Search

This paper discusses energy status of Botswana and the environmental concerns associated with the production of energy. It was offered in response to the growing concerns in industry about the need for the conservation of energy and for combating the increasing environmental degradation. Accomplishing vitality proficiency and diminishing ecological contamination are progressively essential parts of expert designing. The paper is meant to address top to bottom comprehension of basic issues of energy thrift and environmental consequences of irrational use of energy resources in industry. There is need for up to date technical knowledge and skills required for achieving the better management of energy, designing of energy-efficient systems and processes and the reduction and control of pollution cost-effectively. This information can successfully be coordinated to different segments of the economy for application and help the divisions in enhancing their aggressiveness despite lessening assets, likely considerable increment in unit vitality costs and the urgent requirement to comply with the increasingly-restrictive pollution-control standards.

The effect of spray drying process parameters (i.e., inlet temperature, atomization pressure, and feed flow rate) on the denaturation of whey proteins of skimmed camel milk was studied using a face-centered central composite design. Spray drying of skimmed camel milk (i.e., total solids of 8.4% [w/w]) produced powders with a total solids content of 94–97% (w/w), protein 22–29% (w/w) and lactose 27–31% (w/w). The process was optimized using response surface methodology in combination with desirability function. A maximum recovery of 61% of the total solids was achieved while still maintaining denaturation of whey protein and insolubility index levels at their minimum possible value of 39% and 0.1 mL, respectively. The final moisture content of the powder at these conditions was 3.3% (w/w). This implies that, as denaturation was the primary mechanism by which camel milk lose its protective proteins, minimizing denaturation would make it possible to produce skimmed camel milk powders with good nutritional and therapeutic values. The morphology of spray-dried skimmed camel milk processed at 140°C showed greater spherical intact particles than their cow milk powder counterparts.

This research explores the application of Artificial Intelligence (AI) techniques to assess the mechanical properties of geopolymer concrete made from a blend of Banana Peel-Ash (BPA) and Sugarcane Bagasse Ash (SCBA), using a sodium silicate (Na 2 SiO 3 ) to sodium hydroxide (NaOH) ratio ranging from 1.5 to 3. Utilizing three AI methodologies-Artificial Neural Networks (ANN), Adaptive Neuro-Fuzzy Inference System (ANFIS), and Gene Expression Programming (GEP)-the study aims to enhance prediction accuracy for the mechanical properties of geopolymer concrete based on 104 datasets. By optimizing mix designs through varying proportions of BPA and SCBA, alkaline activator molarity, and aggregate-to-binder ratios, the research identified combinations that significantly enhance mechanical properties, demonstrating notable international relevance as it contributes to global efforts in sustainable construction by effectively utilizing industrial by-products. The experimental results demonstrated that increasing the molarity of the alkaline activator from 4 to 10 M significantly enhanced both the compressive and flexural strengths of the geopolymer concrete. Specifically, a mixture containing 52.5% SCBA and 47.5% BPA at a 10 M molarity achieved a maximum compressive strength of 33.17 MPa after 20 h of curing. In contrast, a mixture composed of 95% SCBA and 5% BPA at a 4 M molarity exhibited a substantially lower compressive strength of only 21.27 MPa. Additionally, the highest recorded flexural strength of 9.95 MPa (77.25% SCBA and 22.5 BPA) was observed at the 10 M molarity, while the flexural strength at 4 M was lowest, at 4.12 MPa (95% SCBA and 5% BPA). Microstructural analysis through Scanning Electron Microscopy with Energy-Dispersive X-ray Spectroscopy (ED-SEM) revealed insights into the pore structure and elemental composition of the concrete, while Thermogravimetric Analysis (TGA) provided data on the material's thermal stability and decomposition characteristics. Performance analysis of the AI models showed that the ANN model had an average MSE of 1.338, RMSE of 1.157, MAE of 3.104, and R 2 of 0.989, while the ANFIS model outperformed with an MSE of 0.345, RMSE of 0.587, MAE of 1.409, and R 2 of 0.998. The GEP model demonstrated an MSE of 1.233, RMSE of 1.110, MAE of 1.828, and R 2 of 0.992, confirming that ANFIS is the most accurate model for predicting the mechanical and rheological properties of geopolymer concrete. This study highlights the potential of integrating AI with experimental data to optimize the formulation and performance of geopolymer concrete, advancing sustainable construction practices by effectively utilizing industrial by-products., (© 2024. The Author(s).)

Background: Despite success in HIV treatment, diagnosis and management of hypertension (HTN) and cardiovascular disease (CVD) remains suboptimal among people living with HIV (PLWH) in Botswana, with an overall HTN control of only 19% compared to 98% HIV viral suppressed. These gaps persist despite CVD primary care national guidelines and availability of free healthcare including antihypertensive medications. Our study aims to develop and test strategies to close the HTN care gap in PLWH, through integration into HIV care, leveraging the successful national HIV care and treatment program and strategies., Methods: The InterCARE trial is a cluster randomized controlled hybrid type 2 effectiveness-implementation trial at 14 sites designed to enroll 4652 adults living with HIV and HTN plus up to 2326 treatment partners. Primary outcomes included effectiveness (HTN control) and implementation outcomes using the Reach Effectiveness Adoption Implementation and Maintenance framework, with explanatory mixed methods used to understand variability in outcomes. InterCARE trial's main strategies include healthcare worker HTN and CVD care training plus long-term practice facilitation, electronic health record (EHR) documentation of key indicators and use of reminders, and use of treatment partners to provide social support to people living with HIV and HTN. InterCARE started with formative research to identify contextual factors influencing care gaps using the Consolidated Framework for Implementation Research. Results were used to adapt initial and develop additional implementation strategies to address barriers and leverage facilitators. The package was pilot tested in two clinics, with findings used to further adapt or add strategies for the clinical trial., Discussion: If successful, the InterCARE model can be scaled up to HIV clinics nationwide to improve diagnosis, management, and support in Botswana. The trial will provide insights for scale-up of HTN integration into HIV care in the region., Trial Registration: ClinicalTrials.gov reference NCT05414526. Registered 18 May 2022, https://clinicaltrials.gov/study/NCT05414526?term=NCT05414526.&rank=1 ., (© 2024. The Author(s).)

Background: Successful HIV treatment programs have turned HIV into a chronic condition, but noncommunicable diseases such as hypertension jeopardize this progress. Hypertension control rates among people with HIV (PWH) are low owing to gaps in patient awareness, diagnosis, effective treatment, and management of both conditions at separate clinic visits. Integrated management, such as in our study, InterCARE, can enhance HIV-hypertension integration and blood pressure (BP) control., Methods: Our pilot study was conducted in two Botswana HIV clinics between October 2021 and November 2022. Based on our formative work, we adopted three main strategies; Health worker training on HTN/cardiovascular disease (CVD) management, adaptation of HIV Electronic Health Record (EHR) for HTN/CVD care, and use of treatment partners to support PWH with hypertension for implementation. We employed the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework to assess implementation effectiveness and outcomes for BP control at baseline, 6 and 12 months. HIV viral load (VL) suppression was also measured to assess impact of integration on HIV care., Results: We enrolled 290 participants; 35 (12.1%) were lost to follow-up, leaving 255 (87.9%) at 12-months. Median age was 54 years (IQR 46-62), and 77.2% were females. Our interventions significantly improved BP control to < 140/90 mmHg (or < 130/80 mmHg if diagnosis of diabetes or chronic kidney disease), from 137/290 participants, 47.2% at baseline to 206/290 participants, 71.0%, at 12 months (p < 0.001). Among targeted providers, 94.7% received training, with an associated significant increase in counseling on exercise, diet, and medication (all p < 0.001) but EHR use for BP medication prescribing and cardiovascular risk factor evaluation showed no adoption. In the intention-to-treat analysis, HIV VL suppression at 12 months decreased (85.5% vs 93.8%, p = 0.002) due to loss to follow-up but the per protocol analysis showed no difference in VL suppression between baseline and 12 months (97.3% vs 93.3%, p = 0.060)., Conclusion: The InterCARE pilot study demonstrated that low-cost practical support measures involving the integration of HIV and hypertension/CVD management could lead to improvements in BP control. These results support the need for a large implementation and effectiveness trial., Trial Registration: ClinicalTrials.gov NCT05414526. Registered 18th May 2022., (© 2024. The Author(s).)

Background: Botswana serves as a model of success for HIV with 95% of people living with HIV (PLWH) virally suppressed. Yet, only 19% of PLWH and hypertension have controlled blood pressure. To address this gap, InterCARE, a care model that integrates HIV and hypertension care through a) provider training; b) adapted electronic health record; and c) treatment partners (peer support), was designed. This study presents results from our baseline assessment of the determinants and factors used to guide adaptations to InterCARE implementation strategies prior to a hybrid type 2 effectiveness-implementation study., Methods: This study employed a convergent mixed methods design across two clinics (one rural, one urban) to collect quantitative and qualitative data through facility assessments, 100 stakeholder surveys (20 each PLWH and hypertension, existing HIV treatment partners, clinical healthcare providers (HCPs), and 40 community leaders) and ten stakeholder key informative interviews (KIIs). Data were analyzed using descriptive statistics and deductive qualitative analysis organized by the Consolidated Framework for Implementation Research (CFIR) and compared to identify areas of convergence and divergence., Results: Although 90.3% of 290 PLWH and hypertension at the clinics were taking antihypertensive medications, 52.8% had uncontrolled blood pressure. Results from facility assessments, surveys, and KIIs identified key determinants in the CFIR innovation and inner setting domains. Most stakeholders (> 85%) agreed that InterCARE was adaptable, compatible and would be successful at improving blood pressure control in PLWH and hypertension. HCPs agreed that there were insufficient resources (40%), consistent with facility assessments and KIIs which identified limited staffing, inconsistent electricity, and a lack of supplies as key barriers. Adaptations to InterCARE included a task-sharing strategy and expanded treatment partner training and support., Conclusions: Integrating hypertension services into HIV clinics was perceived as more advantageous for PLWH than the current model of hypertension care delivered outside of HIV clinics. Identified barriers were used to adapt InterCARE implementation strategies for more effective intervention delivery., Trial Registration: ClinicalTrials.gov, ClinicalTrials.gov Identifier: NCT05414526 . Registered 18 May 2022 - Retrospectively registered., (© 2024. The Author(s).)

Background: Despite high rates of HIV testing and enrolment of HIV-positive pregnant women on antiretroviral therapy in Botswana, coverage for HIV-exposed infant (HEI) testing remains suboptimal. Many factors can contribute to suboptimal HEI testing rates, but they have seldom been thoroughly investigated in Botswana. Therefore, the aim of this study was to explore the experiences and perspectives of HIV-positive mothers on the barriers and facilitators of HEI testing to inform interventions to promote HEI testing in Botswana., Methods: We conducted focus group discussions (FGDs) with HIV-positive mothers who gave birth in 2016 at the three largest public hospitals in Botswana. FGDs were held in Maun, Francistown, and Gaborone from September 2019 to March 2020. The maximum variation sampling method was used to select the participants using information that was abstracted from birth registers and other medical records at the study sites. Mothers were asked to describe their HEI testing experiences, what made it easy or difficult for them to return the HEI for testing, and what needs to be done to improve HEI testing in Botswana. A thematic approach was used to analyse the data., Results: Fifteen FGDs with 142 mothers (aged 21-52 years) were held. Participants identified several facilitators to HEI testing, including a mother with adequate knowledge of PMTCT, intensive tracking of HEI by healthcare workers (HCWs), positive attitudes of HCWs toward clients, and social support from significant others. Staff shortages at health care facilities, frequent stock-outs of HIV test kits, fear of stigma, fear of positive test results for the child, and transportation challenges were identified as key barriers to HEI testing. Increasing staffing at healthcare facilities, having adequate supplies of HIV test kits, enhanced HEI tracking, easing access to HEI testing services in rural areas, and providing quality PMTCT education were among the proposed interventions to promote HEI testing., Conclusion: Optimizing HEI testing in Botswana will require multi-level interventions at the policy, health system, community, interpersonal, and individual levels., Competing Interests: The authors have declared that no competing interests exist.

Background: Botswana updated its antiretroviral treatment (ART) guidelines in May 2016 to support breastfeeding for women living with HIV (WLHIV) on ART who have documented HIV RNA suppression during pregnancy., Methods: From September 2016 to March 2019, we evaluated feeding method at discharge among WLHIV at eight government maternity wards in Botswana within the Tsepamo Study. We validated the recorded feeding method on the obstetric record using the prevention of mother-to-child transmission of HIV (PMTCT) counsellor report, infant formula dispensing log or through direct observation. Available HIV RNA results were recorded from the obstetric record, and from outpatient HIV records (starting February 2018). In a subset of participants, we used electronic laboratory records to verify whether an HIV RNA test had occurred. Univariable and multivariable logistic regression analyses were performed to identify factors associated with infant feeding choice., Results: Among 13,354 WLHIV who had a validated feeding method at discharge, 5303 (39.7%) chose to breastfeed and 8051 (60.3%) chose to formula feed. Women who had a documented HIV RNA result in the obstetric record available to healthcare providers at delivery were more likely to breastfeed (50.8%) compared to women who did not have a documented HIV RNA result (35.4%) (aOR 0.59; 95% CI 0.54, 0.65). Among women with documented HIV RNA, 2711 (94.6%) were virally suppressed (< 400 copies/mL). Breastfeeding occurred in a substantial proportion of women who did not meet criteria, including 46 (30.1%) of 153 women with HIV RNA > 400 copies/mL, and 134 (27.4%) of 489 women with no reported ART use. A sub-analysis of electronic laboratory records among 150 women without a recorded result on the obstetric record revealed that 93 (62%) women had an HIV RNA test during pregnancy., Conclusions: In a setting of long-standing use of suppressive ART, with majority of WLHIV on ART from the time of conception, requiring documentation of HIV RNA suppression in the obstetric record to inform infant feeding decisions is a barrier to breastfeeding but unlikely to prevent a substantial amount of HIV transmission., (© 2021. The Author(s).)

: Botswana was one of the first African countries to transition from WHO Option A to Option B for prevention of mother-to-child HIV transmission (MTCT). We evaluated the impact of this transition on projected MTCT risk through review of 10,681 obstetric records of HIV-infected women delivering at 6 maternity wards. Compared with Option A, women receiving antenatal care under Option B were more likely to receive combination antiretroviral therapy (ART), adjusted odds ratio (aOR): 2.59 (95% confidence interval: 2.25 to 2.98), but they were also more likely to receive no antenatal antiretrovirals, aOR: 2.10 (95% confidence interval: 1.74 to 2.53). Consequently, initial implementation of Option B was associated with increased projected MTCT at 6 months of age, 3.79% under Option A and 4.69% under Option B (P < 0.001). Successful implementation of Option B or B+ may require that ART can be initiated within antenatal clinics, and novel strategies to remove barriers to rapid ART initiation.