Mixed-methods evaluation of family medicine research training and peer mentorship in Lesotho

Background: Strengthening primary care research capacity is a priority globally. Family medicine training programmes in sub-Saharan Africa represent an important opportunity to build primary care research; however, they are often limited by insufficient research training and mentorship. Peers can be used to extend research mentorship capacity, but have not been evaluated in this context. Aim: The aim of this study was to evaluate one family medicine training programme's research capacity building efforts through a blended research curriculum and peer mentorship. Setting: Lesotho is a landlocked country within South Africa of approximately two million people. The Family Medicine Specialty Training Programme (FMSTP) is the only accredited postgraduate medical education programme in Lesotho. Methods: This two-year mixed-methods evaluation used: (1) Likert-scale surveys measuring trainee research confidence, (2) written evaluations by trainees, peers, programme faculty and administrators and (3) in-depth, semi-structured interviews. Survey data were analysed using Friedman and sign tests. Interview and written data were analysed thematically via a mixed inductive-deductive approach using Cooke's framework. Results: Family Medicine Specialty Training Programme trainees (n = 8) experienced moderate increases in research confidence that were statistically significant. Skill-building occurred primarily via experiential learning. Research was grounded in trainees' clinical practice and locally relevant. A positive research culture was created, promising for sustainability. We identified infrastructure gaps, including funding and protected time. Peer research mentorship supported trainees' motivation and provided a safe space for questions. Conclusion: The FMSTP research curriculum and peer mentorship programme were successful in positively impacting a number of Cooke's research capacity domains. This evaluation identified improvements that are now being implemented

Occupational lung disease among Basotho ex-miners in a large outreach medical assessment programme

Background: Current initiatives in southern Africa to medically assess former migrant miners for silicosis and tuberculosis, including statutory and lawsuit derived compensation programmes, require burden of disease information. nObjective: To use clinical information collected on ex-miners examined at the Occupational Health Service Centre (OHSC) in Lesotho, operated under the Tuberculosis in Mining Sector in Southern Africa (TIMS) project, to measure the burden of lung disease and respiratory impairment. Methods: Demographic, occupational and medical history information, chest radiology, spirometry, GeneXpert testing for tuberculosis, and pulse oximetry outcomes were analysed, and descriptive summary measures calculated, in a group of ex-miners examined in 2017 and 2018. Results: The study sample comprised 2 758 Basotho former underground miners, with median age of 62 years and median length of service of 28 years. Among ex-gold miners (n = 2 678), disease prevalence was high: radiological tuberculosis (consistent with previous or current disease) 60.9%, silicosis 42.5%, HIV 30.7%, silicotuberculosis 25.7%, and current active tuberculosis 6.8%. Of those with tuberculosis diagnosed microbiologically, 6.7% had no radiological evidence of tuberculosis and 54.1% did not report cough. Conclusion: The findings have public health and compensation implications. There are large numbers of ex-miners with potentially compensable disease under both the statutory system and a settlement trust set up following litigation. This overlaps with a tuberculosis-HIV co-epidemic which requires screening and treatment for tuberculosis and HIV, and managing a considerable disability and care burden on families and the Lesotho health system. Coordinated planning and substantial resources are needed for these programmes to do justice to their mandates

Assessment of tuberculosis knowledge among Lesotho village health workers and utilisation of their tuberculosis services by the communities they serve

Background: The role of village health workers (VHWs), among other roles is to educate communities about tuberculosis (TB), TB screening and its treatment. The knowledge of TB among VHWs is crucial because they will carry out their role at the community well and this will impact the overall outcome of TB treatment. Aim: The study is aimed at assessing the knowledge of TB among VHWs and households at the village level and the utilisation of VHWs' TB services. Setting: The study took place in 19 health centres from 10 districts of Lesotho. Methods: The study used a cross-sectional descriptive design. Three study populations were interviewed, two at the household level (2040 households, 8295 individuals) and one at the clinic level (723 VHW). Results: Overall, TB knowledge among VHWs for the majority of clinics except two was inadequate (below mean of 31.5). The utilisation of VHWs' TB services among community members was also low. Conclusion: Low utilisation of VHWs' TB services by community members emanated from inadequate TB knowledge of VHWs. Regular refresher training among VHWs is recommended as the way forward in order to keep VHWs abreast with new TB developments

Nutritional status and food intake of women residing in rural and urban areas of Lesotho

Objective: The socio-demography, anthropometry and food intake of women residing in rural and urban areas of Lesotho were determined.Design: Cross-sectional survey.Setting: Basotho women from four randomly selected villages in Maseru and Berea, which includes both urban and rural areas.Subjects: A total of 452 women were included in the study. Outcome measures: Socio-demographic information was collected using a structured questionnaire completed in an interview with each participant. Standard methods were used to determine anthropometric measurements, while usual food intake was determined using a short unquantified food frequency questionnaire.Results: A large percentage of participants were unemployed with a significantly higher percentage in urban compared with rural areas (65.5 vs. 49.2%; CI 6.8%; 25.4%). A higher percentage of urban than rural participants had a BMI ≥ 30 kg/m2 (53.5 vs. 44.4%, respectively) and waist circumference ≥ 88 cm (62.7 vs. 54.1%, respectively). For both rural and urban participants, stiff maizemeal porridge was commonly consumed with all meals, often with moroho (cooked green leafy vegetables). Although a variety of vegetables (onions, cabbage, pumpkin, tomatoes, turnips and potatoes) were frequently eaten by most participants, quantities of intake were not determined. Protein sources consumed almost every day by more than 50% of all participants were dried beans.Chicken, eggs and full cream milk were consumed significantly morefrequently by urban participants. Significantly more urban participants had access to a variety of fruits and vegetables, and they were also more likely to consume foods such as polony, russians(sausage containing pork and beef), sausage, sweetened drinks, mayonnaise and margarine more frequently than rural participants.Conclusions: A nutrition transition associated with the frequent intake of processed, sugary and high-fat foods was identified in urban participants. These unhealthy dietary practices may lead to an increased risk of obesity and poor health outcomes. The development of culturally acceptable and relevant interventions is thus recommended

Community health workers in Lesotho: experiences of health promotion activities

Background: Lesotho adopted primary health care in 1979, and community health workers (CHWs) were included in the programme to focus on health promotion, particularly to reach people in underserved rural areas. Although the CHW programme has been successful, the heavy burden of disease because of HIV and/or AIDS and tuberculosis shifted resources from health promotion to home-based care. Aim: The study explored the lived experience of CHWs in conducting health promotion activities in Lesotho.Setting: The study was conducted in four health centres in Berea district, Lesotho. Methods: A qualitative study was conducted using an interviewer guide translated from English into Sesotho for four CHW focus group discussions, four individual interviews of key informants and four semi-structured interviews with the health centre nurses.Results: The roles of CHWs in health promotion ranged from offering basic first aid and home-based care to increasing access to health care services by taking patients to the facilities and promoting behaviour change through health education. Their perceived successes included increased access to health care services and reduced mortality rates. CHW challenges involved their demotivation to carry out their work because of lack of or inconsistent financial incentives and supplies, work overload which compromises quality of their work and limited community involvement.Conclusion: This study concludes that CHWs are beneficial to health promotion and its various activities. They had a clear understanding of their roles and responsibilities, although they did not fully comprehend that what they were describing was, in fact, health promotion. When it came to advocacy, CHWs did not fully understand it, nor did they consider it as part of their roles, although they acknowledged its importance. Their role of increasing access to health care services by accompanying patients to the facilities has increased considerably because of changes in disease burden. This is affecting their ability to practise other health promotion activities which focus on disease prevention

Cervical cancer screening among adolescent girls in Lesotho: levels and determinants

Background. International guidelines have discouraged screening of young women under the age of 21 for cervical cancer. However, a high screening rate is still evident among adolescent girls in Lesotho. Objective. To explore the levels and determinants of cancer screening among adolescent girls in Lesotho. Methods. This cross-sectional study used secondary data from the 2014 Lesotho Demographic and Health Survey collected from 1 542 adolescent girls aged 15 - 19 years. Descriptive statistics, the chi-square test and a binary logistic regression model were used to analyse the data. Results. Despite recommendations that adolescents should not screen for cervical cancer, results show that 15% of adolescent girls in Lesotho attend screening services. Adolescent girls from rural areas are less likely to screen than those from urban areas (odds ratio (OR) 0.22, 95% confidence interval (CI) 0.07 - 0.68; p=0.009). Marital status and level of education were significantly associated with cervical cancer screening among respondents; however, age at first sex was not statistically associated with screening among adolescent girls. Conclusion. With reference to international guidelines, the screening rate for cervical cancer is high among adolescents in Lesotho. Future studies should focus on why adolescents in Lesotho still screen for cervical cancer despite international recommendations discouraging screening before the age of 21

Covariates of multiple sexual partnerships among sexually active men in Lesotho

Multiple sexual partnerships (MSP) have been identified as the main reason for the high rate of HIV prevalence in sub-Saharan Africa, including Lesotho. The aim of this paper is to identify the social and economic variables associated with MSP among men in Lesotho. The study used data from 2009 Lesotho Demographic and Health Survey. A sample of 2335 males in the age group 15­44 was used. Participants qualified if they were sexually active during the past year before the survey. Binary logistic regression was used to analyse the data. Results indicated that 29% of the respondents had engaged in sexual intercourse with multiple partners in the past year. Lower age at sexual debut, employment; having ever moved from home in the past year; believing that men have the right to have sex with other women; believing that beating a woman is justified if she argues with husband and having sex with casual partner were associated with an increased likelihood of MSP.On the other hand, coming from household led by a woman reduced the odds ratio. The study recommends that promotion of awareness programmes on MSP coupled with economic empowerment of women should be intensified in Lesotho

Professional nurses' perception of their clinical teaching role at a rural hospital in Lesotho

Background. Nursing education institutions in Lesotho face an increasing number of enrolments owing to a high demand for professional nurses to work in the community. Enrolments have doubled during the last 3 years; without an increase in teaching resources or staff. Professional nurses in the wards are expected to mentor students and teach the clinical elements of nursing while continuing with their day-to-day clinical duties. Furthermore; professional nurses in Lesotho have not been trained for this clinical teaching role. Objective. To explore the perceptions of professional nurses with regard to their clinical teaching role in the development of competent nurses. Methods. A qualitative study was undertaken at a rural hospital in Lesotho. Data were gathered by conducting semi-structured interviews with professional nurses. Interview transcripts were coded and emerging themes identified. Data saturation was reached after eight interview transcripts were analysed. Results. Four themes representing the perceptions of the professional nurses emerged in the analysis: (i) the clinical teaching role; (ii) the complexities of clinical teaching; (iii) learners have their issues; and (iv) making it work. Conclusion. Professional nurses understand and appreciate their educational role in the development of competent nurses. This clinical teaching role is performed in difficult circumstances; including administrative challenges; limited resources and staff shortages; while maintaining clinical responsibilities. Despite these challenges; the nurses have remained resilient and solution focused. Nursing education institutions should re-orientate professional nurses with regard to current trends and principles of nursing education to enhance their clinical teaching role

Social models of HIV risk among young adults in Lesotho

Extensive research over the past 30 years has revealed that individual and social determinants impact HIV risk. Even so; prevention efforts focus primarily on individual behaviour change; with little recognition of the dynamic interplay of individual and social environment factors that further exacerbate risk engagement. Drawing on long-term research with young adults in Lesotho; I examine how social environment factors contribute to HIV risk. During preliminary ethnographic analysis; I developed novel scales to measure social control; adoption of modernity; and HIV knowledge. In survey research; I examined the effects of individual characteristics (i.e.; socioeconomic status; HIV knowledge; adoption of modernity) and social environment (i.e.; social control) on HIV risk behaviours. In addition; I measured the impact of altered environments by taking advantage of an existing situation whereby young adults attending a national college are assigned to either a main campus in a metropolitan setting or a satellite campus in a remote setting; irrespective of the environment in which they were socialised as youth. This arbitrary assignment process generates four distinct groups of young adults with altered or constant environments. Regression models show that lower levels of perceived social control and greater adoption of modernity are associated with HIV risk; controlling for other factors. The impact of social control and modernity varies with environment dynamics

Knowledge and practices about multidrug-resistant tuberculosis amongst healthcare workers in Maseru

Background: To date; no study has been found that described the knowledge and practices of healthcare workers surrounding multidrug-resistant tuberculosis (MDR-TB) in Lesotho.Aim and setting: This study was conducted to fill this gap by investigating the knowledge level and practices surrounding MDR-TB amongst healthcare workers at Botsabelo Hospital in Maseru; Lesotho.Method: This was a cross-sectional survey conducted by means of a questionnaire designed specifically for this study. Data collected included sociodemographic and professional details; and responses to questions about knowledge and practices regarding MDR-TB. The questions ranged from the definition of MDR-TB to its treatment. Respondents' practices such as the use of masks; guidelines and patient education were also assessed. Results: A response rate of 84.6%(110 out of 130) was achieved. The majority of participants were women (60%); married (71.8%) and nursing staff (74.5%). Overall; less than half (47.3%) of the participants had a good level of knowledge about MDR-TB. With regard to practice; about 83%of participants stated that they used protective masks whilst attending to MDR-TB patients. About two-thirds (66.4%) reported being personally involved in educating patients about MDR-TB; whilst about 55%stated that they referred to these guidelines.Conclusion: The level of knowledge about MDR-TB amongst healthcare workers at the study site was not at an acceptable level. Unsafe practices; such as not wearing protective masks and not referring to the MDR-TB treatment guidelines; were found to be associated with an insufficient level of knowledge about MDR-TB. An educational intervention is recommended for all healthcare providers at this facility

Reading the National Disability and Rehabilitation Policy in the light of Foucault's technologies of power

In the area of disability studies, models have been at the centre of debates, influencing social policies, practices and legal frameworks. The former Ministry of Health and Social Welfare in the Kingdom of Lesotho was not an exception. In its efforts to tackle issues of disability, it produced The National Disability and Rehabilitation Policy: Mainstreaming persons with disabilities into society in 2011. This policy document is rooted in the social model and seeks to address long-standing problems and challenges of people with disabilities in the Kingdom. Using ideas from Foucault, particularly the technologies and regimes of power, which work through language and practice, this article examined ways in which people with disabilities are constituted through state knowledge and government policies, and concluded that these constructions form the basis for alienation and marginalisation in society

Strengthening laboratory management towards accreditation: the Lesotho experience

Introduction: The Lesotho Ministry of Health and Social Welfare's (MOHSW) 5-year strategic plan; as well as their national laboratory policy and yearly operational plans; directly addresses issues of accreditation; indicating their commitment to fulfilling their mandate. As such; the MOHSW adopted the World Health Organization Regional Headquarters for Africa's Stepwise Laboratory Quality Improvement Toward Accreditation (WHO-AFRO-SLIPTA) process and subsequently rolled out the Strengthening Laboratory Management Towards Accreditation (SLMTA) programme across the whole country; becoming the first African country to do so. Methods: SLMTA in Lesotho was implemented in two cohorts. Twelve and nineteen laboratory supervisors and quality officers were enrolled in Cohort 1 and Cohort 2; respectively. These 31 participants represented 18 of the 19 laboratories nationwide. For the purposes of this programme; the Queen Elizabeth II (QE II) Central Laboratory had its seven sections of haematology; blood bank; cytology; blood transfusion; microbiology; tuberculosis laboratory and chemistry assessed as separate sections. Performance was tracked using the WHO-AFRO-SLIPTA checklist; with assessments carried out at baseline and at the end of SLMTA. Two methods were used to implement SLMTA: the traditional 'three workshops' approach and twinning SLMTA with mentorship. The latter; with intensive follow-up visits; was concluded in 9 months and the former in 11 months. A standard data collection tool was used for site visits.Results: Of the 31 participants across both cohorts; 25 (81) graduated (9 from Cohort 1 and 16 from Cohort 2). At baseline; all but one laboratory attained a rating of zero stars; with the exception attaining one star. At the final assessment; 7 of the 25 laboratories examined at baseline were still at a rating of zero stars; whilst 8 attained one star; 5 attained two stars and 4 attained three stars. None scored above three stars. The highest percentage improvement for any laboratory was 51; whereas the least improved dropped by 6 when compared to its baseline assessment.The most improved areas were corrective actions (34) and documents and records (32). Process improvement demonstrated the least improvement (10). Conclusion: The SLMTA programme had an immediate; measurable and positive impact on laboratories in Lesotho. This success was possible because of the leadership and ownership of the programme by the MOHSW; as well as the coordination of partner support