Factors influencing malnutrition among children under 5 years of age in Kweneng West District of Botswana

The purpose of this study was to identify and determine the risk factors for malnutrition among children under the age of 5 years in Kweneng West District of Botswana. A case control study was conducted. The cases consisted of 37 underweight children under the age of 5 (n=37), and the controls consisted of 76 children less than 5 years of age (n=76) recruited concurrently among the under-five children attending Letlhakeng Child Welfare Clinic on a monthly basis. The controls were of good nutritional status. Data collection was done using a combination of a review of records (child welfare clinic registers, and child welfare clinic cards) and structured questionnaires. Following placement of the data in regression models, the factors that were found to be significantly associated with child malnutrition were small number of daily meals taken by the child (Adjusted OR=19.04, 95% CI 3.24-112.13), lack of knowledge of methods of prevention of child malnutrition by the parent (Adjusted OR=4.71, 95% CI 1.41-15.82), parent’s unemployment (Adjusted OR=50.3, 95% CI 4.86-52.1), low birth weight (Adjusted OR=12.34, 95% CI 2.76-55.02), inadequate Vitamin A supplementation (Adjusted OR=13.27, 95% CI 1.94-90.46), child illness (OR=20.95, 95% CI 7.55-58.10), and child raised by a guardian (Adjusted OR=5.67, 95% CI 1.30-24.73). The findings from this study suggest that Socio-economic factors such as unemployment, a lack of knowledge about recommended infant and child feeding practices, the child raised by a guardian, and health-related factors such as low birth weight, inadequate Vitamin A supplementation, and child illness are predictors of malnutrition in under five. Therefore, increasing household food security and reinforcing educational interventions could contribute to a reduction in the prevalence of child malnutrition in the districtHealth StudiesM.A. (Public Health

Population uptake of HIV testing, treatment, viral suppression, and male circumcision following a community-based intervention in Botswana (Ya Tsie/BCPP): a cluster-randomised trial

BACKGROUND: In settings with high HIV prevalence and treatment coverage, such as Botswana, it is unknown whether uptake of HIV prevention and treatment interventions can be increased further. We sought to determine whether a community-based intervention to identify and rapidly treat people living with HIV, and support male circumcision could increase population levels of HIV diagnosis, treatment, viral suppression, and male circumcision in Botswana. METHODS: The Ya Tsie Botswana Combination Prevention Project study was a pair-matched cluster-randomised trial done in 30 communities across Botswana done from Oct 30, 2013, to June 30, 2018. 15 communities were randomly assigned to receive HIV prevention and treatment interventions, including enhanced HIV testing, earlier antiretroviral therapy (ART), and strengthened male circumcision services, and 15 received standard of care. The first primary endpoint of HIV incidence has already been reported. In this Article, we report findings for the second primary endpoint of population uptake of HIV prevention services, as measured by proportion of people known to be HIV-positive or tested HIV-negative in the preceding 12 months; proportion of people living with HIV diagnosed and on ART; proportion of people living with HIV on ART with viral suppression; and proportion of HIV-negative men circumcised. A longitudinal cohort of residents aged 16-64 years from a random, approximately 20% sample of households across the 15 communities was enrolled to assess baseline uptake of study outcomes; we also administered an end-of-study survey to all residents not previously enrolled in the longitudinal cohort to provide study end coverage estimates. Differences in intervention uptake over time by randomisation group were tested via paired Student's t test. The study has been completed and is registered with ClinicalTrials.gov (NCT01965470). FINDINGS: In the six communities participating in the end-of-study survey, 2625 residents (n=1304 from standard-of-care communities, n=1321 from intervention communities) were enrolled into the 20% longitudinal cohort at baseline from Oct 30, 2013, to Nov 24, 2015. In the same communities, 10 791 (86%) of 12 489 eligible enumerated residents not previously enrolled in the longitudinal cohort participated in the end-of-study survey from March 30, 2017, to Feb 25, 2018 (5896 in intervention and 4895 in standard-of-care communities). At study end, in intervention communities, 1228 people living with HIV (91% of 1353) were on ART; 1166 people living with HIV (88% of 1321 with available viral load) were virally suppressed, and 673 HIV-negative men (40% of 1673) were circumcised in intervention communities. After accounting for baseline differences, at study end the proportion of people living with HIV who were diagnosed was significantly higher in intervention communities (absolute increase of 9% to 93%) compared with standard-of-care communities (absolute increase of 2% to 88%; prevalence ratio [PR] 1·08 [95% CI 1·02-1·14], p=0·032). Population levels of ART, viral suppression, and male circumcision increased from baseline in both groups, with greater increases in intervention communities (ART PR 1·12 [95% CI 1·07-1·17], p=0·018; viral suppression 1·13 [1·09-1·17], p=0·017; male circumcision 1·26 [1·17-1·35], p=0·029). INTERPRETATION: It is possible to achieve very high population levels of HIV testing and treatment in a high-prevalence setting. Maintaining these coverage levels over the next decade could substantially reduce HIV transmission and potentially eliminate the epidemic in these areas. FUNDING: US President's Emergency Plan for AIDS Relief through the Centers for Disease Control and Prevention

High HIV-1 RNA among Newly Diagnosed People in Botswana

International audienc

Cross-sectional estimates revealed high HIV incidence in Botswana rural communities in the era of successful ART scale-up in 2013-2015.

BACKGROUND:Botswana is close to reaching the UNAIDS "90-90-90" HIV testing, antiretroviral treatment (ART), and viral suppression goals. We sought to determine HIV incidence in this setting with both high HIV prevalence and high ART coverage. METHODS:We used a cross-sectional approach to assessing HIV incidence. A random, population-based sample of adults age 16-64 years was enrolled in 30 rural and peri-urban communities as part of the Botswana Combination Prevention Project (BCPP), from October 2013 -November 2015. Data and samples from the baseline household survey were used to estimate cross-sectional HIV incidence, following an algorithm that combined Limiting-Antigen Avidity Assay (LAg-Avidity EIA), ART status (documented or by testing ARV drugs in plasma) and HIV-1 RNA load. The LAg-Avidity EIA cut-off normalized optical density (ODn) was set at 1.5. The HIV-1 RNA cut-off was set at 400 copies/mL. For estimation purposes, the Mean Duration of Recent Infection was 130 days and the False Recent Rate (FRR) was evaluated at values of either 0 or 0.39%. RESULTS:Among 12,610 individuals participating in the baseline household survey, HIV status was available for 12,570 participants and 3,596 of them were HIV positive. LAg-Avidity EIA data was generated for 3,581 (99.6%) of HIV-positive participants. Of 326 participants with ODn ≤1.5, 278 individuals were receiving ART verified through documentation and were considered to represent longstanding HIV infections. Among the remaining 48 participants who reported no use of ART, 14 had an HIV-1 RNA load ≤400 copies/mL (including 3 participants with ARVs in plasma) and were excluded, as potential elite/viremic controllers or undisclosed ART. Thus, 34 LAg-Avidity-EIA-recent, ARV-naïve individuals with detectable HIV-1 RNA (>400 copies/mL) were classified as individuals with recent HIV infections. The annualized HIV incidence among 16-64 year old adults was estimated at 1.06% (95% CI 0.68-1.45%) with zero FRR, and at 0.64% (95% CI 0.24-1.04%) using a previously defined FRR of 0.39%. Within a subset of younger individuals 16-49 years old, the annualized HIV incidence was estimated at 1.29% (95% CI 0.82-1.77%) with zero FRR, and at 0.90% (95% CI 0.42-1.38%) with FRR set to 0.39%. CONCLUSIONS:Using a cross-sectional estimate of HIV incidence from 2013-2015, we found that at the time of near achievement of the UNAIDS 90-90-90 targets, ~1% of adults (age 16-64 years) in Botswana's rural and peri-urban communities became HIV infected annually

Mapping of HIV-1C Transmission Networks Reveals Extensive Spread of Viral Lineages Across Villages in Botswana Treatment-as-Prevention Trial

Abstract Background Phylogenetic mapping of HIV-1 lineages circulating across defined geographical locations is promising for better understanding HIV transmission networks to design optimal prevention interventions. Methods We obtained near full-length HIV-1 genome sequences from people living with HIV (PLWH), including participants on antiretroviral treatment in the Botswana Combination Prevention Project, conducted in 30 Botswana communities in 2013\textendash 2018. Phylogenetic relationships among viral sequences were estimated by maximum likelihood. Results We obtained 6078 near full-length HIV-1C genome sequences from 6075 PLWH. We identified 984 phylogenetically distinct HIV-1 lineages (molecular HIV clusters) circulating in Botswana by mid-2018, with 2\textendash 27 members per cluster. Of these, dyads accounted for 62%, approximately 32% (n\hspace0.25em=\hspace0.25em316) were found in single communities, and 68% (n\hspace0.25em=\hspace0.25em668) were spread across multiple communities. Men in clusters were approximately 3 years older than women (median age 42 years, vs 39 years; P\hspace0.25em<\hspace0.25em.0001). In 65% of clusters, men were older than women, while in 35% of clusters women were older than men. The majority of identified viral lineages were spread across multiple communities. Conclusions A large number of circulating phylogenetically distinct HIV-1C lineages (molecular HIV clusters) suggests highly diversified HIV transmission networks across Botswana communities by 2018

Pre- and post-Marinoan carbonate facies of the Democratic Republic of the Congo: Glacially- or tectonically-influenced deep-water sediments?

The upper carbonate-rich parts of theWest Congo Supergroup (~1000-560 Ma) fromthe Democratic Republic of the Congo have hitherto been considered as a record of abrupt eustatic and climatic events accompanying glaciation and deglaciation of a Snowball Earth-type Marinoan ice age that was of global extent. These strata have however never been investigated in detail. Results of new sedimentological work at key outcrops over a 1300 km outcrop belt show that pre -and post-Marinoan carbonates are respectively, storm-influenced sediments deposited principally in a midouter-ramp setting, and deep-water slope carbonates (calicturbidites) representing a lobe-fringe or levee-overbank setting. The Upper Diamictite Formation held previously by some to be a subglacial tillite, comprises gravity flows (debrites) deposited in deep water below wave base along the unstable margins of a carbonate ramp. A direct glacial influence on sedimentation for diamictites or any accompanying facies cannot be readily identified. Sedimentary facies reported here primarily record the presence of deep-water submarine to alluvial fan systems related to extensional tectonic processes of the central-southern Macaúbas Basin (now located in Brazil) between 700 Ma and 660 Ma followed by the 630-Ma onset of the pre-collisional magmatic arc in the Araçuaí-West Congo Orogen. No extreme short-lived climatic or eustatic events of a Snowball Earth-type ice age are recorded in the studied succession, which primarily reflects longterm overriding regional tectonic controls resulting in diachronous sedimentation along the western margin of the Congo Craton.SCOPUS: ar.jinfo:eu-repo/semantics/publishe