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Physical, sexual and overall reported interpersonal violence against adult out-patients with severe mental illness under remission, receiving healthcare at Butabika hospital: A cross-sectional study
(2024-12-02)
Interpersonal violence is a significant public health and human rights concern. People living with severe mental illness are especially vulnerable. The Sustainable Development Goals 2030 Agenda aims to end violence. To this end, we gathered information on the prevalenceand factors associated with interpersonal violence among one of the most impacted groups: individuals with severe mental illness at Butabika Hospital in Kampala, Uganda. We con-ducted a cross-sectional study in 2020, including individuals 18 years or older. Data was col- lected through a socio-demographics questionnaire and nine questions from the modifiedMy Exposure to Community Violence Questionnaire. The assessment evaluated physical or sexual violence experience, frequency, and perpetrator identity. The data was analyzedusing STATA version 12 through simple logistic regression to determine the correlation between a single exposure and the outcome of interest, with a significance level of 5%.Among 385 participants, the past year prevalence of overall reported interpersonal violence was about 34%, while physical and sexual reported interpersonal violence were approxi-mately 29% and 11%, respectively. Participants who had perpetrated physical violence had higher odds of experiencing reported interpersonal violence. With increasing age, the oddsof experiencing reported interpersonal violence decreased; compared to those aged 18–24 years, those aged 35–44 years had AOR = 0.31 (95% CI: 0.14–0.70, p = 0.005), and thoseaged 45 years and above had AOR = 0.34 (95% CI: 0.15–0.80, p = 0.013). Reported inter- personal violence was high among the participants. While individuals of older age had lowerodds of reporting interpersonal violence, those who had perpetrated physical violence in the past year had higher odds. Screening for interpersonal violence among young patients isrecommended. Psycho-education on preventing physical violence should be provided, especially to younger adults. The Ministry of Health should address violence against ndividuals with mental illness through mass sensitization. A prospective study could investi- gate risk and protective factors.
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.
Factors influencing utilisation of cervical cancer screening services among HIV positive women attending care and treatment centres in Kinondoni municipality, Dar es Salaam, Tanzania
(African Health Sciences, 2024-07-11) Mashalla, Yohana J.; Kabalimu, Titus K.; Semali, Innocent A.
Background: Cervical cancer is among the leading causes of cancer-related deaths among HIV+ve women. Objective: To determine factors influencing utilisation of cervical cancer screening among HIV+ve women attending Cancer Treatment and Care in Kinondoni Municipality, Dar es Salaam. Methods: Cross-sectional study among HIV+ve women was carried out between September and October 2021; collected using a standardised questionnaire. Descriptive statistics, bivariate and multivariate analyses were used to determine cervical cancer extent and association of predictors of cervical cancer screening. Results: 230 HIV+ve women aged 21–60 years were interviewed. Only 47% had screened for cervical cancer. Low knowledge of HIV+ve as risk significantly associated with less likelihood to screen for cervical cancer [AOR 0.49, 95% CI (0.253-0.957, P = 0.037)]. Parity of 3 or more was twice likely to screen for cervical cancer [AOR 2.124, 95% CI (1.012-4.456, P = 0.046)]; and housewives were 2.5 more likely to screen for cervical cancer [AOR 2.594, 95% CI (1.149-5.853, P = 0.002)]. Lack of knowledge on preventive measures was less associated with likelihood to screen [AOR 0.114, 95% CI (0.013-0.972, P = 0.047)]. Conclusion: Lack of knowledge on HIV+ve and prevention, age and parity are likely to influence utilisation of cervical cancer screening services.
Comparison on treatment outcomes of patients enrolled on anti-retroviral therapy at different levels of the health-care system in a high HIV/AIDS setting.
(Europe PMC, 2023-01-01) Mashalla, Yohana J.
HIV/AIDS prevalence in Botswana is amongst the highest in the world and remains a significant public health problem. however, the introduction of anti-retroviral therapy (ART) lead to a significant reduction in morbidity and mortality. Decentralization of anti-retroviral therapy has improved access to treatment for people living with HIV. Treatment outcomes for patient initiated on treatment at different levels of care is unknown and this study seeks to compare treatment outcomes of patients enrolled on ART at different levels of the health care. This is a retrospective cross-sectional study that included review of data from January 2017 to December 2018. The study was conducted in 2 health districts in the country. Nine hundred and sixty (960) patient's record were included in analysis. More than half (63%) of patients were enrolled at primary care level while 37% were at tertiary level. Sixty one percent (n = 587) were female while 39% (n = 373) were males. There were no statistically significant differences in viral load suppression after 12 months of treatment between patients enrolled at tertiary level and primary care level, x2 = 0.75, p value = 0.56. Time to initiation was longer at tertiary (median = 126) compared to primary are level (median = 18), p < 0.001. We reccommend further decentralization of ART services to lower levels of the health care system to initiate PLWHIV early on treatment and improve their health outcomes and reduce transmission through treatment by prevention.
Prevalence of late antenatal care booking among pregnant women attending public health facilities of Kigamboni Municipality in Dar es Salaam region, Tanzania
(African Health Sciences, 2023-06-02) Mashalla, Yohana J.; Ndomba, Alana; Ntabaye, Moshi K.; Semali, Innocent A.; Kabalimu, Titus K.; Ndossi, Godwin D.
Background: Good care during pregnancy is important for the health of mothers and development of the unborn baby. The study determined the prevalence and factors associated with late ANC booking among pregnant women at health facilities in Kigamboni Municipality in Dar es Salaam, Tanzania.Methods: This was an analytical cross-sectional study among pregnant women attending ANC services during second and third trimester in the selected health facilities. The study recruited 204 through convenient sampling. Multi-stage cluster sampling was used to select health facilities. A Standardised questionnaire was used to collect information through face-to-face interviews. Data was analysed using SPSS version 25.0. Proportions were used to estimate the magnitude of late ANC booking while bivar-iate and multivariate analyses were performed to determine factors associated with the magnitude of late ANC booking. Results: Late ANC bookings were high 174 (85.3%) among pregnant women who attended clinic week 13 and later compared to those who attended earlier than 13 weeks 30 (14.7%). Factors associated with likelihood for late ANC booking during the initial visit included tertiary education [AOR= 10.174, 95%CI: 1.002-103.301] and primigravida [AOR=0.101, 95%CI: 0.170-0.605].Conclusion: Majority of the pregnant women started ANC later than the recommended time. Health education provision at all community levels on the advantages and disadvantages of early and late ANC booking respectively should be strengthened.Keywords: Pregnant women; ANC; booking; parity; education.
Uptake, Adherence and Retention of Daily Oral Pre-Exposure Prophylaxis among Female Sex Workers in the Greater Gaborone City, Botswana
(International STD Research & Reviews, 2023-01-15) Mashalla, Yohana J.
Introduction: Female sex workers are estimated to be 30 times more likely to be living with Human Immuno-deficiency Virus than other women of reproductive age and face an increased burden of sexually transmitted infections. Pre-Exposure Prophylaxis was introduced in Botswana in 2018 as an addition to combination-prevention strategies. Since then, no study was carried out to assess the efficiency of PrEP as an intervention. This study aimed to assess the uptake, adherence and retention of daily oral Pre-Exposure Prophylaxis among female sex workers in the Greater Gaborone City, Botswana. Methods: Retrospective, quantitative cross-sectional study was carried out Between August 2018 and May 2020. Purposive sampling was used to select the study site and exhaustive sampling was used to select recorded participant’s data. Descriptive statistics using Statistical Package for the Social Sciences (version 26), frequency and proportions were used to organise and analyse the data. Multiple regression analyses were performed to assess the association between variables and p =.05 was considered significant. Results: 207 Female sex workers participated in the study. Adherence to Pre-Exposure Prophylaxis was high (72.9%) but retention was low (16.9%). Unemployed female sex workers adhered more to Pre-Exposure Prophylaxis and age group 18-29 was less likely to be retained in the programme. Perception of no longer at substantial risk to Human Immuno-deficiency Virus infection, loss of interest to continue with Pre-Exposure Prophylaxis, drug side effects and busy life schedules were major reasons for non-retention. Conclusions: Lack of motivation challenged effective Pre-Exposure Prophylaxis retention. Widespread messaging to communities and Pre-Exposure Prophylaxis scale-up are necessary to generate demand and support for Pre-Exposure Prophylaxis uptake among Female sex workers.
Sexual Practices among Cobblestone Construction workers in Addis Ababa, Ethiopia: Challenge to the prevention of HIV infection
(Global Journal of Health Science, 2022-07-28) Mashalla, Yohana J.
Background: HIV infection remains a public health challenge. This study assessed sexual practices among casual workers at the Cobblestone construction, Addis Ababa, Ethiopia. Methods: This was a quantitative cross-sectional study carried out among the labourers at the Cobblestone construction sites between October – December 2018. Multi-stage sampling was used to estimate the sample size. Demographic and sexual practice information were collected using a structured questionnaire. Bivariate and multivariate analyses were used to determine associations between variables; P < 0.05 was considered statistically significant. Results: We recruited 627 labourers. Majority (82.2%) were aged between 18 and 38 years; average age at onset of sexual debut was 17.9 ±2.67 and 19.14 ±2.18 years among males and females respectively. Majority (68.5%) were married; exposure to pornography was 40.2% and 32% among male and female respectively. Lifetime multiple sexual practices were prevalent (59.9% and 50.0%) among males and females respectively; extramarital sex was prevalent (66.9%) among males but protected sex was relatively low (46.2%). Being employed significantly associated with likelihood of first exposure to alcohol (P =0.029), level of education, exposure to pornography and knowledge of symptoms of STIs significantly associated with multiple sexual practices. Conclusion: Prevalence of risky sexual practices among the labourers were high which risks them to HIV infections. Innovative approaches to behavioural change are needed to reduce risks of HIV infection. Keywords: Unprotected sex, extramarital sex, multiple partners, HIV, condom
Reduced lung function among sisal processors
(Occupational and environmental medicine, 2011-02-05) Mashalla, Yohana J.
Objectives: The objective of this study was to examine lung function and chronic respiratory symptoms among sisal workers in Tanzania and compare the results with a control group. Methods: A cross-sectional study on chronic respiratory symptoms and lung function was conducted in 2006 among male Tanzanian sisal processing workers from six sisal estates. Participants included 86 workers in decortication departments, 68 workers in brushing departments and 30 low exposed security guards. The response rate was 97%. Chronic respiratory symptoms and background information were obtained by structured interview. Forced ventilatory capacity ( Results: Workers were aged 19-85, with the oldest in the brushing and security departments. Chronic cough and chest tightness were experienced by 38% and 68% of workers in brushing departments, 20% and 6% of workers in decortication and 7% and 0% of security workers, respectively. A reduced FEV( Conclusions: The results indicate a relationship between work in sisal brushing departments and the development of obstructive lung disorders.
Training tomorrow’s global health leaders: applying a transtheoretical model to identify behavior change stages within an intervention for health leadership development
(Global helath promotion, 2014-04-24) Mashalla, Yohana J.
Training health professionals in leadership and management skills is a key component of health systems strengthening in low-resource settings. The importance of evaluating the effectiveness of these programs has received increased attention over the past several years, although such evaluations continue to pose significant challenges. This article presents evaluation data from the pilot year of the Afya Bora Fellowship, an African-based training program to increase the leadership capacity of health professionals. Firstly, we describe the goals of the Afya Bora Fellowship. Then, we present an adaptation of the transtheoretical model for behavior change called the Health Leadership Development Model, as an analytical lens to identify and describe evidence of individual leadership behavior change among training participants during and shortly after the pilot year of the program. The Health Leadership Development Model includes the following: pre-contemplation (status quo), contemplation (testing and internalizing leadership), preparation - (moving toward leadership), action (leadership in action), and maintenance (effecting organizational change). We used data from surveys, in-depth interviews, journal entries and course evaluations as data points to populate the Health Leadership Development Model. In the short term, fellows demonstrated increased leadership development during and shortly after the intervention and reflected the contemplation, preparation and action stages of the Health Leadership Development Model. However, expanded interventions and/or additional time may be needed to support behavior change toward the maintenance stages. We conclude that the Health Leadership Development Model is useful for informing health leadership training design and evaluation to contribute to sustainable health organizational change.
The afya bora fellowship in global health leadership: dual mentorship to strengthen the next generation of African health leaders
(Annals of Global Health, 2015-02) Mashalla, Yohana J.
Program/Project Purpose Mentorship is critical to develop effective leaders. The Afya Bora Fellowship in Global Health Leadership program, a consortium of four African and four U.S. universities formed in 2008, has incorporated a robust dual mentorship component into its training of over 70 fellows. Each Fellow was assigned two mentors to guide professional growth over the fellowship period. Here, we evaluate 39 Fellows’ experiences with their mentors between 2012 and 2014, and identify how these relationships prepare Fellows to lead major health programs in Botswana, Kenya, Tanzania, and Uganda. Structure/Method/Design As part of their 12-month training, Afya Bora Fellows participate in two 4.5 month experiential learning attachments in the African countries. The attachments take place at pre-accredited “attachment sites”, which include governmental (Ministries of Health) and non-governmental organizations (NGOs). Fellows were assigned a Primary Mentor, who is an academic member of the Fellowship Working Group, and a Site Mentor, who is a senior supervisor at the Fellow's attachment site. Mentors assist in providing support to each Fellow to achieve Fellowship objectives and personal goals, and to gain insight into the realities of building a successful career. Evaluations from the Fellows on both mentors were collected once after the first attachment site rotation (January) and again after the second rotation (June). Outcomes & Evaluation Content analysis of Fellow interview and journal data showed Fellows were positively impacted by their relationships with mentors. Key domains of mentor influence included relationship attributes (“friendship and support”), scientific knowledge and skills (“teaching/guiding me on how to conduct official research”), provision of feedback (“he gives constructive feedback to my work every time we meet”), career or other guidance (“she advised me to apply for a job...luckily I was taken for that position”), and professionalism (“keeps his word and time despite busy schedule”). Fellows reported some differences between Site and Primary Mentors. Primary Mentors were better able to provide emotional support for professional issues (“discussed culture shock/adjustment”) and encouragement for Fellows to go outside their comfort zone (“urged me to work tall and take up distinctive tasks...without fear/hesitation”). Site Mentors were better able to serve as an advocate for attachment site assignments (“prepared the ground for orientation, information, and technical assistance from her and other staff”). Going Forward Dual mentorship can provide a rich range of complementary skills and expertise that is valuable to Fellows, including modeling professional behaviors and teaching specific skills. This aspect of the Afya Bora Fellowship is of great value to participants and will continue for future cohorts. Funding The President's Emergency Program for AIDS Relief, Office of AIDS Research, and US Health Resources and Services Administration
Leadership training to build sustainable workforces and improve health in Africa
(Annals of global health, 2016-06) Mashalla, Yohana J.
Presentation and mortality of patients hospitalised with acute heart failure in Botswana
(Cardiovascular Journal of Africa, 2017-04-01) Mashalla, Yohana J.
Introduction: Heart failure is a common cause of hospitalisation and therefore contributes to in-hospital outcomes such as mortality. In this study we describe patient characteristics and outcomes of acute heart failure (AHF) in Botswana. Methods: Socio-demographic, clinical and laboratory data were collected from 193 consecutive patients admitted with AHF at Princess Marina Hospital in Gaborone between February 2014 and February 2015. The length of hospital stay and 30-, 90- and 180-day in-hospital mortality rates were assessed. Results: The mean age was 54 ± 17.1 years, and 53.9% of the patients were male. All patients were symptomatic (77.5% in NYHA functional class III or IV) and the majority (64.8%) presented with significant left ventricular dysfunction. The most common concomitant medical conditions were hypertension (54.9%), human immuno-deficiency virus (HIV) (33.9%), anaemia (23.3%) and prior diabetes mellitus (15.5%). Moderate to severe renal dysfunction was detected in 60 (31.1%) patients. Peripartum cardiomyopathy was one of the important causes of heart failure in female patients. The most commonly used treatment included furosemide (86%), beta-blockers (72.1%), angiotensin converting enzyme inhibitors (67.4%), spironolactone (59.9%), digoxin (22.1%), angiotensin receptor blockers (5.8%), nitrates (4.7%) and hydralazine (1.7%). The median length of stay was nine days, and the in-hospital mortality rate was 10.9%. Thirty-, 90- and 180-day case fatality rates were 14.7, 25.8 and 30.8%, respectively. Mortality at 180 days was significantly associated with increasing age, lower haemoglobin level, lower glomerular filtration rate, hyponatraemia, higher N-terminal pro-brain natriuretic peptide levels, and prolonged hospital stay. Conclusions: AHF is a major public health problem in Botswana, with high in-hospital and post-discharge mortality rates and prolonged hospital stays. Late and symptomatic presentation is common, and the most common aetiologies are preventable and/or treatable co-morbidities, including hypertension, diabetes mellitus, renal failure and HIV.
Health care workers experiences in emergency obstetric care following implementation of an in-service training program: case of 2 Referral Hospitals in Botswana
(African Health Sciences, 2021-05-23) Mashalla, Yohana J.
Background: Maternal mortality rate remains a challenge in many developing countries. Objectives: This study explored experiences of Health Care Workers on Emergency Obstetrics Care (EMOC) in-service training and its effect on maternal mortality. Methods: Descriptive qualitative study design was conducted using in-depth interviews and focus group discussions. Par- ticipants were EMOC trained midwives and doctors purposively selected from the 2 referral hospitals in the country. Data were transcribed verbatim, coded, and analysed using Grounded Theory approach. Results: Four themes emerged including training, EMOC implementation, maternal death factors and EMOC prioritisation. The duration of training was viewed inadequate but responsiveness to and confidence in managing obstetric emergencies improved post EMOC training. Staff shortage, HCWs non-adherence and negative attitude to EMOC guidelines; delays in instituting interventions, inadequate community involvement, minimal or no health talk to women and their partners and communities on sexual reproductive matters and non-prioritisation of EMOC by authorities were concerns raised. Conclusion: Strengthening health education at health facility levels, stakeholders’ involvement; and prioritising EMOC in-service training are necessary in reducing the national maternal mortality. Keywords: Maternal mortality, health care workers, EMOC, in-service training
The utility of a modified WHO TB screening tool among children at a Botswana child welfare clinic
(African Health Sciences, 2021-05-23) Mashalla, Yohana J.
Background: In high TB/HIV settings, the increased risk for TB amongst children exposed to HIV has been established through biomedical tests. Screening HIV exposed children for TB can improve early childhood TB detection and treatment. Objective: This study assessed the utility of a modified World Health Organization (WHO) tool by including HIV variables, to determine TB exposure amongst HIV exposed children presenting to a “Well Child” Clinic (CWC). Methods: Clinical data were obtained from medical records and/or from the caregivers of children presenting to CWC. Data was analyzed to explore factors associated with positive screening for TB, including being exposed to HIV and current HIV status. Results: Five percent (55/1100) screened reported a close TB contact and 21% (n=231) had positive TB symptom screen. History of close TB contact was a risk factor for positive screening for TB symptoms (OR 1.89 CI 1.05-3.4) while being HIV negative was protective (OR 0.3, Cl 0.19-0.62). HIV exposure was associated with increased risk of TB exposure (OR 2.9 CI 1.61-5.19). Conclusion: Integrating HIV variables in the existing WHO screening tool for childhood TB can be useful in early detec- tion and treatment of TB in HIV exposed children in resource limited settings. Keywords: Childhood TB screening, HIV Exposure screening, TB/HIV integration.
Uptake of HIV re-testing among postpartum women who initially tested negative during antenatal visit in ubungo district, dar es salaam
(Global Journal of Health Science, 2022-05-09) Mashalla, Yohana J.; Kabalimu, Titus K.; Semali, Innocent A.; Ntabaye, Moshi K.
Background: It is recommended that HIV re-testing should be done at third trimester, labour and at six months postpartum. Reports indicate low rates of HIV re-testing among women after delivery. The study assessed the uptake of HIV re-testing among women during postpartum after initially testing negative at ANC clinic in Ubungo district, Dar es salaam. Method: A cross-sectional analytical study was conducted among women who delivered during the study period. Data was collected through a standardised questionnaire and secondary data was collected from the Health Information System and ANC cards. SPSS version 28 was used to analyse data. Bivariate and multivaria te logistic regression models were used to calculate the adjusted odds ratio and to quantify the association. Results: 426 women participated in the study. The overall HIV re-testing rate was 76.1%, 23.9% did not re-test and 2.1% were infected with HIV after the second test. Married women have higher re-testing rates (52.8%) than single, separated and divorcees. Women aged 25-34 years have significant higher (84.6%) proportion of re-testing for HIV than those < 25 and those > 34 years of age (p<0.001). Other significant predictors for HIV re-testing were women who made at least five or more visits to ANC and those who knew the HIV status of their partners. Conclusion: HIV re-testing has not reached the Tanzania national target of 95%. Efforts to sensitise communities on the importance of early ANC booking at ANC and re-testing for HIV during labour, delivery and postpartum should be enhanced. Keywords: ANC, HIV testing, postpartum, re-testing, uptake
Filling the Gap for Healthcare Professionals Leadership Training in Africa: The Afya Bora Consortium Fellowship
(Annals of Global Health, 2017-02) 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 interdisciplinarity 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.
Assessment of prescribing practices at the primary healthcare facilities in Botswana with an emphasis on antibiotics: Findings and implications
(International journal of clinical practice, 2017-11-27) Mashalla, Yohana J.; ; Massele, Amos Y.
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.
Anaemia, renal dysfunction and in-hospital outcomes in patients with heart failure in Botswana
(South African Medical Journal, 2018-01-01) 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.
Transition of adolescents with intellectual disability from schools for learners with special educational needs: Parents views for the preparedness
(Journal of Applied Research in Intellectual Disabilities, 2020-06-15) Mashalla, Yohana J.
Background Studies on preparedness of parents of adolescents living with intellectual disabilities transitioning from school to adulthood are scarce in sub-Saharan Africa. This study explored views of parents on their preparedness to handle adolescents transitioning from special schools to adulthood. Methods Descriptive qualitative method was used to collect views of parents of adolescents with intellectual disability on their preparedness to handle transition of their children from school into community life. Content analysis was used to analyse the data. Findings Twelve female and two male participants expressed concerns on lack of transition plans, adolescent's future, culture and beliefs and inadequate community support. Views of parents of younger children and those of parents of older children were similar. Conclusion Parents were unprepared for transition of their children from school to community life. Multidisciplinary approach including family involvement and community support is necessary to enhance the transition of adolescents with intellectual disability.
Training tomorrow’s leaders in global health: impact of the Afya Bora Consortium Fellowship on the careers of its alumni
(BMC medical education, 2016-09-19) Mashalla, Yohana J.
Background Effective leadership is a cornerstone of successful healthcare delivery in resource limited settings throughout the world. However, few programs in Africa prepare healthcare professionals with the leadership skills vital to the success of the healthcare systems in which they work. One such program, the Afya Bora Consortium Fellowship in Global Health Leadership, has been training health professionals since 2011. The purpose of this study was to assess what career changes, if any, the Afya Bora Fellowship’s alumni have experienced since completing the fellowship, and to describe those changes. Methods The Afya Bora Fellowship is a multidisciplinary, one-year training program that teaches health professionals leadership skills through didactic and experiential learning in four African countries. Between January 2011 and June 2013 the consortium trained 42 nurses and doctors. In November 2013, an electronic survey was sent to all alumni to assess their performance in the workplace post-fellowship. Results Thirty-one (74 %) of 42 alumni completed surveys. Twenty-one (68 %) reported changes to their position at work; of those, sixteen (76 %) believed the change was due to participation in the fellowship. All alumni reported improved performance at work, and cited the application of a wide range of fellowship skills, including leadership, research, communication, and mentoring. Twenty-six (84 %) alumni spearheaded improvements in their workplaces and almost all (97 %) remained in contact with colleagues from the fellowship. Among the respondents there were five publications, nine manuscripts in preparation, and three international conference presentations. Conclusions Afya Bora alumni overwhelmingly reported that the one year fellowship positively influenced both their work and career trajectory. Training health professionals in leadership skills through didactic modules with the opportunity to apply learned skills at attachment sites in the Afya Bora Fellowship has an impact on performance in the workplace and the potential to improve long-term institutional capacity.

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