPV vaccine prior to the survey, 88% (329/376) said they definitely will have their adolescent daughters receive HPV vaccine. Most respondents would get the vaccine for their daughters at a public or community clinic (42%) or a gynecology or obstetrician's office (39%), and 74% would get it for a daughter if it were available at her school. Respondents were more likely to say that they definitely will get HPV vaccine for their daughters if they had less education (OR = 0.20, 95% CI = 0.07–0.58) or lived more than 30 kilometers from the capital, Gaborone (OR = 2.29, 95% CI = 1.06–4.93). Other correlates of acceptability were expecting to be involved in the decision to get HPV vaccine, thinking the vaccine would be hard to obtain, and perceiving greater severity of HPV-related diseases. Conclusions HPV vaccination of adolescent girls would be highly acceptable if the vaccine became widely available to the daughters of healthcare-seeking parents in Gaborone, Botswana. Potential HPV vaccination campaigns should provide more information about HPV and the vaccine as well as work to minimize barriers.

2011-10-25T00:00:00Z Madzimbamuto, Farai D. Ray, Sunanda C. Mogobe, Keitshokile D. Ramogola-Masire, Doreen Phillips, Raina Haverkamp, Miriam Mokotedi, Mosidi Motana, Mpho http://hdl.handle.net/10311/2177 2021-10-07T00:00:35Z 2014-07-16T00:00:00Z

A root-cause analysis of maternal deaths in Botswana: towards developing a culture of patient safety and quality improvement Madzimbamuto, Farai D.; Ray, Sunanda C.; Mogobe, Keitshokile D.; Ramogola-Masire, Doreen; Phillips, Raina; Haverkamp, Miriam; Mokotedi, Mosidi; Motana, Mpho Background: In 2007, 95% of women in Botswana delivered in health facilities with 73% attending at least 4 antenatal care visits. HIV-prevalence in pregnant women was 28.7%. The maternal mortality ratio in 2010 was 163 deaths per 100 000 live births versus the government target of 130 for that year, indicating that the Millennium Development Goal 5 was unlikely to be met. A root-cause analysis was carried out with the aim of determining the underlying causes of maternal deaths reported in 2010, to categorise contributory factors and to prioritise appropriate interventions based on the identified causes, to prevent further deaths. Methods: Case-notes for maternal deaths were reviewed by a panel of five clinicians, initially independently then discussed together to achieve consensus on assigning contributory factors, cause of death and whether each death was avoidable or not at presentation to hospital. Factors contributing to maternal deaths were categorised into organisational/management, personnel, technology/equipment/supplies, environment and barriers to accessing healthcare. Results: Fifty-six case notes were available for review from 82 deaths notified in 2010, with 0–4 contributory factors in 19 deaths, 5–9 in 27deaths and 9–14 in nine. The cause of death in one case was not ascertainable since the notes were incomplete. The high number of contributory factors demonstrates poor quality of care even where deaths were not avoidable: 14/23 (61%) of direct deaths were considered avoidable compared to 12/32 (38%) indirect deaths. Highest ranking categories were: failure to recognise seriousness of patients’ condition (71% of cases); lack of knowledge (67%); failure to follow recommended practice (53%); lack of or failure to implement policies, protocols and guidelines (44%); and poor organisational arrangements (35%). Half the deaths had some barrier to accessing health services. Conclusions: Root-cause analysis demonstrates the interactions between patients, health professionals and health system in generating adverse outcomes for patients. The lessons provided indicate where training of undergraduate and postgraduate medical, midwifery and nursing students need to be intensified, with emphasis on evidence-based practice and adherence to protocols. Action plans and interventions aimed at changing the circumstances that led to maternal deaths can be implemented and re-evaluated.

2014-07-16T00:00:00Z Ramogola-Masire, Doreen, M.D. Russell, Anthony, H., M.D. Dryden-Peterson, Scott, M.D. Efstathiou, Jason A. M.D., D.Phil. Kayembe, Mukendi K.A., M.D Wilbur, David C., M.D. http://hdl.handle.net/10311/2176 2021-10-07T00:00:44Z 2014-03-22T00:00:00Z

Case 16-2014: a 46-year-old woman in Botswana with postcoital bleeding Ramogola-Masire, Doreen, M.D.; Russell, Anthony, H., M.D.; Dryden-Peterson, Scott, M.D.; Efstathiou, Jason A. M.D., D.Phil.; Kayembe, Mukendi K.A., M.D; Wilbur, David C., M.D. In Botswana, limited specialized oncologic services are available in the face of a rising burden of cancer. A collaborative outreach program between doctors at MGH and in Botswana was established in 2011 to build the capacity to deliver quality cancer care in Botswana. A goal of the outreach program was the creation of a multidisciplinary tumor board, which involves physicians in Botswana and physicians based at MGH and Harvard Medical School who have expertise in a variety of cancer-related fields. The tumor board discussed this patient’s case by telephone-based and Internet-based conferencing and helped to develop the treatment plan. This 46-year-old HIV infected woman presented after 10 months of recurrent postcoital bleeding. Other symptoms included intermittent urinary frequency, dysuria, pelvic pain, vaginal discharge, and pruritus. She had had two Pap tests, 3 years apart, with the results showing low-grade and high-grade squamous intraepithelial lesions. She had been receiving treatment for HIV for approximately 4 years, with virologic suppression and good CD4+ T-cell recovery. This patient received chemoradiation followed by intravaginal brachytherapy and had a complete clinical response, with no palpable tumor. No changes were made to her ART and no nephrotoxic effects were detected. Diarrhea and mild vaginal stenosis developed during the course of therapy. One year after completing treatment, she remained in remission, without any pain, and was able to resume normal sexual activity.

2014-03-22T00:00:00Z