Background: Atrial fibrillation (AF) is the commonest sustained cardiac arrhythmia associated with high morbidity and mortality rates. Notwithstanding the scale of the problem, there are sparse data on the characteristics and outcomes of both valvular and non-valvular AF patients in sub-Saharan Africa (SSA). Objective: This study aimed at describing the clinical features and outcome of AF patients at a tertiary hospital in Botswana. Methods: This prospective study was carried out in the Princess Marina Hospital in Gaborone, Botswana between August 2016 and July 2018. We consecutively enrolled 138 (97.8% black Africans) adult patients with electrocardiographically documented AF. Their baseline clinical and biomedical data were documented, and each patient was followed up for 12 months. The primary study outcome was 12-month all-cause mortality. Results: The mean [standard deviation (SD)] age of enrolled patients was 66.7 (17.2) years, and 63.8% were females. Common co-morbidities were hypertension (59.4%), rheumatic heart disease (37.7%) and heart failure (35.5%). Stroke/ transient ischaemic attack (TIA) (21.7%) and obesity (34.8%) were also prevalent. Compared to patients with non-valvular AF, those with valvular AF were more likely to be female (82 vs 55%, p = 0.003), younger (60 vs 75 years, p < 0.001), on anticoagulation (88.6 vs 66%, p = 0.005), or have a dilated left atrium (5.3 vs 4.5 cm, p < 0.001). They were also less likely to present with hypertension (33 vs 72%, p < 0.001), stroke/TIA (nine vs 27%, p < 0.017), chronic kidney disease (five vs 20%, p < 0.02), or history of cigarette smoking (two vs 13%, p = 0.049) than non-valvular AF patients. The mean (SD) CHA 2 DS 2-VASc score in non-valvular AF patients was 3.6 (1.5), and the median HAS-BLED score was 2.0 [interquartile range (IQR) 1.0-3.0]. During the 12-month follow up, 20 (14.5%) patients died. Despite differences in baseline characteristics, there was no difference in mortality rate in patients with valvular compared to those with non-valvular AF (13.8 vs 15.9%; p = 0.746). Conclusion: In this study, hypertension, rheumatic heart disease and heart failure were the most prevalent co-morbidities. AF presented in young people and conferred high mortality rates in both valvular and non-valvular AF patients. Prevention and optimal management of AF and associated co-morbidities are of critical importance.

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Background. Factors associated with overweight/obesity among antiretroviral therapy (ART) recipients have not been sufficiently studied in Botswana. Objectives. To: (i) estimate the prevalence and trends in overweight/obesity by duration of exposure to ART among recipients, (ii) assess changes in BMI categories among ART recipients between their first clinic visit (BMI-1) and their last clinic visit (BMI-2), (iii) identify ART regimen that predicts overweight/obesity better than the others and factors associated with BMI changes among ART recipients. Methods. A 12-year retrospective record-based review was conducted. Potential predictors of BMI change among patients after at least three years of ART exposure were examined using a multiple logistic regression model. Adjusted odds ratios (AOR) and their 95% confidence intervals (CIs) were computed. ART regimens, duration of exposure to ART, and recipients’ demographic and biomedical characteristics including the presence or absence of diabetes mellitus-related comorbidities (DRC), defined as any morbidity associated with type 2 diabetes as described in the international statistical classification of diseases and related health problems (ICD-10-CM) codebook index, were investigated as potential predictors of overweight/obesity. Results. Twenty-nine percent of recipients were overweight, 16.6% had obesity of whom 2.4% were morbidly-obese at the last clinic visit. Overweight/obese recipients were more likely to be female, to have DRC and less likely to have CD4 count between 201 and 249 cells/mm3. Neither the first-line nor the second-, third-line ART regimens predicted overweight/obesity better than the other and neither did the duration of exposure to ART. No significant linear trends were observed in the prevalence of overweight/obesity by the duration of exposure to ART. Conclusion. These results suggest that the ART regimens studied have a comparable effect on overweight/obesity and that the duration of exposure does not affect the outcome. This study calls for further research to elucidate the relative contribution of various factors to BMI change among recipients, including ART regimens.

ObjectivesExposure to combination antiretroviral therapy (cART) is associated with the development of diabetes mellitus related comorbidities (DRCs). This study aims to: (i) estimate the incidence of DRCs among cART recipients, (ii) assess the time-to-event (development of DRC) and, (iii) compare survival function between recipients on first-line regimen and those on second-, third-line cART regimen.ResultsThe incidence of DRCs was 26.8/1000 person-years, with total time of exposure of 3316 person-years. The average time to event for all the three regimens was 11.72 ± 0.20 years. The first-line cART regimen had a shorter mean ± SE of 10.59 ± 0.26 years to the event compared to 12.69 ± 0.24 years for the second-, third-line cART regimen. Recipients on the first-line had a shorter survival than recipients on second-, third-line cART (Log-rank X2 = 8.98, p < 0.003). Data from this study showed that the risk of developing DRCs per year of exposure was significantly greater for patients on first-line compared to those who were on second-, third-line regimen; which, suggests that monitoring of cART long-term side effects and regular reviewing of cART regimens is important. Meticulous selection of drug combinations is a key to improving recipients’ survival.Electronic supplementary materialThe online version of this article (10.1186/s13104-018-3144-9) contains supplementary material, which is available to authorized users.