Research articles (Dept of Internal Medicine)http://hdl.handle.net/10311/12512024-03-29T10:22:44Z2024-03-29T10:22:44ZProphylactic antibiotics to prevent surgical site infections in Botswana: findings and implicationsMwita, Julius C.Souda, SajiniMagafu, Mgaywa G. M. D.Massele, AmosGodman, BrianMwandri, Michaelhttp://hdl.handle.net/10311/22682022-01-13T00:00:46Z2018-03-23T00:00:00ZProphylactic antibiotics to prevent surgical site infections in Botswana: findings and implications
Mwita, Julius C.; Souda, Sajini; Magafu, Mgaywa G. M. D.; Massele, Amos; Godman, Brian; Mwandri, Michael
Background and aims: Antibiotic prophylaxis in surgery is known to reduce the rate of surgical site infections (SSI) as well as shorten hospital stay. However, there is currently a scarcity of data on antibiotic prophylaxis and SSIs among African countries including Botswana. Consequently, this study aimed to address this.
Methods: A prospective study involving 400 patients was carried out at a leading tertiary hospital in Botswana from 2014–2015. Patients’ demographic information, type of surgery performed and peri-operative use of antibiotics were documented. All enrolled patients were followed-up for 30 days post discharge to fully document the incidence of SSIs.
Results: Median age of patients was 35.5 (25 – 50) years, with 52% female. There were 35.8% emergency and 64.2% elective surgeries. The most common operations were exploratory laparotomy (25%), appendectomy (18.3%), excision, and mastectomy (8%). Antibiotics were given in 73.3% of patients, mainly postoperatively (58.3%). The most commonly prescribed antibiotics were cefotaxime (80.7%), metronidazole (63.5%), cefradine (13.6%) and amoxicillin/clavulanate (11.6%). The incidence of SSI was 9%. The most common organisms were Pseudomonas aeruginosa, Staphylococcus aureus, and coagulase-negative staphylococci.
Conclusion: The rate of SSI is a concern, and may be related to inappropriate antibiotic prophylaxis given post operatively. Interventions are in place to decrease SSI rates to acceptable levels in this leading hospital by improving for instance infection prevention practices including the timing of antibiotic prophylaxis. Research is also ongoing among other hospitals in Botswana to reduce SSI rates building on these findings.
2018-03-23T00:00:00ZGlobal Burden of Cardiovascular Diseases and Risk Factors, 1990–2019: update from the GBD 2019 StudyRoth, Gregory A.Mensah, GeorgeJohnson, CatherineAddolorato, GiovanniAmmirati, EnricoBaddour, Larry M.GBD-NHLBI-JACC Global Burden of Cardiovascular Diseases Writing GroupRwegerera, Godfrey Mutashambarahttp://hdl.handle.net/10311/20862021-03-28T00:00:49Z2020-12-11T00:00:00ZGlobal Burden of Cardiovascular Diseases and Risk Factors, 1990–2019: update from the GBD 2019 Study
Roth, Gregory A.; Mensah, George; Johnson, Catherine; Addolorato, Giovanni; Ammirati, Enrico; Baddour, Larry M.; GBD-NHLBI-JACC Global Burden of Cardiovascular Diseases Writing Group; Rwegerera, Godfrey Mutashambara
Cardiovascular diseases (CVDs), principally ischemic heart disease (IHD) and stroke, are the leading cause of
global mortality and a major contributor to disability. This paper reviews the magnitude of total CVD burden,
including 13 underlying causes of cardiovascular death and 9 related risk factors, using estimates from the
Global Burden of Disease (GBD) Study 2019. GBD, an ongoing multinational collaboration to provide
comparable and consistent estimates of population health over time, used all available population-level data
sources on incidence, prevalence, case fatality, mortality, and health risks to produce estimates for 204
countries and territories from 1990 to 2019. Prevalent cases of total CVD nearly doubled from 271 million (95% uncertainty interval [UI]: 257 to 285 million) in 1990 to 523 million (95% UI: 497 to 550 million) in 2019, and the number of CVD deaths steadily increased from 12.1 million (95% UI:11.4 to 12.6 million) in 1990, reaching 18.6 million (95% UI: 17.1 to 19.7 million) in 2019. The global trends for disability-adjusted life years (DALYs) and years of life lost also increased significantly, and years lived with disability doubled from 17.7 million (95% UI: 12.9 to 22.5 million) to 34.4 million (95% UI:24.9 to 43.6 million) over that period. The total number of DALYs due to IHD has risen steadily since 1990, reaching 182 million (95% UI: 170 to 194 million) DALYs, 9.14 million (95% UI: 8.40 to 9.74 million) deaths in the year 2019, and 197 million (95% UI: 178 to 220 million) prevalent cases of IHD in 2019. The total number of DALYs due to stroke has risen steadily since 1990, reaching 143 million (95% UI: 133 to 153 million) DALYs, 6.55 million (95% UI: 6.00 to 7.02 million) deaths in the year 2019, and 101 million (95% UI: 93.2 to 111 million) prevalent cases of stroke in 2019.
Cardiovascular diseases remain the leading cause of disease burden in the world. CVD burden continues its
decades-long rise for almost all countries outside high-income countries, and alarmingly, the age-standardized
rate of CVD has begun to rise in some locations where it was previously declining in high-income countries.
There is an urgent need to focus on implementing existing cost-effective policies and interventions if the world
is to meet the targets for Sustainable Development Goal 3 and achieve a 30% reduction in premature mortality
due to noncommunicable diseases.
2020-12-11T00:00:00ZFive insights from the Global Burden of Disease Study 2019GBD 2019 Viewpoint Collaboratorshttp://hdl.handle.net/10311/20852021-03-28T00:00:38Z2020-10-17T00:00:00ZFive insights from the Global Burden of Disease Study 2019
GBD 2019 Viewpoint Collaborators
The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a rules-based synthesis of the available evidence on levels and trends in health outcomes, a diverse set of risk factors, and health system responses. GBD 2019 covered 204 countries and territories, as well as first administrative level disaggregations for 22 countries, from 1990 to 2019. Because GBD is highly standardised and comprehensive, spanning both fatal and non-fatal outcomes, and uses a mutually exclusive and collectively exhaustive list of hierarchical disease and injury causes, the study provides a powerful basis for detailed and broad insights on global health trends and emerging challenges. GBD 2019 incorporates data from 281 586 sources and provides more than 3·5 billion estimates of health outcome and health system measures of interest for global, national, and subnational policy dialogue. All GBD estimates are publicly available and adhere to the Guidelines on Accurate and Transparent Health Estimate Reporting. From this vast amount of information, five key insights that are important for health, social, and economic development strategies have been distilled. These insights are subject to the many limitations outlined in each of the component GBD capstone papers.
2020-10-17T00:00:00ZAntimicrobial utilization research and activities in Botswana, the past, present and the futureTiroyakgosi, CeldaMatome, MatshedisoKgatlwane, JoyceParamadhas, Bene D AnandMalone, BrighidMpinda-Joseph, PinkieRwegerera, Godfrey MutashambaraMaika, KeamogetseMashalla, YohanaGodman, BrianMaselle, Amoshttp://hdl.handle.net/10311/20842021-03-27T00:00:45Z2019-09-23T00:00:00ZAntimicrobial utilization research and activities in Botswana, the past, present and the future
Tiroyakgosi, Celda; Matome, Matshediso; Kgatlwane, Joyce; Paramadhas, Bene D Anand; Malone, Brighid; Mpinda-Joseph, Pinkie; Rwegerera, Godfrey Mutashambara; Maika, Keamogetse; Mashalla, Yohana; Godman, Brian; Maselle, Amos
A number of activities are ongoing to reduce AMR in Botswana by improving antimicrobial utilization
across all sectors. However, there is a need to share experiences. With the objective of sharing these,
the second one day symposium was held in the University of Botswana in October 2018 involving both
private and public hospitals. In Lenmed Bokamoso hospital, ESKAPE organisms were associated with 50-
90% of clinical infections; however, there was no correlation between healthcare associated infections
(HAIs) and admission swab positivity with ESKAPE or ESBL isolates. Hang times, the time between
a prescription and IV administration, were also discussed. At Nyangabwe Hospital, the prevalence of
HAIs was 13.54%, 48.9% were laboratory confirmed of which 8.5% were blood stream infections (BSIs).
The prevalence of different bacteria causing neonatal BSIs was also investigated. At Princess Marina
Hospital, positive cultures were seen in 22.4% of blood cultures with contaminants comprising the
majority. Several activities are ongoing in Botswana across sectors as a result of the findings and will be
periodically reported to further improve antibiotic utilization.
2019-09-23T00:00:00Z