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PubMed2004

Provision of family planning services in Lesotho.

CONTEXT: One of Lesotho's population goals is to achieve replacement-level fertility by 2011, but the contraceptive prevalence rate of 41% is considerably below the target of 70-75%. METHODS: A situation analysis framework was used to assess family planning providers' readiness to provide services and women's perceptions of service delivery. Data were collected in 1997-1998 through surveys of 38 service delivery points and 52 providers, and focus group discussions with 50 women. RESULTS: Most facilities were open five days a week, during working hours; closure during lunchtime and on weekends restricted access by employed people. There were no clear guidelines on the provision of family planning methods, and providers created their own rules and restrictions. Some women were discouraged by provider bias, lack of visual privacy and recurrent shortages of their preferred brand of pills. Although the government had a uniform pricing policy for contraceptive methods, costs varied and generally were higher in rural than in urban areas. In rural areas, transportation costs increased the overall cost of using family planning methods. CONCLUSIONS: Expanding women's access to service sites, developing guidelines for family planning providers and ensuring that standard prices are adopted should be government priorities if contraceptive prevalence is to increase.

Adult↗

PubMed1988

Drinking water source, diarrheal morbidity, and child growth in villages with both traditional and improved water supplies in rural Lesotho, southern Africa.

This study examined the growth and morbidity rates of young children in relation to exclusive and non-exclusive use of improved water supplies in rural Lesotho, southern Africa. Data were collected for 247 children 60 months of age and under between July 1984 and February 1985 in 10 villages that had an improved water supply at least one year prior to investigation. Children whose families relied exclusively on the new water supply for their drinking and cooking needs grew 0.438 cm and 235 g more in six months than children whose families supplemented the new water supply with the use of contaminated traditional water for drinking and cooking. The difference in growth was greater among children over 12 months of age at the start of the evaluation than among infants. This may be explained partly by lower rates for Giardia lamblia, the most commonly identified pathogen in stools in older children. Among infants, similar rates of Campylobacter, the most commonly isolated pathogen among infants, may have prevented larger differences. Results suggest that improved drinking water supplies can benefit preschool children's health after infancy, but only if they are functioning and utilized exclusively for drinking and cooking purposes.

Body Height↗

PubMed1993

Perspective reports of corporal punishment by pupils in Lesotho schools.

This study surveyed reports of practices of corporal punishment at secondary schools in Lesotho by 60 randomly selected pupils. There were 34 males and 26 females, whose mean age was 21 years, with a range between 14 and 29 years. Responses to a questionnaire confirmed that punishment was associated with pupils' reports of academic impairment, psychological damage, and physical injury.

Adolescent↗

PubMed1999

Quantitative bacterial examination of domestic water supplies in the Lesotho Highlands: water quality, sanitation, and village health.

Reported are the results of an examination of domestic water supplies for microbial contamination in the Lesotho Highlands, the site of a 20-year-old hydroelectric project, as part of a regional epidemiological survey of baseline health, nutritional and environmental parameters. The population's hygiene and health behaviour were also studied. A total of 72 village water sources were classified as unimproved (n = 23), semi-improved (n = 37), or improved (n = 12). Based on the estimation of total coliforms, which is a nonspecific bacterial indicator of water quality, all unimproved and semi-improved water sources would be considered as not potable. Escherichia coli, a more precise indicator of faecal pollution, was absent (P < 0.001) in most of the improved water sources. Among 588 queried households, only 38% had access to an "improved" water supply. Sanitation was a serious problem, e.g. fewer than 5% of villagers used latrines and 18% of under-5-year-olds had suffered a recent diarrhoeal illness. The study demonstrates that protection of water sources can improve the hygienic quality of rural water supplies, where disinfection is not feasible. Our findings support the WHO recommendation that E. coli should be the principal microbial indicator for portability of untreated water. Strategies for developing safe water and sanitation systems must include public health education in hygiene and water source protection, practical methods and standards for water quality monitoring, and a resource centre for project information to facilitate programme evaluation and planning.

Adolescent↗

PubMed1982

Emigration and development in Southern Africa, with special reference to Lesotho.

"The introduction defines development and describes the scope of the paper. Section two briefly describes the historical evolution of [labor] migration in southern Africa, the ambiguities of data, and recent quantitative trends. Section three discusses alternative theoretical perspectives. Section four examines the case of Lesotho as an extreme example of a sending country and provides occasional allusions to other southern African sending countries. Section five concludes that the most important effect of [labor] migration on development in southern Africa has been to trade short run income benefits for long run development difficulties."

Africa↗

PubMed2003

Parents' attitudes to adolescent sexual behaviour in Lesotho.

This study investigated the knowledge, attitudes and opinions of parents on various aspects of adolescents' sexual and reproductive health in Lesotho. The study used a qualitative methodology. Findings reveal that parents are aware that male and female adolescents engage in sexual relationships. Some parents believe that adolescents are too young to initiate sexual activities while others said they don't mind older unmarried adolescents having sex. In addition, parents felt that adolescents do not face discrimination in obtaining family planning services. In relation to passing sexual and reproductive health knowledge to adolescents, there seems to be a dilemma on who should take the responsibility. A number of policy implications have emerged from this study. There should be awareness campaign for parents who are not aware that adolescents engage in sexual relationships. Parents should be encouraged to communicate with their adolescent children on sex-related matters. Government should carry on with the dialogue on introducing sex education in schools curriculum.

Adolescent↗

PubMed2006

Lesotho embarks on universal HIV testing.

On 1 December 2005, this past World AIDS Day, Lesotho embarked on the "Know Your Status" initiative to provide country-wide voluntary counselling and testing (VCT) for HIV/AIDS. In a country of two million people with a 29 percent HIV infection rate, the universal testing initiative may help prevent a humanitarian and economic crisis capable of destroying the country. However, the initiative raises human rights concerns.

AIDS Serodiagnosis↗

PubMed1990

Comparison of mothers' understanding of two child growth charts in Lesotho.

Reported are the results of a study that compared mothers' understanding of two growth monitoring charts in Lesotho, which was carried out to assist the government in selecting a national growth chart. The study was conducted over 4 months in nine primary health care (PHC) clinics, where 1221 mothers were enrolled. Mothers were assigned to one of the following chart groups: "road-to-health" (RTH), "growth surveillance" (GS), or no chart (controls). Mothers in the first two groups received instruction on their respective chart during monthly growth monitoring sessions and were tested on their knowledge of this chart before and after the follow-up period. The mothers in the control group were tested on the RTH and GS charts at the beginning and at the end of the study. The results indicated that mothers who received training on either chart markedly improved their understanding compared with the control group and that the RTH group understood their chart better than the GS group did theirs.

Audiovisual Aids↗

PubMed1991

A study of the association between improved sanitation facilities and children's height in Lesotho.

The impact of improved sanitation on the anthropometric status of children under 5 years in Lesotho was investigated using children recruited into a case-control study of diarrhoea morbidity. The children's height-for-age Z-scores were used as an indicator of chronic undernutrition. Classifying children as 'stunted' or 'adequately nourished' revealed some evidence of an association between latrine ownership and attained height. After allowing for confounding variables, the odds of stunting were 18 per cent lower among children in households with latrines (95 per cent confidence interval, 36 per cent lower to 3 per cent higher). More powerful analyses, using height-for-age as a continuous outcome variable, revealed that the mean height-for-age Z-score of children from households with a latrine was 0.27 standard deviations higher than that of children from households without a latrine (95 per cent c.i. = 0.12 to 0.42). These results suggest that the anthropometric status of children may be as responsive to improvements in sanitation facilities as diarrhoea morbidity in some settings.

Analysis of Variance↗

PubMed1990

A case-control study of the impact of improved sanitation on diarrhoea morbidity in Lesotho.

A health impact evaluation of the Rural Sanitation Pilot Project in Mohale's Hoek district, Lesotho, was conducted from October 1987 to September 1988. A clinic-based case-control design was used to investigate the impact of improved sanitation on diarrhoea morbidity in young children. The results indicate that under-5-year-olds from households with a latrine may experience 24% fewer episodes of diarrhoea than such children from households without a latrine (odds ratio = 0.76; 95% confidence interval, 0.58-1.01). The impact of latrines on diarrhoea was greater in those households that used more water, practised better personal hygiene, and where the mothers had a higher level of education or worked outside the home. In common with studies conducted in Malawi, Philippines, and Sri Lanka, little evidence was found that the relationship between latrine ownership and diarrhoea was confounded by socioeconomic status or environmental variables. For a sample of cases and controls, data on exposure status (presence or absence of a latrine) that were collected by interview at the clinics agreed closely with those obtained by observation during a home visit.

Case-Control Studies↗

PubMed1989

Severe protein energy malnutrition in Lesotho, conditioning factors and death and survival in hospital.

Information was obtained on infants and children admitted for severe protein energy malnutrition (PEM) to Lesotho's central hospital in 1981 and 1982 as regards feeding pattern, socio-economic, environmental factors and vaccination status. Acute gastroenteritis (GE) appeared to be a major precipitating cause in the development of severe PEM. Of children 13-24 months of age only 13% was still breast fed. Compared to kwashiorkor significantly more children with marasmus or marasmic kwashiorkor had never been breast fed, or were early weaned and bottle fed. Above age nine months, children had a similar diet during the last three days before admission. Children of nevermarried single mothers appear to be more at risk for severe PEM. Absence of the father's support and a grandmother as caretaker may be other risk factors as well. The vaccination status was poor. In marasmus death was significantly (p less than 0.01) associated with bottle feeding and survival (p less than 0.05) with breast feeding. In kwashiorkor death was significantly (p less than 0.01) associated with an unprotected source of drinking water and survival (p less than 0.05) with consumption of green vegetables in the last three days before admission and employment of the mother. Data collection in hospital may provide a rationale for interventions in the development of severe PEM and identify those at risk to die from it.

Breast Feeding↗

PubMed1989

Seasonal abundance and parity of Culicoides biting midges associated with livestock at Roma, Lesotho (Diptera: Ceratopogonidae).

A light-trap survey was undertaken of the species composition, seasonal abundance and parity of Culicoides at Roma, Lesotho, to establish whether the likely vectors for bluetongue and African horse sickness occur in this area as well as the chance of transmission. A total of 34 catches was made between 21 September 1985 and 24 September 1986; 32,819 Culicoides were caught belonging to 19 species. Culicoides numbers rapidly built up from December to a peak in February which implies that this may also be the optimum time for virus transmission. The number of Culicoides dropped sharply in April with the onset of cooler conditions. C. zuluensis was the dominant species forming 69.6% of the totalled catches, followed by C. pycnostictus with 11.7%. C. imicola, the only proven vector of bluetongue, was never abundant representing only 4.4% of the midges caught. The parous rate for each of the 2 commonest species was low, implying a low vector capacity.

Animal Diseases↗

PubMed1989

[Use of human body parts in the preparation of "protective medicine" in Lesotho. Parallels between African preventive medicine and drug preparations in Western paramedicine].

Special situations in life require very strong "protective medicine" which then has to contain human flesh. Such ingredients are obtained by so called medicine murder. Post-mortem examination on the victim, which in this case a difficult task, has to be performed by the medical officer in the District Hospitals of Lesotho. The exclusion of medicine murder has a calming effect on the community. Analysing the rationale of such medicine brings parallels to paramedical practice in our country.

Cause of Death↗

PubMed1986

Severe protein energy malnutrition in Lesotho, death and survival in hospital, clinical findings.

In Lesotho's central hospital 55 (25%) of 218 admissions for severe PEM died during 1981 and 1982. Most deaths (62%) occurred in the first week. The most important causes of death were acute GE and pneumonia in marasmus and kwashiorkor, respectively. The cause of death remained obscure in 16 children, however. In marasmus a poor prognosis was significantly associated with the finding on admission of a temperature less than 36.5 degrees C (P less than 0.05), apathy (P less than 0.01) and a depigmented skin (P less than 0.05), while in marasmic kwashiorkor only the finding of the latter was significantly (P less than 0.05) associated with death. In non-survivors with kwashiorkor the following characteristics were observed significantly more often: complaints of diarrhoea and/or vomiting on admission (P less than 0.05), the finding of apathy, pallor, skin defects and hepatomegaly on admission (P less than 0.01), and the finding of a low serum albumen, Na+ and K+ in the first days (P less than 0.05). Irritability was significantly (P less than 0.05) more common in survivors with kwashiorkor. Xerophthalmia was observed only once. Infections were diagnosed in 86% of all and giardiasis in 28% of 146 children. Twenty-eight children contracted measles of whom 5 died. Severe PEM still carries a high mortality despite hospitalisation. The findings confirm the need for intensive management of severe PEM.

Acute Disease↗

PubMed1986

Birthweight distribution in the Mantsonyane area: Lesotho.

A total of 832 maternal and newborn records in a rural hospital in Lesotho were analysed. The mean birthweight was 3.07 kg and the incidence of low birthweight rate 7.5%. This was compared with other countries in Africa. Increasing birth order was associated with higher birthweight irrespective of maternal age, except for the very young mothers. No seasonal variation in birthweight was observed. Of 313 newborns the gestational age was assessed. The overall anthropometric measurements of newborns in the Mantsonyane area were comparable to better off industrialized countries.

Adolescent↗

PubMed1980

Penetrating keratoplasty in Lesotho.

Sixty-four Basotho patients underwent therapeutic penetrating keratoplasty in Lesotho, a developing African nation. The overall long-term success rate of 60.7% was comparable to similar series in developed countries. Analysis of variables found to significantly affect graft outcome included size of graft, anterior segment pathology, postoperative iris adhesion to graft wound, and onset of graft rejection during hospitalization or after discharge. McCarey-Kaufman medium was found to be highly successful for corneal storage up to seven days, and corneal transplantation across racial lines was not associated with increased immune rejection reactions.

Adolescent↗

PubMed1982

Screening of pre-school and school children for ocular anomalies in Lesotho.

One thousand two hundred and ninety-six pre-school and school children were examined in the first screening programme for ocular anomalies in Maseru, Lesotho. One hundred and eighteen children (8.9%) were found to have significant ocular anomalies requiring treatment. The most common anomalies included refractive errors, squint, convergence insufficiency, amblyopia, vernalis, lid abnormalities, leukoma cornea, and cataract. The importance of school screening for ocular anomalies in a developing African nation is emphasized.

Child↗

PubMed1994

Lack of difference in blood pressure between the urban and rural population in Lesotho, Africa.

In this preliminary study, blood pressure and associated factors were studied in 233 urban and 194 rural Basotho's, aged 18 to 88 years. Blood pressure was shown to increase with age in both sexes, but no significant differences were noted between urban and rural men. A significant in difference diastolic BP was seen between urban and rural women aged 18 to 34 years, (p < 0.01), and women over 55 years (p < 0.05) but this did not correlate with the Body Mass Index (BMI). Significant difference in BMI between men and women was seen in the 18 to 34 years, 35 to 54 years age groups, (p < 0.001), and the over 55 years group (p < 0.05). However, significant blood pressure differences between men and women were only seen in the 18 to 34 years group, in which men who had a lower BMI had a significantly higher blood pressure (p < 0.001) than women with a higher BMI. Prevalence of 14.9 pc rural, 12.4 pc urban hypertension was seen. This may be partly contributed by diet and urbanisation of rural Basothos. Further studies into factors contributing to hypertension should be carried out in Lesotho.

Adolescent↗