Dipesalema Joel | University of Botswana (original) (raw)

Papers by Dipesalema Joel

Congenital hyperinsulinism is genetic disorder characterized by dysregulation of insulin secretio... more Congenital hyperinsulinism is genetic disorder characterized by dysregulation of insulin secretion It is the most common cause of persistent hypoglycaemia in infancy The incidence in individuals of northern European extraction is approximately 1:30,000 live births. Published data on the diagnosis and management of congenital hyperinsulinsim in resource limited setting is scarce.

The incidence of type 1 and type 2 diabetes mellitus in children and adolescent has been on the r... more The incidence of type 1 and type 2 diabetes mellitus in children and adolescent has been on the rise for the last decades. While the reasons behind these are not known, one possible explanation for the emergence of type 2 diabetes in children is the increase of obesity and decreasing physical activity. Adolescents are at the cross roads between childhood and adulthood and that makes classification of their diabetes mellitus at presentation a diagnostic challenge.

Puberty is a period of transition in the stage of development which is characterized by the occur... more Puberty is a period of transition in the stage of development which is characterized by the occurrence of secondary sexual characteristics. The timing and the onset of puberty is regulated by a combination of genetic and external factors such as nutrition, state of the individual's health and physical exercise. Through the complex neuro-signaling pathway which is not fully elucidated, the Hypothalamic–Pituitary–Gonadal axis is stimulated. The Gonadotrophin Releasing Hormone (GnRH) is secreted by the hypothalamic cells into the blood vessels and subsequently stimulate the gonadotroph cells of the anterior pituitary gland to secrete the gonadotrophins, follicle stimulating hormone (FSH) and the luteinizing hormone (LH). The gonadotropins stimulate sex-steroidogenesis with the resultant production of testosterone and oestradiol from the testes and ovaries respectively. These in turn are responsible for the development of the secondary sex characteristics of puberty. The signs of pu...

Journal of Pediatric and Adolescent Gynecology

Journal of Asthma and Allergy

This study aims to describe the spectrum of allergic diseases of children and adolescents in a si... more This study aims to describe the spectrum of allergic diseases of children and adolescents in a single allergy treatment centre in Botswana, over a period of 8 years. Patients and Methods: A retrospective cross-sectional study was conducted using medical records of all patients aged 18 years or younger, seen at an allergy treatment centre in Botswana. Data were presented descriptively. Association between variables was explored by χ 2-test. Results: Four hundred and seven patients with a mean age of 5.8 years (SD 4.4) at the time of presentation included 239 (58.7%) females and 365 (87.5%) black Africans. The most common diseases were asthma (n=249, 61.2%) followed by allergic rhinitis (AR) (n=232, 57.0%) and atopic dermatitis (AD) (n=165, 40.5%). One hundred and fifteen cases (46.2%) of asthmatic patients were skin prick test positive; sensitized to grass, moulds, dust mites and animal dander, in decreasing frequency, whereas those with allergic rhinitis (AR) and allergic conjunctivitis (AC) were sensitized to trees and all allergens identified in asthmatics. Concomitant asthma was diagnosed in 171 (73.7%) with AR, 71 (68.3%) with AC, 75 (45.5%) with AD and 42 (47.7%) with food allergy. The most common triggers for asthma exacerbations include upper respiratory tract infections, weather changes, and exposure to passive cigarette smoke. Paternal allergy and allergic disease in grandparents are predisposing factors for asthma (p=0.016 and p=0.001, respectively). Paternal allergy is also predisposed to AR (p=0.007), while maternal history of allergic disease was associated with AD (p=0.019). Conclusion: The most common chronic pediatric conditions seen in our allergic disease study were asthma, allergic rhinitis and atopic dermatitis with the most common triggers being viral upper respiratory tract infections, weather changes and exposure to cigarette smoke, all of which are modifiable risk factors. This exploratory study lays the foundation for future interventional studies that may be directed towards the spectrum of allergic diseases.

Clinical Ophthalmology

Background: Retinopathy of prematurity (ROP) is a widely recognized cause of blindness after pret... more Background: Retinopathy of prematurity (ROP) is a widely recognized cause of blindness after preterm birth. The incidence of ROP is rising especially in low-and middle-income countries (LMIC) because of improved neonatal care and increased survival of very premature neonates. To date, there is no data on incidence of ROP in Botswana. Objective: The purpose of this study was to provide initial data and determine ROPassociated risk factors from a single neonatal care center on the incidence of ROP in Gaborone, Botswana. Methods: A prospective observational study was conducted at Princess Marina Hospital (PMH) in Gaborone, Botswana. Premature neonates with birth weights (BW) of <1,801 g or gestational age (GA) of <34 weeks were enrolled in this study. Diagnostic examinations were conducted using an indirect ophthalmoscope with 28D lens. ROP findings were classified according to the most advanced stage of ROP reached using the International Classification of ROP (2005). Data were entered into STATA version 15 statistical software for analysis. Results: There were 264 premature infants enrolled in the study. ROP screening was performed on 200 (75.8%). Of all 264 enrolled patients 133 (50.4%) were female. The mean GA was 30.3±2.6 (range 24-37) weeks and the mean BW was 1302.2±285.9 g (range 725-2035). Out of 200 who were screened, we identified 22 with ROP with a ROP incidence of 11%. The incidence of type 1 ROP (sight-threatening) was found to be 3.5%. This study identified a significant difference in possible ROP risk factors between those infants who develop ROP and those who do not, eg, BW (p<0.001), GA (p=0.024) and blood transfusion (p=0.001). Conclusion: This study demonstrates that ROP is a treatable cause of blindness in Botswana. Lack of a proper screening protocol, delay in diagnosis and management are plausible reasons for poor outcome in those who were diagnosed with type 1 ROP.

Journal of the International Association of Providers of AIDS Care (JIAPAC)

Objectives: To determine the prevalence and sociodemographic predictors of HIV among pregnant wom... more Objectives: To determine the prevalence and sociodemographic predictors of HIV among pregnant women in Botswana. Methods: This was a cross-sectional study of randomly enrolled women aged 18 to 49 years, attending 7 health facilities in Botswana. Data were gathered from November 2017 to March 2018 and analyzed using SPSS version 24. Result: Of the 429 women enrolled, 407 (96.4%) were included in the analysis. The HIV prevalence was 17%; 69 of 407 (95% CI: 13.4- 21.0). Women aged 35 to 49 years had higher HIV prevalence than those 18 to 24 years (adjusted odds ratio [AOR] = 6.2; 95% CI: 2.7-14.4). Illiterate and elementary school educated women had higher HIV prevalence than those with a tertiary education (AOR = 8.5; 95% CI: 1.8-39.1). Those with a history of alcohol intake had a higher HIV prevalence than those without (AOR = 2.6; 95% CI: 1.3-5.3). Conclusion: HIV prevalence was lower than it was in 2011. Age, level of education, and history of alcohol intake were strong predictors ...

Molecular Genetics and Metabolism

PLOS ONE

High mortality among adolescents with HIV reflects delays and failures in the care cascade. We so... more High mortality among adolescents with HIV reflects delays and failures in the care cascade. We sought to elucidate critical missed opportunities and barriers to care among adolescents hospitalized with HIV at Botswana's tertiary referral hospital. We enrolled all HIV-infected adolescents (aged 10-19 years) hospitalized with any diagnosis other than pregnancy from July 2015 to January 2016. Medical records were reviewed for clinical variables and past engagement in care. Semi-structured interviews of the adolescents (when feasible) and their caregivers explored delays and barriers to care. Twenty-one eligible adolescents were identified and 15 were enrolled. All but one were WHO Clinical Stage 3 or 4. Barriers to diagnosis included lack of awareness about perinatal HIV infection, illness or death of the mother, and fear of discrimination. Barriers to adherence to antiretroviral therapy included nondisclosure, isolation, and mental health concerns. The number of hospitalized HIVinfected adolescents was lower than expected. However, among those hospitalized, the lack of timely diagnosis and subsequent gaps in the care cascade elucidated opportunities to improve outcomes and quality of life for this vulnerable group.

African Journal of Paediatric Surgery

Hormone research in paediatrics, 2017

This paper represents an international collaboration of paediatric endocrine and other societies ... more This paper represents an international collaboration of paediatric endocrine and other societies (listed in the Appendix) under the International Consortium of Paediatric Endocrinology (ICPE) aiming to improve worldwide care of adolescent girls with polycystic ovary syndrome (PCOS)1. The manuscript examines pathophysiology and guidelines for the diagnosis and management of PCOS during adolescence. The complex pathophysiology of PCOS involves the interaction of genetic and epigenetic changes, primary ovarian abnormalities, neuroendocrine alterations, and endocrine and metabolic modifiers such as anti-Müllerian hormone, hyperinsulinemia, insulin resistance, adiposity, and adiponectin levels. Appropriate diagnosis of adolescent PCOS should include adequate and careful evaluation of symptoms, such as hirsutism, severe acne, and menstrual irregularities 2 years beyond menarche, and elevated androgen levels. Polycystic ovarian morphology on ultrasound without hyperandrogenism or menstrual...

The lancet. Diabetes & endocrinology, Aug 5, 2017

Journal of the International Association of Providers of AIDS Care

Children with HIV infection are often reported to be short. The aim of this study was to assess t... more Children with HIV infection are often reported to be short. The aim of this study was to assess the prevalence of HIV-associated short stature in HIV endemic setting. Data were obtained by retrospective review of the electronic medical records. Patients were grouped into various clinical categories. For each category, the proportion of patients with height-for-age Z score of less than -2 standard deviation [SD] and of less than -3 SD was determined. The prevalence of short stature (less than -2 SD) was 28.4%. Severe short stature (less than -3 SD) is more likely with percentage of CD4 <15% (odds ratio [OR]: 3.30, confidence interval [CI]: 1.51-7.09, P = .002) and with males (OR: 1.49, CI: 1.19-1.87, P = .001). Severe short stature is more likely with viral load >400 copies/mL (OR 2.64, CI 1.27-5.38, P = .008) and poor adherence (<95%; OR 1.72, CI 1.03-2.05, P = .037). In Botswana, short stature affects a quarter of HIV-infected children and severe short stature is associate...

Journal of the International Association of Providers of AIDS Care (JIAPAC), 2013

Background: Data on the use of ritonavir-boosted darunavir (DRV/r) and/or raltegravir (RAL) in re... more Background: Data on the use of ritonavir-boosted darunavir (DRV/r) and/or raltegravir (RAL) in resource-limited settings are rare and there is currently no published data regarding their use among African children. Botswana has recently made DRV/r and RAL available for patients failing second-line antiretroviral therapy (ART). Methods: Retrospective chart review of 4 multidrugresistant pediatric patients on DRV/r-and/or RAL-based regimens. Viral load, CD4 count, adherence by pill count, and World Health Organization (WHO) clinical stage prior to and after switch to DRV/r-and/or RAL-based regimen were assessed. Antiretroviral therapy history, duration of virologic failure, and time to viral suppression were also noted. Genotypic resistance assays reviewed for mutations present prior to switch. Results: All patients achieved viral suppression, showed improved/stable CD4 counts, and obtained or maintained WHO clinical treatment stage I, even after long-standing virologic/immunologic failure. Conclusions: Well tolerated by and effective in our patients, DRV/r and RAL provide potentially lifesaving ART options for children and adolescents in resource-limited settings failing ART due to ritonavir-boosted lopinavir (LPV/r) resistance.

The International Journal of Tuberculosis and Lung Disease, 2014

Four public hospitals in Botswana, a high tuberculosis (TB) burden setting. To assess the feasibi... more Four public hospitals in Botswana, a high tuberculosis (TB) burden setting. To assess the feasibility and utility of sputum induction in the diagnosis of paediatric TB. From 2008 to 2010, children aged ≤18 years referred for suspected pulmonary TB underwent sputum induction. Confirmed TB was defined as the presence of at least one of the signs and symptoms suggestive of TB and positive Mycobacterium tuberculosis culture. Information on TB-associated symptoms (cough, fatigue, night sweats, low appetite, chest pain, weight loss, haemoptysis and contact with a TB case) was collected for three risk groups: human immunodeficiency virus (HIV) positive children, HIV-negative children aged &amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;3 years and HIV-negative children aged ≥3 years. The median age of the 1394 subjects who underwent sputum induction was 3.8 years (IQR 1.3-8.4); 373 (27%) were HIV-positive, 419 (30%) were HIV-negative and 602 (43%) had unknown HIV status. TB was confirmed in 84 (6.0%); cases were more likely to have weight loss, chest pain or TB household contacts. There were no serious complications attributable to sputum induction during and after the procedure; only 0.8% (9/1174) of patients reported minor complications. In Botswana, paediatric sputum induction was feasible, safe and assisted bacteriological confirmation in a subgroup of children treated for TB.

Acta Paediatrica, 2004

The management of diabetes in children presents a number of challenges. The ideal is to achieve o... more The management of diabetes in children presents a number of challenges. The ideal is to achieve optimal glycaemic control using an insulin regimen that is acceptable to the child and family, which improves glycaemic control, whilst avoiding hypoglycaemia. The paediatric population differ from their adult counterparts in several ways, such as variability of exercise and eating patterns, and the hormonal influences of puberty, which means that the insulin regimen must be tailored to suit an individual child and their family. This review will focus on the particular difficulties of managing diabetes in children and, in particular, the problem of avoiding hypoglycaemia while maintaining adequate glycaemic control.

Hormone Research in Paediatrics, 2015

dress a series of questions regarding the diagnosis of PCOS during adolescence including the foll... more dress a series of questions regarding the diagnosis of PCOS during adolescence including the following: clinical and biochemical evidence of hyperandrogenism, criteria for oligoanovulation and polycystic ovary morphology, diagnostic criteria to exclude other causes of hyperandrogenism and amenorrhea, role of insulin resistance, and intervention. Results and Conclusion: Features of PCOS overlap normal pubertal development. Hence, caution should be taken before diagnosing PCOS without longitudinal evaluation. However, treatment may be indicated even in the absence of a definitive diagnosis. While obesity, insulin resistance, and hyperinsulinemia are common findings in adolescents with hyperandrogenism, these features should not be used to diagnose PCOS among adolescent girls.