Last data update: Jun 03, 2024. (Total: 46935 publications since 2009)
Records 1-5 (of 5 Records) |
Query Trace: Legwaila K [original query] |
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Quality assurance of prevention of mother-to-child transmission of HIV in Botswana
Matambo S , Machakaire E , Motswere-Chirwa C , Legwaila K , Letsholathebe V , Dintwa E , Lu L , Voetsch AC , Glenshaw M . Afr J Midwifery Womens Health 2014 8 (3) 130-133 The HIV prevalence rate among pregnant women is 37% in Botswana. According to UNICEF (2011), maternal and under-5 mortality rates in Botswana were 160 per 100000 live births and 26 per 1000 live births, respectively. Therefore, this study sought to identify the effects of ongoing clinic audits of the prevention of mother-to-child transmission of HIV (PMTCT) in Francistown, Botswana for the period 2008–2012. | Methods: | Existing data for all women attending antenatal and postnatal clinics were collected and collated manually from monthly from clinic PMTCT registers. | Results: | There were 19 720 new antenatal clinic visits between 2008 and 2012 with an HIV prevalence of 35% among the women. Mother-to-child transmission of HIV decreased from 3% in 2008 to 1% in 2012. The decrease was due, in part, to the introduction of triple antiretroviral prophylaxis/antiretroviral therapy (TAP/ARV) (PMTCT Option B) in 2011. | Conclusions: | Audit results over a 5-year period showed a steady improvement in the cascade of PMTCT interventions. Clinic audits should be implemented nationally to reduce maternal and under-5 mortality. |
Monitoring prevention of mother-to-child transmission in Botswana
Legwaila K , Motswere-Chirwa C , Matambo S , Kolobe T , Jimbo W , Keapoletswe K , Letsholathebe V , Lu L . Afr J Midwifery Womens Health 2014 8 (2) 73-75 BACKGROUND: In Botswana, the prevention of mother-to-child transmission (PMTCT) programme has succeeded in reducing rates of transmission of HIV from mother to child since the start of the national antiretroviral (ARV) programme in 2002. METHODS: Data on PMTCT interventions for women who delivered at Nyangabgwe Referral Hospital (NRH), the second largest hospital in Botswana, from 2003 to 2012 were collected from maternity registers. RESULTS: Of 46,354 women, 33% were HIV-positive, 58% were HIV-negative, and 9% were not tested. The percentage of women with a known HIV status increased from 50% in 2003 to 97% in 2012. PMTCT uptake for women on any ARV increased from 61% in 2003 to 86% in 2012. Infants given azidothymidine (AZT) and nevirapine prophylaxis increased from 61% to 85%. CONCLUSIONS: Review of maternity registers demonstrated improvement of multiple PMTCT interventions at NRH. This is a useful approach for monitoring programme quality and guiding strategic planning. |
Follow-up of infants diagnosed with HIV - Early Infant Diagnosis Program, Francistown, Botswana, 2005-2012
Motswere-Chirwa C , Voetsch A , Lu L , Letsholathebe V , Lekone P , Machakaire E , Legwaila K , Matambo S , Maruping M , Kolobe T , Petlo C , Lebelonyane R , Glenshaw M , Dale H , Davis M , Halabi SE , Pelletier A . MMWR Morb Mortal Wkly Rep 2014 63 (7) 158-60 The 2011 prevalence of human immunodeficiency virus (HIV) among pregnant women in Botswana was 30.4%. High coverage rates of HIV testing and antiretroviral prophylaxis have reduced the rate of mother-to-child transmission of HIV in Botswana from as high as 40% with no prophylaxis to <4% in 2011. In June 2005, the national Early Infant Diagnosis (EID) Program began testing HIV-exposed infants (i.e., those born to HIV-infected mothers) for HIV using polymerase chain reaction (PCR) at 6 weeks postpartum. During 2005-2012, follow-up of all HIV-infected infants diagnosed in all 13 postnatal care facilities in Francistown, Botswana, was conducted to ascertain patient outcomes. A total of 202 infants were diagnosed with HIV. As of September 2013, 82 (41%) children were alive and on antiretroviral therapy (ART), 79 (39%) had died, and 41 (20%) were either lost to follow-up, had transferred, or their mothers declined ART. Despite success in preventing mother-to-child transmission in Botswana, results of the EID program highlight the need for early diagnosis of HIV-infected infants, prompt initiation of ART, and retention in care. |
Case-control study to determine risk factors for diarrhea among children during a large outbreak in a country with a high prevalence of HIV infection
Arvelo W , Kim A , Creek T , Legwaila K , Puhr N , Johnston S , Masunge J , Davis M , Mintz E , Bowen A . Int J Infect Dis 2010 14 (11) e1002-7 OBJECTIVES: Between January and March of 2006, over 35,000 diarrhea cases and 532 deaths were reported among children aged <5 years in Botswana. We conducted an investigation to characterize the outbreak, identify risk factors for diarrhea, and recommend control strategies. METHODS: We enrolled children <5 years of age presenting to the emergency department between March 2 and March 20, 2006. Cases had ≥3 loose stools per day and no antecedent diarrhea among household members. Controls had had no diarrhea since January 1, 2006. We conducted a multivariate logistic regression analysis controlling for socioeconomic status, age, and maternal HIV status. RESULTS: Forty-nine cases with median age of 12 months (range 0-45 months) and 61 controls with median age of 24 months (range 0-59 months) were enrolled; 33 (30%) were born to HIV-positive mothers. Case-parents were more likely to report storing household drinking water (adjusted odds ratios (AOR) 3.9, 95% confidence interval (CI) 1.2-15.7). Lack of hand washing after using the toilet or latrine (AOR 4.2, 95% CI 1.1-20.4) was more likely to be reported by case-parents. Case-children were less likely to be currently breastfeeding (AOR 30.3, 95% CI 2.0-1000.0). Five (10%) case-patients and no control-patients died. Multiple causal pathogens were identified. CONCLUSIONS: During this diarrhea outbreak in a country with a national program to prevent mother-to-child transmission of HIV, ill children were less likely to be breastfed and more likely to have been exposed to environmental factors associated with fecal contamination. These findings underscore the importance of adequate access to safe water, sanitation, hygiene, and nutrition education among populations using breast milk substitutes. |
Hospitalization and mortality among primarily non-breastfed children during a large outbreak of diarrhea and malnutrition in Botswana, 2006
Creek TL , Kim A , Lu L , Bowen A , Masunge J , Arvelo W , Smit M , Mach O , Legwaila K , Motswere C , Zaks L , Finkbeiner T , Povinelli L , Maruping M , Ngwaru G , Tebele G , Bopp C , Puhr N , Johnston SP , Dasilva AJ , Bern C , Beard RS , Davis MK . J Acquir Immune Defic Syndr 2009 53 (1) 14-9 BACKGROUND: In 2006, a pediatric diarrhea outbreak occurred in Botswana, coinciding with heavy rains. Surveillance recorded a 3 times increase in cases and a 25 fold increase in deaths between January and March. Botswana has high HIV prevalence among pregnant women (33.4% in 2005), and an estimated 35% of all infants under the age of 6 months are not breastfed. METHODS: We followed all children <5 years old with diarrhea in the country's second largest referral hospital at the peak of the outbreak by chart review, interviewed mothers, and conducted laboratory testing for HIV and enteric pathogens. RESULTS: Of 153 hospitalized children with diarrhea, 97% were <2 years old; 88% of these were not breastfeeding. HIV was diagnosed in 18% of children and 64% of mothers. Cryptosporidium and enteropathogenic Escherichia coli were common; many children had multiple pathogens. Severe acute malnutrition (kwashiorkor or marasmus) developed in 38 (25%) patients, and 33 (22%) died. Kwashiorkor increased risk for death (relative risk 2.0; P = 0.05); only one breastfeeding child died. Many children who died had been undersupplied with formula. CONCLUSIONS: Most of the severe morbidity and mortality in this outbreak occurred in children who were HIV negative and not breastfed. Feeding and nutritional factors were the most important determinants of severe illness and death. Breastfeeding is critical to infant survival in the developing world, and support for breastfeeding among HIV-negative women, and HIV-positive women who cannot formula feed safely, may prevent further high-mortality outbreaks. |
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