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PubMed2001

Cattle eradication and malnutrition in under five's: a natural experiment in Botswana.

BACKGROUND: An outbreak of contagious bovine pleuropneumonia (CBPP) in the northern part of Botswana in 1996 was contained through eradication of all heads of cattle in Ngamiland district (Ngami East and West) in the period April 1996 to February 1997. This disaster posed a serious threat to those who depended on the livestock sector for sustenance and to the nutrition security of the population, especially the under five's. AIM: The aim of this study was to assess the impact of the cattle eradication on the nutritional status of children. METHOD: A secondary analysis of existing data from the Botswana National Nutrition Surveillance System enabled us to study the impact of this disaster on malnutrition in the under five's by comparing quarterly malnutrition rates for Ngami East with national figures for the period of January 1995 to March 1998. RESULTS: While the risk for malnutrition among under five's in Ngami East increased from 0.046 to 0.105 during the study period, giving a relative risk of 2.299, the increase in risk for Botswana was from 0.133 to 0.139, giving a relative risk of 1.048. The attributable risk for cattle eradication impact on malnutrition was 4.6% for Botswana and 54.4% for Ngami East. CONCLUSION: The cattle eradication impacted seriously on the food and nutrition security of the under five's in Ngami East, compared with the country as a whole.

Animal Husbandry↗
PubMed1988

A comparison between patients admitted to psychiatric hospitals in Botswana and South Australia.

Cohorts of patients admitted to psychiatric hospitals in Botswana and South Australia were compared. The psychiatric hospital in Botswana was used almost entirely for the care of patients with psychotic disorders, whilst one third of the patients in South Australia had either a neurotic or personality disorder diagnosis. A higher proportion of patients in Botswana than South Australia had had only a brief period of illness prior to admission. Violence was equally common amongst Tswana and Australian patients, but was directed outwards towards property and other people in Botswana and inwards towards the self in Australia. It was tentatively concluded that in both countries there was a group of severely ill patients who could not be handled without containment.

Alcoholism↗
PubMed2005

Major histocompatibility complex class II (HLA-DRB and -DQB) allele frequencies in Botswana: association with human immunodeficiency virus type 1 infection.

Southern Africa is facing an unprecedented public health crisis due to the high prevalence of human immunodeficiency virus type 1 (HIV-1). Vaccine development and testing efforts, mainly based on elicitation of HIV-specific T cells, are under way. To understand the role of human leukocyte antigen (HLA) class II alleles in HIV pathogenesis and to facilitate HLA-based HIV-1 vaccine design, we analyzed the frequencies of HLA class II alleles within the southern African country of Botswana. Common HLA class II alleles were identified within the Botswana population through the molecular genotyping of DRB and DQB1 loci. The DRB1 allele groups DRB1*01, DRB1*02/15, DRB1*03, DRB1*11, and DRB1*13 were encountered at frequencies above 20%. Within the DQB1 locus, DQB1*06 (47.7%) was the most common allele group, followed by DQB1*03 (39.2%) and DQB1*04 (25.8%). We found that DRB1*01 was more common in HIV-negative than in HIV-positive individuals and that those who expressed DRB1*08 had lower median viral loads. We demonstrate that the frequencies of certain HLA class II alleles in this Botswana population differ substantially from those in North American populations, including African-Americans. Common allele groups within Botswana cover large percentages of other African populations and could be targeted in regional vaccine designs.

AIDS Vaccines↗
PubMed2000

Morbidity and health care utilisation among elderly people in Mmankgodi village, Botswana.

OBJECTIVE: To evaluate the health status among the elderly in a village in Botswana and their pattern of health care utilisation. DESIGN: A descriptive study where all persons 60 years and older were invited to participate, including a medical examination, laboratory testing and a questionnaire aiming at gathering sociodemographic data. SETTING: Mmankgodi village of Botswana. SUBJECTS: 419 persons were identified as elderly in the village, out of which 337 were included. MAIN OUTCOME MEASURES: The general medical examination also included eye status, vision and hearing tests, nutritional status, blood pressure and registering of physical disabilities. Laboratory tests included haemoglobin, blood glucose, HIV antibodies and serum lipids. The questionnaire contained questions regarding family and civil status, self assessed general health, health problems experienced during the previous month, and health care utilisation. Questions also pertained to smoking, taking snuff, and alcohol consumption. RESULTS: A majority (75%) of the elderly experienced good or only somewhat reduced health, while one quarter suffered more serious health problems. The most frequent health problems were related to the musculoskeletal system. Eye diseases, including cataract and blindness, were also common. The concentration of serum lipids is lower than the one found in the elderly population of Norway. Nutritional status indicated a relatively high prevalence (7%) of malnutrition. The majority of men were still married (87%), while most women were widowed (71%). Women reported more health problems than men, and they also reported more worries regarding their own life situation. There is a tendency for the elderly to seek assistance from the established clinics and other health facilities for their health problems. Worries are either kept to themselves or advice is sought from relatives. Traditional healers were not often consulted for health problems or worries. CONCLUSIONS: Major health problems were identified among the elderly in this geographical area of Botswana. There is presently no health programme in Botswana aimed at the elderly. Some of the diseases and conditions found in this study could easily be identified and treated in the present health system through a health care programme.

Aged↗
PubMed2005

HIV-1 subtype C drug-resistance background among ARV-naive adults in Botswana.

Current HIV-1 antiretroviral (ARV) drug resistance knowledge is limited to HIV-1 subtype B (HIV-1B). We addressed whether unique genetic and phenotypic properties of HIV-1 subtype C (HIV-1C), southern Africa's most prevalent subtype, may foment earlier and/or distinct resistance mutations. Population-level HIV-1C genotypes were evaluated with respect to drug resistance prevalence before Botswana's public ARV treatment programme began. Viruses were genotyped from 11 representative districts of northern and southern Botswana, and consensus sequences from these 71 individuals and 51 previously reported sequences from HIV-positive blood donors were constructed. Phylogenetic analysis classified all 71 sequences but one, which exhibited pol gene mosaicism, as HIV-1C. The protease and reverse transcriptase coding region had no detectable known primary mutations associated with HIV-1B protease inhibitor (PI) drug resistance. Secondary mutations associated with PI drug resistance were found in all sequences. Several HIV-1C-specific polymorphic sites were found across the pol gene. Northern and southern Botswana viral sequences showed no significant differences from each other. Population genotyping shows that, without countrywide ARV treatment, HIV-1C-infected Batswana harbour virtually no primary mutations known to confer resistance to the three major HIV-1B ARV drug classes. Some secondary PI mutations and polymorphic sites in the protease enzyme necessitate continuous population monitoring, particularly after introduction of countrywide ARV treatment in Botswana. Although its PI resistance development rate and kinetics are not known, our data may suggest increased susceptibility and readiness of HIV-1C to develop resistance under drug pressure when the PI class of drugs is used.

Amino Acid Sequence↗
PubMedDate not supplied

Public-private partnerships and antiretroviral drugs for HIV/AIDS: lessons from Botswana.

The African Comprehensive HIV/AIDS Partnerships (ACHAP) played a major role in initiating Botswana's antiretroviral (ARV) program in 2001. ACHAP is a prominent public-private partnership involving Merck and its foundation, the Bill and Melinda Gates Foundation, and the government of Botswana. This paper analyzes ACHAP's efforts to assist Botswana with its ARV program, the first and most advanced in sub-Saharan Africa. It identifies five features of the model and shows how they contributed to the ARV program. It also raises questions about ACHAP's role in scaling up and sustaining the program, as Botswana faces the challenges of treating growing numbers of HIV-infected people.

Anti-HIV Agents↗
PubMed2006

Orphan care in Botswana's working households: growing responsibilities in the absence of adequate support.

OBJECTIVES: Botswana has one of the world's highest HIV-prevalence rates and the world's highest percentages of orphaned children among its population. We assessed the ability of income-earning households in Botswana to adequately care for orphans. METHODS: We used data from the Botswana Family Health Needs Study (2002), a sample of 1033 working adults with caregiving responsibilities who used public services, to assess whether households with orphan-care responsibilities encountered financial and other difficulties. Thirty-seven percent of respondents provided orphan care, usually to extended family members. We applied logistic regression models to determine the factors associated with experiencing problems related to orphan caregiving. RESULTS: Nearly half of working households with orphan-care responsibilities reported experiencing financial and other difficulties because of orphan care. Issues of concern included caring for multiple orphans, caring for sick adults and orphans simultaneously, receiving no assistance, and low income. CONCLUSIONS: The orphan crisis is impoverishing even working households, where caregivers lack sufficient resources to provide basic needs. Neither the public sector nor communities provide adequate safety nets. International assistance is critical to build capacity within the social welfare infrastructure and to fund community-level activities that support households. Lessons from Botswana's orphan crisis can provide valuable insights to policymakers throughout sub-Saharan Africa.

Adolescent↗
PubMed2004

The control of foot-and-mouth disease in Botswana: special reference to vaccination.

Botswana has a history of Foot-and-Mouth Disease (FMD) occurrence and control that dates far back into the 1930s. Conditions in the southern African region are favourable for spiking FMD outbreaks due to Southern African Territories (SAT) serotypes, because of the co-existence of the agent, hosts and a conducive environment. In the past these parameters were less controlled and FMD outbreaks were common in the region, causing tremendous social and economic losses. The inception of conventional FMD vaccines in the region in the 1970s led to a significant improvement in the control of the disease. Vaccination used with other appropriate strategies has been the cornerstone of FMD control strategy in Botswana. FMD vaccine used in Botswana is manufactured locally; it is effective and has been responsible for the elimination of FMD outbreaks since the early eighties. FMD vaccination is a costly exercise. The programme has been sustained for decades because there is political will and financial support from government. However, its economic value can only be determined through a cost-benefit analysis, which is not a subject of this paper. The experience of FMD control in Botswana, with special reference to vaccination, is discussed.

Animals↗
PubMed2002

More woody plants? The status of bush encroachment in Botswana's grazing areas.

Foci points, which are currently intensified by increased anthropogenic activities, have resulted in vegetation changes in the cattle-dominated grazing areas of Botswana. Bush encroachment species--for instance Acacia tortilis, A. erubescens, A. mellifera, Dichrostachys cinerea, Grewia flava, and Terminalia sericea--are increasing in cover and density around foci points (e.g. water points and kraals) at the expense of the grass cover. A number of factors have the effect of encouraging the germination and survival of bush encroachment species. The practice of cattle husbandry and continual shifting of foci points within grazing areas have resulted in the spread of the distribution of bush encroachment species across the country. This is evidenced by the potential extent of 37,000 km2 (6.4% of Botswana) of darkened and near infrared (NIR) reflective bush encroached areas in 1994. This paper suggests that specific management strategies should be adopted to help overcome the bush encroachment problem, which is causing a significant reduction in the extent of Botswana's high quality rangeland. These strategies may vary from the enforced reduction of grazing intensity in areas identified as being heavily bush encroached to the selective management of opportunistic (communal) grazing in better quality predominantly grassland areas. Further work is however required to update this analysis and especially to consider trends since 1994-1995. While some work on the extent of woody cover and the further causes of bush encroachment is being undertaken under the SAFARI2000 project, more research is needed in specific areas to pinpoint causes and responses to the bush encroachment problem.

Agriculture↗
PubMed2005

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.

Aflatoxins↗
PubMedDate not supplied

Antituberculosis drug resistance and anonymous HIV surveillance in tuberculosis patients in Botswana, 2002.

Two surveys undertaken in Botswana in the 1990s have recorded low rates of antituberculosis drug resistance, despite a three-fold rise in tuberculosis since 1989. We undertook a third survey to determine both trends since 1995 and HIV prevalence in tuberculosis patients in Botswana. Sputum specimens were obtained from patients nationwide in 2002 who also underwent anonymous, rapid HIV testing by use of Oraquick. Of 2200 sputum smear-positive patients and 219 previously treated patients with suspected recurrent tuberculosis, 1457 (60%) were infected with HIV. Resistance to at least one drug in new patients rose from 16 (3.7%) isolates in 1995 to 123 (10.4%; p<0.0001) in 2002. Interventions for tuberculosis control are urgently needed in Botswana to prevent further emergence of drug resistance.

AIDS Serodiagnosis↗
PubMed2003

Multilevel analysis of women's empowerment and HIV prevention: quantitative survey Results from a preliminary study in Botswana.

This preliminary study explored relationships between women's empowerment and HIV prevention on the national and individual level with a focus on Botswana. Among sub-Saharan Africa countries, HIV prevalence was positively correlated with indirect indicators of women's empowerment relating to their education (female enrollment in secondary education and ratio of female to male secondary school enrollment), but not to their economic status (female share of paid employment in industry and services) or political status (women's share of seats in national parliament), while controlling for gross national income, percentage of births attended, and percentage of roads paved. Condom use at last sexual encounter was positively and significantly correlated with both indicators of women's educational empowerment, but was not significantly related to the other two indices. Empowerment at the individual level was explored through a preliminary quantitative survey of 71 sexually active women in Gaborone, Botswana, that was conducted in February 2001. Regression analyses showed that women's negotiating power and economic independence were the factors most strongly related to condom use, and did not show that education was a crucial factor. Economic independence was the factor most strongly related to negotiating power. These results suggest that in Botswana, HIV prevention efforts may need to improve women's negotiating skills and access to income-generating activities.

Adult↗
PubMed2004

Phenotypic characterization of indigenous Tswana goats and sheep breeds in Botswana: continuous traits.

The majority of Tswana sheep and goats in Botswana are indigenous. These animals provide income, employment and food security to the resource-poor farmers. Limited characterization of these species has been done, resulting in poor efforts to fully exploit and conserve them. The objective of this study was to phenotyically characterize indigenous sheep and goats countrywide. Measurements were collected from 2783 goats and 1282 sheep kept by traditional farmers, covering nearly all the districts of Botswana. In each district a total of 15 farmers with sheep and goats were selected randomly and records were taken on 4-12 animals per farm, depending on average district flock size. Traits recorded for each animal were body length, body weight, ear length, heart girth, height at withers, hip width, neck length, rump height, shoulder width, tail length (goats only) and horn length. Age (estimated from dentition) and sex of the animals were also recorded and vegetation type was noted. The data were analysed using the general linear model procedure in Statistical Analysis System. Prior to analyses, a main effects model of sex, age and vegetation type was fitted. Later, two types of analyses were done: (i) within a vegetation type fitting sex and age and their interaction, and (ii) within sex fitting age and vegetation type and their interaction. Least-squares means were separated using Student's t-test. Sex, age and vegetation significantly (p<0.05) affected the magnitude of traits. Phenotypic body measurements of castrates were generally higher than in both females and entire males, which were similar. The body measurements of younger animals were less than those of older age groups since the former were still growing compared to the latter. Different vegetation types promoted different body measurements, which should be expected due to differences in nutrient supply from different vegetation types. The indigenous breeds of sheep and goats can be classified as medium-size breeds. The breeds should be conserved since they are well suited to the harsh environment of Botswana where drought and livestock diseases are ever present. Efforts should be undertaken to characterize them genetically and increase their productivity.

Age Factors↗
PubMed1975

A retrospective study of the cancer patterns among hospital in-patients in Botswana 1960-72.

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.

Adolescent↗
PubMed2002

Adherence to treatment guidelines in primary health care facilities in Botswana.

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.

Adolescent↗
PubMed2006

Botswana's Tebelopele voluntary HIV counseling and testing network: use and client risk factors for HIV infection, 2000-2004.

BACKGROUND: : HIV services, including voluntary counseling and testing (VCT) and antiretroviral (ARV) therapy, expanded rapidly in Botswana from 2000 through 2004. METHODS: : Client data from Botswana's Tebelopele VCT network were analyzed to describe clients, factors associated with HIV infection, and trends in VCT use. RESULTS: : Tebelopele provided free, anonymous, same-day HIV tests for 117,234 clients from 2000 through 2004. Before ARV therapy was available, 8.3% of clients sought a test because of illness, and 26.3% were HIV-positive. After ARV therapy became available, 20.1% of clients sought a test because of illness, and 38.8% were HIV-positive. Most VCT clients (82.7%) were unmarried; 89.8% reported no or 1 sexual partner in the last 3 months; and 50.2% of unmarried clients reported always using condoms in the last 3 months. In multivariate analysis, higher educational level, marriage, and always using condoms were associated with a lower risk of HIV. Having only 1 recent sexual partner was associated with less condom use and a higher risk of being HIV-positive for men. CONCLUSIONS: : VCT has been well accepted in Botswana. Analysis of this data set supports efforts to promote 100% condom use and to emphasize that partner reduction must be combined with condom use and HIV testing to protect against HIV.

Adult↗
PubMed1994

The prevention and mitigation of famine: policy lessons from Botswana and Sudan.

Botswana and Sudan experienced consecutive years of drought in the 1980s. Sudan faced a large decline in food entitlement and nutritional deterioration, which translated into famine in 1984/85. Botswana, on the other hand, nearly compensated income losses and averted nutritional deterioration and famine-related deaths. There are important lessons to learn from the famine prevention experience of Botswana. Its strategy for dealing with drought and famine combines policies of steady economic growth with supplementary poverty alleviation and drought relief programs. To provide continuity and stabilization of market operations in times of distress, the country channels sufficient food through market chains, provides price support to preempt market collapse and augments the income of consumers through public income transfer programs to prevent demand failure. In addition, it maintains a responsive and accountable political system and a decentralized participatory administrative structure. While Sudan should develop policies that are compatible with its own environment, it is crucial that it recognizes the critical role of public action in promoting growth, alleviating poverty, and providing timely relief responses in times of anticipated growth failure.

Botswana↗
PubMed2001

Molecular and conventional epidemiology of Mycobacterium tuberculosis in Botswana: a population-based prospective study of 301 pulmonary tuberculosis patients.

Little is known about patterns of tuberculosis (TB) transmission among populations in developing countries with high rates of TB and human immunodeficiency virus (HIV) infection. To examine patterns of TB transmission in such a setting, we performed a population-based DNA fingerprinting study among TB patients in Botswana. Between January 1997 and July 1998, TB patients from four communities in Botswana were interviewed and offered HIV testing. Their Mycobacterium tuberculosis isolates underwent DNA fingerprinting using IS6110 restriction fragment length polymorphism, and those with matching fingerprints were reinterviewed. DNA fingerprints with >5 bands were considered clustered if they were either identical or differed by at most one band, while DNA fingerprints with < or =5 bands were considered clustered only if they were identical. TB isolates of 125 (42%) of the 301 patients with completed interviews and DNA fingerprints fell into 20 different clusters of 2 to 16 patients. HIV status was not associated with clustering. Prior imprisonment was the only statistically significant risk factor for clustering (risk ratio, 1.5; 95% confidence interval, 1.1 to 2.0). In three communities where the majority of eligible patients were enrolled, 26 (11%) of 243 patients overall and 26 (25%) of 104 clustered patients shared both a DNA fingerprint and strong antecedent epidemiologic link. Most of the increasing TB burden in Botswana may be attributable to reactivation of latent infection, but steps should be taken to control ongoing transmission in congregate settings. DNA fingerprinting helps determine loci of TB transmission in the community.

AIDS-Related Opportunistic Infections↗