Identification of a Large Pool of Microorganisms with an Array of Porphyrin Based Gas Sensors.

The association between volatile compounds (VCs) and microorganisms, as demonstrated by several studies, may offer the ground for a rapid identification of pathogens. To this regard, chemical sensors are a key enabling technology for the exploitation of this opportunity. In this study, we investigated the performance of an array of porphyrin-coated quartz microbalance gas sensors in the identification of a panel of 12 bacteria and fungi. The porphyrins were metal complexes and the free base of a functionalized tetraphenylporphyrin. Our results show that the sensor array distinguishes the VC patterns produced by microorganisms in vitro. Besides being individually identified, bacteria are also sorted into Gram-positive and Gram-negative.

Design and rationale of the Botswana Smoking Abstinence Reinforcement Trial: a protocol for a stepped-wedge cluster randomized trial.

BACKGROUND: With expanded and sustained availability of HIV treatment resulting in substantial improvements in life expectancy, the need to address modifiable risk factors associated with leading causes of death among people living with HIV/AIDS (PLWH), such as tobacco smoking, has increased. Tobacco use is highly prevalent among PLWH, especially in southern Africa, where HIV is heavily concentrated, and many people who smoke would like to quit but are unable to do so without assistance. SBIRT (Screening, Brief Intervention and Referral to Treatment) is a well-established evidence-based approach successful at supporting smoking cessation in a variety of settings. Varenicline is efficacious in supporting smoking cessation. We intend to assess the effectiveness of SBIRT and varenicline on smoking cessation among PLWH in Botswana and the effectiveness of our implementation. METHODS: BSMART (Botswana Smoking Abstinence Reinforcement Trial) is a stepped-wedge, cluster randomized, hybrid Type 2 effectiveness-implementation study guided by the RE-AIM framework, to evaluate the effectiveness and implementation of an SBIRT intervention consisting of the 5As compared to an enhanced standard of care. SBIRT will be delivered by trained lay health workers (LHWs), followed by referral to treatment with varenicline prescribed and monitored by trained nurse prescribers in a network of outpatient HIV care facilities. Seven hundred and fifty people living with HIV who smoke daily and have been receiving HIV care and treatment at one of 15 health facilities will be recruited if they are up to 18 years of age and willing to provide informed consent to participate in the study. DISCUSSION: BSMART tests a scalable approach to achieve and sustain smoking abstinence implemented in a sustainable way. Integrating an evidence-based approach such as SBIRT, into an HIV care system presents an important opportunity to establish and evaluate a modifiable cancer prevention strategy in a middle-income country (MIC) setting where both LHW and non-physician clinicians are widely used. The findings, including the preliminary cost-effectiveness, will provide evidence to guide the Botswanan government and similar countries as they strive to provide affordable smoking cessation support at scale. CLINICAL TRIAL REGISTRATION: NCT05694637 Registered on 7 December 2022 on clinicaltrials.gov, https://clinicaltrials.gov/search?locStr=Botswana&country=Botswana&cond=Smoking%20Cessation&intr=SBIRT.

Self-reported neck and back pain among supermarket cashiers in Gaborone, Botswana.

Objective. This study aimed to investigate the prevalence, risk factors and impacts of neck and back pain among supermarket cashiers in Botswana. Results. A total of 174 supermarket cashiers participated in this study, the majority of whom were females (72%). The prevalence of lower back pain was 69%, upper back pain 53% and neck pain 37%. Increasing age was associated with neck (95% confidence interval [CI] [1.43, 5.15]) and upper back (95% CI [1.43, 3.60]) pain. Cashiers working at a low work surface and overreaching for items were 19 and 11 times more likely to report neck (95% CI [1.7, 255.9]) and lower back (95% CI [1.84, 62.1]) pain, respectively. Almost 6% of cashiers who reported lower back pain reported considering changing jobs due to pain. Conclusions. More than two-thirds, one-half and about two-fifths of supermarket cashiers reported lower back, upper back and neck pain, respectively. Individual and work-related factors were associated with neck and/or back pain. To reduce their prevalence and progression, supermarkets should introduce occupational health and safety talks.

Depression, Anxiety, and Cigarette Smoking Among Patients with Tuberculosis.

Smoking adversely affects tuberculosis (TB) outcomes and may be associated with depression and anxiety among people diagnosed with TB in Botswana. We conducted a cross-sectional study among patients newly diagnosed with TB in Gaborone, Botswana, evaluating factors associated with self-reported cigarette smoking. We performed Poisson regression analyses with robust variance to examine whether depressive and anxiety symptoms were associated with smoking. Among 180 participants with TB enrolled from primary health clinics, depressive symptoms were reported in 47 (26.1%) participants and anxiety symptoms were reported in 85 (47.2%) participants. Overall, 45 (25.0%) participants reported current smoking. Depressive symptoms were associated with a higher prevalence of smoking (adjusted prevalence ratio [aPR]: 2.04; 95% confidence interval [CI]: 1.29-3.25) in the adjusted analysis. The association between anxiety symptoms and smoking did not reach statistical significance (aPR: 1.26; 95% CI: 0.77-2.05). Future studies should further investigate these associations when addressing TB care.

Risk factors for self-reported carpal tunnel syndrome among hairstylists in Gaborone, Botswana.

OBJECTIVES: Hairstylists form an occupational group whose tasks involve repetitive and forced movements of hands and wrists, thus posing a risk of developing carpal tunnel syndrome (CTS). This study assessed the prevalence of and factors associated with CTS symptoms among hairstylists in Gaborone, Botswana. MATERIAL AND METHODS: A cross-sectional study was conducted using a self-administered questionnaire distributed among randomly selected hairstylists. The questionnaire gathered information on demographic characteristics, lifestyle, work-related characteristics and psychosocial factors. The Boston Carpal Tunnel Syndrome Questionnaire was used to determine the severity of CTS symptoms and its functional effects. Data were then analyzed using χ2 and logistic regression models. The level of significance was determined at p < 0.05. RESULTS: A total of 165 hairstylists took part in the study, with 92 (56%) of the respondents being females. The mean age (M±SD) of the respondents was 35.05±7.54 years with an age range of 22-63 years. Seventy-three (42.2%) hairstylists reported CTS symptoms, with the majority (73%) being females. Out of all the CTS cases, 53 (72.6%) and 16 (21.9%) had mild and moderate symptoms, respectively. Over 80% of the hairstylists did not know about CTS. Among individual factors, CTS symptoms were associated with being female (the odds ratio [OR] of 9.99, and the 95% confidence interval [CI]: 3.64-27.44), increasing age (OR 9.84, 95% CI: 2.74-35.36), the length of employment (OR 3.73, 95% CI: 1.39-9.95), hair washing (OR 2.88, 95% CI: 1.41-5.85), an awkward posture (OR 2.52, 95% CI: 1.03-6.19), and the use of a great muscular effort when performing a task (OR 2.39, 95% CI: 1.01-5.72). Perceived heavy workload and stressful work were also risk factors. CONCLUSIONS: The results suggest a high prevalence of CTS among female hairstylists in Gaborone, and also point out that individual, work-related and psychosocial factors are associated with this syndrome. Future large-scale research is needed to establish the extent of CTS countrywide to influence policy-making. Currently, CTS is not listed amongst occupational health diseases in Botswana. Int J Occup Med Environ Health. 2021;34(3):437-50.

Nature and sources of poisoning in patients admitted to a referral hospital in Gaborone, Botswana; findings and implications.

BACKGROUND: Intentional poisoning is becoming an important public health concern particularly among young women globally. Consequently, there is a need to analyze this further within countries to establish pertinent policies to reduce current incidence rates. This includes sub-Saharan African countries where there has been a scarcity of information. Consequently, we sought to establish the nature and sources of poisoning in patients admitted to a leading hospital in Botswana to help develop pertinent future policies for Botswana and surrounding countries. METHODS: Retrospectively reviewing the medical records of all patients admitted to Princess Marina Hospital (PMH), which is a leading tertiary hospital in the capital city of Botswana, due to acute poisoning over a six-year period. RESULTS: The records for 408 patients were reviewed. The majority of admissions (58%) were females, and the mean age of patients was 21(±14) years. Most poisoning cases (53%) were intentional. The 15-45 years age group was most likely to intentionally poison themselves compared to other age groups, with females four and half times more likely to intentionally poison themselves compared to males (AOR 4.53, 95% CI: 2.68-7.89, p < 0.001). Half of the patients were poisoned by medicines followed by household chemicals (22%), with females overall four times more likely to be poisoned by medicines compared to males. The medicine mostly ingested was paracetamol (30%). Failing relationships (57%) were the principal reason for intentional poisoning. Six patients died from poisoning representing a 1.5% mortality rate. CONCLUSIONS: The findings suggest in-depth and urgent investigations on intentional poisoning are needed among young women across countries including sub-Saharan African countries to inform future policies on prevention strategies. Further, strategies for poisoning prevention should target social and family relationship problems. We will be following this up in the future.

The theory of planned behavior as a behavior change model for tobacco control strategies among adolescents in Botswana.

BACKGROUND: Behavioral intentions (motivational factors), attitudes, subjective norm (social pressures), and perceived behavioral control promote or discourage smoking behavior among adolescents. OBJECTIVE: To assess students' behavioral intentions, attitudes, subjective norms and perceived behavioral control on smoking using the Theory of Planned Behavior. The prevalence of smoking among the adolescents is also calculated. METHODS: In this cross-sectional study, structured self-administered questionnaires were used to collect data from adolescents in primary and secondary schools. Data on demographics, behavioral intentions, attitudes, subjective norms, and perceived behavioral control towards smoking were collected. Pearson product moment correlations and logistic regression models were used to determine factors associated with current smoking. RESULTS: A total sample of 2554 (mean age = 15; Range = 12-18 years) students participated in the study. Twenty-nine percent (n = 728) of the students had tried smoking at least once. Smoking was predicted by attitudes, subjective norms, perceived behavioral control and intention.There was a strong association between having a parent or guardian, caregiver or close friend who smoked (p < 0.001) and being a smoker. The majority of students (57%) conveyed that adults talked to them about the harmful effects of cigarette smoking and 50% had discussed smoking concerns with their friends. Students who had positive attitudes towards smoking like "smoking makes you confident" were more likely to be current smokers (OR: 1.63, 95% CI: 1.03-2.59). The feeling or conviction that they could refuse a cigarette if offered was an impediment from smoking (OR: 0.18, 95% CI: 0.13-0.26). CONCLUSIONS: Attitudes, subjective norms, and perceived behavioral control contributed significantly to the students' smoking. Right attitudes must be cultivated and behavioral control must be strengthened for early effective interventions to curtail smoking among adolescents.

Healthcare waste management: current practices in selected healthcare facilities, Botswana.

Healthcare waste management continues to present an array of challenges for developing countries, and Botswana is no exception. The possible impact of healthcare waste on public health and the environment has received a lot of attention such that Waste Management dedicated a special issue to the management of healthcare waste (Healthcare Wastes Management, 2005. Waste Management 25(6) 567-665). As the demand for more healthcare facilities increases, there is also an increase on waste generation from these facilities. This situation requires an organised system of healthcare waste management to curb public health risks as well as occupational hazards among healthcare workers as a result of poor waste management. This paper reviews current waste management practices at the healthcare facility level and proposes possible options for improvement in Botswana.

Incidence of diabetes mellitus-related comorbidities among patients attending two major HIV clinics in Botswana: a 12-year retrospective cohort study.

OBJECTIVES: Exposure to combination antiretroviral therapy (cART) is associated with the development of diabetes mellitus related comorbidities (DRCs). This study aims to: (i) estimate the incidence of DRCs among cART recipients, (ii) assess the time-to-event (development of DRC) and, (iii) compare survival function between recipients on first-line regimen and those on second-, third-line cART regimen. RESULTS: The incidence of DRCs was 26.8/1000 person-years, with total time of exposure of 3316 person-years. The average time to event for all the three regimens was 11.72 ± 0.20 years. The first-line cART regimen had a shorter mean ± SE of 10.59 ± 0.26 years to the event compared to 12.69 ± 0.24 years for the second-, third-line cART regimen. Recipients on the first-line had a shorter survival than recipients on second-, third-line cART (Log-rank X2 = 8.98, p < 0.003). Data from this study showed that the risk of developing DRCs per year of exposure was significantly greater for patients on first-line compared to those who were on second-, third-line regimen; which, suggests that monitoring of cART long-term side effects and regular reviewing of cART regimens is important. Meticulous selection of drug combinations is a key to improving recipients' survival.

Predictors of smoking among primary and secondary school students in Botswana.

This study seeks to determine the prevalence and risk factors for smoking among students aged 12-18 years in two cities in Botswana. Using a sample of 2554 students we adapted the Global Youth Tobacco Survey (GYTS) methodology to assess students' smoking practices, knowledge, beliefs and attitudes. Logistic regression models were used to evaluate factors associated with smoking. The results revealed that 10% of students were current tobacco smokers with 29% reporting having tried smoking. Self-image and acceptance by peers were the strongest predictors of smoking overall (adjusted Odds Ratio [aOR]: 3.13, 95%, Confidence Interval [CI]: 2.67-3.66). Intention to smoke or to continue to smoke and perceived norms in conformity with smoking were also independently associated with smoking (aOR: 1.81, 95% CI: 167-2.11 and aOR: 1.31, 95% CI: 1.10-1.57, respectively). Perceived prevalence and exposure to smoking by peers and family and access to tobacco products was stronger among females (aOR: 1.69, 95% CI: 1.52-1.91) compared to males (aOR: 0.93, 95% CI: 0.70-1.24). Our results indicate that anti-tobacco interventions in Botswana should prioritize intra-personal factors associated with smoking. Our findings also suggest that different interventions targeting male and female students should be explored.

Knowledge and Attitudes towards Cervical Cancer Screening amongst University of Botswana Female Students

Background: Cervical cancer is the leading cause of cancer deaths in Botswana. More than two-thirds of cases occur in HIV-infected women, in a nation with a high HIV prevalence of 17%. Even though cancer screening is free in health facilities, cervical cancer screening is low. The objective of this study was to assess the knowledge and attitudes of University of Botswana female students on cervical cancer screening. Methods: A cross-sectional study was conducted among University of Botswana female students to elicit information about their knowledge and attitudes on cervical cancer screening. Results: A total of 335 students completed the questionnaire and all reported that they were aware of cervical cancer. The awareness was mostly through brochures, posters and other printed material. Regarding cervical cancer risk 315 (94%) attributed cervical cancer to smoking and 301 (89.9%) to early sexual debut. The majority of students 329 (98.2 %) were aware of cervical cancer screening. Papanicolaou (Pap) smear was the most popular screening test reported by 160 (47.8%) of the respondents as compared to Human Papilloma Virus testing (HPV) reported by 106 (31.6 %) of the respondents. The overall Pap smear screening rate was 92 of 335 students (27.5%). Those who perceived themselves to be at risk of contracting cervical cancer 203 (60.6%) where 1.8 times more likely to go for Pap smear than those who perceived to be safe, (Adjusted Odds Ratio [AOR] 1.834; 95% Confidence Interval [CI]; 1.094-3.067), (P = 0.02). Conclusions: Pap smear screening uptake is low amongst University of Botswana female students. The likely reason for this could be because students do not perceive themselves to be susceptible to cancer so the lesser the likelihood of engaging in preventive behaviours. There is urgent need for university based cancer education campaign on cervical cancer screening benefits and incorporating these campaigns into the existing university medical services to increase uptake of screening programs offered.

Diagnosis of pulmonary tuberculosis and assessment of treatment response through analyses of volatile compound patterns in exhaled breath samples.

OBJECTIVES: We determined the performance of a sensor array (an electronic nose) made of 8 metalloporphyrins coated quartz microbalances sensors for the diagnosis and prognosis of pulmonary tuberculosis (TB) using exhaled breath samples. METHODS: TB cases and healthy controls were prospectively enrolled. Signals from volatile organic compounds (VOCs) in breath samples were measured at days 0, 2, 7, 14, and 30 of TB therapy and correlated with clinical and microbiological measurements. RESULTS: Fifty one pulmonary TB cases and 20 healthy HIV-uninfected controls were enrolled in the study. 31 (61%) of the 51 pulmonary TB cases were coinfected with HIV. At day 0 (before TB treatment initiation) the sensitivity of our device was estimated at 94.1% (95% confidence interval [CI], 83.8-98.8%) and specificity was 90.0% (95% CI, 68.3-98.8%) for distinguishing TB cases from controls. Time-dependent changes in the breath signals were identified as time on TB treatment progressed. Time-dependent signal changes were more pronounced among HIV-uninfected patients. CONCLUSION: The identification of VOCs' signals in breath samples using a sensor array achieved high sensitivity and specificity for the diagnosis of TB and allowed following signal changes during TB treatment.

Dichlorodiphenyltrichloroethane in the aquatic ecosystem of the Okavango Delta, Botswana, South Africa.

Concentrations of DDT and its metabolites were measured in water, plants, invertebrates, and fish from lagoons in the Okavango Delta, Botswana (Africa), where DDT has been used for approximately 50 years. The sampling area was sectioned to distinguish spraying for malaria and for African sleeping sickness. Average concentrations of total DDT (sum of DDT and its metabolites) in the Okavango ranged from 0.009 ng/L in water to 18.76 ng/g wet weight in fish. These levels are approximately 1% of those found in piscivorous fish from temperate North America. The dichlorodiphenyl ethylene (DDE) metabolite was the most abundant fraction of total DDT. Although total DDT concentrations were higher in areas treated for malaria than areas treated for sleeping sickness, these concentrations were likely driven by factors other than the historic application of the pesticide. Equilibration with air concentrations is the most likely explanation for these levels. Since the mean annual temperature exceeds the temperature of vaporization of DDT, this research points to the need for reliable transport models. Our results showed that total DDT concentration in fish was best explained by lipid content of the fish and trophic position inferred by delta15N, regardless of DDT application history in those areas. The reservoir above Gaborone Dam, an area downstream of the Okavango but where DDT had not been used, was sampled to compare total DDT levels to the treated areas. The two species (a herbivorous threespot talapia and the omnivorous sharptooth catfish) from Gaborone had levels higher than those found in the Okavango Delta, but these differences can again be explained using trophic position inferred by delta15N rather than by fish size or location.