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PubMedDate not supplied

Profile of drinking behaviour and comparison of self-report with the CAGE questionnaire and carbohydrate-deficient transferrin in a rural Lesotho community.

This paper aims to: (1) profile the drinking behaviour of a rural Lesotho community facing relocation; (2) compare the following measures of hazardous drinking in this community: quantity/frequency self-report, the CAGE questionnaire and carbohydrate-deficient transferrin (CDT) levels; (3) describe community awareness of, and attitude towards, treatment services. As part of a larger baseline survey of community health status, households in 29 villages in Lesotho were randomly sampled. Consenting adults (n = 348) participated in a face-to-face interview about alcohol use, which included the CAGE. Blood was taken from participants for CDT determination. Fifty-three per cent of men (37/69) and 19% of women (53/279) reported drinking alcohol. Thirty-six per cent of men (25/69) and 9% of women (25/279) were classified as hazardous drinkers defined as drinking 350 g (males) or 225 g (females) of alcohol/week, or 'engaged in bouts of heavy drinking 1 to 2 days a month or more during the past 12 months'. Hazardous drinkers were significantly more likely to be male and older, but did not differ from the rest of the sample on marital status. Using hazardous drinking as the standard, CAGE (score > or = 2) had a positive predictive value (PPV) of 75% for men and 62% for women. The parameters for CDT must be interpreted with caution as the cut-offs for hazardous drinking, especially for women's drinking, were lower than the usual cut-offs in published CDT studies. However, the high specificities for CDT in men (100%; 19/19) and in women (77%; 110/142) are consistent with other studies, but the low PPV of 14% (5/37) for men and women combined suggests that CDT is not effective as a predictor of hazardous drinking in this population. There was high awareness of available treatment services among participants, and most believed treatment to be beneficial. Overall, the study provides a comprehensive baseline profile of drinking behaviour in this community, but did not show the CAGE questionnaire or CDT profile to be useful in in this community.

Adolescent↗
PubMed1990

The effective case management of childhood diarrhoea with oral rehydration therapy in the Kingdom of Lesotho.

In Lesotho prior to 1986, diarrhoea was the leading cause of hospital mortality in children less than 5 years of age. At the Queen Elizabeth II Hospital, diarrhoea-related admissions as a proportion of all admissions in children less than 5 years of age declined from 23% in the year prior to the opening of the Oral Rehydration Therapy Unit (ORTU) to 13% in the first nine months of 1987 (p less than 0.05). In addition, the case-fatality ratio of children treated in the ORTU declined from 1.4% in the first quarter of 1986 to zero in the second and third quarters of 1987 (p less than 0.05). In a case-control study conducted to identify reasons for children failing ORTU treatment, factors associated with an increased risk of hospitalization included male gender (odds ratio [OR] = 4.9; 95% confidence limits [CL] = 2.0, 11.9), fever greater than or equal to 38.5 degrees C (OR = 2.0; CL = 1.2, 3.3), undernutrition (OR = 3.2; CL = 1.1, 9.4), and moderate dehydration (OR = 2.3; CL = 1.2, 4.4) or severe dehydration. (OR = 12.1; CL = 3.8, 38.5). Breastfed children less than 2 years of age were at decreased risk of hospitalization (OR = 0.4; CL = 0.2, 0.7). At this major hospital in Lesotho, the standardization of outpatient treatment for diarrhoea with oral rehydration salts (ORS) in the context of an ORTU resulted in a marked decrease in diarrhoea-associated hospitalization and deaths in children less than 5 years of age.

Case-Control Studies↗
PubMed1992

The mediating effect of maternal nutrition knowledge on the association between maternal schooling and child nutritional status in Lesotho.

The present study tested whether maternal nutrition knowledge was a mediating factor in the association between maternal schooling and child nutritional status, and whether the mechanism involved differed according to socioeconomic status. The data were collected in Lesotho on 921 mother-child pairs and included scores from a nutrition knowledge test, socioeconomic and demographic information, and the child's anthropometric data. A wealth factor derived from a factor analysis was used to stratify the sample into two socioeconomic groups. Two-stage least-squares estimation was used to test the mediating role of nutrition knowledge between maternal schooling and child weight-for-age. Results showed that both the importance of maternal schooling and the mechanism by which it affects the child's weight-for-age are contingent upon the family's socioeconomic status. While maternal schooling was positively associated with weight-for-age for both wealthier and poorer households, the size of the effect was much larger for the latter group. The effect of maternal schooling on weight-for-age was mediated by the mother's nutrition knowledge only among wealthier households. These results imply that, in Lesotho, nutrition education for mothers could contribute to improving children's growth, but only in households that have access to a minimum level of resources. For poorer households, nutrition education would not be sufficient.

Adult↗
PubMed1989

Use of alcohol among high school students in Lesotho.

Data on alcohol consumption, attitudes to and knowledge of alcohol were collected by means of questionnaires from 1133 high school students aged 11-22 years in Lesotho. Additional data were obtained by means of classroom discussion and 13 in depth interviews. About half of the students (54% of the boys and 42% of the girls) had drunk alcohol at some point in their lives. Drinking was found to be related to age, sex, drinking of friends, family income, and drinking in the family. No indication of widespread alcohol abuse was found, but about half of the students (drinkers and non-drinkers) believed that moderate drinking is impossible and that the fun of drinking is to get drunk, indicating the possibility of alcohol abuse in the future. The results have implications for future research and for preventive work among youth and adults in Lesotho.

Adolescent↗
PubMed1994

Female alcoholism problems in Lesotho.

This paper gives an overview of alcohol and alcohol-related problems facing women in Lesotho. As in many other developing countries, the cultural position of women in Lesotho facilitates a vicious circle in which women are at one time brewers of alcohol, then sellers, then become excessive consumers due to the problems created by their drinking husbands. Married women encounter social censure if they drink, and termination of their marriages if they abuse alcohol. Culturally women are regarded as minors and depend on their husbands for economic survival, so that alcohol abuse can cause great hardship. Due to a lack of trained and specialized medical staff, women's particular and multi-faceted treatment needs are largely unmet and no research is done on problems of female alcoholism.

Alcoholism↗
PubMed2006

Sexual violence in Lesotho.

The magnitude and characteristics of sexual violence in two urban areas of Lesotho are described based on a random household survey of 939 sexually active women aged 18-35. Sexual violence is defined as nonconsensual sex ranging from the use of threats and intimidation to unwanted touching and forced sex. Twenty-five percent of women surveyed reported ever being physically forced to have sex; 13 percent reported that forced sex was attempted; 31 percent said that they were touched against their will; and 11 percent reported being forced to touch a man's genitals. Boyfriends were the most common perpetrators of actual and attempted forced sex (66 percent and 44 percent, respectively); known community members were the most common perpetrators of touching the respondent against her will (52 percent). Currently married women and those with more education were less likely than others to report that sex was forced upon them by an intimate partner or by another type of perpetrator. Women living in areas where a program raising awareness about sexual violence was ongoing were more likely to report a history of sexual violence. Given the high prevalence of HIV in Lesotho, programs should address women's right to control their sexuality.

Adolescent↗
PubMed1990

Anxiety and depression in a village in Lesotho, Africa: a comparison with the United States.

Adults in a village in Lesotho, Africa, were interviewed to determine the community prevalence of major depression, panic disorder, and generalised anxiety disorder. The prevalence data were compared with data from a large epidemiological study in the United States utilising the same research instrument. There was a significantly higher prevalence of all three diagnoses in Lesotho as compared with the United States. As in the United States, women were at an increased risk for these disorders, although statistical significance was not demonstrated for depression. The majority of people (77%) who had experienced panic attacks said they had sought help for their symptoms, with the majority attending Western-trained doctors. The relationship between explanatory models and help-seeking behaviour was explored in people who had had panic attacks. Less than 40% of those with generalised anxiety disorder said they sought help.

Adult↗
PubMed1998

Comparison of clinically directed, disease specific, and syndromic protocols for the management of genital ulcer disease in Lesotho.

OBJECTIVE: To evaluate two protocols for the syndromic management of genital ulcer disease (GUD) in Lesotho, southern Africa and to compare the performance of these protocols with that of a conventional disease specific approach. METHODS: A cross sectional study was conducted among consecutive patients with GUD attending an STD clinic in Maseru, Lesotho. The clinical diagnoses were made by using predefined criteria at the initial visit before the performance of laboratory tests. Attempts were made to detect the specific aetiology of the genital ulcers using PCR assays and syphilis serology. The results of PCR assays and syphilis serology were used as the gold standard against which the performance of the management approaches were applied. RESULTS: Of 100 patients initially recruited into the study, Haemophilus ducreyi infection was detected in 56%, herpes simplex virus in 26%, Treponema pallidum in 23%, and lymphogranuloma venereum in 7%. No pathogens were detected in 6% of patients. 17% of patients had mixed infections. Sensitivity, specificity, positive and negative predictive values of the three management protocols for GUD were compared after applying each to the study population. Theoretically, the lowest correct treatment rate would have been obtained by using the disease specific protocol (62%) compared with more than 90% in both syndromic management protocols. Considerable overtreatment for primary syphilis would occur following application of both syndromic protocols. This would be the result of the overdiagnosis of chancroid, in particular the misdiagnosis of genital herpes as chancroid, which would receive treatment for syphilis unnecessarily. The HIV seroprevalence among these patients was 36%. A significantly higher rate of HIV seropositivity was detected among the patients with herpes simplex virus infection when compared with those patients having other causes of genital ulcer disease (58% v 27%; odds ratio 3.73; 95% CI 1.26-11.26; p = 0.01). CONCLUSIONS: Poor sensitivity, specificity, and predictive values were recorded when the disease specific protocol was applied to the study population. In contrast, the syndromic management protocols provided adequate treatment for more than 90% of patients with GUD. Protocol C, which identified a minority of cases of genital herpes, was found to have an advantage when compared with protocol B (all patients with genital ulcer disease treated for both syphilis and chancroid) in that 29% of genital herpes cases would receive appropriate counselling.

Chancroid↗
PubMed1998

Antibiotic resistance of nasopharyngeal isolates of Streptococcus pneumoniae from children in Lesotho.

Villages associated with the Lesotho Highlands Development Agency were randomized with a bias in favour of larger villages, and children < 5 years of age from cluster-randomized households in these villages were chosen for the assessment of antibiotic resistance in pneumococci. Children of the same age group attending clinics in the capital, Maseru, were selected for comparison. Nasopharyngeal cultures of Streptococcus pneumoniae from both groups of children were examined for antibiotic resistance and a questionnaire was used to assess risk factors for the acquisition of resistant strains. Carriage of penicillin- and tetracycline-resistant pneumococci was significantly higher among 196 Maseru children compared with 324 rural children (P < 0.05 and P = 0.01, respectively). Maseru children tended to visit clinics at an earlier age compared with their rural counterparts. The rural children were less exposed to antibiotics (P < 0.01), were less frequently hospitalized (P < 0.001), and rarely attended day care centres (P < 0.001). The very low incidence of antibiotic resistance in rural Lesotho and the higher incidence in Maseru are in stark contrast with the much higher frequencies found in the Republic of South Africa, many European countries, and the USA.

Anti-Bacterial Agents↗
PubMed1987

Labor migration in Southern Africa and agricultural development: some lessons from Lesotho.

The authors examine policy issues with regard to attempts by Lesotho to develop agriculture as a viable alternative to out-migration for employment and income. They argue that "an appropriate agricultural development strategy for Lesotho would emphasize relatively labor- and land-intensive agricultural enterprises, such as horticultural operations and closely managed livestock activities. The suggestion is that only agriculture of this kind will generate sufficient returns on a limited land base to dissuade men from going to the mines. Our paper develops a more complete theoretical and empirical foundation for examining this as well as other agricultural strategies."

Africa↗
PubMed1976

Cross-sectional-type weight reference values for village children under five years in Lesotho.

Cross-sectional-type reference values for weight attained are described for village children under five years in rural Lesotho (formerly Basutoland). Weight measurements derive from observations on 1317 children attending an Under-Fives clinic; it is estimated that 60-70% of the children under five in the catchment area were represented. 4585 weighings on boys and 4826 weighings for girls are included in the analysis. Figures of weight-for-age of boys and girls are given separately as centile distributions suitable for use on Growth Charts. Lesotho 50 centile approximates to 3 centile of British children and slightly exceeds 80% Harvard standard. Weight attained for age is similar, in both sexes, to reports from other less-priviledged urban and rural areas, emphasizing the relative importance of environmental as compared to genetic influences in determining weight-for-age in early childhood. It is suggested that the construction of locally-derived growth reference values is both appropriate and practicable.

Age Factors↗
PubMed2005

Lesotho midwives' utilization of non-pharmacological pain management methods during the first of stage labour.

The purpose of this study was to determine the use of non-pharmacologic methods of pain management used by midwives in Lesotho. The research design was non-experimental and of a descriptive nature. The data was obtained by means of a structured questionnaire which was compiled after a thorough literature analysis was done. Midwives, working in the Maternity wards of the Christian Hospital Association of Lesotho as well as the government Hospitals completed the questionnaires. All data was analysed on a nominal descriptive level. According to the results, the midwives indicated that they were taught non-pharmacologic methods of pain management, however they expressed that they inadequately use these methods during the first stage of labour due to shortage of staff, lack of privacy and space, a high midwife-mother ratio, culture and hospital policies. In the light of these findings, recommendations were made of maximizing the use of non-pharmacologic methods during the first stage of labour.

Adaptation, Psychological↗
PubMed2003

A randomized controlled study of the impact of dietary zinc supplementation in the management of children with protein-energy malnutrition in Lesotho. I: Mortality and morbidity.

Protein-energy malnutrition (PEM) remains one of the common causes of morbidity and mortality among children throughout the world. The supplementation of 10 mg elemental zinc, as zinc sulphate, was evaluated in the management of PEM in a randomized, controlled double-blind clinical trial in 300 children, aged 6-60 months (zinc, n = 150; control, n = 150) admitted to the Queen Elizabeth II Hospital, Maseru, Lesotho. Supplementation and follow-up were done for 3 months post-discharge from the hospital. Mortality during hospitalization was significantly lower in the zinc supplemented group (4.7 per cent), compared with 16.7 per cent in the control group. The prevalence of morbidity was significantly higher in the control group at 1, 2, and 3 month's follow-up. In the zinc supplemented group 58 per cent of the children were above the 80th percentile of expected weight-for-age 3 months after discharge, compared with 27.6 per cent in the control group. Dietary zinc supplementation resulted in a significant reduction in diarrhoeal disease, respiratory morbidity, and episodes of clinical anaemia, skin infections, and fever as well as vomiting in children with PEM. These findings suggest that interventions to improve zinc intake in their management may be of benefit to Basotho children in Lesotho with PEM.

Anthropometry↗
PubMed2003

A randomized controlled study of the impact of dietary zinc supplementation in the management of children with protein-energy malnutrition in Lesotho. II: Special investigations.

Protein-energy malnutrition (PEM) remains one of the common causes of morbidity and mortality among children throughout the world. The supplementation of 10 mg elemental zinc, as zinc sulphate, was evaluated in the management of PEM in a randomized, controlled, double-blind clinical trial in 300 children, aged 6-60 months (zinc, n = 150; control, n = 150) admitted to the Queen Elizabeth II Hospital, Maseru, Lesotho. Supplementation and follow-up were done for 3 months post-discharge from the hospital. Both the supplemented and the control groups presented with biochemically determined zinc deficiency on presentation. Despite supplementation the treated group only began to show evidence of biochemical increase in serum zinc at 60 days post-discharge from hospital. This may represent the period of replacement of the total body zinc. Zinc deficiency was more severe in those children in the control group that died after admission to hospital than those that survived, suggesting that low serum levels in children with PEM are associated with a poor prognosis. Zinc did not emerge as a predicator of poor prognosis in the supplemented group as very few children died in this group. The supplemented group also made significant gains as far as albumin levels were concerned, which probably reflects rehabilitation of their malnutrition. The associated improvement in haematological parameters has not been described before and may be secondary to the decreased burden of disease in the supplemented group. These findings suggest that not only were significant benefits of zinc supplementation shown for morbidity in mortality of children in Lesotho with PEM, but these trends were also demonstrated on biochemical profiles.

Child↗
PubMed1994

Anxiety and depression in an outpatient clinic in Lesotho, Africa.

OBJECTIVE: Past studies of psychiatric disorders in primary care in developing countries have utilized measures to determine conspicuous psychiatric morbidity (CPM) rather than diagnoses. Our goal was to determine the prevalence of DSM-III major depression (DEP), panic disorder (PD), and generalized anxiety disorder (GAD) in an outpatient clinic in Lesotho, Africa. METHODS: As part of a larger community study, we utilized a translated version of the N.I.M.H. Diagnostic Interview Schedule to determine the prevalence of DEP, PD, and GAD in 126 randomly selected outpatients (response rate = 77%) attending a general hospital clinic. We compared these data to information about demographics and symptom presentation. RESULTS: We found twenty-nine (23%) patients with DEP, thirty (24%) with PD, and thirty-six (29%) with GAD. Forty-six (36%) had either DEP or PD, with thirteen (45%) having concurrent illness. Patients with DEP and/or PD presented with a significantly higher number of physical symptoms, and a higher percentage of symptoms that were pain or autonomic nervous system related than patients with no disorder ever. CONCLUSION: There is significant psychiatric morbidity of common diagnoses in outpatient clinic in Lesotho, and patients present primarily with somatic symptoms, as in developed countries. There is a need for better elucidation of cross-cultural phenomenology, medical co-morbidity as a confounder, and help-seeking and treatment patterns in the developing world.

Africa↗
PubMedDate not supplied

Crowded outpatient departments in city hospitals of developing countries: a case study from Lesotho.

'Overuse' of hospital outpatient departments in urban areas of developing countries is perceived as a problem by many health planners. The World Health Organization is promoting advanced health centres, or 'reference centres', as part of a strategy to develop urban health systems and to reduce primary contact care at hospitals. However, hospital-based information to assist city health service planning is limited in many countries. This study examined user characteristics, patient flow and prescribing quality at the national referral hospital in Maseru, Lesotho, using simple and replicable methods. The study found that most users were self-referred and came from the city. The majority of respondents were aware of their local health centre but reported they would normally use the hospital when they were ill. Examination of patient flow showed that, on average, patients spent a total of 3.7 h waiting. Quality of care was compromised by a tendency to over-prescribe, particularly antibiotics and sedatives. The study suggests that in Maseru, the perception of 'overuse' is due to congestion and that improved patient flow management will reduce the numbers of patients waiting. Quality of care could be strengthened by regular audit of prescribing practices by clinicians in the hospital.

Adult↗
PubMedDate not supplied

Hospital or health centre? A comparison of the costs and quality of urban outpatient services in Maseru, Lesotho.

Urban hospital outpatient clinics in developing countries are said to be overburdened and some policy experts are proposing a new intermediate tier of advanced health centres between hospitals and health centres to solve this problem (termed 'reference centres' by the World Health Organization). In Maseru, Lesotho, hospital congestion led the Ministry of Health to decide to build reference centres. To delineate precisely how these centres should operate, research was carried out on the existing system comparing utilization, quality and cost between health centre and hospital outpatient care. The study showed that throughout per clinician at the hospital and the city health centres was similar; that the hospital service saw a greater proportion of adults and more men; that the technical care quality was similar; and, that health centre staff took longer with patients and had higher interpersonal consultation scores. Average costs at the hospital were 39 per cent greater, but, the calculated net costs to the provider at the hospital and at government centres were very similar once user fees had been taken into account. The results questioned the assumptions underlying the decision to build reference centres in Maseru, and also the relevance of a new tier to solve health service delivery problems in the city. The study highlights the need for national and municipal planners to examine carefully existing health services with respect to utilization, quality and cost before adopting urban reference centres as a standard solution to congested hospitals.

Community Health Centers↗
PubMed1989

Shedding of coronavirus-like particles by children in Lesotho.

Stools from 266 children in four districts of Lesotho were examined for viruses by electron microscopy (EM) over a 5-week period. Eighty one (30.5%) of the children shed coronavirus-like particles (CVLPs). Shedding was not significantly associated with diarrhea. The proportion of children shedding these particles increased with increasing age. In one district, the prevalence of CVLP shedding (67.9%) was at least twice the prevalence in any of the other three districts. This was the only district to be sampled during the first week of the study. It was shown that the proportion of children shedding CVLPs declined during each of the 5 weeks of study. The stools of six children who shed CVLPs in the early summer of 1984-85 were negative by EM 5 months later. There was no association between the shedding of pathogenic bacteria or parasites and the presence or absence of CVLPs in the stool.

Age Factors↗