Rapid dynamic changes of FL.2 variant: A case report of COVID-19 breakthrough infection

We investigated intra-host genetic evolution using two SARS-CoV-2 isolates from a fully vaccinated (primary schedule x2 doses of AstraZeneca plus a booster of Pfizer), >70-year-old woman with a history of lymphoma and hypertension who presented a SARS-CoV-2 infection for 3 weeks prior to death due to COVID-19. Two full genome sequences were determined from samples taken 13 days apart with both belonging to Pango lineage FL.2: the first detection of this Omicron sub-variant in Botswana. FL.2 is a sub-lineage of XBB.1.9.1. The repertoire of mutations and minority variants in the Spike protein differed between the two time points. Notably, we also observed deletions within the ORF1a and Membrane proteins; both regions are associated with high T-cell epitope density. The internal milieu of immune-suppressed individuals may accelerate SARS-CoV-2 evolution; hence, close monitoring is warranted.

Knowledge, attitudes and preventive practices towards COVID-19 among workers at two points of entry in South-Eastern Botswana: A cross-sectional study

Introduction

Adherence to control measures and provision of appropriate information at international borders and points of entry (POE) are key to limiting the importation of COVID-19. This study aimed to describe the knowledge, attitudes, and practices (KAPs) of POE staff towards COVID-19 in Botswana.

Methods

This was a cross-sectional study of the COVID-19 KAPs among workers at Tlokweng border and Sir Seretse Khama International Airport (SSKIA) using a self-administered questionnaire. The tool incorporated the participants’ demographics and selected questions on COVID-19 KAPs. Analysis was descriptive. Categorical data were summarized with frequencies while numeric data were summarized with medians and interquartile ranges (IQR). The total knowledge and practice scores of each individual were computed by adding their individual scores for each question. The scores were then categorized according to Bloom’s cutoffs of good (80–100%), moderate (60–79%) and poor (<60%).

Results

A total of 276 individuals participated in the study. Of these, 70 were from Tlokweng border and 206 were from SSKIA. The participants performed worst on questions on the frequency of severe disease and asymptomatic transmission of COVID-19. The attitudes were mainly positive. However, 54.6% of participants thought that the COVID-19 burden is exaggerated. For practice, the worst performance was on social distancing, sanitizing shared surfaces, and going to work while symptomatic. Overall, good and moderate knowledge was observed in 47.8% and 38.0% of participants, respectively. Similarly, good and moderate performance on practices was observed in 63.6% and 24.4% of participants respectively.

Conclusion

The knowledge, attitudes, and practices were generally good at the 2 points of entry. More than 85% of respondents had moderate or good performance on knowledge and practice questions. However, the respondents performed poorly in some key questions. Targeted health information and promotion must address the identified gaps.

May Measurement Month 2018: an analysis of blood pressure screening results from Botswana

During the May Measurement Month 2018 (MMM18) campaign, we aimed to raise hypertension awareness and measure blood pressure (BP) across different communities in Botswana. Study sites included four large villages and Gaborone (capital city). Screening sites were shopping malls, train stations, churches, and workplaces. Individuals aged ≥18 years were recruited through fliers, word of mouth, and as volunteer walk-ins at the sites. Demographic and risk factor data were collected through a questionnaire prior to measuring three BP readings per participant. Weight was measured while height was usually estimated. Hypertension was defined as: systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg or taking antihypertensive medication. The mean of readings 2 and 3 was used and was estimated using multiple imputation where missing. Amongst 4599 participants whose BPs were measured, 54.5% were female, while mean age was 35.9 years. A total of 1510 (32.8%) participants were hypertensive and of those, 712 (47.1%) were aware of the hypertension. Only 35.2% of hypertensives were on antihypertensive treatment with 54.4% had controlled BP. Amongst all hypertensives, only 19.1% had controlled BP. Risk factors associated with higher BP included obesity, more than 1 unit of alcohol/week and BP measured on Sunday. Less than half (47.1%) of those identified as having hypertension during MMM18 were aware of their condition, despite the escalating prevalence of hypertension in the country. Regular BP awareness and opportunistic BP measurement campaigns like MMM are recommended to improve detection and control of hypertension and other cardiovascular risk factors.

Data quality self-assessment of child health and sexual reproductive health indicators in Botswana, 2016-2017

There is no published data on quality of administrative data for various health indicators in Botswana, yet such data are used for policy making and future planning. This article reports on quality of data on child health and sexual and reproductive health (SRH) indicators in Botswana. The main objective of the study was to assess the quality of administrative data from Expanded Immunization Program (EPI) and condom use, Depo-Provera uptake and domiciliary care attendance in Botswana. This was a retrospective study entailing a review of data retrieved from district health records and District Health Information System (DHIS). A total of 30 clinics and health posts were randomly selected from two cities, a town and three rural villages which makes up 6 districts commonly denoted urban, semi-urban and rural respectively. Through a stratified random sampling health facilities were selected. EPI data (Penta 3- third dose of pentavalent vaccine and Measles vaccine) and SRH data (condom use, Depo-Provera uptake and Domiciliary care) were assessed for completeness, discrepancies and verification factor using WHO Routine data quality (RDQA) assessment tool. A verification score of less than 90%% was considered as underreporting while more than 110% is over reporting. However, the score which is within +-10% is acceptable, reliable and a good indicator of data quality and reporting system. About 56% (9/16) SRH indicators had a verification factor score outside the accepted range and 87% (13/15) discrepancy value outside the accepted range. For immunization, 10% (1/10) had a verification factor score outside the accepted range and 33% (3/9) had a discrepancy value outside the accepted range. The level of completeness was high for both Penta3 and Measles coverage and it was lowest for condom. Our findings highlight a poorer data quality for SRH indicators compared to child health indicators. A comprehensive program review drawing lessons from the child health indicators is required to improve the quality of administrative data in Botswana.