A preliminary, quantitative study on the use of traditional and complementary medicine by cancer patients seen at the Senkatana oncology clinic, Maseru, Lesotho.

BACKGROUND: The use of traditional and complementary medicine (TCM) by cancer patients remains common in several countries especially in the Sub-Saharan Africa. However, the reasons for use are complex and change with time and geographic location, they may vary from therapy to therapy, and they are different from one individual to another. The use of TCM has been associated with active coping behaviour and a way through which patients take control of their own health. However, cancer patients do not disclose their use of TCM to the attending healthcare professionals and therefore the effects of these medicines on the patients may not be ascertained. AIM: To investigate the use of traditional and complementary medicines among patients diagnosed with cancer. METHODS: A cross-sectional, quantitative study was conducted at Senkatana Oncology clinic in May to June 2023. Cancer patients underwent standardized, quantitative interviews using structured questionnaires about their use of TCM. Descriptive statistics were used to analyse the data. Logistic regression analysis was also used to identify factors associated with satisfaction with the performance of TCM. RESULTS: All interviewed patients (n = 50, 100%) reported to be using TCM. Patients consisted of 24 females (48%) and 26 males (52%) in the age range 14 to 82 years old. The majority of the study population was in the age group 35-44 years old. The most prevalent cancer among participating males was prostate cancer and among females was cervical cancer. Biological products use was the most prominent with the highest average percentage usage (14.7%). The majority of patients (66%, n = 33) indicated that they just wanted to try everything that could help. Patients (n = 47, 94%) further reported that they had been using complementary medicine during the same period as they were using conventional treatment so that both may work to help each other. Neither gender nor age predicted satisfaction with the performance of traditional and complementary medicine. CONCLUSIONS: It is concluded that all interviewed cancer patients use TCM. Patients indicated that one of the reasons for using TCM was that they wanted to try everything that could help in their cancer care. Patients further reported that they did not inform their oncologist of their concurrent use of TCM because they had been advised not to use other medicines besides what they are given at the clinic.

Learning from the End of the Public-Private Partnership for Lesotho's National Referral Hospital Network.

Background: Public-private partnerships (PPP) are one strategy to finance and deliver healthcare in lower-resourced settings. Lesotho's Queen 'Mamohato Memorial Hospital Integrated Network (QMMH-IN) was sub-Saharan Africa's first and largest integrated healthcare PPP. Objective: We assessed successes and challenges to performance of the QMMH-IN PPP. Methods: We conducted 26 semi-structured interviews among QMMH-IN executive leadership and staff in early 2020. Questions were guided by the WHO Health System Building Blocks Framework. We conducted a thematic analysis. Findings: Facilitators of performance included: 1) PPP leadership commitment to quality improvement supported by protocols, monitoring, and actions; 2) high levels of accountability and discipline; and 3) well-functioning infrastructure, core systems, workflows, and internal referral network. Barriers to performance included: 1) human resource management challenges and 2) broader health system and referral network limitations. Respondents anticipated the collapse of the PPP and suggested better investing in training incoming managerial staff, improving staffing, and expanding QMMH-IN's role as a training facility. Conclusions: The PPP contract was terminated approximately five years before its anticipated end date; in mid-2021 the government of Lesotho assumed management of QMMH-IN. Going forward, the Lesotho government and others making strategic planning decisions should consider fostering a culture of quality improvement and accountability; ensuring sustained investments in human resource management; and allocating resources in a way that recognizes the interdependency of healthcare facilities and overall system strengthening. Contracts for integrated healthcare PPPs should be flexible to respond to changing external conditions and include provisions to invest in people as substantively as infrastructure, equipment, and core systems over the full length of the PPP. Healthcare PPPs, especially in lower-resource settings, should be developed with a strong understanding of their role in the broader health system and be implemented in conjunction with efforts to ensure and sustain adequate capacity and resources throughout the health system.

A Critical Analysis of Indigenous Systems and Practices of Solid Waste Management in Rural Communities: The Case of Maseru in Lesotho.

The aims of this study were to understand and to do a critical analysis of the different indigenous systems and practices of waste management to inform waste management policy development in Lesotho. To achieve these aims, the objective was to assess community perceptions of the impact of the indigenous systems and practices of solid waste management on the environment and human wellbeing. A simple random sampling method was employed. The primary data were collected through observations and survey questionnaires that were distributed among the communities in the study areas. The sample size was 693 participants from a total estimated population of 6917 in May 2021 in the Matsieng, Koro-Koro and Rothe constituencies. The data were analysed quantitatively by using the International Business Management Statistical Package for Social Science version 25.0. The descriptive method was used to interpret the results. For validity, the interview questions were set towards answering the study research questions. For reliability, open- and close-ended questions were designed. The research clearly indicated that indigenous systems and practices are culturally accepted in areas lacking formal waste collection services by the local authorities. The tradition, culture, values, and belief of the communities play a major role in the systems and practices implemented. Although some people convert waste items into useful products, the practices of general disposal were often unsafe from the human wellbeing and environmental perspectives. In Lesotho, a lack of awareness about conservation and sustainable use of natural resources could be attributed to flawed education at the grassroots level in schools.

Improving child tuberculosis contact identification and screening in Lesotho: Results from a mixed-methods cluster-randomized implementation science study.

BACKGROUND: Child tuberculosis (TB) contact management is recommended for preventing TB in children but its implementation is suboptimal in high TB/HIV-burden settings. The PREVENT Study was a mixed-methods, clustered-randomized implementation study that evaluated the effectiveness and acceptability of a community-based intervention (CBI) to improve child TB contact management in Lesotho, a high TB burden country. METHODS: Ten health facilities were randomized to CBI or standard of care (SOC). CBI holistically addressed the complex provider-, patient-, and caregiver-related barriers to prevention of childhood TB. Routine TB program data were abstracted from TB registers and cards for all adult TB patients aged >18 years registered during the study period, and their child contacts. Primary outcome was yield (number) of child contacts identified and screened per adult TB patient. Generalized linear mixed models tested for differences between study arms. CBI acceptability was assessed via semi-structured in-depth interviews with a purposively selected sample of 20 healthcare providers and 28 caregivers. Qualitative data were used to explain and confirm quantitative results. We used thematic analysis to analyze the data. RESULTS: From 01/2017-06/2018, 973 adult TB patients were recorded, 490 at CBI and 483 at SOC health facilities; 64% male, 68% HIV-positive. At CBI and SOC health facilities, 216 and 164 child contacts were identified, respectively (p = 0.16). Screening proportions (94% vs. 62%, p = 0.13) were similar; contact yield per TB case (0.40 vs. 0.20, p = 0.08) was higher at CBI than SOC health facilities, respectively. CBI was acceptable to caregivers and healthcare providers. CONCLUSION: Identification and screening for TB child contacts were similar across study arms but yield was marginally higher at CBI compared with SOC health facilities. CBI scale-up may enhance the ability to reach and engage child TB contacts, contributing to efforts to improve TB prevention among children.

Designing an optimized diagnostic network to improve access to TB diagnosis and treatment in Lesotho.

BACKGROUND: To reach WHO End tuberculosis (TB) targets, countries need a quality-assured laboratory network equipped with rapid diagnostics for tuberculosis diagnosis and drug susceptibility testing. Diagnostic network analysis aims to inform instrument placement, sample referral, staffing, geographical prioritization, integration of testing enabling targeted investments and programming to meet priority needs. METHODS: Supply chain modelling and optimization software was used to map Lesotho's TB diagnostic network using available data sources, including laboratory and programme reports and health and demographic surveys. Various scenarios were analysed, including current network configuration and inclusion of additional GeneXpert and/or point of care instruments. Different levels of estimated demand for testing services were modelled (current [30,000 tests/year], intermediate [41,000 tests/year] and total demand needed to find all TB cases [88,000 tests/year]). RESULTS: Lesotho's GeneXpert capacity is largely well-located but under-utilized (19/24 sites use under 50% capacity). The network has sufficient capacity to meet current and near-future demand and 70% of estimated total demand. Relocation of 13 existing instruments would deliver equivalent access to services, maintain turnaround time and reduce costs compared with planned procurement of 7 more instruments. Gaps exist in linking people with positive symptom screens to testing; closing this gap would require extra 11,000 tests per year and result in 1000 additional TB patients being treated. Closing the gap in linking diagnosed patients to treatment would result in a further 629 patients being treated. Scale up of capacity to meet total demand will be best achieved using a point-of-care platform in addition to the existing GeneXpert footprint. CONCLUSIONS: Analysis of TB diagnostic networks highlighted key gaps and opportunities to optimize services. Network mapping and optimization should be considered an integral part of strategic planning. By building efficient and patient-centred diagnostic networks, countries will be better equipped to meet End TB targets.

PEBRA trial - effect of a peer-educator coordinated preference-based ART service delivery model on viral suppression among adolescents and young adults living with HIV: protocol of a cluster-randomized clinical trial in rural Lesotho.

BACKGROUND: Despite tremendous progress in controlling the HIV epidemic in sub-Saharan Africa, HIV-related mortality continues to increase among adolescents and young people living with HIV (AYPLHIV). Globally, sub-Saharan Africa accounts for 85% of the AYPLHIV. Overall outcomes along the HIV care cascade are worse among AYPLHIV as compared to all other age groups due to various challenges in accessing and adhering to antiretroviral therapy (ART). New, innovative multicomponent packages of differentiated service delivery (DSD) models, are required to address the specific needs of AYPLHIV. This study aims to evaluate the feasibility and effectiveness of a multicomponent DSD model (PEBRA model) designed for AYPLHIV and coordinated by a peer-educator. METHODS: PEBRA (Peer-Educator Based Refill of ART) is a cluster randomized, open-label, superiority trial conducted at 20 health facilities in three districts of Lesotho, Southern Africa. The clusters (health facilities) are randomly assigned to either the PEBRA model or standard of care in a 1:1 ratio, stratified by district. AYPLHIV aged 15-24 years old in care and on ART at one of the clusters are eligible. In the PEBRA model, a peer-educator coordinates the antiretroviral therapy (ART) services - such as medication pick-up, SMS notifications and support options - according to the preferences of the AYPLHIV. The peer-educator delivers this personalized model using a tablet-based application called PEBRApp. The control clusters continue to offer standard of care: ART services coordinated by the nurse. The primary endpoint is viral suppression at 12 months. Secondary endpoints include self-reported adherence to ART, quality of life, satisfaction with care and engagement in care. The target sample size is 300 AYPLHIV. Statistical analyses are conducted and reported in line with CONSORT guidelines for cluster randomized trials. DISCUSSION: The PEBRA trial will provide evidence on the feasibility and effectiveness of an inclusive, holistic and preference-based DSD model for AYPLHIV that is coordinated by a peer-educator. Many countries in SSA have an existing peer-educator program. If proven effective, the PEBRA model and PEBRApp have the potential to be scaled up to similar settings. TRIAL REGISTRATION: Clinicaltrials.gov, NCT03969030. Registered on 31 May 2019. More information: www.pebra.info.

Rifampicin Resistant Tuberculosis in Lesotho: Diagnosis, Treatment Initiation and Outcomes.

The Lesotho guidelines for the management of drug-resistant tuberculosis (TB) recommend initiation of patients diagnosed with rifampicin resistant (RR)-TB on a standardized drug resistant regimen while awaiting confirmation of rifampicin resistant TB (RR-TB) and complete drug susceptibility test results. Review of diagnostic records between 2014 and 2016 identified 518 patients with RR-TB. Only 314 (60.6%) patients could be linked to treatment records at the Lesotho MDR hospital. The median delay in treatment initiation from the availability of Xpert MTB/RIF assay result was 12 days (IQR 7-19). Only 32% (101) of patients had a documented first-line drug resistant test. MDR-TB was detected in 56.4% of patients while 33.7% of patients had rifampicin mono-resistance. Only 7.4% of patients assessed for second-line resistance had a positive result (resistance to fluoroquinolone). Treatment success was 69.8%, death rate was 28.8%, loss to follow up was 1.0%, and 0.4% failed treatment. Death was associated with positive or unavailable sputum smear at the end of first month of treatment (Fisher exact p < 0.001) and older age (p = 0.007). Urgent attention needs to be given to link patients with RR-TB to care worldwide. The association of death rate with positive sputum smear at the end of the first month of treatment should trigger early individualization of treatment.

Applying Quality Improvement Approaches to Reduce Mother-to-Child HIV Transmission and Improve Health and Nutrition Care in Five Countries: Lessons from the Partnership for HIV-Free Survival.

The World Health Organization guidelines for treating pregnant HIV-positive women and preventing HIV transmission to infants now recommend lifelong antiretroviral treatment for pregnant and breastfeeding women. We applied quality improvement (QI) methods to support governments and facility staff to address service gaps in 5 countries under the Partnership for HIV-Free Survival (PHFS). We used 3 key strategies: break the complex problem of improving HIV-free survival into more easily implementable phases, support a national management team to oversee the project, and support facility-level staff to learn and apply QI methods to reducing mother-to-child transmission. The key results in each country were increases in data completeness and accuracy, increases in retention in care of mother-baby pairs (MBPs), increase in coverage of MBPs with appropriate services, and reduction in vertical transmission of HIV. The PHFS experience offers a model that other multicountry networks can adopt to improve service delivery and quality of care.

Exploring the Potential of Participatory Theatre to Reduce Stigma and Promote Health Equity for Lesbian, Gay, Bisexual, and Transgender (LGBT) People in Swaziland and Lesotho.

Stigma and discrimination affecting lesbian, gay, bisexual, and transgender (LGBT) people compromise health and human rights and exacerbate the HIV epidemic. Scant research has explored effective LGBT stigma reduction strategies in low- and middle-income countries. We developed and pilot-tested a participatory theatre intervention (PTI) to reduce LGBT stigma in Swaziland and Lesotho, countries with the world's highest HIV prevalence. We collected preliminary data from in-depth interviews with LGBT people in Lesotho and Swaziland to enhance understanding of LGBT stigma. Local LGBT and theatre groups worked with these data to create a 2-hour PTI composed of three skits on LGBT stigma in health care, family, and community settings in Swaziland (Manzini) and Lesotho (Maseru, Mapoteng). Participants ( n = 106; nursing students, health care providers, educators, community members) completed 12 focus groups following the PTI. We conducted thematic analysis to understand reactions to the PTI. Focus groups revealed the PTI increased understanding of LGBT persons and issues, increased empathy, and fostered self-reflection of personal biases. Increased understanding included enhanced awareness of the negative impacts of LGBT stigma, and of LGBT people's lived experiences and issues. Participants discussed changes in attitude and perspective through self-reflection and learning. The format of the theatre performance was described as conducive to learning and preferred over more conventional educational methods. Findings indicate changed attitudes and awareness toward LGBT persons and issues following a PTI in Swaziland and Lesotho. Stigma reduction interventions may help mitigate barriers to HIV prevention, treatment, and care in these settings with a high burden of HIV.

Implementing a competency-based midwifery programme in Lesotho: A gap analysis.

Global reforms in health professions education, including midwifery, support the transformation of education programmes to adopt competency-based models. Lesotho, a small sub-Saharan African country, with perennially high maternal and neonatal mortality, adopted a competency-based education model in the design and subsequent implementation of a one-year post-basic midwifery programme. Through a gap analysis involving administrators, educators and students in all the nursing education institutions in Lesotho, we explored their experiences related to the implementation of a competency-based midwifery programme after three years of continuous implementation. The findings revealed a vast gap between the described curriculum, and what was enacted in the nursing education institutions. The essential components of the midwifery programme had not been transformed to accommodate competency-based education. We argue that structural and operational elements of a programme should be adjusted before and during the implementation of such a curriculum innovation to enhance a positive teaching and learning experience, further sustaining the programme. Therefore, contextually relevant frameworks aimed at supporting the implementation and sustainability of the entire programme should be developed.

The Midwifery Services Framework: Lessons learned from the initial stages of implementation in six countries.

In 2015, the International Confederation of Midwives (ICM) launched the Midwifery Services Framework (MSF): an evidence-based tool to guide countries through the process of improving their sexual, reproductive, maternal and newborn health services through strengthening and developing the midwifery workforce. The MSF is aligned with key global architecture for sexual, reproductive, maternal and newborn health and human resources for health. This third in a series of three papers describes the experience of starting to implement the MSF in the first six countries that requested ICM support to adopt the tool, and the lessons learned during these early stages of implementation. The early adopting countries selected a variety of priority work areas, but nearly all highlighted the importance of improving the attractiveness of midwifery as a career so as to improve attraction and retention, and several saw the need for improvements to midwifery regulation, pre-service education, availability and/or accessibility of midwives. Key lessons from the early stages of implementation include the need to ensure a broad range of stakeholder involvement from the outset and the need for an in-country lead organisation to maintain the momentum of implementation even when there are changes in political leadership, security concerns or other barriers to progress.

Removal of helminth eggs by centralized and decentralized wastewater treatment plants in South Africa and Lesotho: health implications for direct and indirect exposure to the effluents.

Wastewater may contain contaminants harmful to human health; hence, there is the need for treatment before discharge. Centralized wastewater treatment systems are the favored treatment options globally, but these are not necessarily superior in reduction of pathogens as compared to decentralized wastewater treatment systems (collectively called DEWATS). This study was therefore undertaken to assess the soil-transmitted helminth (STH) and Taenia sp. egg reduction efficiency of selected anaerobic baffled reactors and planted gravel filters compared to centralized wastewater treatment plants in South Africa and Lesotho. The risk of ascariasis with exposure to effluents from the centralized wastewater treatment plants was also assessed using the quantitative microbial risk assessment (QMRA) approach. Eggs of Ascaris spp., hookworm, Trichuris spp., Taenia spp., and Toxocara spp. were commonly detected in the untreated wastewater. The DEWATS plants removed between 95 and 100% of the STH and Taenia sp. eggs, with centralized plants removing between 67 and 100%. Helminth egg concentrations in the final effluents from the centralized wastewater treatment plants were consistently higher than those in the WHO recommended guideline (≤ 1 helminth egg/L) for agricultural use resulting in higher risk of ascariasis. Therefore, in conclusion, DEWATS plants may be more efficient in reducing the concentration of helminth eggs in wastewater, resulting in lower risks of STH infections upon exposure.

Sustaining a newly implemented competence-based midwifery programme in Lesotho: Emerging issues.

The need to develop midwives who improve maternal and neonatal outcomes underpins decisions to adopt competence-based education models in low- and middle-income countries. Competence-based education means a shift in the training of midwives to include student self-directed performance-oriented training. Sustaining the implementation of a curricular innovation, such as a competence-based curriculum, requires new skills and resources by countries adopting such innovation. The skills and resources needed to sustain such a curricular innovation are influenced by issues that arise during implementation of the curricular innovation. Through structured interviews with stakeholders in midwifery education and document analysis in a small sub-Saharan African country, we reveal emerging issues that threaten the sustainability of a newly implemented competence-based midwifery curriculum. In this article, we argue that monitoring and supporting the implementation of a curricular innovation, is essential in enhancing midwifery education institutions ability to sustain curricular innovation. Regulation through professional bodies and councils enhance institutional, programmatic and classroom accountability.

Student and preceptor perceptions of primary health care clinical placements during pre-service education: Qualitative results from a quasi-experimental study.

As a practice discipline, nursing education has a mandate to collaborate with all clinical settings, including primary health care (PHC), to prepare nursing students to function effectively in different settings upon deployment. Prior to 2011, nursing and midwifery students received minimal exposure to PHC settings in Lesotho. In 2010, the Maternal and Child Health Integrated Program began working with nurses' training institutions to support PHC clinical placements. Between April 2013 and June 2014, a multi-methods study was conducted to describe the effect of PHC placements on students and preceptors. The study employed qualitative methods, namely seven focus group discussions (FGDs), held with 69 students and preceptors. Data analysis followed the principles of grounded theory. Students, nurse educators and preceptors perceived PHC clinical placements as appropriate settings for acquisition of a variety of country relevant clinical experiences for nurses and midwives in Lesotho. Students expressed their likelihood to accept deployment at PHC settings post-graduation. Preceptors indicated that PHC clinical placements re-enforced the importance of continuing education for practicing clinicians. The placements supported an increase in competence and confidence of nursing and midwifery students, which will likely aid their transition into the workforce and perhaps increase the likelihood for the young professionals to accept deployment to these areas post-graduation. Given the disease burden in Lesotho and that majority of Basotho people access healthcare at the PHC level, every effort should be taken to ensure that nursing and midwifery students get adequate exposure to health care provision at these facilities.

The PREVENT study to evaluate the effectiveness and acceptability of a community-based intervention to prevent childhood tuberculosis in Lesotho: study protocol for a cluster randomized controlled trial.

BACKGROUND: Effective, evidence-based interventions to prevent childhood tuberculosis (TB) in high TB/HIV-burden, resource-limited settings are urgently needed. There is limited implementation of evidence-based contact management strategies, including isoniazid preventive therapy (IPT), for child contacts of TB cases in Lesotho. METHODS/DESIGN: This mixed-methods implementation science study utilizes a two-arm cluster-randomized trial design with randomization at the health facility level. The study aims to evaluate the effectiveness and acceptability of a combination community-based intervention (CBI) versus standard of care (SOC) for the management of child TB contacts. The study includes three phases: (I) exploratory phase; (II) intervention implementation and testing phase; (III) post-intervention explanatory phase. Healthcare provider interviews to inform intervention refinement (phase I) were completed in December 2015. In phase II, 10 health facilities were randomized to deliver the CBI or SOC, with stratification by facility type (i.e., hospital vs. health center). CBI holistically addresses the complex provider-related, patient-related, and caregiver-related barriers to prevention of childhood TB through nurse training and mentorship; health education for caregivers and patients by village health workers; adherence support using text messaging and village health workers; and multidisciplinary team meetings, where programmatic data are reviewed and challenges and solutions are discussed. SOC sites follow country guidelines for child TB contact management. Routine TB program data will be abstracted for all adult TB cases newly registered during the study period and their child contacts from TB registers and cards. The anticipated sample size is 1080 child contacts. Primary outcomes are yield (number) of child contacts, including children < 5 years of age and HIV-positive children < 15 years of age; IPT initiation; and IPT completion. Secondary outcomes include HIV testing; yield of active prevalent TB among child contacts; and acceptability and utilization of CBI components. Intervention implementation began in February 2016 and is ongoing. Post-intervention interviews with healthcare providers and caregivers (phase III) commenced in February 2017. DISCUSSION: The PREVENT study tests the effectiveness and acceptability of a novel combination CBI for child TB contact management in Lesotho. If effective, CBI will have important implications for addressing childhood TB in Lesotho and elsewhere. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02662829 . Registered on 15 January 2016.

Water insecurity in a syndemic context: Understanding the psycho-emotional stress of water insecurity in Lesotho, Africa.

Syndemics occur when populations experience synergistic and multiplicative effects of co-occurring epidemics. Proponents of syndemic theory highlight the importance of understanding the social context in which diseases spread and cogently argue that there are biocultural effects of external stresses such as food insecurity and water insecurity. Thus, a holistic understanding of disease or social vulnerability must incorporate an examination of the emotional and social effects of these phenomena. This paper is a response to the call for a renewed focus on measuring the psycho-emotional and psychosocial effects of food insecurity and water insecurity. Using a mixed-method approach of qualitative interviews and quantitative assessment, including a household demographic, illness, and water insecurity scale, the Household Food Insecurity Access Scale, and the Hopkins Symptoms Checklist-25, this research explored the psycho-emotional effects of water insecurity, food insecurity, and household illness on women and men residing in three low-land districts in Lesotho (n = 75). Conducted between February and November of 2011, this exploratory study first examined the complicated interaction of water insecurity, food insecurity and illness to understand and quantify the relationship between these co-occurring stresses in the context of HIV/AIDS. Second, it sought to separate the role of water insecurity in predicting psycho-emotional stress from other factors, such as food insecurity and household illness. When asked directly about water, qualitative research revealed water availability, access, usage amount, and perceived water cleanliness as important dimensions of water insecurity, creating stress in respondents' daily lives. Qualitative and quantitative data show that water insecurity, food insecurity and changing household demographics, likely resulting from the HIV/AIDS epidemic, are all associated with increased anxiety and depression, and support the conclusion that water insecurity is a critical syndemic dimension in Lesotho. Together, these data provide compelling evidence of the psycho-emotional burden of water insecurity.

Medicinal plants used in Lesotho for treatment of reproductive and post reproductive problems.

ETHNOPHARMACOLOGICAL RELEVANCE: Reproductive healthcare has been highlighted as a major challenge in Lesotho mainly due to the high prevalence of HIV/AIDS and sexually transmitted infections. As a result other reproductive ailments have not received much attention, particularly because healthcare facilities are already limited and many of them are inaccessible. For these reasons, medicinal plants play a major role in primary healthcare system in the country, in addition the plants are easily accessible, more affordable, and their use forms part of the cultural heritage. However, documentation of medicinal plants used for reproductive ailments is scattered, more importantly the biological and pharmacological properties, as well as toxicity of many of these plants are not yet known. AIM OF THE STUDY: To document the plants used by both male and female Basotho (residing in Lesotho) for the treatment of reproductive ailments, to explore their recorded biological and pharmacological effects as well as their toxicity, and to establish if these plants are used for similar purposes in other southern African cultures. MATERIALS AND METHODS: The results stem from published findings of recent interviews of traditional medicinal practitioners in the Maseru District of Lesotho, first author's own experiences and observations from the Qacha's Nek District as well as comprehensive literature survey including numerous books and unpublished data. Electronic databases such as Google, Google Scholar, PubMed, and ScienceDirect were also used to search for the chemical compounds, pharmacological activity, and toxicity of the plants. RESULTS: A total of 87 plant species are reported to be used for the treatment of several reproductive problems such as infertility, complications associated with pregnancy (twelve plants are used to treat conditions such as colic, heartburn, nausea, and constipation), cleansing and/ or toning of the uterus (with a purpose either to induce pregnancy or to get rid of the placenta, for example Withania somnifera and Zantedeschia albomaculata), difficult childbirth, as well treatment of breast and cervical cancer, cysts, fibroids, and testicular tumours (e.g. Hypoxis hemerocallidea). For the toning of the uterus, it is common to use a combination of plants, e.g. Gunnera perpensa, Scabiosa columbaria, and Eriospermum ornithogaloides. CONCLUSIONS: Of the 87 plants used for reproductive healthcare, the highest number (31) is used for the treatment of infertility (in both men and women). The pharmacological effects, active compounds, and toxicology of many of these plants are not yet known.

MEDICINAL HERBS USED BY HIV-POSITIVE PEOPLE IN LESOTHO.

BACKGROUND: The use of medicinal herbs whose efficacy and toxicities are not known by HIV-positive people in Lesotho is a threat to the effectiveness of antiretroviral treatment. This study explored some medicinal herbs used by HIV-positive people in Lesotho and the reasons for their use. METHODS: This was a cross sectional study based on a questionnaire distributed to purposively-sampled HIV-positive people in Leribe and Maseru districts of Lesotho. The participants' socio-demographic and clinical variables were summarized using frequency tables in Stata version 13 statistical software. Data variables for medicinal herbs used, frequency of use, uses by the participants and in the literature, parts of plants used and the method of preparation were also explored. RESULTS: Out of 400 questionnaires distributed to the participants, 389 were returned with data acceptable for analysis. Ages of the participants ranged from 18 to 75 years (Mean=43 + 11.6). Out of the 272 (69.9%) participants who conceded that they had used medicinal herbs at least once, 30 (7.7%) participants used medicinal herbs frequently while 242 (62.2 %) rarely used the herbs. At least 20 plant species belonging to 16 families were reportedly used by the participants. Asteraceae was the most common plant family reportedly used by the participants. Allium sativum and Dicoma anomala, reportedly used by 21.0% and 14.3% respectively, were the most commonly used medicinal herbs in this population. In addition, boosting the immune system and treating gastrointestinal ailments, apparently cited by 32% and 28% participants respectively, were the most commonly reported reasons for using medicinal herbs. CONCLUSION: A considerable proportion (69.9%) of HIV-positive people use medicinal herbs in this population, and 7.7% use them frequently. At least 20 plant species belonging to 16 families were reportedly used by the participants. HIV counselling protocols in Lesotho should emphasize the dangers of using medicinal herbs whose safety and compatibility with antiretroviral drugs is not known. The efficacy and toxicity profiles of the medicinal plants identified in this study need to be investigated. Furthermore, the effects of these plants on antiretroviral treatment outcomes including herb-drug interactions need to be explored.

Ethnobotanical survey of medicinal plants used in the Maseru district of Lesotho.

ETHNOPHARMACOLOGICAL RELEVANCE: Ethnobotanical knowledge in Lesotho is passed on orally from one generation to another. As a result it has not been well documented. Existing publications have relied on previous literature and are limited either in terms of scope or coverage. Furthermore, some of them are out of print. Therefore, there are gaps in the documentation of medicinal plants used in Lesotho. AIM OF THE STUDY: The purpose of the current study is to investigate common ailments in Lesotho's traditional medicine and document plants that are used in treating such ailments. MATERIALS AND METHODS: Interviews were conducted in five urban and four rural areas of the capital town of Maseru, by means of questionnaires to elicit information on medicinal plant use to cure common ailments. The informants were 20 males and seven females comprising 15 traditional healers, 11 herbalists and one pharmacist. RESULTS: Reproductive ailments were found to be the most commonly treated, followed by respiratory, degenerative and digestive problems. A list of the 80 plants used for treating the common ailments is given. A total of 44 families is represented, with Asteraceae, Fabaceae, Asphodelaceae and Poaceae families having the highest number of species used for medicinal purposes. The most frequently mentioned medicinal plants in interviews include; Elephantorrhiza elephantina, Pentanisia prunelloides, Hypoxis hermerocallidea, Eriocephalus sp., Salvia runcinata, Scabiosa columbaria, Dicoma anomala, Morella serrata, Xysmalobium undulatum, and Leobordea lanceolata. Due to the high demand of medicinal plants, some species such as L. lanceolata, Tephrosia capensis, E. elephantina, D. anomala and P. prunelloides were reported as over-harvested. In some cases animal products are added to the medicinal plants to enhance their curative abilities. CONCLUSIONS: A total of 80 plants were recorded in the study as treating 38 common ailments in the Maseru district of Lesotho. Records of eight medicinal plants and 146 new medicinal uses of 34 plants that were not recorded elsewhere in literature are reported in the current study for the first time. The new records of medicinal plants used in traditional healing practices in Lesotho clearly show the need to document these practices, and the wealth of new knowledge gained with the current study reinforces the importance of extending the study to other parts of Lesotho.

Comprehensive approach to improving maternal health and achieving MDG 5: report from the mountains of Lesotho.

BACKGROUND: Although it is now widely recognized that reductions in maternal mortality and improvements in women's health cannot be achieved through simple, vertical strategies, few programs have provided successful models for how to integrate services into a comprehensive program for maternal health. We report our experience in rural Lesotho, where Partners In Health (PIH) in partnership with the Ministry of Health and Social Welfare implemented a program that provides comprehensive care of pregnant women from the community to the clinic level. METHODS: Between May and July 2009, PIH trained 100 women, many of whom were former traditional birth attendants, to serve as clinic-affiliated maternal health workers. They received performance-based incentives for accompanying pregnant women during antenatal care (ANC) visits and facility-based delivery. A nurse-midwife provided ANC and delivery care and supervised the maternal health workers. To overcome geographic barriers to delivering at the clinic, women who lived far from the clinic stayed at a maternal lying-in house prior to their expected delivery dates. We analyzed data routinely collected from delivery and ANC registers to compare service utilization before and after implementation of the program. RESULTS: After the establishment of the program, the average number first ANC visits increased from 20 to 31 per month. The clinic recorded 178 deliveries in the first year of the program and 216 in the second year, compared to 46 in the year preceding the program. During the first two years of the program, 49 women with complications were successfully transported to the district hospital, and no maternal deaths occurred among the women served by the program. CONCLUSIONS: Our results demonstrate that it is possible to achieve dramatic improvements in the utilization of maternal health services and facility-based delivery by strengthening human resource capacity, implementing active follow-up in the community, and de-incentivizing home births.