Prevalence and associated risk factors of scabies and impetigo: A cross-sectional study in Tutume district, Botswana.

BACKGROUND: The epidemiology of scabies is poorly understood, particularly in regions with high disease burden. This lack of epidemiological data, especially in sub-Saharan Africa, hampers the control and preventative measures. This study is aimed at estimating the prevalence and associated risk factors of scabies and impetigo in the Nata and Sowa catchment areas of Tutume district. METHODOLOGY: A cross-sectional study was conducted in the Tutume District, targeting the settlements of Manxhotae, Malelejwe, Ndutshaa, and Tshwaane. Participants were randomly selected from households in the settlements. Data were collected using questionnaires, and participants were classified as having scabies typical lesions if they met criteria B and or C of International Alliance for the Control of Scabies (IACS) consensus criteria. Statistical significance was set at p<0.05, with a 95% confidence interval for precision. RESULTS: A total of 429 participants were enrolled across the four settlements. The overall prevalence of scabies was found to be 18.18% (95%CI 14.8-22.1). The highest prevalence of scabies was in Manxhotae at 27.1% (95%CI 21.2-34.0) and Ndutshaa at 23.4% (95%CI 13.4-37.3). Malelejwe and Tshwaane had lower prevalence of 10.4% (95%CI 6.2-16.8) and 3.4% (95%CI 0.8-12.7), respectively. Only five (5) cases of impetigo were identified. Multivariable logistic regression analysis revealed that younger age of 0-4 years, 5-18 years and a household member with an itch were strongly associated with scabies, with adjusted odds ratios (aOR) of 7.9 (95%CI 2.4-25.6) p-value 0.001, 5.7(95%CI 2.7-11.7), p-value 0.001 and 14.3(95%CI 5.3-38.5) p-value 0.001 respectively. CONCLUSION: The prevalence of scabies in the Nata catchment area was noted to be high. The risk factors included younger age, a household member with an itch, and less frequent bathing. Prospective studies are needed to explore household disease transmission dynamics and risk factors specific to the youth.

Knowledge, attitudes and preventive practices towards COVID-19 among workers at two points of entry in South-Eastern Botswana: A cross-sectional study.

INTRODUCTION: Adherence to control measures and provision of appropriate information at international borders and points of entry (POE) are key to limiting the importation of COVID-19. This study aimed to describe the knowledge, attitudes, and practices (KAPs) of POE staff towards COVID-19 in Botswana. METHODS: This was a cross-sectional study of the COVID-19 KAPs among workers at Tlokweng border and Sir Seretse Khama International Airport (SSKIA) using a self-administered questionnaire. The tool incorporated the participants' demographics and selected questions on COVID-19 KAPs. Analysis was descriptive. Categorical data were summarized with frequencies while numeric data were summarized with medians and interquartile ranges (IQR). The total knowledge and practice scores of each individual were computed by adding their individual scores for each question. The scores were then categorized according to Bloom's cutoffs of good (80-100%), moderate (60-79%) and poor (<60%). RESULTS: A total of 276 individuals participated in the study. Of these, 70 were from Tlokweng border and 206 were from SSKIA. The participants performed worst on questions on the frequency of severe disease and asymptomatic transmission of COVID-19. The attitudes were mainly positive. However, 54.6% of participants thought that the COVID-19 burden is exaggerated. For practice, the worst performance was on social distancing, sanitizing shared surfaces, and going to work while symptomatic. Overall, good and moderate knowledge was observed in 47.8% and 38.0% of participants, respectively. Similarly, good and moderate performance on practices was observed in 63.6% and 24.4% of participants respectively. CONCLUSION: The knowledge, attitudes, and practices were generally good at the 2 points of entry. More than 85% of respondents had moderate or good performance on knowledge and practice questions. However, the respondents performed poorly in some key questions. Targeted health information and promotion must address the identified gaps.

Factors influencing health care workers' implementation of tuberculosis contact tracing in Kweneng, Botswana.

INTRODUCTION: TB contact tracing rates remain low in high burden settings and reasons for this are not well known. We describe factors that influence health care workers' (HCW) implementation of TB contact tracing (CT) in a high TB burden district of Botswana. METHODS: Data were collected using questionnaires and in-depth interviews in 31 of the 52 health facilities in Kweneng East Health District. Responses were summarized using summary statistics and comparisons between HCW groups were done using parametric or non-parametric tests as per normality of the data distribution. RESULTS: One hundred and four HCWs completed questionnaires. Factors that influenced HCW TB contact tracing were their knowledge, attitudes and practices as well as personal factors including decreased motivation and lack of commitment. Patient factors included living further away from the clinic, unknown residential address and high rates of migration and mobility. Administrative factors included staff shortages, lack of transport, poor reporting of TB cases and poor medical infrastructure e.g. suboptimal laboratory services. A national HCW strike and a restructuring of the health system emerged as additional factors during in-depth interviews of TB coordinators. CONCLUSION: Multiple factors lead to poor TB contact tracing in this district. Interventions to increase TB contact tracing will be informed by these findings.

Criteria for a just strike action by medical doctors.

In response to a strike action by some doctors at the Safdarjung Hospital, the Delhi Medical Council issued a statement, in December 2010, that it was "...of the view that under no circumstances doctors should resort to strike as the same puts patient care in serious jeopardy and such actions are also in violation of the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002". Statements such as this are common responses of medical councils across the world whenever they are confronted with the increasingly difficult issue of striking doctors. Evidently, these statements are not effective in stopping doctors from repeatedly engaging in strike action. In India, the statement by the medical council was, for instance, followed by many strikes, amongst which was the well-publicised nationwide strike initiated by the Indian Medical Association in June 2012.

HIV pre-exposure prophylaxis trials: socio-economic and ethical perspectives for sub-Saharan Africa.

The advent of HIV pre-exposure prophylaxis (PrEP) as a HIV-prevention strategy has received optimistic support among HIV researchers. However, discourse on PrEP trials has tended to be dominated by the disputes arising between some activist groups and researchers about the research methodologies. Instead, this paper discusses other issues oftentimes neglected in discussions relating to PrEP trials. Specifically, I focus on the possible ethical implications and the potential impact of sub-Saharan Africa's socio-economic conditions on the promised benefits of PrEP trials for the region and the continent. I argue that the concept of PrEP as a affordable and practical HIV-prevention intervention presents challenges and questions that urgently need addressing as we await results from several ongoing trials. If research is undertaken with no plans on how the results of specific trials can render actual HIV-prevention-benefits - especially for the world's poor - then such endeavours risk being merely information-acquiring ventures.

An unequal activism for an unequal epidemic?

This paper observes that a substantially large moral duty of dealing with the AIDS situation in Africa has been placed on the drug companies and argues that this approach is inequitable. Using the poverty-AIDS relationship and the human rights framework it argues for a more balanced AIDS activism, which puts equal pressure on all potential stakeholders in the war against AIDS. It argues that this redistribution of the HIV/AIDS moral burden is perhaps the only hope for curbing the African AIDS epidemic that continues to ravage communities on that continent.