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Induction of HIV-specific functional immune responses by a multiclade HIV-1 DNA vaccine candidate in healthy Ugandans
(Vaccine, 2007) Eller, Michael A.; Eller, Leigh Anne; Opollo, Marc S.; Ouma, Benson J.; Oballah, Peter O.; Galley, Lynee; Karnasuta, Chitraporn; Kim, Silvia Ratto; Robb, Merlin L.; Michael, Nelson L.; Kibuuka, Hannah; Wabwire-Mangen, Fred; Graham, Barney S.; Birx, Deborah L.; de Souza, Mark S.; Cox, Josephine H.
A phase I randomized, double blind, placebo-controlled trial to assess the immunogenicity of a multiclade HIV-1 DNA plasmid vaccine was conducted in 31 HIV-1-negative Ugandans. Following immunization with DNA at 0, 1, and 2 months, the frequency of HIV-specific immune responses was assessed up to 10 months using a standard chromium release assay (CRA), lymphoproliferative assay (LPA), and antibody dependent cell-mediated cytotoxicity assay (ADCC). Seven of 15 (47%) vaccinees demonstrated CTL activity using the CRA to HIV-1 Env B with responses observed 1 month following the second vaccination and as late as 7 months following complete immunization. Additionally, lymphoproliferative reponses were observed in 14/15 vaccinees against p24. No CTL or LPA responses were observed at baseline or in the placebo group. ADCC activity was minimally induced by DNA vaccination. This study demonstrates that immunization with DNA alone induces CTL and lymphoproliferative responses in a population that will participate in a phase IIb study evaluating HIV-1 DNA priming followed by boosting with a replication-defective recombinant adenovirus vector. Keywords: DNA vaccine; HIV-1; CTL; LPA; ADCC
Factors associated with DPT 1-3 vaccine dropout in Kabarole district
(International Journal of Infectious Diseases, 2010) Opollo, M.-S.; Makumbi, F.; Mukanga, D.; Namusisi, O.; Ayebazibwe, N.; Tweheyo, R.
Background: Among the top ten causes of poor health in the district are complications due to vaccine preventable diseases notably diphtheria, pertussis and tetanus (DPT). In 2008, the DPT dropout rate in Kabarole was high (18%). This study assessed the service, community and individual factors associated with DPT1-3 dropout in Kabarole District. Methods: A cross sectional study using cluster sampling was employed. Two clusters at parish level (rural and urban) each from a county in the district were selected by sim ple random sampling and all villages therein were studied. A total of 230 children (115 from either cluster) were recruited and their parent or guardian interviewed. Cross-tabulations and chi-square tests were used to determine the strength of associations between independent variables and the outcome. Binary logistic regression was done to adjust for potential confounders and identify independent predic tors. Key informant interviews were held with in-charges of health units. Qualitative data was analysed manually using thematic approach and results presented in the form of text. Results: Factors found to be associated with DPT1-3 dropout were; lack of caretaker knowledge about DPT dosage, (adj. OR = 8.2; 95% CI: 3.12, 21.53); Child’s Birth Order, 6th and above (adj. OR = 3.0; 95% CI: 0.80, 11.05); Child Birth Order 2-3 (adj. OR = 2.2; 95% CI: 0.70, 6.71); Child age group 31-36 compared to 12-18 (adj. OR = 2.5; 95% CI: 0.81, 7.84). However, Rural residence (OR = 1.2; 95% CI: 0.56, 2.57); and Child without immunisation card (OR = 4.4; 95% CI: 0.35, 39.86) were not significantly associated with DPT dropout. Conclusion: The current DPT1-3 dropout prevalence in Kabarole is still high but dropping (13.7%). DPT 1-3 dropout is associated with caretaker lack of knowledge of number of dosages a child should receive and involvement of religious leaders, long travel distance to point of accessing transport means, and convenient time for immunisation. Findings from this study can be used to improve DPT immunisation services. Specific campaigns on DPT immunisation through home visits, involving community leaders and full day immunisation can help further reduce the dropout rate
Prevalence of HIV-AssociatedMetabolic Abnormalities among Patients Taking First-Line Antiretroviral Therapy in Uganda
(International Scholarly Research Network, 2012) Omech, Bernard; Sempa, Joseph; Castelnuovo, Barbara; Opio, Kenneth; Otim, Marcel; Mayanja-Kizza, Harriet; Colebunders, Robert; Manabe, Yukari C.
Introduction. While the introduction of highly active antiretroviral therapy decreased HIV-related morbidity and mortality rates in the sub-Saharan Africa, a subsequent increase in metabolic abnormalities has been observed. We sought to determine the prevalence of HIV-associated metabolic abnormalities among patients on first-line antiretroviral therapy (ART) in an ART clinic in Kampala, Uganda. Methods. Four hundred forty-two consecutive patients on first-line ART for at least 12 months were screened for eligibility in a cross-sectional study, and 423 were enrolled. Pre-ART patient characteristics were abstracted from medical charts, examinations included anthropometric measurement and physical assessment for lipodystrophy. Results. The prevalence of hyperglycemia and dyslipidemia was 16.3% (69/423) and 81.5% (345/423), respectively. Prevalence of dyslipidemia between stavudine- and zidovudine-based regimens (91% versus 72%; P < 0.001). Being on stavudine (aOR 4.79, 95%, 2.45–9.38) and peak body weight (aOR 1.44, 95% CI 1.05–1.97) were independent risk factors for dylipidemia. Stavudine (aOR 0.50, 95% CI 0.27–0.93) use was associated with lower risk for hyperglycemia while, and older age (aOR 1.31, 95% CI 1.11–1.56) and having a family history of DM (aOR 2.18, 95% CI 1.10–4.34) were independent risk factors for hyperglycemia. Conclusions. HIV-associated metabolic complications were prevalent among patients on thymidine analogue-containing ART regimens. Screening for lipid and glucose abnormalities should be considered in ART patients because of cardiovascular risks.
Assessing factors associated with CD4 cell absolute count in patients at Gulu Regional Referral Hospital: A case study by Marc Sam Opollo, Uganda
(South American Journal of Public Health, 2014) Opollo, Marc Sam
Background: This study is set to assess individual, environmental and medication factors associated with CD4 cell count in patients attending HIV/AIDS treatment and care clinic in Gulu Regional Referral Hospital. Gulu Regional Referral Hospital is located in the northern district of Gulu. Gulu Regional Referral Hospital performs CD4 cell counts to monitor HIV +ve patients. Methodology: A cross-sectional study, with study population of Gulu and target population being HIV +ve patients attending HIV clinic in Gulu Regional Referral Hospital. Systematic random sampling will be used. Questionnaires will be administered to patients after informed consent. Results: will be presented in Texts, Tables, Graphs.
A case of Shapiro’s Syndrome in an African young man
(Case Reports in Internal Medicine, 2015) Chacha, Mwita Julius; Omech, Bernard; Keatlaretse, Siamisang; Humphrey, Bose
Shapiro’s syndrome is a rare congenital neurological disease characterized by episodes of excessive sweating and hypothermia, and by complete/partial agenesis of the corpus callosum. We report an 18 year-old male who was referred to Princess Marina Hopsital with a longstanding history of episodic shaking chills, excessive sweating, fatigue, and unsteady gait. During the episodes, he was bradycardic (pulse rate of less than 36 beats/minute), with blood pressure of less than 80/45 mmHg, and his axillary body temperatures were unrecordably low. Neurologic examination showed cerebellar signs. The MRI of the brain revealed agenesis of the corpus callosum with no other abnormalities. The patient responded to clonidine therapy. Shapiro’s syndrome is an important consideration when evaluating a patient with episodic hyperhidrosis and hypothermia. The syndrome is rare worldwide and to the best of our knowledge, this report constitutes the first documentation of a case from Africa.
HIV Type 1 Disease Progression to AIDS and Death in a Rural Ugandan Cohort Is Primarily Dependent on Viral Load Despite Variable Subtype and T-Cell Immune Activation Levels
(The Journal of infectious diseases, 2015) Eller, Michael A.; Opollo, Marc S.; Liu, Michelle; Redd, Andrew D.; Leigh, Anne Eller; Kityo, Cissy; Kayiwa, Joshua; Laeyendecker, Oliver; Wawer, Maria J.; Milazzo, Mark; Kiwanuka, Noah; Gray, Ronald H.; Serwadda, David; Sewankambo, Nelson K.; Quinn, Thomas C.; Michael, Nelson L.; Wabwire-Mangen, Fred; Sandberg, Johan K.; Robb, Merlin L.
Background. Untreated human immunodeficiency virus type 1 (HIV) infection is associated with persistent im mune activation, which is an independent driver of disease progression in European and United States cohorts. In Uganda, HIV-1 subtypes A and D and recombinant AD viruses predominate and exhibit differential rates of disease progression. Methods. HIV-1 seroconverters (n = 156) from rural Uganda were evaluated to assess the effects of T-cell acti vation, viral load, and viral subtype on disease progression during clinical follow-up. Results. The frequency of activated T cells was increased in HIV-1–infected Ugandans, compared with commu nity matched uninfected individuals, but did not differ significantly between viral subtypes. Higher HIV-1 load, sub type D, older age, and high T-cell activation levels were associated with faster disease progression to AIDS or death. In a multivariate Cox regression analysis, HIV-1 load was the strongest predictor of progression, with subtype also contributing. T-cell activation did not emerge an independent predictor of disease progression from this particular cohort. Conclusions. These findings suggest that the independent contribution of T-cell activation on morbidity and mortality observed in European and North American cohorts may not be directly translated to the HIV epidemic in East Africa. In this setting, HIV-1 load appears to be the primary determinant of disease progression. Keywords. HIV-1; AIDS; subtype D; immune activation; PD-1; viral load.
Validity of the Finnish Diabetes Risk Score for Detecting Undiagnosed Type 2 Diabetes among General Medical Outpatients in Botswana
(ournal of diabetes research, 2016) Omech, Bernard; Mwita, Julius Chacha; Tshikuka, Jose-Gaby; Tsima, Billy; Nkomazna, Oathokwa; Amone-P’Olak, Kennedy
This was a cross-sectional study designed to assess the validity of the Finnish Diabetes Risk Score for detecting undiagnosed type 2 diabetes among general medical outpatients in Botswana. Participants aged ≥20 years without previously diagnosed diabetes were screened by (1) an 8-item Finnish diabetes risk assessment questionnaire and (2) Haemoglobin A1c test. Data from291 participants were analyzed (74.2% were females). The mean age of the participants was 50.1 (SD = ±11) years, and the prevalence of undiagnosed diabetes was 42 (14.4%) with no significant differences between the gender (20% versus 12.5%, 𝑃 = 0.26). The area under curve for detecting undiagnosed diabetes was 0.63 (95% CI 0.55–0.72) for the total population, 0.65 (95% CI: 0.56–0.75) for women, and 0.67 (95% CI: 0.52–0.83) formen.The optimal cut-off point for detecting undiagnosed diabetes was 17 (sensitivity = 48% and specificity = 73%) for the total population, 17 (sensitivity = 56% and specificity = 66%) for females, and 13 (sensitivity = 53% and specificity = 77%) for males.The positive predictive value and negative predictive value were 20% and 89.5%, respectively. The findings indicate that the Finnish questionnaire was only modestly effective in predicting undiagnosed diabetes among outpatients in Botswana.
Prevalence and determinants of metabolic syndrome: a cross-sectional survey of general medical outpatient clinics using National Cholesterol Education Program-Adult Treatment Panel III criteria in Botswana
(Dovepress, 2016) Omech, Bernard; Tshikuka, Jose-Gaby; Mwita, Julius C; Tsima, Billy; Nkomazana, Oathokwa; Amone-P’Olak, Kennedy
Background: Low- and middle-income countries, including Botswana, are facing rising prevalence of obesity and obesity-related cardiometabolic complications. Very little information is known about clustering of cardiovascular risk factors in the outpatient setting during routine visits. We aimed to assess the prevalence and identify the determinants of metabolic syndrome among the general outpatients’ attendances in Botswana. Methods: A cross-sectional study was conducted from August to October 2014 involving outpatients aged ≥20 years without diagnosis of diabetes mellitus. A precoded questionnaire was used to collect data on participants’ sociodemographics, risk factors, and anthropometric indices. Fasting blood samples were drawn and analyzed for glucose and lipid profile. Metabolic syndrome was assessed using National Cholesterol Education Program-Adult Treatment Panel III criteria. Results: In total, 291 participants were analyzed, of whom 216 (74.2%) were females. The mean age of the total population was 50.1 (±11) years. The overall prevalence of metabolic syndrome was 27.1% (n=79), with no significant difference between the sexes (female =29.6%, males =20%, P=0.11). A triad of central obesity, low high-density lipoprotein-cholesterol, and elevated blood pressure constituted the largest proportion (38 [13.1%]) of cases of metabolic syndrome, followed by a combination of low high-density lipoprotein, elevated triglycerides, central obesity, and elevated blood pressure, with 17 (5.8%) cases. Independent determinants of metabolic syndrome were antihypertensive use and increased waist circumference. Conclusion: Metabolic syndrome is highly prevalent in the general medical outpatients clinics. Proactive approaches are needed to screen and manage cases targeting its most important predictors.
The utilization of HbA1c test in the screening and diagnosis of type 2 diabetes mellitus: An outpatient clinics survey in Botswana
(Journal of Diabetes and Endocrinology, 2017) Omech, Bernard; Tshikuka, Jose-Gaby; Amone-P’Olak, Kennedy; Mwita, Julius; Tsima, Billy; Nkomazana, Oathokwa
This study aimed to assess HbA1c performance against single fasting blood glucose (FBG) for diagnosis of undiagnosed type 2 diabetes (T2D) and impaired fasting glycaemia (IFG) among general medical outpatients in Botswana. Participants aged, ≥20 years were cross-sectionally surveyed from August to October, 2014. All the participants underwent testing for HbA1c and FBG. The HbA1c sensitivity, specificity and predictive values in the diagnosis of T2D and IFG were computed and their Pearson’s correlation and scatter diagrams determined. A total of 291 participants (74.2% women) with a mean age of 50.1±11.0 years provided data for the current analysis. HbA1c at cut-off of ≥ 6.5% (48 mmol/mol) had a sensitivity and specificity for T2D of 100 (15.81 to 100.00) and 86.3% (86.16 to 89.92), respectively. Similarly, for IFG, the sensitivity and specificity was 100 (2.5 to 100) and 36.3% (30.3 to 42.6), respectively. The positive predictive value (PPV) was 4.8 (0.58 to 16.16) and 0.6% (0.02 to 3.45) for T2D and IFG screening, respectively. The negative predictive value (NPV) was 100% in both cases of T2D and IFG screening. HbA1c had a modest, positive correlation (r) with FBG for the overall population (r = 0.536, p < 0.001); for women, (r = 0 .578, p < 0.001) and men (r =0 .336, p =0.003). HbA1c had high sensitivity but widely varying specificity, high proportion of discordant results and poor prediction of T2D and IFG in this setting. Although, HbA1c correlation with fasting glucose was modest, both tests are required to improve diagnostic reliability in asymptomatic T2D screening program.
Presentation and mortality of patients hospitalised with acute heart failure in Botswana
(Cardiovascular journal of Africa, 2017) Mwita, Julius Chacha; Dewhurst, Matthew J; Magafu, Mgaywa GMD; Goepamang, Monkgogi; Omech, Bernard; Majuta, Koketso Lister; Gaenamong, Marea; Palai, Tommy Baboloki; Mosepele, Mosepele; Mashalla, Yohana
Introduction: Heart failure is a common cause of hospitalisation and therefore contributes to in-hospital outcomes such as mortality. In this study we describe patient characteristics and outcomes of acute heart failure (AHF) in Botswana. Methods: Socio-demographic, clinical and laboratory data were collected from 193 consecutive patients admitted with AHF at Princess Marina Hospital in Gaborone between February 2014 and February 2015. The length of hospital stay and 30-, 90- and 180-day in-hospital mortality rates were assessed. Results: The mean age was 54 ± 17.1 years, and 53.9% of the patients were male. All patients were symptomatic (77.5% in NYHA functional class III or IV) and the majority (64.8%) presented with significant left ventricular dysfunction. The most common concomitant medical conditions were hypertension (54.9%), human immuno-deficiency virus (HIV) (33.9%), anaemia (23.3%) and prior diabetes mellitus (15.5%). Moderate to severe renal dysfunction was detected in 60 (31.1%) patients. Peripartum cardiomyopathy was one of the important causes of heart failure in female patients. The most commonly used treatment included furosemide (86%), beta-blockers (72.1%), angiotensin converting enzyme inhibitors (67.4%), spironolactone (59.9%), digoxin (22.1%), angiotensin receptor blockers (5.8%), nitrates (4.7%) and hydralazine (1.7%). The median length of stay was nine days, and the in-hospital mortality rate was 10.9%. Thirty-, 90- and 180-day case fatality rates were 14.7, 25.8 and 30.8%, respectively. Mortality at 180 days was significantly associated with increasing age, lower haemoglobin level, lower glomerular filtration rate, hyponatraemia, higher N-terminal pro-brain natriuretic peptide levels, and prolonged hospital stay. Conclusions: AHF is a major public health problem in Botswana, with high in-hospital and post-discharge mortality rates and prolonged hospital stays. Late and symptomatic presentation is common, and the most common aetiologies are preventable and/or treatable co-morbidities, including hypertension, diabetes mellitus, renal failure and HIV.
Undiagnosed and diagnosed diabetes mellitus among hospitalised acute heart failure patients in Botswana
(SAGE open medicine, 2017) Mwita, Julius Chacha; Magafu, Mgaywa Gilbert Mjungu Damas; Omech, Bernard; Tsima, Billy; Dewhurst, Matthew J; Goepamang, Monkgogi; Mashalla, Yohana
Objective: The objective of this study was to determine the burden of diagnosed and undiagnosed type 2 diabetes mellitus among patients hospitalised with acute heart failure in Botswana. Methods: The study enrolled 193 consecutive patients admitted with acute heart failure to the medical wards at Princess Marina Hospital in Gaborone. Patients were classified as previously known diabetics, undiagnosed diabetics (glycated haemoglobin ≥ 6.5%) or as non-diabetics (glycated haemoglobin < 6.5%). Data on other comorbid conditions such as hypertension, atrial fibrillation, ischaemic heart disease, stroke, and renal failure were also collected. Results: The mean (SD) age of the participants was 54.2 (17.1) years and 53.9% were men. The percentage of known and undiagnosed diabetes mellitus was 15.5% and 12.4%, respectively. Diabetic patients were significantly more likely to have hypertension (77.8% vs 46.0%, p < 0.001), ischaemic heart disease (20.4% vs 5.0%, p < 0.001), chronic kidney disease (51.3% vs 23.0%, p < 0.001), and stroke (20.4% vs 5.8%, p < 0.01). In addition, diabetics were older than non-diabetics (61.0 years vs 51.6 years, p < 0.001). Conclusion: About 27.9% of patients admitted with acute heart failure in Botswana had diabetes, and almost half of them presented with undiagnosed diabetes. These findings indicate that all hospitalised patients should be screened for diabetes.
Anaemia, renal dysfunction and in-hospital outcomes in patients with heart failure in Botswana
(South African Medical Journal, 2018) Mwita, Julius Chacha; Magafu, Mgaywa Gilbert Mjungu Damas; Omech, Bernard; Dewhurst, Matthew J; Mashalla, Yohana
Background. Anaemia and renal dysfunction are associated with an increased morbidity and mortality in heart failure (HF) patients. Objective. To estimate the frequency and impact of anaemia and renal dysfunction on in-hospital outcomes in patients with HF. Methods. A total of 193 consecutive patients with HF admitted to Princess Marina Hospital, Gaborone, Botswana, from February 2014 to February 2015, were studied. Anaemia was defined as haemoglobin <13 g/dL for men and <12 g/dL for women. Renal dysfunction was defined by an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, calculated by the simplified Modification of Diet in Renal Disease formula. The in-hospital outcomes included length of hospital stay and mortality. Results. The mean (standard deviation (SD)) age was 54.2 (17.1) years and 53.9% of the patients were men. The overall median eGFR was 75.9 mL/min/1.73 m2 and renal dysfunction was detected in 60 (31.1%) patients. Renal dysfunction was associated with hypertension (p=0.01), diabetes mellitus (p=0.01) and a lower haemoglobin level (p=0.008). The mean (SD) haemoglobin was 12.0 (3.0) g/dL and 54.9% of the patients were anaemic. Microcytic, normocytic and macrocytic anaemia were found in 32.1%, 57.5% and 10.4% of patients, respectively. The mean (SD) haemoglobin level for males was significantly higher than for females (12.4 (3.3) g/dL v. 11.5 (2.5) g/dL; p=0.038). Anaemia was more common in patients with diabetes (p=0.028) and in those with increased left ventricular ejection fraction (p=0.005). Neither renal dysfunction nor anaemia was significantly associated with the length of hospital stay or in-hospital mortality. Conclusion. Anaemia and renal dysfunction are prevalent in HF patients, but neither was an independent predictor of length of stay or in-hospital mortality in this population. These findings indicate that HF data in developed countries may not apply to countries in sub- Saharan Africa, and call for more studies to be done in this region.
Coping with post-war mental health problems among survivors of violence in Northern Uganda: Findings from the WAYS study
(J Health Psychol, 2018-05-01) Amone-P'Olak, Kennedy; Omech, Bernard
Cognitive emotion regulation strategies and mental health problems were assessed in a sample of war-affected youth in Northern Uganda. Univariable and multivariable regression models were fitted to assess the influence of CERS on mental health problems. Maladaptive cognitive emotion regulation strategies (e.g., rumination) were significantly associated with more mental health problems while adaptive cognitive emotion regulation strategies (e.g., putting into perspective) were associated with reporting fewer symptoms of mental health problems. The youth with significant scores on mental health problems (scores ≥ 85th percentile) reported more frequent use of maladaptive than adaptive strategies. Interventions to reduce mental health problems should focus on enhancing the use of adaptive strategies.
Knowledge of alcohol-disease links and sociodemographic factors as predictors of support for alcohol-related policies among university students in Botswana
(Drugs: Education, Prevention and Policy, 2019) Amone-P’Olak, Kennedy; Chilunga, Wilfred; Omech, Bernard; Renison Opondo, Phillip
Background: Worldwide, harmful alcohol use is causally related to about 60 diseases and is linked to about 3.3 million deaths annually. Yet, awareness of alcohol-disease links is low. Objective: This study aims to assess socio-demographic characteristics and knowledge of alcoholdisease links as predictors of support for alcohol-related policies. Methods: A survey of 615 university students (age¼19.8; SD¼1.6; 18–25) in Botswana assessed alcohol use and knowledge of alcohol-disease links as predictors of support for alcohol-related policies. T-tests and regression analyses were performed to estimate differences and predictors. Results: Forty per cent of respondents (n¼245) use alcohol, 38% (n¼93) of whom were hazardous users. Awareness of alcohol-disease links was low for diabetes (39%) and cancer (41%) but high for liver cirrhosis (89%) and injuries (87%). Female gender (relative to male) (b¼0.19, 95% CI: 0.11, 0.27), harmful alcohol use (b¼ 0.49, 95% CI: 0.56, 0.42), higher maternal education (b¼0.11, 95% CI: 0.02, 0.18), and more knowledge of alcohol-disease links (b¼0.13, 95% CI: 0.05, 0.21) predicted support for policies. Conclusions: Awareness of alcohol-disease links was low. Support for policies was predicted by being female (relative to male), reporting no harmful alcohol use, having more educated mothers, and knowledge of alcohol-disease links. Improving awareness of alcohol-disease links could be an effective intervention to increase support for alcohol-related policies.
Autoimmune skin disease among dermatology outpatients in Botswana: a retrospective review
(International journal of dermatology, 2019) Madu, Pamela N.; Williams, Victoria L.; Noe, Megan H.; Omech, Bernard; Kovarik, Carrie L.; Wanat, Karolyn A.
Background There is a paucity of data describing autoimmune skin diseases in sub- Saharan Africa and in HIV positive cohorts. We describe the incidence of autoimmune skin diseases in public dermatology clinics in Botswana. Methods New patient records from public dermatology clinics were reviewed retrospectively for the period of September 2008 to December 2015. New diagnoses of cutaneous lupus erythematosus, systemic lupus erythematosus (SLE) with cutaneous involvement, dermatomyositis, systemic sclerosis, lichen sclerosus, bullous pemphigoid, pemphigus foliaceus, pemphigus vulgaris, and pemphigus vegetans were identified. Demographic data were recorded, and incidence was determined. Results A total of 262 patients were diagnosed with autoimmune skin disease (4% of all new patients) with an incidence rate of 28.8 (per 1,000,000). Cutaneous lupus was the most common diagnosis with discoid lupus occurring most frequently (12.6). The incidence of systemic sclerosis (2.2), morphea (1.6), lichen sclerosus (1.5), SLE with cutaneous involvement (1.3) and dermatomyositis (1.2) was relatively lower. Bullous pemphigoid was the most common bullous disease (3.8). Pemphigus foliaceus (0.9), pemphigus vulgaris (0.6), and pemphigus vegetans (0.2) were observed at a lower rate. At least 19.8% of these patients were also HIV positive. Conclusions The incidence of autoimmune skin diseases in Botswana is lower compared to other published studies in other geographic areas, which may be reflective of a younger population, barriers to access, genetic differences, and a lack of comparative studies in sub-Saharan Africa. The hygiene hypothesis and helminth infections may also contribute to these differences. Further studies are needed to understand these disorders in this region
Glycaemic, blood pressure and lowdensity lipoprotein-cholesterol control among patients with diabetes mellitus in a specialised clinic in Botswana: a cross-sectional study
(BMJ Open, 2019) Mwita, Julius Chacha; Francis, Joel M; Omech, Bernard; Botsile, Elizabeth; Oyewo, Aderonke; Mokgwathi, Matshidiso; Molefe-Baikai, Onkabetse Julia; Godman, Brian; Tshikuka, Jose-Gaby
Objective Control of glycaemic, hypertension and lowdensity lipoprotein-cholesterol (LDL-C) among patients with type 2 diabetes mellitus (T2DM) is vital for the prevention of cardiovascular diseases. The current study was an audit of glycaemic, hypertension and LDL-C control among ambulant patients with T2DM in Botswana. Also, the study aimed at assessing factors associated with attaining optimal glycaemic, hypertension and LDL-C therapeutic goals. Design A cross-sectional study. Setting A specialised public diabetes clinic in Gaborone, Botswana. Participants Patients with T2DM who had attended the clinic for ≥3 months between August 2017 and February 2018. Primary outcome measure The proportion of patients with optimal glycaemic (HbA1c<7%), hypertension (blood pressure <140/90 mm Hg) and LDL-C (<1.8 mmol/L) control. Results The proportions of patients meeting optimal targets were 32.3% for glycaemic, 54.2% for hypertension and 20.4% for LDL-C. Age≥ 50 years was positively associated with optimal glycaemic control (adjusted OR [AOR] 5.79; 95% CI 1.08 to 31.14). On the other hand, an increase in diabetes duration was inversely associated with optimal glycemic control (AOR 0.91; 95% CI 0.85 to 0.98). Being on an ACE inhibitor was inversely associated with optimal hypertension control (AOR 0.35; 95% CI 0.14 to 0.85). Being female was inversely associated with optimal LDL-C control (AOR 0.24; 95% CI (0.09 - 0.59). Conclusion Patients with T2DM in Gaborone, Botswana, presented with suboptimal control of recommended glycaemic, hypertension and LDL-C targets. These findings call for urgent individual and health systems interventions to address key determinants of the recommended therapeutic targets among patients with diabetes in this setting.
Stroke and HIV in Botswana: A prospective study of risk factors and outcomes
(Journal of the Neurological Sciences, 2020) Beardena, David R.; Omech, Bernard; Rulaganyangc, Ikanyeng; Sesayd, Sheikh O.; Kolsone, Dennis L.; Kasnere, Scott E.; Mullene, Michael T.
Objective: HIV is associated with an increased risk of stroke, but there are sparse data on risk factors for stroke in people living with HIV in Sub-Saharan African. The goal of this study was to identify HIV-specific stroke characteristics and risk factors among adults in Botswana. Methods: We conducted a prospective cohort study in Gaborone, Botswana from June 2015 to June 2017 comparing risk factors and outcomes among adults with and without HIV admitted for acute stroke. In addition, we conducted a case-control study comparing patients with HIV and stroke to outpatients with HIV and no history of stroke. Results: A total of 52 patients with imaging-confirmed acute stroke were enrolled. Stroke patients with HIV were younger than those without HIV (median age 40 vs 54, p = .005). Hypertension was the most common risk factor identified in both HIV+ and HIV- groups, but was more common in patients without HIV (81% vs. 55%, p = .04). Patients with HIV were significantly more likely to have a small-vessel lacunar syndrome compared to patients without HIV (67% vs. 29%, p = .02). In the case-control analysis, patients with HIV and stroke were more likely to have hypertension than stroke-free controls (53% vs. 16%; OR 7.2, 95% CI 1.5–33.8, p=.01), and were more likely to drink alcohol (53% vs. 21%, OR 3.7, 95% CI 1.1–12.1, p = .03). Conclusions: Individuals with HIV present with strokes at younger ages than individuals without HIV. Among those with HIV, hypertension and alcohol use are significant risk factors for stroke
Predictors of Somatic Symptomatology in War-Affected Youth in Northern Uganda: Findings from the WAYS Study
(Psychological Studies, 2020) Amone-P’Olak, Kennedy; Omech, Bernard
War experiences have been shown to have adverse long-term psychological sequelae. Nevertheless, the roles of different types of war events in predicting which mental health outcomes remain unclear. This study investigated the effects of different types of war events and socio-demographic characteristics on somatic symptoms in war-affected youth in Northern Uganda. A sample of 539 youth (mean age = 22.39; ± 2.03) participated in the study. Using maximum likelihood estimation in structural equation modelling, regression analyses were fitted to relate binary indicators of different types of war events to one latent factor capturing somatic symptoms. The results indicated that sex, marital status, and war types of ‘‘direct personal harm’’, ‘‘deaths’’, and ‘‘sexual abuse’’ independently and uniquely predicted somatic symptoms. Types of war events should be considered when planning interventions. Somatic symptoms may be a window into physical health and psychological sequelae. Implications for mental health service delivery are discussed.
Infection Prevention and Control at Lira University Hospital, Uganda: More Needs to Be Done
(Tropical Medicine and Infectious Disease, 2021) Opollo, Marc Sam; Otim, Tom Charles; Kizito, Walter; Thekkur,Pruthu; Kumar, Ajay M. V. ; Kitutu, Freddy Eric; Kisame, Rogers; Zolfo, Maria
Globally, 5–15% of hospitalized patients acquire infections (often caused by antimicrobialresistant microbes) due to inadequate infection prevention and control (IPC) measures. We used the World Health Organization’s (WHO) ‘Infection Prevention and Control Assessment Framework’ (IPCAF) tool to assess the IPC compliance at Lira University hospital (LUH), a teaching hospital in Uganda. We also characterized challenges in completing the tool. This was a hospital-based, crosssectional study conducted in November 2020. The IPC focal person at LUH completed the WHO IPCAF tool. Responses were validated, scored, and interpreted per WHO guidelines. The overall IPC compliance score at LUH was 225/800 (28.5%), implying a basic IPC compliance level. There was no IPC committee, no IPC team, and no budgets. Training was rarely or never conducted. There was no surveillance system and no monitoring/audit of IPC activities. Bed capacity, water, electricity, and disposal of hospital waste were adequate. Disposables and personal protective equipment were not available in appropriate quantities. Major challenges in completing the IPCAF tool were related to the detailed questions requiring repeated consultation with other hospital stakeholders and the long time it took to complete the tool. IPC compliance at LUH was not optimal. The gaps identified need to be addressed urgently.
The Potential of Citizen- Driven Monitoring of Freshwater Snails in Schistosomiasis Research
(Citizen Science: Theory and Practice, 2021) Brees, Jef; Huyse, Tine; Tumusiime, Julius; Kagoro-Rugunda, Grace; Namirembe, Daisy; Mugabi, Faith; Nyakato, Viola; Anyolitho, Maxson Kenneth; Tolo, Casim Umba; Jacobs, Liesbet
Schistosomiasis is a tropical parasitic disease affecting more than 200 million people worldwide, predominantly in Africa. The World Health Organization recently highlighted the importance of targeted control of the freshwater snails acting as intermediate hosts for the parasites causing schistosomiasis. However, because of a shortage of trained experts and resources, detailed information on spatiotemporal snail distributions, which is needed for targeted control measures, is often missing. We explore the potential of citizen science to build these much-needed datasets through fine-grained, frequent snail sampling. We trained a network of 25 citizen scientists to weekly report on snail host abundances in 77 predefined water contact sites in and around Lake Albert (western Uganda). Snail abundance, together with marked GPS locations, water chemistry parameters, and photographs of the identified snails are recorded and submitted using the freely available mobile phone application KoBoToolbox. Trained researchers then engage in remote, semi-automatic validation of the submissions, after which there is an opportunity to provide targeted feedback to the citizen scientists. Five months after the operationalisation of the network, a total of 570 reports were submitted and personalized feedback was given, resulting in lasting improvements in subsequent reporting and snail genus identification. The preliminary results show the possibility of citizen science to independently obtain reliable data on the presence of schistosome snail hosts. We therefore argue that citizen-driven monitoring on a high spatiotemporal resolution could help to generate the much-needed data to support local targeted snail control measures in remote and/or resource-limited environments.

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