Incidence of Retinopathy of Prematurity in Botswana: A Prospective Observational Study.

BACKGROUND: Retinopathy of prematurity (ROP) is a widely recognized cause of blindness after preterm birth. The incidence of ROP is rising especially in low- and middle-income countries (LMIC) because of improved neonatal care and increased survival of very premature neonates. To date, there is no data on incidence of ROP in Botswana. OBJECTIVE: The purpose of this study was to provide initial data and determine ROP-associated risk factors from a single neonatal care center on the incidence of ROP in Gaborone, Botswana. METHODS: A prospective observational study was conducted at Princess Marina Hospital (PMH) in Gaborone, Botswana. Premature neonates with birth weights (BW) of <1,801 g or gestational age (GA) of <34 weeks were enrolled in this study. Diagnostic examinations were conducted using an indirect ophthalmoscope with 28D lens. ROP findings were classified according to the most advanced stage of ROP reached using the International Classification of ROP (2005). Data were entered into STATA version 15 statistical software for analysis. RESULTS: There were 264 premature infants enrolled in the study. ROP screening was performed on 200 (75.8%). Of all 264 enrolled patients 133 (50.4%) were female. The mean GA was 30.3±2.6 (range 24-37) weeks and the mean BW was 1302.2±285.9 g (range 725-2035). Out of 200 who were screened, we identified 22 with ROP with a ROP incidence of 11%. The incidence of type 1 ROP (sight-threatening) was found to be 3.5%. This study identified a significant difference in possible ROP risk factors between those infants who develop ROP and those who do not, eg, BW (p<0.001), GA (p=0.024) and blood transfusion (p=0.001). CONCLUSION: This study demonstrates that ROP is a treatable cause of blindness in Botswana. Lack of a proper screening protocol, delay in diagnosis and management are plausible reasons for poor outcome in those who were diagnosed with type 1 ROP.

Pediatric Spectrum of Allergic Diseases and Asthma in a Tertiary Level Hospital in Botswana: an Exploratory Retrospective Cross-Sectional Study.

PURPOSE: This study aims to describe the spectrum of allergic diseases of children and adolescents in a single allergy treatment centre in Botswana, over a period of 8 years. PATIENTS AND METHODS: A retrospective cross-sectional study was conducted using medical records of all patients aged 18 years or younger, seen at an allergy treatment centre in Botswana. Data were presented descriptively. Association between variables was explored by χ 2-test. RESULTS: Four hundred and seven patients with a mean age of 5.8 years (SD 4.4) at the time of presentation included 239 (58.7%) females and 365 (87.5%) black Africans. The most common diseases were asthma (n=249, 61.2%) followed by allergic rhinitis (AR) (n=232, 57.0%) and atopic dermatitis (AD) (n=165, 40.5%). One hundred and fifteen cases (46.2%) of asthmatic patients were skin prick test positive; sensitized to grass, moulds, dust mites and animal dander, in decreasing frequency, whereas those with allergic rhinitis (AR) and allergic conjunctivitis (AC) were sensitized to trees and all allergens identified in asthmatics. Concomitant asthma was diagnosed in 171 (73.7%) with AR, 71 (68.3%) with AC, 75 (45.5%) with AD and 42 (47.7%) with food allergy. The most common triggers for asthma exacerbations include upper respiratory tract infections, weather changes, and exposure to passive cigarette smoke. Paternal allergy and allergic disease in grandparents are predisposing factors for asthma (p=0.016 and p=0.001, respectively). Paternal allergy is also predisposed to AR (p=0.007), while maternal history of allergic disease was associated with AD (p=0.019). CONCLUSION: The most common chronic pediatric conditions seen in our allergic disease study were asthma, allergic rhinitis and atopic dermatitis with the most common triggers being viral upper respiratory tract infections, weather changes and exposure to cigarette smoke, all of which are modifiable risk factors. This exploratory study lays the foundation for future interventional studies that may be directed towards the spectrum of allergic diseases.

Sight threatening vitreous haemorrhage and retinal detachment in a patient with sickle cell disease.

We report a case of sight threatening vitreous haemorrhage and retinal detachment as complication of sickle cell disease (SCD). A 35 years old female Nigerian patient had presented to ophthalmology clinic of Princess Marina Hospital, Botswana, with two weeks history of poor vision in the left eye. The loss of vision was due to vitreous haemorrhage and retinal detachment which was confirmed by direct and indirect ophthalmoscopy and B-Scan ultrasound. Prior to presentation, patient didn't have any follow up by an ophthalmologist as part of regular medical care for patients with SCD. We emphasize the importance of regular follow up for early detection, treatment and prevention of complication associated with sickle cell disease.

Presenting signs of retinoblastoma at a tertiary level teaching hospital in Ethiopia.

INTRODUCTION: Retinoblastoma is a primary malignant intraocular neoplasm that arise from immature retinoblasts with in developing retina. The commonest presenting sign in developing country is proptosis which is the late presenting sign. We report presenting signs of retinoblastoma in Ethiopian children seen at a tertiary level teaching hospitals in Ethiopia. METHODS: Prospective case series study was done on children who presented with retinoblastoma between May 1, 2005 and September 1, 2006. This study was done as part of requirement for partial fulfilment of certificate of specialty study in ophthalmology during the year 2005 to 2006. SPSS 11 statistical package was used to analyse the data. RESULTS: Among 41 patients seen during the study period, 24 (58.5%) were males and 17(41%) were females. Unilateral retinoblastoma was found in 32 (78%) patients and bilateral cases were found in 9(22%). Mean age of onset for right eye was 27.5 months and left eye 33.7 months. The mean ages of presentation at time of diagnosis for right and left eye were 34.4 and 40.2 months, respectively .In bilateral retinoblastoma mean age of presentation was 33.3 months. The commonest presenting sign was proptosis 22(53.7%) followed by leucocorea nine (22%),ocular inflammation four (9.0 %), strabismus three (7.3%), glaucoma one (2.4%), loss of vision one (2.4%)and hyphemaone (2.4%). CONCLUSION: The commonest presenting signs of retinoblastoma in our set up were Proptosis followed by leucocorea. This is due to late presentation of patient and late referral by medical professionals. Health education to the public and health professionals will help early detection of retinoblastoma.

Misplaced subclavian central venous catheter.

Percutaneous Central Venous Catheter (CVC) insertion using internal jugular and Subclavian veins routes is common procedure for all intensive care admitted patients and some patients in the ward as demand arises in central and referral hospitals of Botswana. This is a case report of a patient on whom a third attempt of re-inserting a CVC for fluid and total parenteral nutrition (TPN) was made. X-ray showed that left Subclavian inserted catheter was mis-directed to internal jugular vein of the same side creating discomfort to the patient. Ultra sound is recommended for routine investigation to confirm proper Central venous catheter placement as it can reduce failure, minimize complication and reduce cost of treatment.

Preoperative fasting times in elective surgical patients at a referral Hospital in Botswana.

INTRODUCTION: Adults and children are required to fast before anaesthesia to reduce the risk of regurgitation and aspiration of gastric contents. However, prolonged periods of fasting are unnecessary and may cause complications. This study was conducted to evaluate preoperative fasting period in our centre and compare it with the ASA recommendations and factors that influence fasting periods. METHODS: This is a cross-sectional study of preoperative fasting times among elective surgical patients. A total numbers of 260 patients were interviewed as they arrived at the reception area of operating theatre using questionnaire. RESULTS: Majority of patients (98.1%) were instructed to fast from midnight. Fifteen patients (5.8%) reported that they were told the importance of preoperative fasting. The mean fasting period were 15.9±2.5 h (range 12.0-25.3 h) for solids and 15.3±2.3 h (range 12.0-22.0 h) for liquids. The mean duration of fasting was significantly longer for patients operated after midday compared to those operated before midday, p<0.001. CONCLUSION: The mean fasting periods were 7.65 times longer for clear liquid and 2.5 times for solids than the ASA guidelines. It is imperative that the Hospital should establish Preoperative fasting policies and teach the staff who should ensure compliance with guidelines.

A young Botswana patient with congenital iris ectropion uvea.

Congenital iris ectropion is a rare condition; non-progressive anomaly characterised by the presence of iris pigment epithelium on the anterior surface of the iris stroma and is frequently associated with anterior iris insertion, dysgenesis of the drainage angle and glaucoma. This paper describes unusual case of bilateral case of congenital iris ectropion in adult patient with pupillary abnormality, normal anterior chamber angle structure and with no evidence of glaucoma.