Predictors of mass psychogenic illness in a junior secondary school in rural Botswana: A case control study.

Background: In March 2019, students at Lempu Secondary School in Kweneng District, Botswana displayed symptoms including headache, abnormal leg movements and difficulty walking. Within days, 133 students were admitted to Scottish Livingstone Hospital where mass psychogenic illness (MPI) was diagnosed. Aim: To identify predictors of this illness. Setting: Kweneng West District, Botswana. Methods: This was a case control study using interviewer-administered questionnaires. Cases were students who displayed MPI symptoms from the 2nd of March to the time of the interviews or who were admitted with MPI diagnosis. Analysis was restricted to female students. Logistic regression was used to generate odds ratios. A p value of < 0.05 was considered to demonstrate significant association between variables. Results: Interviews were conducted with 142 cases and 202 controls. The median age was 15 years. Most of the cases (95.8%) were boarding girls. Residence in school campus (AOR 13.2), history of evaluation by psychologist and/or social worker (AOR 2.6), history of traumatic events (AOR 1.8), contact with sick peers (AOR 2.3) and contact with spiritual healer (AOR 2.0) were independent predictors of MPI. Additionally, perception of adequate security in the dormitories (AOR 0.3) and perception of poor lighting (AOR 6.8) were significant predictors of MPI amongst boarding girls. Conclusion: The outbreak in Lempu Community Junior Secondary School (CJSS) was typical of mass psychogenic illness affecting mainly boarding girls and was associated with psychological and environmental risk factors. Changing the boarding environment and continuous psychological support are key to preventing future outbreaks. Interventions should also target the identified risk factors.

Resurgent rotavirus diarrhoea outbreak five years after introduction of rotavirus vaccine in Botswana, 2018.

INTRODUCTION: Botswana had a resurgent diarrhea outbreak in 2018, mainly affecting children under five years old. Botswana introduced rotavirus vaccine (RotarixTM) into the national immunization programme in July 2012. Official rotavirus vaccine coverage estimates averaged 77.2% over the five years following introduction. MATERIALS AND METHODS: The outbreak was investigated using multiple data sources, including stool laboratory testing, immunization data review, water assessment, and vaccine storage assessment. We reviewed official reports of the routine immunization data from 2013 to 2017 and compared district-level rotavirus vaccine coverage with district-level attack rates during the outbreak. RESULTS: During the outbreak, a total of 228 stool samples were tested at the national health laboratory and 152 (67%) of the specimens were positive for rotavirus. A portion of adequate samples (80) were selected for referral to the Regional Reference Lab. The laboratory testing of 80 samples at the Regional Reference Laboratory in South Africa showed that 91% of the stool samples were positive for rotavirus, and the dominant strain 47/80 (58.7%) was G3P[8]. The immunization data showed that rotavirus vaccine coverage varied widely among districts, and there was no correlation between districts with high attack rates and those with low immunization coverage. Water assessment showed that some water sources were contaminated with E Coli. There was no problem with vaccine storage. CONCLUSION: The outbreak was caused by rotavirus G3P[8], a strain that was not common in the country prior to the outbreak. Despite the significant pressure and anxiety that outbreaks cause, the number of diarrhea cases and deaths were less compared to pre-vaccine era due to the impact of vaccination. This highlights the need for continuous implementation of high impact child survival interventions.

The prevalence of cervical abnormalities: Comparison of youth with perinatally acquired HIV and older women in Botswana.

Background: Cervical cancer burden and prevalence of precursor lesions is unknown among young women living with HIV in high prevalence settings. Current cervical cancer screening guidelines in resource-limited settings with high HIV prevalence typically exclude adolescents and young women. After observing two cases of advanced cervical cancer among young women with perinatally acquired HIV, a pilot screening programme was established in Botswana. Objectives: To compare the prevalence of cervical abnormalities in young women with perinatally acquired HIV with women aged 30-49 years, regardless of HIV status. Method: We conducted a cross-sectional study of 30-49-year-old women who had visual inspection with acetic acid screening through the Botswana public sector programme, and youth (aged 15-24 years) with perinatally acquired HIV, at a single referral site between 2016 and 2018. We describe the prevalence of cervical abnormalities in each group as well as the crude prevalence ratio. Results: The prevalence of cervical abnormalities in women 30-49 years of age was 10.9% (95% confidence interval [CI]: 10.4, 11.4), and 10.1% (95% CI: 4.7, 18.3) for youth. The crude prevalence ratio was 1.07 (95% CI: 0.58, 2.01). Conclusion: Inclusion of youth living with HIV in cervical cancer screening services should be considered in settings with a high prevalence of HIV and cervical cancer.

The Impact of China's Lockdown Policy on the Incidence of COVID-19: An Interrupted Time Series Analysis.

BACKGROUND: Policy changes are often necessary to contain the detrimental impact of epidemics such as those brought about by coronavirus disease (COVID-19). In the earlier phases of the emergence of COVID-19, China was the first to impose strict restrictions on movement (lockdown) on January 23rd, 2020. A strategy whose effectiveness in curtailing COVID-19 was yet to be determined. We, therefore, sought to study the impact of the lockdown in reducing the incidence of COVID-19. METHODS: Daily cases of COVID-19 that occurred in China which were registered between January 12th and March 30th, 2020, were extracted from the Johns Hopkins CSSE team COVID-19 ArcGIS® dashboards. Daily cases reported were used as data points in the series. Two interrupted series models were run: one with an interruption point of 23 January 2020 (model 1) and the other with a 14-day deferred interruption point of 6th February (model 2). For both models, the magnitude of change (before and after) and linear trend analyses were measured, and ß-coefficients reported with 95% confidence interval (CI) for the precision. RESULTS: Seventy-eight data points were used in the analysis. There was an 11% versus a 163% increase in daily cases in models 1 and 2, respectively, in the preintervention periods (p ≤ 0.001). Comparing the period immediately following the intervention points to the counterfactual, there was a daily increase of 2,746% (p < 0.001) versus a decline of 207% (p = 0.802) in model 2. However, in both scenarios, there was a statistically significant drop in the daily cases predicted for this data and beyond when comparing the preintervention periods and postintervention periods (p < 0.001). CONCLUSION: There was a significant decrease the COVID-19 daily cases reported in China following the institution of a lockdown, and therefore, lockdown may be used to curtail the burden of COVID-19.