Clinical use of blood and blood components in post-abortion care in Botswana.

BACKGROUND: Understanding the pattern and gaps in blood product utilisation in post-abortion care is crucial for evidence-based planning and priority setting. OBJECTIVE: To describe the current use of blood and blood components in post-abortion care in Botswana. METHODS: We conducted a retrospective cross-sectional study across four hospitals in Botswana using routine patients' records. We included all patients admitted for an abortion between January and August 2014. Descriptive statistics are used to report the results. RESULTS: Whole blood and red cell concentrates were used in 59/619 (9·5%) of patients. Plasma and platelet use was 1·3 and 0·7%, respectively. The mean admission haemoglobin level was 10·07 g dL(-1) (SD 2·69) and differed significantly between referral and district hospitals. The mean number of blood units transfused per patient was 2·23 (standard deviation (SD) 1·23), with 15/55 (27·3%) receiving a single unit. A total of 43/288 (14·9%) of the patients had haemoglobin levels below 7 g dL(-1) but did not receive any transfusion. There was a moderate positive correlation between admission haemoglobin level and time to transfusion (Spearman's rho = 0·37, P = 0·01). The number of blood units given increased with decreasing admission haemoglobin level. The strength of this association was moderate (Spearman's rho = -0·48, P < 0·001). CONCLUSION: There is a relatively low utilisation of blood and blood components in post-abortion care in Botswana despite an apparent clinical need in some instances. The reason for this shortfall, as well as its impact on morbidity and mortality, needs to be explored and be a focus of health systems research in Botswana.

Addressing the challenge of the emerging NCD epidemic: lessons learned from Botswana's response to the HIV epidemic.

Botswana has the second highest prevalence of human immunodeficiency virus/acquired immune-deficiency syndrome (HIV/AIDS) in the world, and yet it has built one of Africa's most progressive and comprehensive HIV programs. While public health infrastructure has responded remarkably to the HIV epidemic, the prevalence of non-communicable diseases (NCDs), particularly diabetes mellitus and cardiovascular disease, in both HIV-infected and non-infected individuals, is increasing rapidly. Applying lessons learned from the scale-up of HIV/AIDS services may help with the implementation of an effective response to the challenges of the emerging NCD epidemic. We suggest that a successful response should include integrated service delivery, capacity building to provide disease-specific care, and strong partnerships to mobilize communities.

C'est au Botswana que se trouve la deuxième prévalence la plus élevée du virus de l'immunodéficience humaine/syndrome d'immunodéficience acquise (VIH/SIDA) au monde, et pourtant il a élaboré les programmes les plus progressifs et complets du VIH de toute l'Afrique. Alors que l'infrastructure de santé publique a répondu remarquablement à l'épidémie de VIH, la prévalence des maladies non transmissibles (NCD), particulièrement du diabète sucré et des maladies cardiovasculaires, augmente rapidement à la fois chez les sujets infectés et non infectés par le VIH. L'application des leçons retenues de l'extension des services VIH/SIDA peut aider à la mise en œuvre d'une réponse efficiente au défi de l'émergence de l'épidémie des NCD. Nous suggérons qu'une réponse couronnée de succès comporte la fourniture de services intégrés, la formation des compétences à fournir des soins spécifiques à la maladie ainsi que de puissants partenariats pour mobiliser les collectivités.

Botsuana presenta la segunda prevalencia más alta de infección por el virus de la inmunodeficiencia humana (VIH) y síndrome de inmunodeficiencia adquirida (SIDA) en el mundo y sin embargo, ha establecido uno de los programas más progresistas e integrales contra el VIH en África. Si bien la infraestructura de salud pública ha respondido de manera sobresaliente a la epidemia de infección por el VIH, la prevalencia de enfermedades no transmisibles (NCD), en especial la diabetes y las enfermedades cardiovasculares, progresa rápidamente en todas las personas, ya sea que padezcan o no la infección por el virus. Las enseñanzas extraídas de la ampliación de escala de los servicios contra el VIH y el SIDA podrían contribuir a poner en práctica una respuesta eficaz frente a los retos que plantea la epidemia incipiente de NCD. En el presente artículo se propone que la eficacia de esta respuesta exige los siguientes elementos: la prestación de servicios integrados, el fortalecimiento de la capacidad de suministrar una atención orientada a enfermedades específicas y el establecimiento de colaboraciones dinámicas que movilicen las comunidades.