Roy Tapera

SD Bioline malaria antigen Pf (HRP-2/pLHD) for assessing efficacy of artemisinin combination therapy against plasmodium falciparum in pediatric patients in the Democratic Republic of the Congo

Introduction The emergence of Plasmodium falciparum resistance to artemisinin combination therapy (ACT) is a worrying development. It calls for close surveillance to monitor the efficacy of the drugs. The objectives of this study were to determine the performance of SD Bioline malaria AgPf(HRP-2/pLDH) 3 band Rapid Diagnostic Test (RDT) against Giemsa-stained blood smear and evaluate the suitability of this test in assessing the therapeutic efficacy of ACT in pediatric malaria patients in the Democratic Republic of the Congo (DRC). Methods Five hundred and one patients with malaria symptoms were screened for P. falciparum in Kinshasa, DRC. Of the 166 patients who tested positive for P. falciparum at recruitment (day 0), 103 consented to participate in this study and were followed up and retested for P. falciparum on day 3, day 7, day 14, day 21 and day 28. Results Sensitivity and specificity of the test were significantly high on day 0 and so were their positive and negative predictive values. Higher proportions of false positive cases were observed on the HRP-2 band irrespective of patient parasite densities during the follow up but these were barely seen on the pLDH band. Some patients turned positive during follow up but pLDH readings remained consistent with blood smear readings. Conclusion SD Bioline malaria AgPf(HRP-2/pLDH) RDT demonstrated high performance in DRC. Thus, the test can be employed to assess the efficacy of ACT in pediatric malaria patients and prioritize areas that require the deployment of advanced testing like polymerase chain reaction (PCR).

Knowledge of HIV/AIDS, attitudes towards sexual risk behaviour and perceived behavioural control among college students in Botswana

Abstract This study examines the knowledge of HIV/AIDS, attitudes towards risky sexual behaviour and perceived behavioural control among students in Botswana. Data were collected from 445 students randomly selected from the University of Botswana and Boitekanelo College. Hundred and seventy three males and 272 females participated in the study. The study established that although more than 90% of students correctly identified routes of HIV transmission, misconceptions regarding HIV/AIDS still exist. This includes the belief that people can be infected with HIV because of witchcraft and that only people who have sex with gay or homosexual partners can be infected with HIV. Majority of students were aware of various sexual risks. However, the percentage of students who indicated that “it is difficult to ask my partner to use a condom” was still relatively high (13.5%) based on the assumption that students are supposed to know the consequences of sexual risky behaviour. It was also found that male students were 3.48 times more likely to negotiate sex than their female counterparts (OR = 3.48, 95% CI: 1.09 − 11.13) and students who were 18 years and below were more likely to negotiate sex than students above 18 years of age (OR = 2.78, 95% CI: 1.42 − 18.32). Christians are four times less likely to negotiate sex compared to non-Christians (OR = 0.219, 95% CI: 0.095 − 0.506). More than 80% of students were comfortable discussing HIV or sex and sexuality with their friends, boyfriends/girlfriends or partners but uncomfortable discussing the same issues with their parents.

How well does the process of screening and diagnosis work for HIV-infected persons identified with presumptive tuberculosis who are attending HIV care and treatment clinics in Harare city, Zimbabwe?

Background Intensified TB case finding is recommended for all HIV-infected persons regularly attending HIV care and treatment clinics. The authors aimed to determine how well this system worked among HIV-infected patients diagnosed with presumptive TB in 14 health facilities of Harare province, Zimbabwe, between January and December 2016. Methods Retrospective review using routine programme records. Results Of 47 659 HIV-infected persons enrolled in HIV care, 102 were identified with presumptive TB through the programmatic electronic database. Of these, 23% (23/102) were recorded in presumptive TB registers and, of these 65% (15/23) were traced to laboratory registers. Of 79 patients not recorded in presumptive TB registers, 9% (7/79) were traced to laboratory registers. Of 22 patients in the laboratory register, all had negative sputum smears for acid-fast bacilli and 45% (10/22) had Xpert MTB/RIF assays with one positive result. Six patients altogether started anti-tuberculosis treatment, the median time from presumptive tuberculosis diagnosis to treatment being 12 days. The only significant risk factor for loss-to-follow-up between presumptive TB diagnosis and laboratory registration was not being recorded in presumptive TB registers. Conclusions Follow-up mechanisms for presumptive TB cases diagnosed in HIV care clinics in Harare city need strengthening, particularly through improved documentation in presumptive TB registers and better Xpert MTB/RIF use.

The status of health promotion in Botswana

Health education and promotion remains an integral part of public health. This paper details health promotion activities in Botswana since the establishment of the profession in 1988. It further describes health promotion infrastructure, investment in health promotion, human resource training and collaborations within the country. Infrastructure and services for health promotion in the country are mainly provided by government through educational institutions, faith based organizations, non-governmental organizations, general medical practitioners and mining companies complementing the Ministry’s efforts. More than 1000 health promotion cadres have been trained at certificate, diploma and degree levels by Boitekanelo College and the Ministry of Health through Serowe Institute of Health Sciences.

Factors associated with uptake of voluntary medical male circumcision among University of Botswana undergraduate male students

Abstract Background: The human immunodeficiency virus (HIV)/AIDS prevalence in Botswana of 18.4% is the third highest in the world. Thus, the Voluntary Medical Male Circumcision strategy was rolled out with a target of 80% uptake by year 2016. The programme targets mainly young people (15–24 years) as they account for 40% of all new adult infections. We, therefore, aimed at identifying the factors associated with uptake of voluntary medical male circumcision among University of Botswana undergraduate male students as well as to establish the male circumcision prevalence among the same group so as measure the success of the male circumcision (MC) strategy. Methods: A cross-sectional study was conducted amongst 303 undergraduate male students. Data were collected through self-administered questionnaires using stratified sampling. Data were captured and analysed using Statistical Package for the Social Sciences version 23, where adjusted odds ratios and p-values were calculated. Results: Uptake of male circumcision was 47.9%. Respondents’ knowledge on male circumcision was high (88%). However, a large majority of those uncircumcised (52.1%) indicated unwillingness to get circumcised although they were knowledgeable about the benefits MC. Believing that there are no risks in MC surgery [AOR:1.02; 95% CI: 1.004–1.037] and knowing that an injection is given before undergoing surgery (AOR: 1.072; 95% CI: 1.057–1.087) were positively associated with circumcision status. The main reasons stated for being circumcised were hygiene (49.7%) and protection from HIV (22.1%). Conclusions: There is need for a combination of factors to induce motivation for students to be circumcised. Referent others need to be targeted as well as they are role models and able to positively influence their peers and children.

The prevalence and factors associated with overweight and obesity among University of Botswana students

Abstract Recently, overweight and obesity were found to be an increasing public health crisis in Botswana. Despite these findings, there is scant epidemiological studies carried out to investigate the prevalence and risk factors of obesity among tertiary students in Botswana. The aim of this study was to determine the prevalence and factors associated with overweight/obesity among University of Botswana (UB) students. A descriptive cross sectional study was conducted at University of Botswana between February and April 2016 using convenient sampling to recruit participants. A total of 202 students in the age range of 18–30 with mean age 21.59 ± 1.81 completed the study procedures. Self-administered questionnaires were used for data collection, body mass and height were measured from participants in order to calculate Body Mass Index (BMI) to determine whether they fall under the category of being overweight/obese. The prevalence of overweight and obesity was 36.8%. Overweight and obesity among students was significantly associated with age (Odds Ratio [OR]: 1.72, 95% Confidence Interval [CI]: 1.06–4.46), year of study (OR: 1.60, 95%CI: 1.09–3.99), physical activity and ones opinion about him/her being overweight/obese (p < 0.05). The findings also revealed that gender, faculty of study, family history of obesity and alcohol are not significantly associated with obesity. The prevalence of obesity is relatively high (36.8%) among UB students. Obesity and overweight are associated with age and level of studies. Students practiced unhealthy dietary practices and lifestyle behaviors that should be targeted and modified. Promoting healthy dietary and weight management practices might be of great importance when developing health education programs.

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.

Addressing the Challenge of P-Value and Sample Size when the Significance is Borderline: The Test of Random Duplication of Participants as a New Approach

The issue of borderline p -value seems to divide health scientists into two schools of thought. One school of thought argues that when the p -value is greater than or equal to the statistical significance cut-off level of 0.05, it should not be considered statistically significant and the null hypothesis should be accepted no matter how close the p -value is to the 0.05. The other school of thought believes that by doing so one might be committing a Type 2 error and possibly missing valuable information. In this paper, we discuss an approach to address this issue and suggest the test of random duplication of participants as a way to interpret study outcomes when the statistical significance is borderline. This discussion shows the irrefutability of the concept of borderline statistical significance, however, it is important that one demonstrates whether a borderline statistical significance is truly borderline or not. Since the absence of statistical significance is not necessarily evidence of absence of effect, one needs to double check if a borderline statistical significance is indeed borderline or not. The p -value should not be looked at as a rule of thumb for accepting or rejecting the null hypothesis but rather as a guide for further action or analysis that leads to correct conclusions.