Feasibility of an ultrasound service on district health care level in Botswana.
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OBJECTIVE: To assess the clinical benefit and financial feasibility of an ultrasound service in a district hospital in Botswana. METHOD: An ultrasound service was established in the study hospital. Clinical and ultrasound-aided diagnoses were compared in patients who met eligibility criteria laid down in an indication list. RESULTS: We enrolled 2309 patients over 18 months. The most frequent indications for ultrasound were pregnancy-related diagnoses followed by gynaecological and hepato-biliary disorders. Ultrasound assistance improved case management in 696 cases (30%) and led to an immediate change in management in 151 patients. Ultrasound diagnosis was used as gold standard to assess the accuracy of the clinical diagnosis of incomplete abortion (sensitivity 24%; positive predictive value, PPV 66%), pelvic mass (sensitivity 53%; PPV 69%), ectopic pregnancy (sensitivity 75%; PPV 28%), and gall bladder stones (sensitivity 30%; PPV 32%). CONCLUSIONS: Ultrasound improved case management for a wide diversity of clinical problems encountered on district health care level. The service proved to be affordable for the Botswana health care system. (+info)
A retrospective study of the cancer patterns among hospital in-patients in Botswana 1960-72.
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Records of approximately 310,000 patients admitted to the 10 hospitals in Botswana between 1960 and 1972 have been studied and details of 1445 patients with malignant tumours abstracted. For the 894 tumours for which there was some supporting evidence--at best histological proof and minimally a clinical description of symptoms--proportional frequencies have been calculated for all sites and comparison made with the findings of other surveys. Cancer of the cervix uteri is overwhelmingly the most commonly occurring malignant tumour and the proportional frequency is among the highest observed in Africa south of the Sahara. Skin tumours are unusually common for Southern Africa in both sexes. In males, penile and prostatic tumours have a relatively high frequency whilst the frequencies for liver and lung are lower than in other parts of Southern Africa. Oesophageal cancer in males has a moderate frequency. Other tumours which show a marked variation of frequency within Africa--Kaposi's sarcoma and cancers of the stomach and bladder--are all low in frequency in Botswana. Tumours which are rare throughout Africa but common in Western Europe and North America--cancers of the colon, rectum and corpus uteri--are also rare in Botswana. (+info)
Adherence to treatment guidelines in primary health care facilities in Botswana.
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OBJECTIVES: To assess the quality of nurses' prescribing through an assessment of their prescription in relation to diagnosis, and to investigate trends in drug use in Botswana primary health care. METHODS: Key data regarding nurses' adherence to national prescription and treatment guidelines were obtained through participatory observation using a questionnaire, related to each consultation. Adherence was categorized into (i) Full adherence, (ii) acceptable adherence, (iii) acceptable adherence, but one or more useless, but not dangerous, drugs and (iv) insufficient or dangerous treatment. The study comprises data on nurses' prescriptions, diagnoses and quality of dispensing in 2994 consecutive consultations in 30 primary health care facilities in three districts of Botswana: Ngami East, Gaborone and Kgalagadi North. RESULTS: The average number of drugs prescribed per patient was 2.3. Antibiotics were prescribed in 27% of all encounters. Full adherence was found in 44%, acceptable compliance in 20%, 'acceptable, but one or more useless, but not dangerous, drugs' in 33% and 'insufficient or dangerous treatment' in 3% of the consultations. Four factors were found to be independently associated with full adherence: patient age 16-31 years, specified diagnosis, type of health facility and nurses' years of practice (4-11 years best). CONCLUSION: Although Botswana's health workers perform relatively well in terms of drug use indicators, there is a clear potential for improving health workers' adherence to national treatment guidelines. (+info)
The role of soil factors and leaf protein in the utilization of mopane plants by elephants in northern Botswana.
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BACKGROUND: Mopane (Colophospermum mopane) plants form monotypic woodlands that cover extensive areas in northern Botswana. Mopane is also a principal food item in the diet of elephants. Obtrusive damage to mopane plants as a result of elephant feeding may alter the structure of mopane woodlands. Some mopane woodland areas in northern Botswana are subjected to heavy elephant utilization rates whereas other mopane areas are less affected. However, the underlying reason for the concentrated elephant utilization is unknown. RESULTS: Ten mopane plots were subjected to sampling of soil properties that included structure, pH, nitrogen, phosphorus, potassium contents and protein contents. Elevated nitrogen and phosphorus contents in soils correlated with high protein levels in mopane leaves. Protein levels in leaves of mopane plants differed significantly between sites. However, multivariate analyses of environmental parameters and plots suggested that on a regional scale, there was no difference in the extent of elephant damage to mopane plants due to differential protein levels in leaves or any of the underlying soi factors that were examined. CONCLUSIONS: From management perspective, this pattern mitigates the likelihood that an even more prolific elephant population will alter mopane woodland habitats irreversibly. (+info)
Modelling HIV/AIDS epidemics in Botswana and India: impact of interventions to prevent transmission.
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OBJECTIVE: To describe a dynamic compartmental simulation model for Botswana and India, developed to identify the best strategies for preventing spread of HIV/AIDS. METHODS: The following interventions were considered: a behavioural intervention focused on female sex workers; a conventional programme for the treatment of sexually transmitted infections; a programme for the prevention of mother-to-child transmission; an antiretroviral treatment programme for the entire population, based on a single regimen; and an antiretroviral treatment programme for sex workers only, also based on a single regimen. FINDINGS: The interventions directed at sex workers as well as those dealing with sexually transmitted infections showed promise for long-term prevention of human immunodeficiency virus (HIV) infection, although their relative ranking was uncertain. In India, a sex worker intervention would drive the epidemic to extinction. In Botswana none of the interventions alone would achieve this, although the prevalence of HIV would be reduced by almost 50%. Mother-to-child transmission programmes could reduce HIV transmission to infants, but would have no impact on the epidemic itself. In the long run, interventions targeting sexual transmission would be even more effective in reducing the number of HIV-infected children than mother-to-child transmission programmes. Antiretroviral therapy would prevent transmission in the short term, but eventually its effects would wane because of the development of drug resistance. CONCLUSION: Depending on the country and how the antiretroviral therapy was targeted, 25-100% of HIV cases would be drug- resistant after 30 years of use. (+info)
Mycobacterium tuberculosis: an emerging disease of free-ranging wildlife.
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Expansion of ecotourism-based industries, changes in land-use practices, and escalating competition for resources have increased contact between free-ranging wildlife and humans. Although human presence in wildlife areas may provide an important economic benefit through ecotourism, exposure to human pathogens may represent a health risk for wildlife. This report is the first to document introduction of a primary human pathogen into free-ranging wildlife. We describe outbreaks of Mycobacterium tuberculosis, a human pathogen, in free-ranging banded mongooses (Mungos mungo) in Botswana and suricates (Suricata suricatta) in South Africa. Wildlife managers and scientists must address the potential threat that humans pose to the health of free-ranging wildlife. (+info)
Functional heterostyly in Tylosema esculentum (Caesalpinioideae).
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Tylosema esculentum is a long-lived perennial species endemic to arid areas of southern Africa. Its potential as a crop species has long been recognized as a result of the high oil and protein content of its seeds. The reproductive biology and breeding systems of the species were investigated in wild and experimental populations growing in Botswana. Field observations confirmed that the species is heterostylous with the pistil and anthers exhibiting reciprocal heights in the two morphs, although pollen size and sculpturing do not vary. The wet, nonpapillate stigma characteristic of the species is the first to be reported in the Caesalpinioideae. In vivo and in vitro diallel crossing experiments demonstrated that a diallelic self-incompatability system exists in T. esculentum. The major site of pollen tube inhibition in the intramorph crosses was found to be in the style. This is the first report of functional heterostyly in the Fabaceae and of a confirmed self-incompatibility system in the Caesalpinioideae. Three separate lines of evidence, the monitoring of fruit development in open-pollinated plants, fruit set in diallel crossing experiments, and observations made in wild populations, demonstrated that fruit set and, by implication, seed set, are very low in this species. Floral abscission was a major limitation to the production of mature pods but there were also significant losses at other developmental stages of fruit production. The results suggest that low seed set may be an adaptation of the species to an environment in which rainfall is scarce. (+info)
Rapid assessment of tuberculosis in a large prison system--Botswana, 2002.
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Prisons are settings in which tuberculosis (TB) transmission occurs, and TB rates in prisons are often five to 10 times higher than national rates. Data on the prevalence of TB in prisons in Africa are limited; however, studies from Malawi, Ivory Coast, and Tanzania that used active screening found TB rates > or = 10 times higher than national rates. During 1989-2001, TB rates in Botswana increased threefold, from 199 cases per 100,000 population to 620 (Botswana National TB Program, unpublished data, 2002). This increase has been associated with the human immunodeficiency virus (HIV) epidemic. In Botswana, prisoners are not screened routinely for TB. To determine the prevalence of TB and drug-resistant TB in the Botswana prison system and to improve future screening for TB among prisoners and guards, CDC, in collaboration with the Botswana Ministry of Health and the Division of Prisons and Rehabilitation, screened prisoners and guards at four prisons during April-May 2002. This report summarizes the results of the survey, which indicate a high point prevalence of TB among prisoners in Botswana of 3,797 cases per 100,000 population and support the need for improved screening. (+info)