Dissertations / Theses on the topic 'Health services – Lesotho – Roma'

Thesis (MMed) -- Stellenbosch University, 2010.
Bibliography
Objective: The objective of this retrospective cohort study is to assess whether demographic and anthropometric parameters, laboratory tests, co-morbidity, co-infection, treatment regimen, IRIS and adherence to treatment predict the expected response to HAART and differences if any, in the pattern of response as measured by CD4 count, weight gain and haemoglobin levels in two cohorts of patients in Roma, The Kingdom of Lesotho. Method: Data were collected randomly from a computerised database of the Antiretroviral Centre of the hospital and two cohorts of 151 subjects in each of the two arms of the study were identified from hospital records from January 2008. Each of these subjects was followed up over a period of 12 months with data obtained for at least 2 visits within the 12 month span. Data were obtained at baseline, 3 months and also at 6 and 12 months marks. Data on characteristics were compared between the two arms. Variables that may be potential confounders were identified and univariate and multivariate logistic regression analyses were carried out to establish differences independent of confounding factors for the combined endpoints as well as for each endpoint separately. Results: In all 302 patients had their records analysed and comparison of clinical and immunological response patterns in patients taking AZT and TDF-containing ART regimens and the possible prediction of which the regimen would be better and within which population. Despite the perceived mismatch between two NRTIs it can be concluded from the results of this study that, overall, the inclusion of AZT in treatment regimen showed a modest protective effect over the TDF counterpart as measured by the endpoints of the discriminative powers of the Receiver Operating Curves of the explanatory variables being 66% , 77% and 66% for CD4, Haemoglobin and Weight respectively, and 63%, 70% and 65% for the same variables in the AZT and TDF arms of the study respectively. Conclusion: In a population of HIV patients on treatment in resource-limited settings AZT-containing regimens appear to show a slight improvement over the TDF-containing ones.

Thesis (MPH)--University of Limpopo, 2010.
Background: Sexual health of young people is a matter of public health concern and Reproductive health occupies a central position in health and development. Unwanted pregnancy and sexually transmitted infections among young women can be prevented through effective use of contraception. Unmet need for contraception in developing world and rates of unintended pregnancy among young women is high. Aim of the Study: To assess the level of awareness of contraceptives and utilization of family planning services among young women and barriers that hinders effective use of such services Methods: A quantitative descriptive survey was conducted among 360 female undergraduate students of the National University of Lesotho, Roma, Lesotho. A hand delivered self administered questionnaire was used to collect data with the help of four trained research assistants. Epi info version 3.5 was used for data entry and analysis. Results: Awareness of family planning is high among the participant (98.3%); Condom is the most commonly known and used family planning method. Level of sexual experience and Contraceptive prevalence is high. Married status is associated with current use, positive perception on health benefit while Formal teaching on family planning is associated with misconceptions. Conclusion: The level of awareness and Utilization of family planning services is high among female students of university of Lesotho. Access to services is good but there are misconceptions. There is the need to introduce family planning teaching that is based on accurate knowledge to school curriculum

Primary Health Care (PHC) plays a vital role in decentralization of health care services. PHC is designed to ensure health care coverage at the community level through the involvement of the community in improving their healthy living. PHC offers treatment and care in continuum that is supported by a facility-linked home- based care system and a referral system. While PHC is global, its operation and functioning in the area of community health provisioning varies across communities. The main objective of this study is to find out whether PHC is effective or not in Roma Valley, Lesotho. The study was carried out in Roma Valley, in the Maseru district of Lesotho. The population for this study includes the nurses under the department of PHC, village health workers, Chiefs and out-patients from four different villages. Out of this, a sample of thirty individuals was selected. The data for this study was collected through qualitative research technique, particularly oral interviews and written records or secondary data sources. The analysis revealed that nurses and village health workers respond to the social needs and health problems of the community and community members are also involved in improving their health status. Village health workers face many challenges in their engagement in this system such as not being given incentives for what they do and often uncooperative disposition of some community members including their leaders. It was also found that they operate under a lot of stress due to lack of resources.

Magister Public Health - MPH (Public Health)
The oral health programme in Lesotho aims to offer curative, preventive, promotive and rehabilitative oral health services. However, observations as well as annual reports suggest that oral health service utilization is poor, as most patients only attend dental clinics with advanced stages of decayed teeth which can only be extracted. The reasons for this very undesirable late utilization of oral health services have not been systematically explored and understood in Lesotho. This makes it difficult for health planners to find solutions for improving access, utilizations and responsiveness of oral health services.

Research Question: This research will assess whether the Roma population are able to effectively access primary care services, and if not, what barriers prevent them from doing so. Background: The Canadian International Development Agency (CIDA), in partnership with the Serbian government and the Canadian Society for international Health, has prioritized equitable access to healthcare services for vulnerable populations in Serbia. As part of this larger initiative, the factors that affect access to primary care services for the Roma population will be analyzed in an attempt to determine if and how services can be improved. Methodology: Disaggregated data was collected from three population groups in Serbia; the general population, the poorest quintile (not including the Roma), and the Roma population. The effective coverage framework, which incorporates availability, affordability, accessibility, acceptability, and effectiveness, was used to structure the analysis. Results: This research found that the Roma are disadvantaged across a range of equity dimensions. The Roma are less likely to be able to afford health services, or physically access primary care centers, and are more likely to be discriminated against by health workers.

Thesis (MPH) -- University of Limpopo, 2012.
Background: Youth friendly services were introduced in all the ten districts t of Lesotho to meet the adolescents health needs including reproductive health of adolescents. Despite this initiative there is still a high prevalence of teenage pregnancy and human immunodeficiency virus (HIV) infection among young people. Aim: The aim of the study was to investigate the utilization, and factors influencing the utilization of reproductive health services (RHS) among high school adolescents in Thaba-Tseka district of Lesotho. Methodology: This was a quantitative descriptive cross-sectional study. The study population was adolescents aged between 13 -19 years in the two high schools in the district. A total of 800 adolescents were asked to complete a structured, self-administered questionnaire. Descriptive statistics were used to summarise demographics, sexual activity, experience of sexually transmitted infections (STIs), and awareness and use of RHS. The chi-square test was used to identify associations between categorical variables, and binary logistical regression modelling was used to identify significant predictors of utilisation of RHS. Results: The response rate was 97.5% (780/800), but only 723 questionnaires had sufficient data to be analysed. The mean age of respondents was 16.4 years with a standard deviation of 1.7years. Of the respondents, 49.5% (358/723) had been sexually active with the youngest age at sexual debut of 8 years. Of these, 71.5% (256/358) were presently sexually active; 82.4% (295/358) had low overall levels of awareness of RHS; 37.9% (136/358) had ever visited the adolescent health corner (AHC); 34.9% (125/358) reported that there was a place that provided RHS in their local clinic; 57.3% (205/358) had ever used condoms; and 56.7% (203/358) had experienced a STI; Of those presently sexually active, 89.5% (229/256) used some form of contraceptive, with 95.2% (218/229) buying condoms from a retail shop although only 94.0% (205/218) reported using them, while 38.9% (89/229) also obtained them from the AHC. Only 13.3% (27/203) of those who had experienced signs of STI ever visited the AHC for treatment. Of those who knew about RHS, 54.4% (68/125) utilized the services. Statistically significant predictors of RHS utilization were having a friend using RHS (odds ratio [OR] =8.87; P value< 0.001) and access to RHS (OR=7.97; P < 0.001). Participants in higher grades were significantly less likely to use RHS compared to participants in lower grades (OR=0.21; P<0.001). Conclusion: Almost half of the adolescents engage in sexual activity at an early age and RHS are under-utilised, mostly because of lack of access. There is a need to embark on increasing accessibility of RHS among adolescents to promote utilization of RHS.

Thesis (M Social Work)--Stellenbosch University, 2015.
ENGLISH ABSTRACT: HIV/AIDS is one of the worst pandemics affecting the world today. It cuts across all boundaries and many people are infected as well as affected. The virus has reached all the corners of the globe, but the most hit by it is Africa, especially southern Africa, which carries more than half of the population infected and affected by HIV/AIDS. The top five countries whose populationsare infected with HIV are in southern Africa. Lesotho is amongst the top three on this list and also has problems of poverty and a high unemployment rate. Women and children, who are the target groups that are most affected by poverty, are also those living in rural areas. Thus, being an HIV-positive mother living in the rural areas of Lesotho means one has to deal with poverty, the inaccessibility of services and the psychological impacts of HIV. The aim of the study was to gain a better understanding of the views of health service providers on the need and accessibility of support services for HIV-positive mothers in the rural areas of Lesotho from an ecological perspective. To achieve this aim, the objectives were: to offer an overview of the phenomenon of HIV and describe the psychosocial needs and sociocultural circumstance of HIV-positive mothers in the rural areas of Lesotho, and to discuss the HIV-positive mothers’ need for support services from an ecological perspective. Both quantitative and qualitative research approaches were used. The research utilised exploratory and descriptive design. Purposive sampling was used to select the 30 participants who took part in the study. Data was gathered by means of semi-structured questionnaires that were administered during individual interviews. The questionnaires were formulated on the basis of information retrieved during the literature review. The findings of the study reveal that HIV-positive mothers living in the rural areas of Lesotho have economic, social and cultural circumstance as factors hindering their treatment and prevention of HIV/AIDS. They are also faced with the psychological impacts of HIV, and the findings revealed that disclosure was the key to addressing their problems. The findings also show that most mothers receivedemotional, instrumental, informational and appraisal support from their families at the micro-level of the ecological perspective. The other levels – meso, exo and macro – provided only limited support for the mothers. The recommendations are that these mothers need social support at all levels of the ecological perspective to meet their needs
AFRIKAANSE OPSOMMING: MIV/vigs is een van die ergste pandemies in die moderne wêreld. Dit ken geen grense nie, en vele mense ly hetsy daaraan of daaronder. Die virus het reeds alle uithoeke van die aarde bereik. Tog gaan Afrika, veral Suider-Afrika, die swaarste daaronder gebuk, en word meer as die helfte van die totale populasie wat aan of onder MIV/vigs ly hier aangetref. Die vyf lande met die hoogste MIV-infeksiesyfers ter wêreld is almal in die streek geleë. Lesotho is een van die drie lande boaan hierdie lys, en het terselfdertyd te kampe met die probleme van armoede en ’n hoë werkloosheidsyfer. Vroue en kinders, synde die groepe wat die ergste deur armoede geraak word, woon ook meestal in landelike gebiede. ’n MIV-positiewe moeder in die landelike gebiede van Lesotho moet dus armoede, ontoeganklike dienste sowel as die sielkundige uitwerking van MIV trotseer. Die doel van hierdie studie was om vanuit die ekologiese perspektief ’n beter begrip te vorm van gesondheidsdiensverskaffers se sienings oor die behoefte aan en toeganklikheid van steundienste vir MIV-positiewe moeders in die landelike gebiede van Lesotho. Om hierdie doel te bereik, was die oogmerke om ’n oorsig van die MIV-verskynsel te bied, die psigososiale behoeftes en sosiokulturele omstandighede van MIV-positiewe moeders in die landelike gebiede van Lesotho te beskryf, en die moeders se behoefte aan steundienste vanuit die ekologiese perspektief te bespreek. ’n Kwantitatiewe sowel as ’n kwalitatiewe navorsingsmetode is gevolg, en die navorser het van ’n verkennende en beskrywende ontwerp gebruik gemaak. Doelgerigte steekproefneming is gebruik om die 30 studiedeelnemers te kies. Data is met behulp van semigestruktureerde vraelyste gedurende individuele onderhoude ingesamel. Die vraelyste is opgestel op grond van inligting wat in die literatuuroorsig bekom is. Die studie bevind dat ekonomiese, maatskaplike en kulturele omstandighede MIV/vigs-behandeling en -voorkoming vir MIV-positiewe vroue in die landelike gebiede van Lesotho belemmer. Daarbenewens moet hulle die sielkundige uitwerking van MIV die hoof bied, en die studie dui op openbaarmaking as die sleutel om hul probleme te hanteer. Die bevindinge toon ook dat die meeste moeders emosionele, fisiese, inligting- en bevestigende steun van hul families op die mikrovlak van die ekologiese perspektief ontvang. Die ander vlakke – meso, ekso en makro – bied slegs beperkte steun. Die studie kom tot die gevolgtrekking dat hierdie moeders op alle vlakke van die ekologiese perspektief maatskaplike steun moet ontvang om in hul behoeftes te voorsien.

This study explores how Central and Eastern European Roma communities perceive and experience UK health and public services. The Roma arguably experience poorer health than any other minority ethnic group in the UK, according to a range of indicators, measures and outcomes. Health issues in UK Roma communities are reported to stem from language barriers, difficulties in registering with a GP and mistrust of health professionals. To date, there has been little comprehensive exploration of the influence of social, cultural and political factors on health in Central and Eastern European Roma communities in the UK. Much of the literature provides an overview of barriers to access, yet gives limited attention to the complex social dynamics underlying interactions between the Roma and health service providers. This study investigates the interplay of Roma migration experiences, personal histories of discrimination, barriers to accessing health and benefits systems, and the influence of public policy decisions in shaping UK Roma people's experiences of health services. This study incorporates data collection through participant observation and interviews, as well as an analysis of national and local policy attention to the health situations of Gypsy, Roma and Traveller (GRT) communities. The policy analysis occurred concurrently with fieldwork, and findings helped to contextualise Roma interviewees' impressions of health system functioning. Field data was collected over the course of volunteer work carried out at Roma community organisations in London and Luton. Field notes were recorded throughout the course the this fieldwork, and interviews with 27 Roma community members and 10 health professionals began after approximately 5 months of active participant observation. Analysis of field data proceeded according to a strategy that hybridised grounded theory and narrative methodologies. This entailed an initial round of grounded theory analysis, which involved the constant comparison methods of analysing concepts arising from the data, and provided an overarching framework for understanding the social phenomena under observation. Fieldnotes and selected interviews were then subjected to a second round of scrutiny, with particular emphasis on their narrative character. Analysing these individual stories added nuance and depth to the results of grounded theory analysis, and provided insight into the ways in which Roma migrants experience discrimination, unconscious bias and unequal treatment within UK public service environments. The time period in which this study occurred - 2014 to 2018 - was a time of substantial political change in the UK, and the results are best understood in the context of growing public hostility to migrant groups. Within a policy landscape of limited official attention to the needs of the Roma, intra-community development of health-related knowledge, direct contact with health services and engagement in a broader environment of public service provision contribute to the development of power differentials between Roma individuals and service providers. Many participants in this study suffered from long-term ill health, yet intra-community networks of health information-sharing aided participants in better understanding their health conditions and empowering themselves to seek out support. Their contact with health and benefits systems, however, revealed barriers related to limited language support, lack of transparency in administrative procedures, difficulties in navigating complex and unfamiliar systems and cultural disparities between patients and providers. Analysis of these factors in light of participants' distinct narrative revealed further dimensions of service providers' unconscious bias, participants' efforts to assert their right to equitable access to services and the long-term emotional impacts of unequal treatment.

Ce travail aborde la question des interventions sanitaires dans les espaces urbains dits « campi nomadi », où vivent les communautés roms, dans la ville de Rome.Dans la première partie, les données de type démographique sont abordées sous l’angle d’une problématisation de leurs formes de collecte des données et des enjeux politiques qui les déterminent. Leur analyse est mise en relation avec le constat que la majorité des études de type médical sur les Roms concernent des questions génétiques, comme c’est aussi le cas des nouvelles formes de fichage et d’identification. Dans la deuxième et troisième partie, l’attention se concentre sur l’ethnographie qui a été menée dans les « campi nomadi » de Rome, en suivant l’activité quotidienne d’une unité médicale mobile (dite « Camper sanitario ») dédiée au soin dans ces espaces urbains. La rencontre médicale dans les espaces d’exception où ces patients résident devient l’occasion d’observer les dynamiques de leurs relations avec la société majoritaire et les institutions qui la réglementent. L’enquête vise à identifier les éléments de l’économie morale des gestes des interventions médicales. Le but est de les restituer à leur dimension biopolitique de pacification de sujets qui font l’objet de strictes politiques de sécurité et de rejet de la part du gouvernement soit national soit local
This work deals with the sanitary interventions in the urban spaces called “campi nomadi” that can be found around the city of Rome, where Roma communities live. The first part of this research deals with the demographic data, from the point of view of the problematization of the ways it had been collected and the political stakes which determine it. Its analysis is related to the acknowledgement of the fact that the grand majority of the medical studies on Roma population engage on genetic data, in the same way the new forms of profiling and identification. The second and third part of this work concentrate on the ethnographic research pursued in the nomad camps of Rome, following the daily activity of a mobile medical unit (also called “sanitary camper”) who’s main activity was offering medical support in this urban spaces. The medical encounter that takes place in this spaces of exception, where the patients live, becomes the occasion for observing the dynamics of their relations with the dominant society and the institutions which rule it. This research aims to identify those elements which relate to the moral economy of the acts of medical intervention by underlying their bio-political dimension related to the pacification of the subjects which are otherwise object of strict security policies and of rejection from local and national administrations

As the Human Immunodeficiency Virus (HIV) prevalence rises, uninfected Basotho face an increased risk of exposure. This necessitates strengthening of strategies that prevent exposure, and where exposure has occurred, measures that prevent infection. One such measure is Human Immunodeficiency Virus (HIV) Post-Exposure Prophylaxis (PEP). Awareness and knowledge of HIV PEP is therefore of paramount importance. The purpose of this study was to assess knowledge, attitudes and utilisation of HIV PEP among adults in Roma, Lesotho. A quantitative cross-sectional study was conducted among 96 adult outpatients at St Joseph’s Hospital. Data were collected by means of structured questionnaire and analysed using SPSS version 23.0. Results were presented using charts and tables. Awareness of HIV PEP among the respondents was found to be very low and for most respondents’ knowledge of HIV PEP was either non-existent or very poor. Utilisation was also found to be very low. Attitudes towards HIV PEP were, however, found to be favourable. More studies should be conducted throughout the country to further explore Basotho’s knowledge, attitude and use of HIV PEP.
Health Studies
M.A. (Nursing Science)

M.P.H., Faculty of Health Sciences, University of the Witwatersrand, 2011
Although the nursing sector has not been spared the effects of human resource shortages and Human Immune-deficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) crisis in Lesotho, it still remains the backbone of the primary health care delivery. There is a well-established linkage between oral health and HIV/AIDS with many of the early symptoms of HIV manifesting in the oro-facial region. However, the lack of oral health personnel at primary health care levels in Lesotho makes Primary Health Care Nurse Practitioners (PHCNPs) often the first health care providers to consult, manage and refer patients with such oral lesions. Aim: To assess the “knowledge, attitude and practice” (KAP) of the PHCNPs regarding oral health and oral HIV lesions in Queen Elizabeth II (QE II) and Roma health service areas (HSA) of Maseru district in Lesotho. Objectives: To assess the demographic profile of PHCNPs in the target health facilities, their knowledge, attitude and practice regarding oral health and oral HIV lesions. Methods and Materials: The research was a descriptive cross-sectional survey. A convenience sample of 57 primary health care nurse practitioners (PHCNPs) from QE II and Roma health service areas were identified. During their monthly PHC meeting, a questionnaire was administered to assess the knowledge, attitude and practice regarding oral health and oral HIV lesions. The information gathered was both quantitative and qualitative. Data was entered and analysed using the SPSS statistical package. Results: The response rate was 87.7%. There was 100% consensus regarding the importance of oral health to the total well being of individuals. The majority of the PHCNPs recognised oral candidiasis (OC) (94.7%), bleeding gums (87.7%), herpes lesions (71.9%) and dental caries (75.4%). Lesions such as acute necrotizing ulcerative gingivitis (ANUG) (40.3%), angular cheilitis (AC) (56.1%) and apthous ulcerations (24.6%) were also recognised but to a lesser extent. The respondents associated OC (84%), herpes (61%), AC (54%), Oral Hairy Leukoplakia (OHL) (49%), Kaposi‟s‟ sarcoma (KS) (49%) with HIV/AIDS. OC was the most common lesion associated with HIV. Some lesions commonly seen in the clinics such as apthous ulceration and ANUG were not significantly associated with HIV (18% and 33%, respectively). The majority of PHCNPs (81%) indicated that they had knowledge about oral HIV lesions. Twenty nine 6 respondents (50.8 %) reported having received this knowledge through training institutions. Mass media (Radio (53%), TV (40%), and newspapers/magazines (49%)) was one of the major sources of information. Forty-four PHCNPs (77.2%) saw only Zero or one (0-1) HIV patients with oral lesions. Similarly, 15.8 % and 7% of the PHCNPs saw 11 to 20 and more than 20 (21+) HIV patients with oral lesions, respectively. The two thirds of the PHCNPs (67%) said they would not advise patients to seek care from Traditional Health Practitioners (THP) due to their lack of trust and confidence in the practices, knowledge and the patient management of the THPs. However, 16% of them reported that they would refer because they thought traditional medicine boosts the immune system. Only seven respondents (12.3%) routinely washed their hands with antiseptics. However, 44 of respondents (77.2 %) cleaned their instruments with bleach and disinfectants. The majority (89.5%) washed their hands with water and soap. Forty three respondents (75.4%) wore gloves during examination. Routine use of facemasks was limited to only 12 respondents (21.1 %). Ninety eight percent of the PHCNPs stated that they would like to learn to manage oral lesions at health centres. The majority (79%) of the respondents said that they would like to receive more training on the management of oral lesions through workshops. Conclusions: There was an observable correlation between PHCNPs self-assessment of oral health knowledge and the objective knowledge as assessed by ability to identify the oral lesions on a chart ( 2 –sided Fischer‟s test-0.000-0.261).This needs to be confirmed by undertaking a study with a larger sample size. OC was the most common lesion associated with HIV as reported by the PHCNPs. The majority of the participants (94.7%) identified OC and associated it (84%) with HIV infection. The finding indicated that with training and/or mentoring, PHCNPs are likely to confidently diagnose oral HIV lesions. PHCNPs showed a positive attitude towards learning more about the oral manifestations of HIV/AIDS. PHCNPs should be utilised more effectively in the diagnosis and management of HIV/AIDS.

The purpose of the study was to explore and describe the existing relationship between traditional healers and nurse practitioners in Maseru Health Service Area in Lesotho and also to determine why people consult traditional healers. Qualitative and quantitative methods were used to investigate the relationship between traditional healers and nurse practitioners and also to determine why people utilize the services of traditional healers. The study was limited to Maseru Health Service Area in Lesotho. Data was collected from twenty-seven (27) nurses from nineteen (19) clinics and from thirty (30) traditional healers from the same health service area. Data from traditional healers was collected using semi-structured interviews while nurse practitioners were given a questionnaire to complete. The study revealed that there was no formal relationship between traditional healers and nurse practitioners. Support for traditional healers was revealed to be limited, for example, only four (14.8%) nurses had a programme for traditional healers while twenty ( 66.7%) traditional healers did not have any contact with nurse practitioners. Involvement of traditional healers in primary health care at grassroots level has therefore been very minimal. The reasons why people utilize traditional healers were found to be as follows: • When people think they have been bewitched. • Traditional healers can tell the actual cause of disease • Failure of modern practice • For social problems According to the study, both traditional healers and nurse practitioners felt that collaboration between traditional healers and nurse practitioners was essential because it would enable planned referral of patients from one group to another where necessary; it would also facilitate exchange of ideas and knowledge for the benefit of the people served. Recommendations on collaboration and on support systems are given in Chapter Six.
Health Studies
D. Litt. et Phil. (Nursing Science)

Sub-Saharan Africa has the highest number of people living with HIV and AIDS in the world. Several studies that were carried out suggest that there is a negative impact of HIV and AIDS on the health sector. This impacts directly on health care providers as they are the first point of contact for ill people. This study seeks to explore the impact of HIV and AIDS on health care provision looking at the perception of health care providers. Qualitative methods were used for collecting data from the health care providers. Two focus group discussions were conducted and ten in-depth interviews were conducted in three health care facilities in Lesotho. Audio tapes were used to record the interviews and thematic analysis was utilized to analyse the data. The results showed that the workload has increased due the increased number of people who seek health care services. There is also a shortage of staff in facilities which leads to health workers having to work extra hours. The study further indicated that there is lack of knowledge among health care providers regarding the management of HIV and AIDS. Consequently, the health care providers fear the risk of contracting HIV from their patients. In addition, the results revealed that the poor infrastructure at the facilities hinder health care providers from performing their duties effectively. The other concern was the lack of support structures from the management. Furthermore, stigma and discrimination emerged as the major problems for providers as work and home. As a result, the health care providers are stressed and suffered from burnout. There is a need for further research on the impact of HIV and AIDS on health providers. Government should take more responsibility for encouraging students to enroll at health training institutes. The curriculum should include an emphasis on HIV and AIDS and workshops on HIV and AIDS should be held.
Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2010.

MSc., Faculty of Science, University of the Witwatersrand, 2011
There is an increasing adoption of outdoor visits in high schools in Lesotho and this study was done to find out what students learn about community health as they visit Lesotho Water and Sewage Authority (WASA). Eighty Form D (equivalent to grade 11 in South Africa) learners were the participants in this study. In order to capture students‘ learning a qualitative study was designed. The study used observations, questionnaire (n=80) and semi-structured interviews (n=8) with learners. The data was analyzed inductively and deductively in order to answer questions about knowledge changes as a result of a visit to WASA, and about the aspects of the visit that influence learners‘ knowledge about community health. Analysis of the questionnaire and the interviews revealed that learners greatly gained knowledge as a result of the visit to WASA while others developed misconception and others did not change their conceptions at all. The forms of conceptual change identified from learners responses were enrichment and conceptual capture. Learners realized that water purification is not a minute-made activity since there are several steps involved in water purification and that taps are not the main water sources. Learners also became aware that boiling water is not the only effective way of treating water instead other purifying stations like WASA can purify water suitable for domestic use. However, some learners believed that water that has been treated by the sewage plant is not suitable to be purified and used for domestic purpose. The observation analysis indicated that the physical facilities, displays, prior knowledge and participation during the visit are some of the aspects that influence learners‘ knowledge about community health. The realism of concepts communicated during the visit enhanced learners‘ ability to acquire knowledge about community health. The physical facilities such as the machinery at WASA provided the concrete evidence that water is drawn from the rivers therefore rivers are the main water sources. Visual displays contributed much in learners‘ ability to gain knowledge during the visit to WASA. It has also been found that although manipulation of objects was minimal, learners still gained information communicated during the visit. With the stated findings above, a visit to WASA enhance learner‘s ability to acquire information about community health.

The high prevalence of HIV has been a major cause for concern in Lesotho and the clinical course has witnessed some service lapses, complications and deaths. The researcher was therefore motivated to conduct this study with the aim to assess care and outcomes offered to HIV patients at St. Joseph’s Hospital. The objectives were to describe patient socio-demographic and clinical characteristics at initiation of antiretroviral therapy, to describe clinical parameters of haemoglobin, AST, CD4 count levels as outcome proxy of care and to analyze the rate and predictors of patient retention and lost to follow-up. Methods A retrospective cohort study of 1060 patients initiated on ART at the Thusong ART Clinic in St. Joseph’s Hospital, Roma between August 2005 and July 2008 was conducted. Relevant documentation was captured from the patients’ clinical records hard copy files onto the Therapy-Edge (TE) database tool used. Patient confidentiality was respected The dataset was closed on 31st October 2012. Data were analyzed using STATA version 11. Results The total number of patients enrolled during the study period of August 2005 – July 2008 was 1060. The findings on the patients studied showed that 99.5% were Sotho with the majority of 70.2% being female. Patients in the age group of 16-35 years were 22.2%, in the age groups of 36-55 years and >55 years were 58.3% and 19.5% respectively. Median age was 43 years. Employed persons were 24.3%, students were 2.3%, unemployed persons were 44.8% and 28.6% were of unknown employment status. On WHO classification, 18.1% was WHO Stage I, 34.6% was Stage II, 43.4% was Stage III and 3% was Stage IV. Median weight at enrollment was 55.6kg. Baseline CD4 count < 50 cells/mm3 was 13.3%, count of 50 – 199 cells/mm3 was 43.2%, CD4 count ≥ 200 cells was 38.7%. Patients with Hb <10g/dl were 17.3%. On patient retention over a period of about 6 years, 57% of the patients were still alive and in care, 11.3% had been transferred out to the health centers and clinics, 29.5% were lost to follow up. It is noteworthy that only 2.2% were recorded as dead. Conclusion The study showed that more than half of the HIV patients on ART were female, thus suggesting better access to care and health seeking behaviour. Clinical parameters of haemoglobin, AST, CD4 cell counts used to monitor progress over follow-up period showed results comparable with other similar studies. Baseline CD4 count, WHO stage, age, gender and employment status were agreeable with studies in other settings to predict those lost to follow-up (LFTU). The low percentage of documented deaths suggests that some deaths may have been included in LTFU. Better documentation, staff training and retention, decentralization of care and proper follow-up measures are steps in the right direction for better ART monitoring and outcomes.

Medical male circumcision prevalence in Lesotho remains at 23% even though efforts are made to encourage men to be circumcised. The purpose of this study was to explore and describe perceptions of men regarding male circumcision in a hospital in Morija, Lesotho and make recommendations on how to promote uptake of medical male circumcision. A descriptive, explorative and contextual qualitative design was used. In-depth, unstructured individual interviews were conducted on ten (10) uncircumcised men who were selected via purposive sampling. The findings revealed that men’s perceptions on circumcision can be classified under the following themes: perceived health beliefs of men about circumcision, perceived community-held beliefs about circumcision, men’s knowledge regarding circumcision, and perceived misconceptions about circumcision. It is recommended that knowledge on circumcision be reinforced and negative perceptions be corrected with the multi-sectoral approach to promote uptake of circumcision services.
Health Studies
M.A. (Public health)

The purpose of this study was to evaluate the antiretroviral therapy program in primary health care settings in Lesotho. Mixed methods research using a convergent parallel mixed methods design was used to collect both quantitative and qualitative data which were analysed during the same phase of the research process. Two groups of participants participated in the study, the registered nurse group was composed of registered nurses/midwives/nurse clinicians involved in ART service provision and the second group was composed of adults aged 18 years and older who were HIV/AIDS positive. Quantitative data had a compliance rate of 92% and it were analysed using SPSS (23). Qualitative data were analysed using constant comparison analysis and seven themes, fourteen categories and twenty two sub-categories emerged from the data analysis. Findings of the study revealed that the majority of PHC facilities were staffed by registered nurse midwives and nurse clinicians who were qualified, confident, knowledgeable and competent in the execution of duties. Generally there were a large number of patients that sought ART services which were offered on a weekly basis although there was variation in the actual number of days the services were provided. The time patients spent seeking ART services varied across the facilities and ARVs and other drugs were usually available. Challenges in the delivery of ART services included unsatisfactory staffing resulting in the provision of inadequate services and work overload, lack of knowledge of some patients, use of incentives by some partners and too many partners being involved in ART, inadequate documentary evidence and stigma pertaining to the HIV status of individuals. Furthermore, ARVs were reported to make patients feel hungry hence resulting in lack of satisfaction in ART services, ART services were inadequate due to dysfunctional equipment and some patients had been lost due to inability to screen for cancer and there was incomplete monitoring and evaluation of the ART program. However, participants in this study generally showed their acknowledgement of the ART services as they generally improved their health status despite the many challenges that were being faced.
Health Studies
D.Litt.et Phil. (Health Studies)

A descriptive quantitative study was undertaken in the Leribe and Butha-buthe northern districts of Lesotho. Thirty-six trained, twenty-four untrained TBAs and nine nurses involved in training TBAs were recruited. In line with research by Clarke and Lephoto (1989:3) the TBAs were elderly females who had children of their own. In contrast with the MOH (1993: 10) where TBAs were found to be illiterate, most (93%) of the TBAs in this study had at least a primary education. The art of primary midwifery was learned through assisting with a delivery and being taught by mothers or mothers-in-law. The public health nurses conduct formal training ofTBAs in Lesotho over a period of two weeks, where subjects like ante-natal care, delivery of the baby and post- natal care are addressed. The majority (78.8%) provide antenatal care at their homes or the home of the mother. This includes palpation, history taking, and abdominal massage and health education. An important role is identifying women at risk. During labour the progress of labour is monitored and care is given to the mother and baby post-natally. Trained TBAs could identify women at risk more readily than untrained TBAs. Cases referred most frequently were prolonged labour and retained placenta. Trained TBAs practiced hygiene more often and gave less herbs than untrained TBAs. The health care system is providing support to the TBAs through training and supervision, but was found to be inadequate. Community leaders are involved in the selection of TBAs for training. Regular meetings are held with the TB As to discuss problems. Communication is one of the problems the TB As have to face, because of the long distances from health care centres. A lack of infrastructure and supplies is also of concern. It can be concluded that TBAs play an important role in maternal health care in Lesotho and are supported to a lesser degree by the health care system, which causes problems for the TBAs in their practices. It is recommended that the ministry of health becomes more aware of the need for training TBAs and that a programme for training should be more appropriate, taking cultural practices into account.
Advanced Nursing Science
D.Lit. et Phil.

The proposition that inadequate health literacy on antenatal care (ANC) is exacerbating maternal mortality in sub Saharan Africa (SSA) is undisputable. Yet, little is known about ANC literacy in Lesotho, an SSA country with high maternal mortality rates. This cross-sectional study explored the levels of ANC literacy and the associated factors in 451 purposively sampled women in two districts using a semi-structured questionnaire making recourse to statistical principles. Overall, 16.4% of the participants had grossly inadequate ANC literacy, while 79.8% had marginal levels. Geographic location and level of education were the most significant predictors of ANC literacy. Participants had the lowest scores on knowledge of danger signs in pregnancy and true signs of labour. Furthermore, significant knowledge gaps on baby layette and mother’s essential items for delivery were found. Adequate ANC literacy is critical to reducing maternal mortality in Lesotho. Improving access to ANC education, particularly in rural areas is recommended.
Health Studies
M.A. (Nursing Science)

This qualitative exploratory study explored adolescents’ perceptions of the HIV youth friendly centre at a hospital in Lesotho in order to improve adolescent-friendly health care services in Lesotho. Data was obtained through interviewing nine purposively selected adolescents aged 18–19 years who accessed health care services at the centre, and was analysed using an adapted version of Colaizzi’s seven-step thematic analysis. Six themes emerged from this study: attributes experienced during adolescents’ visits to health care facilities, adolescents’ perceptions of the health care facility, waiting times, facts related to HIV pre-test counselling, description of services available for adolescents’ health, and challenges faced by adolescents in relation to their HIV positive status. The adolescents explained the factors that encouraged them to be tested, and to commit to HIV management and treatment. The findings showed that it is important to reserve a dedicated space for adolescents, to provide comprehensive health services at one site, to ensure adolescents’ privacy and confidentiality, to indicate patient flow clearly, to indicate the service offering clearly, to offer flexible operating hours and days, to involve youth in the service provision, to keep queues short, and to establish peer support groups.
Health Studies
M.A. (Public Health)

A quantitative approach was used to investigate the stigmatization of HIV positive clients in the Leribe District of Lesotho. The study population included 5200 HIV positive patients who enrolled for ARV in government clinics. A randomly selected sample of 520 clients responded through a questionnaire and interviews. The statistical package (STATA version 9) was used to analyze data. The objectives of the study were to explore the type and level of stigmatization of HIV-positive clients and to describe ways in which health workers in the PHC can reduce the stigmatization of HIV-positive clients at the clinics. The findings revealed that types of stigmatization included separation, isolation, labeling and discrimination. Ways to reduce the stigma within a community based primary health care facility included educating people living with HIV on how to protect themselves from multiple infection, providing effective counselling to clients and families maintaining confidentiality, and using change strategies to change attitudes of health care providers. The integration of HIV-related activities is a strong recommendation and the importance of the consistent availability of ARV treatment was emphasized.
Public Health
M.A. (Public Health)