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Browsing Journals by Author "Mashalla, Yohana J."

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    Anaemia, renal dysfunction and in-hospital outcomes in patients with heart failure in Botswana
    (2018) Mashalla, Yohana J.
    Background. Anaemia and renal dysfunction are associated with an increased morbidity and mortality in heart failure (HF) patients. Objective. To estimate the frequency and impact of anaemia and renal dysfunction on in-hospital outcomes in patients with HF. Methods. A total of 193 consecutive patients with HF admitted to Princess Marina Hospital, Gaborone, Botswana, from February 2014 to February 2015, were studied. Anaemia was defined as haemoglobin <13 g/dL for men and <12 g/dL for women. Renal dysfunction was defined by an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, calculated by the simplified Modification of Diet in Renal Disease formula. The in-hospital outcomes included length of hospital stay and mortality. Results. The mean (standard deviation (SD)) age was 54.2 (17.1) years and 53.9% of the patients were men. The overall median eGFR was 75.9 mL/min/1.73 m2 and renal dysfunction was detected in 60 (31.1%) patients. Renal dysfunction was associated with hypertension (p=0.01), diabetes mellitus (p=0.01) and a lower haemoglobin level (p=0.008). The mean (SD) haemoglobin was 12.0 (3.0) g/dL and 54.9% of the patients were anaemic. Microcytic, normocytic and macrocytic anaemia were found in 32.1%, 57.5% and 10.4% of patients, respectively. The mean (SD) haemoglobin level for males was significantly higher than for females (12.4 (3.3) g/dL v. 11.5 (2.5) g/dL; p=0.038). Anaemia was more common in patients with diabetes (p=0.028) and in those with increased left ventricular ejection fraction (p=0.005). Neither renal dysfunction nor anaemia was significantly associated with the length of hospital stay or in-hospital mortality. Conclusion. Anaemia and renal dysfunction are prevalent in HF patients, but neither was an independent predictor of length of stay or in-hospital mortality in this population. These findings indicate that HF data in developed countries may not apply to countries in sub- Saharan Africa, and call for more studies to be done in this region.
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    Assessment of prescribing practices at the primary healthcare facilities in Botswana with an emphasis on antibiotics: Findings and implications
    (International journal of clinical practice, 2017) Mashalla, Yohana J.
    Background and Aims: Inappropriate drug prescribing has increased especially in developing countries where systems for monitoring medicine use are not well developed. This increases the rate of antimicrobial resistance. The study aim was to assess the prescribing patterns among urban primary health facilities in Botswana to provide future guidance including developing future quality indicators. Methods: Retrospective data from patients’ records between January and December 2013 in 19 clinics were collected in a cross-sectional study. The WHO/International Network for Rational Use of Drugs indicators were used to assess prescribing patterns in the study clinics. Results: Average number of drugs per prescription was 2.8; 78.6% of the prescribed antibiotics were by International Non-proprietary Name and 96.1% complied with the Botswana Essential Drugs List. Overall rate of antibiotic prescribing was high (42.7%) with 14.7%, 5.9% and 1.3% of prescriptions having two, three and four antibiotics, respectively. Systemic antibiotics (JO1C) accounted for 45.4% of prescribed antibiotics of which amoxicillin accounted for 28.4% and metronidazole 14.4% of all antibiotic prescriptions. There was low use of co-amoxiclav (0.3% of all antibiotic prescriptions). Third generation cephalosporins and macrolides accounted for 9.8% and 6.2% of antibiotic prescriptions respectively, with no prescribing of fluoroquinolones. The majority of indications (87%) for antibiotic prescriptions were according to ICD classification. Conclusions: While most indications for antibiotic prescriptions were based on signs and symptoms according to ICD, antibiotic prescribing rates were high with some conditions not requiring antibiotics because they are viral infections. There is a need to further improve prescribing practices through induction and training of in-service prescribers. An effective management tool for monitoring antibiotic prescribing practices at Primary Health Care facilities should be designed and implemented, including developing robust quality indicators.
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    Filling the gap for healthcare proffessionals leadership training in Africa: the Afya bora consortium fellowship
    (Annals of Global Health, 2017) Mashalla, Yohana J.
    Program/Project Purpose: The Afya Bora Consortium is a partnership of five African and four U.S. universities with the mission of providing future global health leaders with advanced skills that are beyond the traditional patient-centered training programs for healthcare professionals. Each year, an interdisciplinary group of twenty physicians, nurses and public health professionals participate in a 12-month African-based intensive fellowship to improve skills in leadership, resource management, program monitoring and evaluation, implementation, and applied research. Structure/Method/Design: The Afya Bora Fellowship provides leadership training in the form of eight in-person and four online modules as well as two 4.5-month mentored attachments at governmental and non-governmental organizations in Botswana, Cameroon, Kenya, Tanzania, and Uganda. The fellows come together during three, month-long highly interactive sessions held in different African countries during which interdisciplinary and multinational learning is encouraged. Afya Bora Fellows complete evaluations of the modules and program as well as self-assessments of learning throughout the year. Data presented here are from all cohorts since 2011 using qualitative analysis of personal reflection reports. Outcome & Evaluation: Fellows described multiple training gaps the fellowship helped fill. Fellows reported that increased skills in communication would help them to better motivate and align others to address pressing problems in their healthcare systems. Improved understanding of and capacity to use data for programmatic purposes was also identified as essential to their ongoing leadership. Fellows reported that their organizational and management abilities had improved both from didactic learning and modeling of program faculty and staff. Finally, fellows reported that the rich cohort experience provided them with an added appreciation of the advantages of inter disciplinarity when solving problems. Going Forward: Well-structured and targeted leadership training is necessary to fill the gaps in traditional medical and nursing education programs. Such training can catalyze healthcare professionals to become more effective in leadership and improve the healthcare systems in their countries while not contributing to “brain drain” (all fellows thus far have remained in their respective countries). The Afya Bora Fellowship can serve as a model for training and research institutions as well as organizations in resource-limited settings to sustainably strengthen human resource capacity to lead and improve health systems.