Building effective public–private partnerships: Experiences and lessons from the African Comprehensive HIV/AIDS Partnerships (ACHAP)

This paper examines the processes for building highly collaborative public-private partnerships for public health, with a focus on the efforts to manage the complex relationships that underlie these partnerships. These processes are analyzed for the African Comprehensive HIV/AIDS Partnerships (ACHAP), a 5-year partnership (2001-2005) between the government of Botswana, Merck & Co., Inc. (and its company foundation), and the Bill & Melinda Gates Foundation. ACHAP is a highly collaborative initiative. The ACHAP office in Botswana engages intensively (on a daily basis) with the government of Botswana (an ACHAP partner and ACHAP's main grantee) to support HIV/AIDS control in that country, which had an adult prevalence of 38.5% HIV infection in 2000 when ACHAP was being established. The paper discusses the development of ACHAP in four stages: the creation of ACHAP, the first year, the second and third years, and the fourth year. Based on ACHAP's experiences over these four years, the paper identifies five lessons for managing relationships in highly collaborative public-private partnerships for public health.

Mother-to-child transmission of HIV in Botswana: an ethical perspective on mandatory testing

Mother-to-child transmission (MTCT) of HIV represents a particularly dramatic aspect of the HIV epidemic with an estimated 600,000 newborns infected yearly, 90% of them living in sub-Saharan Africa. Since the beginning of the HIV epidemic, an estimated 5.1 million children worldwide have been infected with HIV. MTCT is responsible for 90% of these infections. Two-thirds of the MTCT are believed to occur during pregnancy and delivery, and about one-third through breastfeeding. As the number of women of child bearing age infected with HIV rises, so does the number of infected children. It is apparent that voluntary testing in Botswana has made some valuable inroads in decreasing perinatal HIV transmission, but the statistics showing the increased rate of HIV infection among women 15-24 years of age are not very promising. After reviewing all the pertinent scientific data it is clear that mandatory HIV testing of all pregnant women in conjunction with the implementation of a full package of interventions would save thousands of lives -- mothers, newborns and others who could be infected as a result of these women not being aware of their HIV status. If the protection and preservation of human life is a priority in Botswana, then it is time to allow for mandatory HIV testing of all pregnant women, before it is too late for those who are the most vulnerable. To do less would be medically inappropriate and ethically irresponsible.

Out-of-pocket costs of HAART limit HIV treatment responses in Botswana's private sector

A large number of HIV-infected patients in sub-Saharan Africa pay out-of-pocket for HAART. This analysis from Botswana indicates that higher median out-of-pocket regimen costs to patients for the initial 30 days of HAART are associated with failure to achieve a viral load< 400 copies/ml [US$32; interquartile range (IQR), 20-84 compared with US$22; (IQR, 17-36), P = 0.001]. HAART costs should be minimized as scale-up efforts in sub-Saharan Africa progress.

Maternal single-dose nevirapine versus placebo as part of an antiretroviral strategy to prevent mother-to-child HIV transmission in Botswana

BACKGROUND

Single-dose nevirapine given to women and infants reduces mother-to-child HIV transmission, but nevirapine resistance develops in a large percentage of women.

OBJECTIVE

To determine whether the maternal nevirapine dose could be eliminated in the setting of zidovudine prophylaxis.

DESIGN, SETTING, AND PARTICIPANTS

A 2 x 2 factorial, randomized, clinical trial, with a double-blinded peripartum factor designed to assess the equivalence of maternal single-dose nevirapine versus placebo with respect to HIV transmission. A total of 709 HIV-infected pregnant women were randomized from four district hospitals in Botswana, resulting in 694 live first-born infants. HAART was available for women with AIDS.

INTERVENTION

All women received a background of zidovudine from 34 weeks' gestation through delivery, and all infants received single-dose nevirapine at birth and zidovudine from birth through 1 month. Women were randomized to receive either single-dose nevirapine or placebo during labor.

MAIN OUTCOME MEASURES

The primary endpoint was infant HIV infection by the 1-month visit.

RESULTS

Of the 694 infants in this equivalence study, 15 (4.3%) of 345 in the maternal nevirapine arm were HIV infected by 1 month, versus 13 (3.7%) of 349 in the maternal placebo arm (95% confidence interval for difference, -2.4% to 3.8%), meeting pre-determined equivalence criteria. Nevirapine resistance at 1 month postpartum was detected in 45% of a random sample of women who received nevirapine.

CONCLUSIONS

In the setting of maternal zidovudine and infant zidovudine plus single-dose nevirapine, infant HIV infection rates were similar whether women received single-dose nevirapine or placebo. This strategy avoids the potential for maternal nevirapine resistance.

Cross-Clade Reactivity of HIV-1-Specific T-cell Responses in HIV-1-Infected Individuals From Botswana and Cameroon

An effective HIV type 1 (HIV-1) vaccine will likely require elicitation of broadly reactive cell-mediated immune (CMI) responses against divergent HIV-1 clades. We compared anti-HIV-1 T-cell immune responses among 363 unvaccinated adults infected with diverse HIV-1 clades. Response rates to clade B Gag and/or clade B Nef in Botswana (95%) and Cameroon (98%) were similar when compared with those in countries previously studied, including Brazil (92%), Thailand (96%), South Africa (96%), Malawi (100%), and the United States (100%). Substantial cross-clade cell-mediated immune responses in Botswana and Cameroon confirm previous findings in a larger, more genetically diverse collection of HIV-1 samples.

Economic and financial analysis of harvesting and utilization of river reed in the Okavango Delta, Botswana

The Okavango Delta, the largest Ramsar wetland site, is one of the most resource-rich ecosystems in Botswana. A range of resources, including reeds, contribute in various ways to the well-being of many of the communities through subsistence and income generation. The economic value of reeds and other resources found in wetlands has been poorly understood, leading to the perception that wetlands are wastelands, and have little or no economic values. Such resources are therefore likely to receive lower priority in conservation when evaluated against other alternative activities. The aim of this research was to determine the benefit and financial and economic viability of harvesting river reed in the Okavango Delta. Primary data were collected through a structured questionnaire administered at three villages in the Okavango Delta. Secondary data were collected from existing literature. Financial and economic analysis was undertaken using static and financial models. Market prices were used to calculate the net income generated from the sale of harvested reed. The measurement criteria for static models were the annual net cash income, net annual economic benefit, and return on investment (ROI), while those under the dynamic models were the net present value (NPV), benefit cost ratio (BCR), and the net benefit investment (N/K) ratio. It was more financially profitable and economically viable to harvest and sell reeds at Shorobe village (a village relatively close to the District economic centre, Maun), than Shakawe or Etsha-13.

Self-reported infection control practices and perceptions of HIV/AIDS risk amongst emergency department nurses in Botswana

This descriptive exploratory study investigated the reported practices and perceptions of emergency nurses related to infection control in the context of the Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) pandemic in Botswana. Quantitative and qualitative data were collected using a self-administered questionnaire. Forty questionnaires were distributed to nurses with emergency department experience in Botswana, with a response rate of 55% (n = 22). Quantitative data were analysed using descriptive statistics while qualitative data were subjected to thematic and content analysis. The majority of respondents reported compliance with universal precautions at the hospital emergency department. However, qualitative data highlighted resource constraints that may hinder compliance with universal precautions such as a lack of appropriate facilities, a shortage of equipment and materials, inadequate staffing and absence of sustainable in-service education programs. Further, the reported compliance with Universal Precautions had not removed the fear of exposure to HIV/AIDS and perceived risk of transmission to family. The authors recommend in-service education and practice initiatives to promote sustainable compliance with universal precautions and realistic risk perception among nurses. Further research is required to evaluate nurses' compliance with universal precautions in developing countries using observational methods or in-depth interviews. This would enable exploration of nurses' actions regarding compliance with universal precautions.

Gene-expression profiling of HIV-1 infection and perinatal transmission in Botswana

Perinatal transmission of human immunodeficiency virus (HIV)-1 represents a major problem in many regions of the world, especially Southern Africa. With the exception of viral and proviral load, the role for maternal cofactors in perinatal transmission outcome is largely unknown. In this study, an assessment was made of peripheral blood mononuclear cells (PBMC) gene-expression profiles to better understand transcriptional changes associated with HIV-1 infection and perinatal transmission among young adult mothers with infants in Botswana. Peripheral blood mononuclear cells specimens were used from 25 HIV+ drug naive and 20 HIV- healthy mothers, similar in age and location, collected in 1999-2000 and 2003, and processed with the exact same methods, as previously described. Expression profiling of 22 277 microarray gene probes implicated a broad initiation of innate response gene-sets, including toll-like receptor, interferon-stimulated and antiviral RNA response pathways in association with maternal HIV-1 infection. Maternal transmission status was further associated with host genes that influence RNA processing and splicing patterns. In addition to real-time polymerase chain reaction validation of specific genes, enriched category validation of PBMC profiles was conducted using two independent data sets for either HIV-1 infection or an unrelated RNA virus, severe acute respiratory virus infection. HIV-1 pathogen-specific host profiles should prove a useful tool in infection and transmission intervention efforts worldwide.

Participation in labor-intensive public works program (LIPWP): effect on staple crop production in southeastern Botswana

A labor-intensive public works program (LIPWP) aims to improve the income of rural households. One of the common criticisms of the LIPWP is that it is a disincentive for staple crop production. This study, conducted between February and May 2000, examined the association between participation in an LIPWP and staple crop production in southeastern Botswana. Participant households were those with at least one member on a semipermanent LIPWP. A control group was drawn from households that were eligible to participate in the LIPWP. All participants in the LIPWP were included, while nonparticipant households were randomly selected. A structured questionnaire was administered to 160 control and 153 participant households. The odds of having no staple crop in the control group were 1.8 times (95% CI, 0.98 to 3.54) higher than that of the LIPWP participants (p = .087), while the odds of having no staple crop in a household with a head between 45 and 64 years of age were 2.5 times (95% CI, 1.06 to 5.96) higher than that of a household with a head less than 45 years old (p < .037). Having more than 10 livestock equivalent units reduced the risk of having no harvest by 40% (95% CI, 0.29 to 1.12). The view that participation in the LIPWP results in reduced staple crop production does not seem to be supported by our data.

Hybrid data capture for monitoring patients on highly active antiretroviral therapy (HAART) in urban Botswana

Individual patient care and programme evaluation are pivotal for the success of antiretroviral treatment programmes in resource-limited countries. While computer-aided documentation and data storage are indispensable for any large programme, several important issues need to be addressed including which data are to be collected, who collects it and how it is entered into an electronic database. We describe a patient-monitoring approach, which uses patient encounter forms (in hybrid paper + electronic format) based on optical character recognition, piloted at Princess Marina Hospital in Gaborone, Botswana's first public highly active antiretroviral therapy (HAART) outpatient clinic. Our novel data capture approach collects "key" data for tracking patient and programme outcomes. It saves physician time and does not detract from clinical care.

Desperately seeking targets: the ethics of routine HIV testing in low-income countries

The human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) pandemic, and responses to it, have exposed clear political, social and economic inequities between and within nations. The most striking manifestations of this inequity is access to AIDS treatment. In affluent nations, antiretroviral treatment is becoming the standard of care for those with AIDS, while the same treatment is currently only available for a privileged few in most resource-poor countries. Patients without sufficient financial and social capital -- i.e., most people with AIDS -- die each day by the thousands. Recent AIDS treatment initiatives such as the UNAIDS and WHO "3 by 5" programme aim to rectify this symptom of global injustice. However, the success of these initiatives depends on the identification of people in need of treatment through a rapid and massive scale-up of HIV testing. In this paper, we briefly explore key ethical challenges raised by the acceleration of HIV testing in resource-poor countries, focusing on the 2004 policy of routine ("opt-out") HIV testing recommended by UNAIDS and WHO. We suggest that in settings marked by poverty, weak health-care and civil society infrastructures, gender inequalities, and persistent stigmatization of people with HIV/AIDS, opt-out HIV-testing policies may become disconnected from the human rights ideals that first motivated calls for universal access to AIDS treatment. We leave open the ethical question of whether opt-out policies should be implemented, but we recommend that whenever routine HIV-testing policies are introduced in resource-poor countries, that their effect on individuals and communities should be the subject of empirical research, human-rights monitoring and ethical scrutiny.

Fungi, aflatoxins, fumonisin Bl and zearalenone contaminating sorghum-based traditional malt, wort and beer in Botswana

Brewing and consumption of traditional beer have social-economic significance in most African countries including Botswana. Traditional sorghum malt, wort, and beer samples were collected from three villages around Gaborone, Botswana. Forty-six malt samples were analyzed for fungi on three different media and developing colonies were subcultured for identification. Rhizopus, Fusarium, Mucor, and Aspergillus were the most common genera isolated. Out of the 46 malt samples, 72% contained Rhizopus stolonifer, 63% Fusarium verticillioides (syn. Fusarium moniliforme), and 37% Aspergillus flavus. Although Aspergillus flavus was isolated from malt samples, aflatoxins (B(1), B(2), G(1), and G(2)) were not detected in any of the samples analyzed. When the malt, wort, and beer samples were analyzed for fumonisin B(l) and zearalenone, fumonisin B(1) was detected in 3 malt samples, with concentrations ranging from 47 to 1316 mug/kg, while zearalenone was detected in 56%, 48% and 48% of the malt, wort and beer samples, respectively. Zearalenone concentration in samples ranged from 102 to 2213 mug/kg in malt, 26 to 285 mug/l in wort and 20 to 201 mug/l, in beer. Zearalenone carry-over from wort to beer ranged from 23 to 403%. Therefore, although aflatoxins and fumonisin B(1) do not appear to be major contaminants, zearalenone is common and could pose a potential problem in traditional beer in Botswana.

Social consequences of HIV-positive women's participation in prevention of mother-to-child transmission programmes

Approximately two-third of the worlds HIV/AIDS cases are found in sub-Saharan Africa. The rate of mother-to-child-transmission (MTCT) has been found to lie between 15 and 40%. The aim of this study was to explore the social consequences affecting the experience HIV-positive women have when taking part in a prevention of mother-to-child-transmission programme (PMTCT). Few studies have investigated this earlier. A cross section of 52 participating women enrolled into a PMTCT programme were randomly selected and interviewed, using a structured questionnaire. There were three main findings. The most important consequence of participating was the difficulty associated with the breast-feeding issue. For the women who because of a wish to prevent MTCT are employing formula feeding, this causes suspicion and prejudice amongst people in the local community. Few people influence a woman's decision to take part, as they tend to keep their HIV status to themselves. More information to the general public about HIV and PMTCT programmes will enhance acceptance to HIV, and generate an environment conducive towards participation in PMTCT programmes.

Utilization characteristics and importance of woody biomass resources on the rural-urban fringe in botswana

This article examines the utilization characteristics and importance of woody biomass resources in the rural-urban fringe zones of Botswana. In the literature for Africa, attention has been given to the availability and utilization of biomass in either urban or rural environments, but the rural-urban fringe has been neglected. Within southern Africa, this neglect is not justified; the rural-urban fringe, not getting the full benefits available in urban environments in Botswana, has developed problems in woody biomass availability and utilization that require close attention. In this article, socioeconomic data on the importance of woody biomass in the Batlokwa Tribal Territory, on the rural-urban fringe of Gaborone, Botswana, were collected together with ecologic data that reveal the utilization characteristics and potential for regrowth of woody biomass. The analysis of these results show that local woody biomass is very important in the daily lives of communities in the rural-urban fringe zones and that there is a high level of harvesting. However, there is no effort in planning land use in the tribal territory to either conserve this resource or provide alternatives to its utilization. The future of woody biomass resources in Botswana's rural-urban fringe is uncertain. The investigators recommend that a comprehensive policy for the development of the rural-urban fringe consider the importance of this resource. The neglect of this resource will have far-reaching implications on the livelihoods of residents as well as the environment in this zone.

Bottom up and top down: analysis of participatory processes for sustainability indicator identification as a pathway to community empowerment and sustainable environmental management

The modern environmental management literature stresses the need for community involvement to identify indicators to monitor progress towards sustainable development and environmental management goals. The purpose of this paper is to assess the impact of participatory processes on sustainability indicator identification and environmental management in three disparate case studies. The first is a process of developing partnerships between First Nations communities, environmental groups, and forestry companies to resolve conflicts over forest management in Western Canada. The second describes a situation in Botswana where local pastoral communities worked with development researchers to reduce desertification. The third case study details an on-going government led process of developing sustainability indicators in Guernsey, UK, that was designed to monitor the environmental, social, and economic impacts of changes in the economy. The comparative assessment between case studies allows us to draw three primary conclusions. (1) The identification and collection of sustainability indicators not only provide valuable databases for making management decisions, but the process of engaging people to select indicators also provides an opportunity for community empowerment that conventional development approaches have failed to provide. (2) Multi-stakeholder processes must formally feed into decision-making forums or they risk being viewed as irrelevant by policy-makers and stakeholders. (3) Since ecological boundaries rarely meet up with political jurisdictions, it is necessary to be flexible when choosing the scale at which monitoring and decision-making occurs. This requires an awareness of major environmental pathways that run through landscapes to understand how seemingly remote areas may be connected in ways that are not immediately apparent.

Initial response to highly active antiretroviral therapy in HIV-1C-infected adults in a public sector treatment program in Botswana

OBJECTIVE

To describe the response to highly active antiretroviral treatment (HAART) in a public sector pilot antiretroviral (ARV) treatment program in Botswana.

METHODS

The response to HAART is described in adult HIV-infected ARV-naive patients initiating treatment from April 2001 to January 2002 at Princess Marina Hospital in Gaborone, Botswana. Patients had medical and laboratory evaluations before initiating ARV treatment and were followed longitudinally. For analysis, data were collected from charts and patient management records.

RESULTS

One hundred fifty-three ARV-naive patients initiated HAART. Most received didanosine plus stavudine (ddI + d4T) with efavirenz or nevirapine. The mean CD4 cell count increase was 149 cells/mm at 24 weeks and 204 cells/mm at 48 weeks. The percentage of patients with an HIV-1 RNA level < or =400 copies/mL was 87.0% at 24 weeks and 78.8% at 48 weeks. The Kaplan-Meier 1-year survival estimate was 84.7% (79.0%, 90.8%), with a 3.2-fold increased risk (P = 0.004) of mortality among patients with a CD4 cell count <50 cells/mm. The 1-year Kaplan-Meier estimate of toxicity-related drug switches was 32.2% (20.3%, 40.4%). The most common toxicity was peripheral neuropathy, occurring more frequently in patients with a preexisting diagnosis of peripheral neuropathy and among those placed on ddI + d4T-containing regimens.

CONCLUSIONS

An excellent response to HAART was observed among HIV-1C-infected patients, paralleling those seen elsewhere. Despite excellent responses, high rates of toxicity were observed for ddI + d4T-containing regimens.

Botswana: Refugees not entitled to same services as citizens

Botswana, among the countries with the highest HIV/AIDS prevalence rates in the world, has been recognized internationally for its ambitious program to offer voluntary counseling and testing, prevention of mother-to-child transmission (PMTCT) and antiretroviral (ARV) treatment to all residents. Unfortunately, these policies have not been extended to the large numbers of refugees in Botswana. Botswana's Refugee Recognition and Control Act does not recognize a refugee as an ordinary resident.

Multilocus sequence typing reveals three genetic subpopulations of Cryptococcus neoformans var. grubii (serotype A), including a unique population in Botswana

We applied multilocus sequence typing (MLST) to investigate the population structure and mode of reproduction of Cryptococcus neoformans var. grubii (serotype A). This MLST system utilizes 12 unlinked polymorphic loci, which are dispersed on nine different chromosomes, and allows the unambiguous identification of closely related strains of serotype A. We compared MLST analyses with the conventional genotyping method of detecting amplified fragment length polymorphisms (AFLPs), and there was excellent correlation between the MLST and AFLP results. However, MLST differentiated a larger number of strains. We analyzed a global collection of isolates of serotype A using both methods, and the results identified at least three genetically distinct subpopulations, designated groups VNI, VNII, and VNB. Groups VNI and VNII are widespread, dominated by isolates with the MATalpha mating type, and predominantly clonal. Conversely, isolates of group VNB are unique to Botswana, include a significant proportion of fertile strains with the MATa mating type, and manifest compelling evidence of recombination. We have AFLP genotyped >1000 strains of serotype A from different parts of the world, including isolates from several African countries, and, to date, haploid serotype A isolates of group VNB have been found only in Botswana.

Changes in the Etiology of Sexually Transmitted Diseases in Botswana between 1993 and 2002: Implications for the Clinical Management of Genital Ulcer Disease

BACKGROUND

In recent years, increasing evidence has accumulated that suggests the majority of cases of genital ulcer disease in sub-Saharan Africa are due to viral and not bacterial infections. Although many cross-sectional studies support such a trend, few serial cross-sectional data are available to show the evolution of genital ulcer disease over time.

METHODS

We surveyed the prevalence of sexually transmitted diseases (STDs) among patients with STD symptoms and women recruited from family planning clinics in 3 cities in Botswana in 2002 and compared our findings with those from a survey of a similar population conducted in 1993.

RESULTS

The observed proportion of cases of genital ulcer disease due to chancroid decreased from 25% in 1993 to 1% in 2002, whereas the proportion of ulcers due to herpes simplex virus increased from 23% in 1993 to 58% in 2002. Although the proportion of ulcers due to syphilis was similar for both surveys, the rate of positive serologic test results for syphilis among patients with genital ulcer disease decreased from 52% in 1993 to 5% in 2002. During this period, decreases in the prevalence of gonorrhea, syphilis-reactive serologic findings, chlamydial infection, and trichomoniasis were also detected among patients with STDs and women from family planning clinics. These changes remained significant after estimates were adjusted for the sensitivity and specificity of diagnostic tests.

CONCLUSIONS

Our findings suggest a decrease in the prevalence of bacterial STDs and trichomoniasis, a reduction in the proportion of ulcers due to bacterial causes, and an increase in the proportion of ulcers due to herpes simplex virus during the period 1993-2002. These changes should be taken into consideration when defining new guidelines for the syndromic management of genital ulcer disease.

Detection and molecular characterisation of group a rotavirus from children in northern Botswana

OBJECTIVES

To determine the presence of group A rotavirus in human stool samples in northern Botswana and to characterise the circulating strains.

DESIGN

A cross sectional study.

SETTING

The University of Botswana and Botswana-Havard Partnership for HIV Research.

SUBJECTS

A total of 210 stool samples was collected; 104 from hospitalised and 106 from non-hospitalised children, five years and below suffering from gastroenteritis.

RESULTS

Out of 210 diarrhoea stool samples collected, 27 (13%) tested positive for group A rotavirus. There was a higher prevalence of infection in hospitalised children (63%) as compared to the non-hospitalised ones (37%). Most rotavirus infections occurred in the age 24 months and below. Of the 13 samples which were positive by PAGE, the predominant electrophoretic pattern detected was the short (S) electrophoretype 9/13 (69%) followed by the long (L) electrophoretype 4/13 (31%). The following G types were detected; G2 (17%), G3 (22%), mixed infections found were G1+G2 (5.6%), G1+G8 (22%), G3+G9 (27.8%) and G1+G3+G9 (5.6%). P[6] was the only VP 4 genotype detected. Rotavirus strains G3P[6] and G3+G9P[6] were identified as the circulating strains in north Botswana.

CONCLUSION

The detection of uncommon rotavirus strains and the high proportion of mixed infections suggest a greater diversity of rotavirus infections among children in Botswana than previously reported. Our study reveals a complex epidemiological profile of rotavirus infection in Botswana that may require further molecular characterisation.

Water quality assessment and modeling of an effluent-dominated stream, the Notwane River, Botswana

In an effort to assess current and future water quality of the only perennial river in southeastern Botswana, this study presents water quality monitoring and modeling results for the effluent-dependent Notwane River. The water quality along the Notwane River, pre- and post-implementation of secondary wastewater treatment, was compared and results demonstrated that water quality improved after the new wastewater treatment plant (WWTP) went online. However, stream standards for chemical oxygen demand, total dissolved phosphorous, and fecal coliform were exceeded in most locations and the critical dissolved oxygen (DO) reached concentrations of less than 4 mg L(-1). High dissolved P concentrations and intense macrophyte growth at the impounding ponds and at sites within 30 km of the effluent waste stream confluence suggest that eutrophication was a function of P release from the ponds. Results of DO modeling demonstrated that an unpolluted inflow at approximately 10 km downstream of the confluence was responsible for raising DO concentrations by 2.3 mg L(-1), while SOD was responsible for a decline in DO concentrations of 1.4 mg L(-1) at 6 km downstream of the confluence. Simulations also showed higher DO concentrations during winter months, when water temperatures were lower. Simulations, in which the distributed biochemical oxygen demand (BOD) loading from cattle excrement was decreased, produced nominal increases in DO concentrations. An increase in WWTP BOD loadings to projected 2020 values resulted in a 1.3 mg L(-1) decrease in the critical DO concentration. Furthermore, a decrease in treatment plant efficiency, from 94% to 70% BOD removal, produced critical DO concentrations and anoxia along much of the modeled reach. This has significant implications for Gaborone, especially if decreased WWTP efficiency occurs as a result of the expected future increase in pollutant loadings.

Wildlife resource utilisation at Moremi Game Reserve and Khwai community area in the Okavango Delta, Botswana

This paper uses the concept of sustainable development to examine the utilisation of wildlife resources at Moremi Game Reserve (MGR) and Khwai community area (NG 18/19) in the Okavango Delta, Botswana. Using both secondary and primary data sources, results show that the establishment of MGR in 1963 led to the displacement of Khwai residents from their land; affected Basarwa's hunting and gathering economy; marked the beginning of resource conflicts between Khwai residents and wildlife managers; and, led to the development of negative attitudes of Khwai residents towards wildlife conservation. Since the late 1980s, a predominantly foreign owned tourism industry developed in and around MGR, however, Khwai residents derive insignificant benefits from it and hence resource conflicts increased. In an attempt to address problems of resource conflicts and promote sustainable wildlife utilisation, the Botswana Government adopted the Community-Based Natural Resource Management (CBNRM) programme, which started operating at Khwai village in 2000. The CBNRM programme promotes local participation in natural resource management and rural development through tourism. It is beginning to have benefits to Khwai residents such as income generation, employment opportunities and local participation in wildlife management. These benefits from CBNRM are thus having an impact in the development of positive attitudes of Khwai residents towards wildlife conservation and tourism development. This paper argues that if extended to MGR, CBNRM has the potential of minimising wildlife conflicts between Khwai residents and the wildlife-tourism sectors. This approach may in the process promote the sustainable wildlife use in and around MGR.