Prevalence of the metabolic syndrome and associated factors among inpatients with severe mental illness in Botswana: a cross-sectional study.

INTRODUCTION: The metabolic syndrome, a cluster of inter-related risk factors for cardiovascular diseases is highly prevalent among individuals with obesity and sedentary lifestyle. Chronic psychiatric disorders such as severe mental illness are associated with increased risk for cardiovascular diseases. We aimed to assess the prevalence and correlates of metabolic syndrome among inpatients with severe mental illness in a resource limited setting with high HIV prevalence. METHODS: This was a cross-sectional study among adult inpatients at a referral psychiatric hospital in Botswana. We used convenience sampling to enrol participants available at the time of the study. The National Cholesterol Education Program Adult Treatment Panel-III (NCEP-ATP III) criteria was used to define the metabolic syndrome. Data were analysed using descriptive statistics as well as multiple logistic regression modelling. RESULTS: A total of 137 participants were enrolled. Of these, 119 (87%) had complete data for the main analysis. The overall prevalence of metabolic syndrome was 22.6% (95% CI 15.9, 30.6) and did not differ significantly by gender or HIV status. Age was significantly associated with the risk of having the metabolic syndrome while gender, body mass index, HIV status, and days of moderate physical activity were not. CONCLUSION: There was a moderately high prevalence of metabolic syndrome. Thus, the management of individuals with severe mental illness in resource limited settings should include assessment of cardiovascular risk and target modifiable risk factors in this population. Consideration for the patient's age should be made when rationalizing the limited resources available for assessing metabolic syndrome among patients with severe mental illness.

Applying the Haddon matrix conceptual model to guide motor vehicle crash injury research and prevention in Botswana.

INTRODUCTION: Little literature addresses the burden of injury in Botswana, including trauma from motor-vehicle crashes (MVCs). In response, the University of Botswana and the Botswana Ministry of Health and Wellness are collaborating with the University of Pennsylvania to enhance injury and trauma research capacity in Botswana. Here we describe this training program and a research exercise to identify opportunities to prevent, through future research and countermeasures, MVCs specifically in Botswana. METHODS: We initiated a mixed-methods study during a training module during the first two years of the program. The module introduced the Haddon matrix as a conceptual framework, and asked trainees to identify host, vector, and physical/social environment risk factors for MVCs that, if targeted, may lead to primary, secondary, or tertiary prevention. We conducted 10 photovoice elicitation interviews; results were thematically analyzed to further elucidate the context of MVCs in Botswana and potential countermeasures. RESULTS: Our process identified a range of ideas as barriers or facilitators to MVC prevention. The most commonly cited barriers were animals on the road, drunk or reckless driving, poor road quality, lack of road signs/traffic signals to orient drivers, and poor visibility (e.g., no street lighting; poor lighting on vehicles). Regarding primary prevention, participants identified features prior to the crash, across all matrix levels, as influencers of crashes in Botswana. Among these, several human factors (i.e., over-speeding; drunk driving) and environmental factors (i.e., livestock on road) were commonly mentioned as contributors to MVCs, as were cattle gates and traffic calming measures for prevention. CONCLUSION: Results of the Haddon matrix exercise proved useful for training burgeoning Batswana researchers to think conceptually about the occurrence of MVCs in Botswana and think creatively about targeting countermeasures for prevention. The exercise resulted in potential research questions for the trainees to pursue in mentored research of their own.