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PubMed2006

Knowledge and perceptions of parents regarding child sexual abuse in Botswana and Swaziland.

This study sought to explore the phenomenon of child sexual abuse by investigating the knowledge and perceptions of parents regarding this problem in Botswana and Swaziland. Although there are no published studies on child sexual abuse in Botswana and Swaziland, literature elsewhere has indicated that child abuse and prostitution prevail in Southern African Development Community countries and that children still continue to be rape victims within and outside the family structure [Muwanigwa, V. (1996). Child Abuse Demands More Preventive Measures. Harare: Zimbabwe. (Southern Africa News Features Southern African Research and Documentation Center)]. In Botswana in 1998, there were 300 cases of child abuse reported, of which 33 were sexual abuse cases. The same year in Swaziland, >50% of child abuse cases were sexual abuse related. In addition, the same year in Swaziland, >50% of sexual abuse case patients reporting for counseling were children younger than 21 years. Respondents of the study included 8 men (1 from Swaziland and 7 from Botswana) and 10 women (3 from Swaziland and 7 from Botswana) who were parents aged between 26 and 70 years; they were determined by way of purposive sampling. A focused interview guide with open-ended questions was used to collect data, and measures to ensure trustworthiness and ethical considerations were adhered to. Analysis of data was facilitated by categorization of themes and concepts and coding systems. The results of the study showed that the respondents acknowledged the prevalence of child sexual abuse in Botswana and Swaziland and further demonstrated their knowledge of the predisposing factors, perpetrators of the problem, and effects of sexual abuse on children. They placed major emphases on community involvement in fighting against the problem; appropriate education of children, parents, families, and community members about child sexual abuse; and improvement on the laws that protect children against sexual abuse to successfully curb the problem.

Adult↗

PubMed2006

Public sector nurses in Swaziland: can the downturn be reversed?

BACKGROUND: The lack of human resources for health (HRH) is increasingly being recognized as a major bottleneck to scaling up antiretroviral treatment (ART), particularly in sub-Saharan Africa, whose societies and health systems are hardest hit by HIV/AIDS. In this case study of Swaziland, we describe the current HRH situation in the public sector. We identify major factors that contribute to the crisis, describe policy initiatives to tackle it and base on these a number of projections for the future. Finally, we suggest some areas for further research that may contribute to tackling the HRH crisis in Swaziland. METHODS: We visited Swaziland twice within 18 months in order to capture the HRH situation as well as the responses to it in 2004 and in 2005. Using semi-structured interviews with key informants and group interviews, we obtained qualitative and quantitative data on the HRH situation in the public and mission health sectors. We complemented this with an analysis of primary documents and a review of the available relevant reports and studies. RESULTS: The public health sector in Swaziland faces a serious shortage of health workers: 44% of posts for physicians, 19% of posts for nurses and 17% of nursing assistant posts were unfilled in 2004. We identified emigration and attrition due to HIV/AIDS as major factors depleting the health workforce. The annual training output of only 80 new nurses is not sufficient to compensate for these losses, and based on the situation in 2004 we estimated that the nursing workforce in the public sector would have been reduced by more than 40% by 2010. In 2005 we found that new initiatives by the Swazi government, such as the scale-up of ART, the introduction of retention measures to decrease emigration and the influx of foreign nurses could have the potential to improve the situation. A combination of such measures, together with the planned increase in the training capacity of the country's nursing schools, could even reverse the trend of a diminishing health workforce. CONCLUSION: Emigration and attrition due to HIV/AIDS are undermining the health workforce in the public sector of Swaziland. Short-term and long-term measures for overcoming this HRH crisis have been initiated by the Swazi government and must be further supported and increased. Scaling up antiretroviral treatment (ART) and making it accessible and acceptable for the health workforce is of paramount importance for halting the attrition due to HIV/AIDS. To this end, we also recommend exploring ways to make ART delivery less labour-intensive. The production of nurses and nursing assistants must be urgently increased. Although the migration of HRH is a global issue requiring solutions at various levels, innovative in-country strategies for retaining staff must be further explored in order to stem as much as possible the emigration from Swaziland.

Journal Article↗

PubMed2002

Survey on maternal mortality in Swaziland using the sisterhood method.

Monitoring and evaluating maternal mortality in African countries is impossible without specific and reliable data and indicators. This study of maternal mortality using the 'Sisterhood Method' was undertaken in Swaziland. The crude data on 'sisterhood mortality' were obtained from the 1993-94 Multi-Purpose Household Survey carried out by the Central Statistics Office and Ministry of Health of Swaziland. A total fertility rate of 6.36, as given in the 1986 Swaziland census, was used in estimating these indicators. Prior to this study, the maternal mortality rate (MMR) in Swaziland (based only on health facility data) was considered to lie within the range of 107-125 maternal deaths per 100 000 live births. Use of the 'Sisterhood Method' allowed a more precise estimate of maternal mortality for the general population of Swaziland. The study revealed the estimated MMR to be 229 and the life-time risk of maternal death to be 1 in 69. These values were most probably stable throughout the 6- to 7-year period before the survey.

Adult↗

PubMed2002

Some herbal remedies from Manzini region of Swaziland.

In this paper, recipes for 41 herbal remedies used for treating 25 illnesses in traditional medicine in Swaziland are reported. Preparation of the herbal remedies involved the use of different parts of 47 species from 32 families, some of which have never been described previously in the flora of Swaziland. Descriptions of the plants used, the preparation of each remedy, dosage, route of administration and medical uses are reported. Some of the diseases the remedies are used to treat include asthma, backache, candidiasis, cardiac problems, cough, diarrhoea, dizziness, eye problems, constipation, menorrhagia, painful shoulders, scabies, threatened abortion, toothache, ulcers and vomiting among others. The remedies were obtained from traditional medical practitioners (TMPs) in an ethnomedical survey carried out in the Manzini region of Swaziland. Voucher samples of the plants used for the remedies were collected, identified and deposited in the National Herbarium of Swaziland.

Eswatini↗

PubMed1998

Regional urban-rural distribution of dental caries experience in Swaziland.

Understanding the regional and countrywide urban-rural distribution of dental caries in Swaziland was considered important for the formulation of a National Oral Health Policy based on the Primary Health Care Approach. A National Oral Health survey was undertaken in Swaziland at the request of the ministry of health. Part of the objective of this study was to establish the regional urban-rural distribution of dental caries in Swaziland. For the 6-18 year olds a cluster sampling technique by schools was used to get a representative sample. For the 35-44 year age group a simple random sampling technique was used in areas of employment influenced by regional and urban-rural distribution. All examinations were carried out using the WHO 1987 criteria. More than 90 per cent of the mean dmft of 6 and 12 year olds was comprised of the decayed component of the dmft/DMFT. The level of restorative care (ft/dmft, FT/DMFT) was low for all age groups. For the 6 and 12 year olds in the Lubombo region there was a significant difference (p < 0.05) in the urban-rural caries experience. When regional data for 6 and 12 year olds were pooled, the difference in urban-rural caries experience is also significant (p < 0.05). For the older age groups there was no significant difference (p > 0.05) in the regional urban-rural caries experience. This study indicates that the oral health care system in Swaziland with its limited resources, should focus its attention on the younger age groups especially in urban areas as far as dental caries treatment needs and preventive programmes are concerned.

Adolescent↗

PubMed1990

Swaziland: perspectives in school health.

Following major quantitative expansions of the educational system in Swaziland during the two decades since independence, the focus has shifted to improving efficiency. Efficiency of any educational system depends mainly on the characteristics of children entering school. Although Swaziland is not among the poorest countries, infant child mortality rates still reflect less than optimum living conditions and parental knowledge of child nutrition and disease prevention and management. Although access to primary schooling is universal, there is substantial waste during the early years of school through dropout and repetition, both associated with low socioeconomic status. School performance can be increased at little extra cost through increasing the nutrition and health status of students before school entry and through the early school years. In Swaziland, many activities are carried out to provide physical and mental health care to students. Coordinating these efforts and formulating clear policy on school health through cooperation among key ministries and nongovernmental organizations remains to be done.

Community Participation↗

PubMed1987

Aflatoxin exposure, hepatitis B virus infection and liver cancer in Swaziland.

A study was carried out in Swaziland to assess the relationship between aflatoxin exposure, hepatitis B infection, and the incidence of liver-cell carcinoma, which is the most commonly occurring malignancy among males in Swaziland. Levels of aflatoxin intake were evaluated in dietary samples from households across the country, and crop samples taken from representative farms. Prevalence of hepatitis B markers was estimated from the serum of blood donors, and liver cancer incidence was recorded for the years 1979-83 through a national system of cancer registration. Across 4 broad geographic regions, there was a more than 5-fold variation in the estimated daily intake of aflatoxin, ranging from 3.1 to 17.5 micrograms. The proportion of HBV-exposed individuals was very high (86% in men), but varied relatively little by geographic region; the prevalence of carriers of the surface antigen was 23% in men, and varied from 21 to 28%. Liver cancer incidence varied over a 5-fold range, and was strongly associated with estimated levels of aflatoxin. In an analysis involving 10 smaller subregions, aflatoxin exposure emerged as a more important determinant of the variation in liver cancer incidence than the prevalence of hepatitis infection. Aflatoxin estimates from crop samples appeared to be a reasonable surrogate for dietary measurements. A comparison with dietary aflatoxin levels measured in an earlier survey in Swaziland suggested that programmes aimed at reducing contamination levels had had some success.

Aflatoxins↗

PubMed2002

Cultural and gender issues related to HIV/AIDS prevention in rural Swaziland: a focus group analysis.

HIV/AIDS is a serious public health problem in Swaziland, a small land-locked Southern African country. The epidemic affects all subpopulations, but women are increasingly at risk for contracting the disease. Focus groups were conducted in a rural area to obtain qualitative information on the rural dimensions of HIV/AIDS, vulnerability to HIV/AIDS, and sociocultural factors influencing the spread of AIDS. Five themes were identified from analyses of the focus groups that are relevant in developing an AIDS prevention program for this population in Swaziland. Implications for future research and health care practice focus on gender-sensitive cultural research (e.g., women and men's roles and responsibilities in rural Swaziland society) and how social, economic, and cultural factors impact the spread of AIDS. Recommendations include reorienting and allocating resources for health, education, and social services to address the relative neglect of rural areas and strengthening policies and programs to achieve the equal participation of all women in all aspects of society's decisions. Specifically, policies related to economic and food security should result in programs to improve local access by women to all resources.

Acquired Immunodeficiency Syndrome↗

PubMed2006

HIV/AIDS and disability: a pilot survey of HIV/AIDS knowledge among a deaf population in Swaziland.

This study sought to establish whether there were measurable differences in the level of knowledge about HIV/AIDS between hearing individuals and individuals who identified themselves as deaf sign language users in Swaziland. A cross-sectional survey of 191 rural and urban hearing and deaf adults was undertaken in Swaziland in December 2003. A structured questionnaire was administered, seeking to establish whether there were statistically significant differences between hearing and deaf populations in their level of knowledge about HIV/AIDS symptoms, transmission and prevention, as well as differences in sources of information about HIV/AIDS. Additional questions were asked regarding whether there were differences in accessibility of HIV testing services and HIV/AIDS-related healthcare for the two groups. Significant differences in levels of knowledge about HIV/AIDS were identified between the hearing and deaf respondents. The deaf population was significantly more likely (P<0.05) to believe in incorrect modes of HIV transmission (e.g. hugging and airborne transmission) and HIV prevention (e.g. avoiding sharing utensils and eating healthy foods). Almost all of the deaf respondents (99%) reported difficulties in communicating with healthcare facility staff, which may result in less use of HIV voluntary counseling and testing services. This paper reports the results of this study, and discusses the need for targeted HIV/AIDS education campaigns and improved accessibility in healthcare facilities for deaf sign language users in countries such as Swaziland.

Acquired Immunodeficiency Syndrome↗

PubMed2005

Swaziland's Traditional Birth Attendants Survey.

The Traditional Birth Attendants (TBAs) Survey in Swaziland was undertaken between March 27th 1996 and April 8th 1996. The objective of the survey was to generate reliable information regarding activities of TBAs in Swaziland. The survey was conducted in 25 Chiefdoms sampled out of a total of 206 Chiefdoms registered in Swaziland. The total number of sampled respondents in the 25 Chiefdoms was 721. From the survey, it is estimated that there were probably 3000 TBAs in the country, and in the majority of cases such TBAs would be a 51-year old woman who herself had delivered six children and had worked as a TBA for at least 10 years. Between 9,000 and 12,000 deliveries are estimated to take place out of health facilities. Of these many, nearly 43.5% are assisted by "TBAs"; 16.3% of woman interviewed deliver relative/family member and 15.1% are assisted by friends/neighbours, etc. Some of TBAs carry out procedures which are considered to be potentially harmful. Nearly 30% of TBAs have administered herbs; 45% attend to abnormal deliveries (breech and multiple pregnancies); 26.7% re-use their cord cutting tools and in the case of haemorrhage 23.4% do manual procedures within reproductive tract of delivering women.

Adult↗

PubMed1993

Project Swaziland (Part 3): periodontal health status of 12 year old school children.

An investigation on the periodontal disease profile and its treatment implications was conducted on a sample of 12-year-old Swazi schoolchildren of the Kingdom of Swaziland using the CPITN index. Only 1.9 per cent of the pupils in the sample were free of periodontal disease and 64.5 per cent had calculus. There was a significant difference (p < 0.05) in the frequency of calculus accumulation between rural and urban pupils. The mean number of sextants with bleeding and calculus was 4.9 and 2.0 respectively while 98.1 per cent of the pupils required TN1 and 65.4 per cent TN2. It would appear that calculus accumulation occurs at a relatively early age amongst children in Swaziland. Moderately trained dental auxiliaries should constitute the backbone of the primary oral health care service in Swaziland.

Age Distribution↗

PubMed1976

Some aspects of sexually transmitted disease in Swaziland.

A survey of sexually transmitted diseases was attempted in Swaziland. Time and the terms of reference limited its scope, but much interesting information was gathered. Neither the prevalence nor the relative frequency of the different diseases in the community could be ascertained, but there was evidence to support the local impression that the sexually transmitted diseases present an increasing problem in Swaziland. An important problem was that of case finding and two aspects of this are stressed: (1) A general lack of knowledge concerning the venereal diseases; (2) The large number of men infected by 'casual' girl friends who cannot easily be traced, and who form a reservoir of infection in the community.

Eswatini↗

PubMed1993

Rights -- Swaziland: women call for stiff penalties for rape.

Swazi women, alarmed by a high incidence of rape in the country, are campaigning for stiffer penalties, including life imprisonment and death sentences, on convicted rapists. Launched last week, the campaign also aims to persuade magistrates and judges not to grant bail or an option of fines to people convicted of rape charges. The campaign is led by the Swaziland Action Group Against Abuse (SWAGAA), Lutsango Lwakangwane, the country's women organization, the King's women regiment, and the Swaziland and Mental Health Society. The increasing cases of sexual assault in this tiny kingdom of 700,000 people are alarming, while the maximum sentence for those convicted ranges from 2 to 5 years. About 10 women, including a 12-year-old school girl, were raped in the first 2 weeks of this year alone, the police say. At least 30 other women, and a 5-year-old girl, were raped--some fatally--between May and September.

Africa↗

PubMed1995

Prevalence of viral infections in Mozambican refugees in Swaziland.

The seroprevalence for antibodies to HIV-1, HTLV-1, hepatitis B virus (HBV), hepatitis C virus (HCV) and hepatitis E virus (HEV) were determined in a large group of Mozambican refugees living in Swaziland. Serum samples were collected from a total of 398 refugees located in the two camps (Ndzevane and Malindza). The prevalence for antibodies in the two camps were as follows: Ndzevane: 1.2% (HIV-1); 2.8% (HTLV-1); 0.3% (HCV); 4% (HEV) and 66% for any HBV marker. Malindza: 10.8% (HIV-1); 5.4% (HTLV-1); nil (HCV); 2% (HEV) and 65.7% for any HBV marker. The difference in the HIV-1 seroprevalence between the two camps was statistically highly significant. The phenomenon is possibly related to the location of the Malindza camp in the northern most populous area of Swaziland, resulting in more frequent contact between refugees and the local Swazi population.

Adolescent↗

PubMed1976

Dietary aflatoxins and human liver cancer. A study in Swaziland.

A study in Swaziland to assess the possible relationship of aflatoxin contamination and the incidence of primary liver cancer is reported. Aflatoxin ingestion levels have been determined in "food from the plate" samples collected over a 1-year period. A significant correlation between the calculated ingested daily dose and the adult male incidence of primary liver cancer in different parts of Swaziland has been established. Samples of foodstuffs other than the plate samples also reflected the correlation of aflatoxin contamination and liver cancer. This study extends and amplifies the findings of an earlier study in the Murang'a district of Kenya and supports the hypothesis that aflatoxin ingestion is a factor in the genesis of primary liver cancer in Africa.

Aflatoxins↗

PubMed1991

Distribution of Boophilus species ticks in Swaziland.

Recent outbreaks of bovine babesiosis caused by Babesia bovis in Swaziland had indicated the presence of the vector tick Boophilus microplus in the country although it had never before been directly identified. Engorged female Boophilus ticks were collected from cattle at diptanks in the course of a tick resistance survey and used to map the distribution of the two different species of Boophilus. B. decoloratus was found to be widespread throughout the country. B. microplus was identified for the first time in Swaziland and was found to have a patchy distribution. The implications of these findings are discussed.

Animals↗

PubMed1984

Traditional healers in Swaziland: toward improved cooperation between the traditional and modern health sectors.

The paper describes applied research efforts, requested by the Swaziland Ministry of Health and funded by U.S. AID, aimed at providing an information base for new government policies regarding traditional healers in Swaziland. Information reported relates to: health care manpower in the traditional sector; treatment seeking behavior in a pluralistic medical setting; traditional health beliefs and practices; payment practices; patterns of patient referral; attempts to establish an association of healers; attitudes of healers toward paraprofessional training; and possibilities for specific types of cooperation between modern and traditional health sectors.

Allied Health Personnel↗

PubMed2001

Negotiating the informed-consent process in developing countries: a comparison of Swaziland and Pakistan.

Protecting the rights of research participants when conducting studies within an international context presents many challenges. The purpose of this article was to compare and contrast the process of obtaining informed consent in two very different countries - Swaziland and Pakistan. Major aspects of the informed-consent process presented included identification of gatekeepers, seeking permission from officials, negotiating with these officials and Institutional Review Board (IRB) committees in regard to the type of data to be collected, and explaining informed consent to participants in the field. Data for this article is based upon qualitative research of collaboration between nurses and healers in Swaziland and from a variety of studies completed in Pakistan. These studies demonstrate the inadequacy and complexity of applying western-based concepts of informed consent to developing countries.

Cross-Cultural Comparison↗