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Dowling J, Arscott-Mills T, Bayani O, Boustany M, Moorad B, Richard-Greenblatt M, Tlhako N, Zalot M, Steenhoff AP, Gezmu AM, Nakstad B, Strysko J, Coffin SE, McGann C. Antibiotic Use for Sepsis in Hospitalized Neonates in Botswana: Factors Associated with Guideline-Divergent Prescribing. Microorganisms 2023; 11:2641. [PMID: 38004653 PMCID: PMC10673292 DOI: 10.3390/microorganisms11112641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 10/23/2023] [Indexed: 11/26/2023] Open
Abstract
In low- and middle-income countries, where antimicrobial access may be erratic and neonatal sepsis pathogens are frequently multidrug-resistant, empiric antibiotic prescribing practices may diverge from the World Health Organization (WHO) guidelines. This study examined antibiotic prescribing for neonatal sepsis at a tertiary referral hospital neonatal unit in Gaborone, Botswana, using data from a prospective cohort of 467 neonates. We reviewed antibiotic prescriptions for the first episode of suspected sepsis, categorized as early-onset (EOS, days 0-3) or late-onset (LOS, >3 days). The WHO prescribing guidelines were used to determine whether antibiotics were "guideline-synchronous" or "guideline-divergent". Logistic regression models examined independent associations between the time of neonatal sepsis onset and estimated gestational age (EGA) with guideline-divergent antibiotic use. The majority (325/470, 69%) were prescribed one or more antibiotics, and 31 (10%) received guideline-divergent antibiotics. Risk factors for guideline-divergent prescribing included neonates with LOS, compared to EOS (aOR [95% CI]: 4.89 (1.81, 12.57)). Prematurity was a risk factor for guideline-divergent prescribing. Every 1-week decrease in EGA resulted in 11% increased odds of guideline-divergent antibiotics (OR [95% CI]: 0.89 (0.81, 0.97)). Premature infants with LOS had higher odds of guideline-divergent prescribing. Studies are needed to define the causes of this differential rate of guideline-divergent prescribing to guide future interventions.
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Affiliation(s)
- Jameson Dowling
- College of Public Health, Temple University, Philadelphia, PA 19122, USA;
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA (S.E.C.)
| | - Tonya Arscott-Mills
- Department of Pediatrics, Wake Forest School of Medicine, Winston Salem, NC 27101, USA
| | - One Bayani
- Faculties of Medicine & Health Sciences, Department of Paediatric & Adolescent Health, University of Botswana, Gaborone P.O. Box 00701, Botswana
| | - Mickael Boustany
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA (S.E.C.)
| | - Banno Moorad
- Botswana-UPenn Partnership, University of Pennsylvania & University of Botswana, Gaborone P.O. Box 45498, Botswana
| | - Melissa Richard-Greenblatt
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A1, Canada
- Public Health Ontario, Toronto, ON M5G 1M1, Canada
| | - Nametso Tlhako
- Botswana-UPenn Partnership, University of Pennsylvania & University of Botswana, Gaborone P.O. Box 45498, Botswana
| | - Morgan Zalot
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA (S.E.C.)
| | - Andrew P. Steenhoff
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA (S.E.C.)
- Botswana-UPenn Partnership, University of Pennsylvania & University of Botswana, Gaborone P.O. Box 45498, Botswana
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Alemayehu M. Gezmu
- Faculties of Medicine & Health Sciences, Department of Paediatric & Adolescent Health, University of Botswana, Gaborone P.O. Box 00701, Botswana
| | - Britt Nakstad
- Faculties of Medicine & Health Sciences, Department of Paediatric & Adolescent Health, University of Botswana, Gaborone P.O. Box 00701, Botswana
| | - Jonathan Strysko
- Botswana-UPenn Partnership, University of Pennsylvania & University of Botswana, Gaborone P.O. Box 45498, Botswana
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Susan E. Coffin
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA (S.E.C.)
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Carolyn McGann
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
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Siamisang AB, Gezmu AM, Slone JS, Gabaitiri L, David T, Phetogo B, Joel D. Prevalence and Associated Risk Factors of Anemia Among Hospitalized Children in a Tertiary Level Hospital in Botswana. Glob Pediatr Health 2023; 10:2333794X231156059. [PMID: 36845557 PMCID: PMC9944186 DOI: 10.1177/2333794x231156059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/20/2023] [Indexed: 02/25/2023] Open
Abstract
Anemia is a global health concern and has been associated with long term cognitive and behavioral adverse effects. A cross sectional study was conducted to determine the prevalence of and risk factors for anemia in infants and children between 6 months to 5 years of age admitted to a tertiary hospital in Botswana. Baseline full blood count of every patient admitted during the study period was assessed to determine if anemia was present. Data were collected from patient's medical inpatient chart, electronic medical record (Integrated Patient Management System (IPMS)), and through interviewing parents and caregivers. Multivariate logistic regression model was used to identify risk factors of anemia. A total of 250 patients were included in the study. Prevalence of anemia in this cohort was 42.8%. There were 145 (58%) males. Of the patients with anemia, 56.1%, 39.2%, and 4.7% had mild, moderate, and severe anemia, respectively. Microcytic anemia consistent with iron deficiency was identified in 61 (57%) patients. Age was the only independent predictor of anemia. Children aged 24 months and more had a 50% lower risk of having anemia than their younger counterparts (odds ratio (OR) 0.52; 95% Confidence Interval (95% CI) 0.30 to 0.89). The findings of this study demonstrate anemia as a serious health concern in the pediatric population in Botswana.
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Affiliation(s)
| | - Alemayehu M. Gezmu
- University of Botswana, Gaborone,
Botswana,Alemayehu M. Gezmu, Department of
Pediatrics and Adolescent Health, Faculty of Medicine, University of Botswana,
PO Box 70505, Notwane Road, Gaborone, Botswana.
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Pernica JM, Arscott-Mills T, Steenhoff AP, Mokomane M, Moorad B, Bapabi M, Lechiile K, Mangwegape O, Batisani B, Mawoko N, Muthoga C, Vanniyasingam T, Ewusie J, Lowe A, Bonsu JM, Gezmu AM, Smieja M, Mazhani L, Stordal K, Thabane L, Kelly MS, Goldfarb DM. Optimising the management of childhood acute diarrhoeal disease using a rapid test-and- treat strategy and/or Lactobacillus reuteri DSM 17938: a multicentre, randomised, controlled, factorial trial in Botswana. BMJ Glob Health 2022; 7:bmjgh-2021-007826. [PMID: 35418412 PMCID: PMC9014020 DOI: 10.1136/bmjgh-2021-007826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/14/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The study aim was to determine if rapid enteric diagnostics followed by the provision of targeted antibiotic therapy ('test-and-treat') and/or Lactobacillus reuteri DSM 17938 would improve outcomes in children hospitalised in Botswana with acute gastroenteritis. METHODS This was a multicentre, randomised, factorial, controlled, trial. Children aged 2-60 months admitted for acute non-bloody diarrhoea to four hospitals in southern Botswana were eligible. Participants were assigned to treatment groups by web-based block randomisation. Test-and-treat results were not blinded, but participants and research staff were blinded to L. reuteri/placebo assignment; this was dosed as 1×108 cfu/mL by mouth daily and continued for 60 days. The primary outcome was 60-day age-standardised height (HAZ) adjusted for baseline HAZ. All analyses were by intention to treat. The trial was registered at Clinicaltrials.gov. RESULTS Recruitment began on 12 June 2016 and continued until 24 October 2018. There were 66 participants randomised to the test-and-treat plus L. reuteri group, 68 randomised to the test-and-treat plus placebo group, 69 to the standard care plus L. reuteri group and 69 to the standard care plus placebo group. There was no demonstrable impact of the test-and-treat intervention (mean increase of 0.01 SD, 95% CI -0.14 to 0.16 SD) or the L. reuteri intervention (mean decrease of 0.07 SD, 95% CI -0.22 to 0.08 SD) on adjusted HAZ at 60 days. CONCLUSIONS In children hospitalised for acute gastroenteritis in Botswana, neither a test-and-treat algorithm targeting enteropathogens, nor a 60-day course of L. reuteri DSM 17938, were found to markedly impact linear growth or other important outcomes. We cannot exclude the possibility that test-and-treat will improve the care of children with significant enteropathogens (such as Shigella) in their stool. TRIAL REGISTRATION NUMBER NCT02803827.
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Affiliation(s)
- Jeffrey M Pernica
- Department of Pediatrics, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada .,Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Tonya Arscott-Mills
- Botswana-UPenn Partnership, Gaborone, Botswana.,The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Global Health Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Andrew P Steenhoff
- Global Health Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Margaret Mokomane
- Department of Microbiology, University of Botswana, Gaborone, South-East District, Botswana
| | | | | | | | | | | | | | - Charles Muthoga
- Botswana-UPenn Partnership, Gaborone, Botswana.,Botswana-Harvard AIDS Institute Partnership, Gaborone, Gaborone, Botswana
| | - Thuvaraha Vanniyasingam
- Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Joycelyne Ewusie
- Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada.,The Research Institute-Biostatistics Unit, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Amy Lowe
- Department of Global Health, McMaster University, Hamilton, Ontario, Canada
| | - Janice M Bonsu
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Alemayehu M Gezmu
- Department of Pediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana
| | - Marek Smieja
- Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada.,Department of Pathology and Molecular Medicine, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Loeto Mazhani
- Department of Pediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana
| | - Ketil Stordal
- Pediatric Research Institute, University of Oslo Faculty of Medicine, Oslo, Norway
| | - Lehana Thabane
- Department of Pediatrics, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada.,The Research Institute-Biostatistics Unit, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.,University of Johannesburg Faculty of Health Sciences, Johannesburg, South Africa
| | - Matthew S Kelly
- Department of Pediatrics, Duke University, Durham, North Carolina, USA
| | - David M Goldfarb
- Department of Pathology and Laboratory Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
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Ramaphane T, Gezmu AM, Tefera E, Gabaitiri L, Nchingane S, Matsheng-Samuel M, Joel D. Prevalence and Factors Associated with Microalbuminuria in Pediatric Patients with Type 1 Diabetes Mellitus at a Large Tertiary-Level Hospital in Botswana. Diabetes Metab Syndr Obes 2021; 14:4415-4422. [PMID: 34754207 PMCID: PMC8572018 DOI: 10.2147/dmso.s322847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/16/2021] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Microalbuminuria is considered the earliest sign of diabetic nephropathy among patients with type 1 diabetes mellitus (T1DM). The prevalence of microalbuminuria among African children with T1DM is reported to be high, yet its prevalence and population-specific risk factors in Botswana are not known. AIM This study aimed to determine the prevalence of microalbuminuria among children and young adults with T1DM in Botswana and identify factors associated with microalbuminuria in this population. METHODS A retrospective cross-sectional study was conducted on 127 T1DM patients aged <24 years followed at a pediatric endocrinology clinic in Botswana from 2010 to 2017. Clinical, laboratory, and demographic data were collected using chart review and patient surveys. Descriptive statistics were reported as mean and standard deviation for continuous variables, and frequency and percentage for categorical variables. Prevalence of microalbuminuria was calculated as a simple proportion. Group comparison was done using two-sample independent t-test, X 2-test, or Fisher's exact test and logistic regression to assess for associations. Level of significance was set at p<0.05. RESULTS There were a total of 71 (55.9%) females. The mean age was 18.7 (±5) years and mean duration of T1DM was 6.6 (±4.6) years. Most study participants were of African descent. The prevalence of microalbuminuria was 28.3%. Group comparison revealed gender (p= 0.040), duration of diabetes (p= 0.002), systolic blood pressure (p=0.003), baseline glycated hemoglobin (HbA1c) (p=0.009) and Tanner's stage (p=008) to be significantly associated with microalbuminuria. On binary logistic regression, only gender (p=0.039) and baseline HbA1c (p=0.039) were independently associated with the presences of microalbuminuria. CONCLUSION This study identified a high prevalence of microalbuminuria among children and young adults with T1DM in Botswana and reaffirms the importance of early detection, glycemic control, and regular screening to prevent diabetic nephropathy.
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Affiliation(s)
- Tshireletso Ramaphane
- Department of Pediatrics and Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Alemayehu M Gezmu
- Department of Pediatrics and Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Correspondence: Alemayehu M Gezmu Department of Pediatrics and Adolescent Health, Faculty of Medicine, University of Botswana, Bag UB00713, Gaborone, Botswana Email
| | - Endale Tefera
- Department of Pediatrics and Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Lesego Gabaitiri
- Department of Statistics, Faculty of Social Sciences, University of Botswana, Gaborone, Botswana
| | | | | | - Dipesalema Joel
- Department of Pediatrics and Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
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Gezmu AM, Shifa JZ, Kgwarae C, Siamisang A. Hydranencephaly in a Neonate: A Literature Review. Neurol India 2020; 68:199-201. [PMID: 32129279 DOI: 10.4103/0028-3886.279698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Alemayehu M Gezmu
- Department of Paediatrics and Adolescent Health, Faculty of Medicine, University of Botswana, Private Bag UB00713, Gaborone, Botswana
| | - Jemal Z Shifa
- Department of Surgery, Faculty of Medicine, University of Botswana, Botswana
| | - Chada Kgwarae
- Department of Paediatrics and Adolescent Health, Princess Marina Hospital, Botswana
| | - Aobakwe Siamisang
- Department of Paediatrics and Adolescent Health, Faculty of Medicine, University of Botswana, Private Bag UB00713, Gaborone, Botswana
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Tefera E, Qureshi SA, Gezmu AM, Mazhani L. Radiation protection knowledge and practices in interventional cardiologists practicing in Africa: a cross sectional survey. J Radiol Prot 2020; 40:311-318. [PMID: 31731286 DOI: 10.1088/1361-6498/ab5840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
We conducted a survey of doctors working in the cardiac catheterisation laboratories in Africa on their knowledge, attitude and practice with respect to radiation protection. Of seventy-two respondents contacted, 61 (84.7%) completed the questionnaire. Twenty-eight, (45.9%) were younger than 45 years. Thirty-seven, (60.6%) had less than 10 years of experience in the laboratory. Only 28 (45.9%) had undertaken radiation protection training. Fifty-eight, (95.1%) consistently used lead aprons. Forty-seven, (77%) reported consistently using thyroid shields. Ten (16.4%) consistently used radiation protection eyeglasses, whilst 36 (59%) never used them. Thermoluminescent Dosimeter badges were consistently used in 23 (37.7%). Forty-two, (68.9%) reported having ceiling mounted lead/acrylic shields. Level of radiation exposure in the most recent one year was ≤2 mSv in 14, between 2 and 20 mSv in 8 and between 20 and 30 mSv in 2, whilst 33 did not know their dose readings. The use of basic radiation protection tools as well as the knowledge and measurement of radiation exposure among interventional cardiologists working in Africa is low. The unavailability of some of the protective tools and a knowledge gap in terms of radiation protection and monitoring of self-exposure were some of the reasons for suboptimal self-protection against ionising radiation among our respondents. We suggest that initiatives be taken by all stakeholders to train this group of medical professionals in basic radiation protection to avoid unnecessary exposure to themselves, co-workers and patients.
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Affiliation(s)
- Endale Tefera
- Department of Paediatrics & Adolescent Health, division of Cardiology, Faculty of Medicine, University of Botswana, Gaborone, Botswana
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