Linkage to care and treatment outcomes for patients diagnosed with drug-susceptible tuberculosis using Xpert MTB/RIF assay in Thaba-Tseka district in Lesotho.

Objectives: To evaluate linkage to care and treatment outcomes of patients with tuberculosis (TB) confirmed by Xpert MTB/RIF assay in Thaba-Tseka district, Lesotho. Design: This was a retrospective cohort study of adult patients diagnosed with drug-susceptible TB using the Xpert MTB/RIF assay at two laboratories in Thaba-Tseka district from January 2016 to December 2020. Results: Six hundred and fifty-five eligible participants were identified for inclusion in this study. Their median age was 40 [interquartile range (IQR) 32-54] years, and 468 (71.45%) were male. Evidence of linkage to care was found for 459 (70.08%) participants, but there was no documentation on treatment initiation for 196 (29.92%) participants. The median time to treatment initiation was 0 days (same-day initiation) (IQR 0-4) and the treatment success rate was 86%. Treatment success was associated with negative sputum smear results after 2, 5 and 6 months (χ2, P<0.001). The overall mortality rate was 10%, with no trend of mortality reduction. Conclusion: There is a need to address the issue of linkage to care of patients diagnosed with TB in Thaba-Tseka district. Efforts should be made to reduce TB mortality in line with the World Health Organization's 'End TB strategy' target.

Misoprostol en la inducción del parto: experiencias en el Queen Elizabeth II Hospital de Maseru, Lesotho / Misoprostol (Cytotec) for artificial delivery: experiences at Queen Elizabeth II Hospital from Maseru, Lesotho

La inducción del parto con misoprostol es un procedimiento médico reconocido por la Organización Mundial de la Salud como práctica clínica beneficiosa para la madre y el perinato y, por ello, los autores de este trabajo se propusieron sistematizar su aplicación por vía vaginal, en dosis de 50 µg (máxima de 200 µg) e intervalos de 4 horas, en gestantes seleccionadas (n= 468) con criterio de interrupción médica del embarazo, ingresadas y tratadas en el Hospital Queen Elizabeth II -- institución de referencia nacional -- de Maseru, capital de Lesotho. Se considera que las experiencias y resultados obtenidos pueden ser de apreciable utilidad para los colegas que en circunstancias y condiciones similares, brinden atención médica internacionalista, puesto que la inducción del parto con ese producto fue altamente efectiva, por cuanto disminuyó el índice de cesáreas; mostró muy buen pronóstico de vida y salud, según puntaje de Apgar al quinto minuto, morbilidad y mortalidad del peripato, así como también garantizó que la morbilidad materna se correspondiera con el patrón de la población obstétrica en general y que no se produjeran defunciones(AU)

Artificial abortion using Misoprostol is a medical procedure recognized by the World Health Organization as a clinical practice that benefits both the mother and the neonate. That is why the authors of the present work proposed to systematize its vaginal application using doses of 50 µg (200 µg as maximum) and time periods of 4 hours in pregnant women (n= 468) who were chosen under the criterion of medical pregnancy interruption and hospitalized and treated at Queen Elizabeth II Hospital -- a national reference institution -- from Maseru, capital of Lesotho. Experiences and results obtained are considered of high usefulness for colleagues who, under similar conditions and circumstances, provide international medical care. Artificial abortion using this product was highly effective; thus, rates of abdominal delivery decreased, life and health prognosis was very good according to Apgar score at fifth minute, and morbidity and mortality of the neonate were also good. In addition, maternal morbidity matched the model of general obstetric population and no death occurred(AU)

Misoprostol en la inducción del parto: experiencias en el Queen Elizabeth II Hospital de Maseru, Lesotho / Misoprostol (Cytotec) for artificial delivery: experiences at Queen Elizabeth II Hospital from Maseru, Lesotho

La inducción del parto con misoprostol es un procedimiento médico reconocido por la Organización Mundial de la Salud como práctica clínica beneficiosa para la madre y el perinato y, por ello, los autores de este trabajo se propusieron sistematizar su aplicación por vía vaginal, en dosis de 50 µg (máxima de 200 µg) e intervalos de 4 horas, en gestantes seleccionadas (n= 468) con criterio de interrupción médica del embarazo, ingresadas y tratadas en el Hospital Queen Elizabeth II -- institución de referencia nacional -- de Maseru, capital de Lesotho. Se considera que las experiencias y resultados obtenidos pueden ser de apreciable utilidad para los colegas que en circunstancias y condiciones similares, brinden atención médica internacionalista, puesto que la inducción del parto con ese producto fue altamente efectiva, por cuanto disminuyó el índice de cesáreas; mostró muy buen pronóstico de vida y salud, según puntaje de Apgar al quinto minuto, morbilidad y mortalidad del peripato, así como también garantizó que la morbilidad materna se correspondiera con el patrón de la población obstétrica en general y que no se produjeran defunciones.

Artificial abortion using Misoprostol is a medical procedure recognized by the World Health Organization as a clinical practice that benefits both the mother and the neonate. That is why the authors of the present work proposed to systematize its vaginal application using doses of 50 µg (200 µg as maximum) and time periods of 4 hours in pregnant women (n= 468) who were chosen under the criterion of medical pregnancy interruption and hospitalized and treated at Queen Elizabeth II Hospital -- a national reference institution -- from Maseru, capital of Lesotho. Experiences and results obtained are considered of high usefulness for colleagues who, under similar conditions and circumstances, provide international medical care. Artificial abortion using this product was highly effective; thus, rates of abdominal delivery decreased, life and health prognosis was very good according to Apgar score at fifth minute, and morbidity and mortality of the neonate were also good. In addition, maternal morbidity matched the model of general obstetric population and no death occurred.

Growth charts only marginally improved maternal learning from nutrition education and growth monitoring in Lesotho.

A study done in Lesotho in 1985-1986 assessed whether growth charts increased the impact of nutrition education and growth monitoring on maternal learning about weaning practices and diarrhea. Seven hundred and seventy six mothers were given three monthly sessions of group nutrition education along with growth monitoring of children and individual counseling. Growth charts, which were taught to one of two groups, fostered learning but only on issues related to diarrhea and only among new clinic attendants, mothers with less than secondary schooling and mothers of malnourished children. These benefits, however, were small (differences less than 10%) compared with the overall impact of the nutrition education and growth monitoring intervention (increases between baseline and post-intervention were greater than 50% for some questions). Our findings suggest that well-designed clinic-based nutrition education and growth monitoring can have a significant impact on maternal nutrition knowledge. Teaching growth charts to mothers may not be necessary for obtaining such results in programs conducted under ideal conditions. More research is needed to determine under what circumstances, for what purposes and for whom growth charts may be beneficial.

PIP: Between December 1985 and November 1986, before and after 3 monthly sessions of group nutrition counseling and individual counseling about weaning and diarrhea management at 9 primary health clinics in Lesotho, researchers compared data on 575 mothers who received a growth chart to monitor their 2-year old children's growth with data on 201 mothers of 2-year old children who did not receive a growth chart. They wanted to learn whether growth charts promoted maternal learning and whether the growth charts better served some mothers than other mothers. Growth monitoring intervention improved knowledge of diarrhea management but not weaning practices. This improvement in learning about diarrhea management was limited to new clinic attendants, mothers with less than high school education, and mothers with malnourished children, however. Yet the differences in benefits between these 2 groups were 10% and insignificant. Nutrition education interventions had significantly improved knowledge of weaning practices and diarrhea management for both groups of mothers (range of improvement 3-119.2%; p.05). The greatest improvements occurred in correct responses to continuous feeding of solid foods during diarrhea (119.2% for mothers who did not receive charts and 85.2% for those who did) and to introduction of protein rich vegetables to children's diet (42.6% and 58.9%, respectively). Thus use of growth charts contributed only slightly to increased effectiveness of nutrition education. It appeared that the quality and specificity of educational projects and proper use of weight information during individual counseling contributed the most to improved maternal learning. Nevertheless further research is warranted to learn the circumstances, purposes, and target audience under which use of growth charts would bring the most benefits.

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

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

Impact of a clinic-based growth monitoring programme on maternal nutrition knowledge in Lesotho.

An evaluation of the impact of a nationwide clinic-based growth monitoring (GM) programme was done in Lesotho to determine if clinic attendance was associated with improved maternal knowledge of weaning practices and diarrhoea. A total of 907 mothers from eight clinics were included in the study. Our results showed that mothers who had attended the clinics knew more about the appropriate timing for introducing animal protein-rich foods in the child's diet and about the use of oral rehydration salts for diarrhoea, than those who had not. The difference in knowledge between previous clinic attendants and new attendants was particularly marked among mothers with less than secondary schooling and mothers with young babies (less than 6 months). From observation in the clinics, we believe that group nutrition education, although it was not integrated with growth monitoring, was probably responsible for the positive association between clinic attendance and maternal knowledge. Prior clinic attendance was not specifically associated with improved knowledge about feeding during diarrhoea or the need to stop breastfeeding gradually. These need to be better incorporated into present clinic nutrition education. Whether improvements in growth monitoring would further significantly improve nutrition education remains to be seen.

PIP: Between December 1985-November 1986, survey data from 907 mothers of 2-year-old children in 8 Catholic Relief Services (CRS) clinics in Mahale's Hoek and Mafeteng districts in Lesotho were analyzed to determine if attendance at a typical nationwide clinic-based growth monitoring program improved maternal knowledge of weaning practices and diarrhea management. 85% of the mothers were Basotho women. At the clinics, the mothers did not undergo individual counseling or receive training in growth charts. Group nutrition education efforts did occur, however, but separately from the program. Mothers who attended a clinic had a significantly higher increased knowledge of the appropriate timing for introducing animal protein rich foods and about the use of oral rehydration salts than those who did not attend (p.05). This association was especially significant for mothers with only primary education and those with infants 6 months old. The mothers reported breast feeding a mean of 2 years. 85% knew to introduce cereals and liquids between 4-6 months old. Yet few mothers knew how to appropriately stop breast feeding. For example, 50% believed it should stop in 1 day. The researchers believed that the separate group nutrition activities contributed to the positive effect of clinic attendance on maternal knowledge of nutrition and diarrhea management. Other research needs to be done to determine if teaching of growth charts and individual counseling would significantly improve maternal knowledge. Clinic staff delivering improved educational messages could have a significant positive effect on the growth and health of Basotho children who are undergoing weaning.