Ethno-Mathema-tics of Basotho

ERIC Educational Resources Information Center

Narayanan, Ajayagosh

2011-01-01

Mathematics as a subject is indispensable in the development of Lesotho with respect to science, technology or any other field of knowledge. It is also a mirror to our past. In this case, Lesotho's indigenous mathematics is not fully explored and understood by Basotho. This author aims to present ethno mathematics of Basotho as compared to…

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

PubMed

Seleteng Kose, Lerato; Moteetee, Annah; Van Vuuren, Sandy

2015-07-21

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. 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. 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. 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. 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. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Labor migration in Southern Africa and agricultural development: some lessons from Lesotho.

PubMed

Plath, J C; Holland, D W; Carvalho, J W

1987-01-01

Using Lesotho as a case study, this paper presents an analytical framework regarding certain policy issues relevant to agriculture becoming a viable alternative to migration for employment and income. 60% of adult Basotho (people of Lesotho) males between the ages of 20 and 44 are employed in the mines in South Africa. About 70% of rural households in Lesotho have at least 1 member who is a migrant. In recent years, over 40% of Lesotho's gross national product has come from mine wages. Migrant remittances contributed about 65% of rural household incomes in the late 1970s. Future opportunities for migrant employment will either remain at current levels or decline as mining becomes less labor intensive and South Africa gives priority to employing local blacks. In Lesotho, only about 2% of the land is arable. Also, the impact of so much migration to South Africa has a direct effect on labor available to Lesotho agriculture. To estimate indirectly the costs of migration, 34 Basotho migrants employed in the South African mines were interviewed in the Nyakosoba area in 1983. Results show that the cost of migration was valued at 40% of their annual average income in 1983. There is sparse ownership of and access to land and oxen; there is also a scarcity of agricultural equipment. The authors calculate that 1) returns from growing traditional field crops using traditional technology are abysmally low, 2) net return from growing the same crops with improved technology are greatly improved, and 3) the commercial planting and cultivation of fruit trees would yield net returns that far exceed the amounts most surveyed migrants indicated would be sufficient to stop them from migrating. Constraints to improved technology adoption include 1) investment in fixed capital and variable inputs, 2) higher levels of management and knowledge of how to use the technology, 3) the necessity to quit mine work and pursue agriculture full time. Production risk needs to be reduced. Orchard development represents an ideal transition enterprise from mining to agriculture. The necessary levels of real income can be generated from rotational field crops with improved practices on at least 2-3 hectares of land. Irrigated fruit or vegetable production is an alternative for those without sufficient land for traditional field crops.

Herder Identity in Lesotho: Implications for Non-Formal Education

ERIC Educational Resources Information Center

Pitikoe, Selloane; Preece, Julia

2016-01-01

This paper reports on selective findings from a larger qualitative PhD study of 30 adult herders in Lesotho. It uses theories of identity and social capital to examine their life histories and educational needs in order to inform the national Non-Formal Education (NFE) policy. The key findings of the study were that the herders demonstrated two…

Geography Teachers' Interpretation of a Curriculum Reform Initiative: The Case of the Lesotho Environmental Education Support Project (LEESP)

ERIC Educational Resources Information Center

Raselimo, Mohaeka; Wilmot, Di

2013-01-01

This article addresses how teachers in a specific developing world context interpreted a curriculum reform initiative. It is located within a broader interpretive study that investigated the integration of Environmental Education into the formal education system of Lesotho with particular reference to secondary school geography. More specifically…

An Investigation of Information-Seeking Behaviour of Geography Teachers for an Information Service Intervention: The Case of Lesotho

ERIC Educational Resources Information Center

Bitso, Constance; Fourie, Ina

2012-01-01

Introduction: This study investigates the information needs and information-seeking patterns of secondary level geography teachers in Lesotho to guide the design and implementation of an information service for these teachers. Leckie, Pettigrew and Sylvain's model of professionals' information-seeking served as a theoretical framework but was…

The Connotations of "Botho Philosophy" and Its Potential Contribution towards Environmental Conservation: The Case of Tlokoeng Community in Lesotho

ERIC Educational Resources Information Center

Mokuku, Tšepo

2017-01-01

This paper explores innovative environmental education strategies to conserve biodiversity in a rural-based context, in Lesotho. A case study approach was employed to investigate the community's conception of botho philosophy and how it might promote nature conservation. Focus Group Interviews were conducted with 105 participants. The responses…

Understanding Challenges Physics Teachers Come Across as They Implement Learner-Centred Approaches in Lesotho

ERIC Educational Resources Information Center

Qhobela, Makomosela; Moru, Eunice Kolitsoe

2014-01-01

Teacher-centred strategies have dominated most physics lessons in Lesotho. This study attempted to understand the contributing factors for the choice of teacher-centred teaching instead of learner-centred teaching with the goal of informing a professional development programme designed to address this problem. The paper responds to the research…

Situation Report--Bahrain, Central African Republic, Gabon, Iraq, Jordan, Kuwait, Lesotho, Libya, Saudi Arabia, Swaziland, Syria, Yemen Arab Republic.

ERIC Educational Resources Information Center

International Planned Parenthood Federation, London (England).

Data relating to population and family planning in twelve foreign countries are presented in these situation reports. Countries included are Bahrain, Central African Republic, Gabon, Iraq, Jordan, Kuwait, Lesotho, Libya, Saudi Arabia, Swaziland, Syria, and Yemen Arab Republic. Information is provided, where appropriate and available, under two…

Rural Teachers' Views: What Are Gender-Based Challenges Facing Free Primary Education in Lesotho?

ERIC Educational Resources Information Center

Morojele, Pholoho

2013-01-01

This paper gives prominence to rural teachers' accounts of gender-based challenges facing Free Primary Education in Lesotho. It draws on feminist interpretations of social constructionism to discuss factors within the Basotho communities that affect gender equality in the schools. The inductive analysis offered makes use of the data generated from…

Nurturing Lifelong Learning in Communities through the National University of Lesotho: Prospects and Challenges

ERIC Educational Resources Information Center

Preece, Julia; Croome, David; Ntene, Mankatso; Ngozwana, Nomazulu

2011-01-01

This paper analyses one aspect of a pan-African action research project called ITMUA (Implementing the Third Mission of Universities in Africa). This particular paper draws on the data from that project to explore the National University of Lesotho's contribution to lifelong learning in its communities. It provides background information on the…

Threats to Inclusive Education in Lesotho: An Overview of Policy and Implementation Challenges

ERIC Educational Resources Information Center

Mosia, Paseka Andrew

2014-01-01

This study looks at how the education of Learners with Special Education Needs (LSEN) has developed in Lesotho as a result of international policies on human rights and education. In particular, it explores various challenges to inclusive education such as proper understanding of inclusive education, the development of a policy on special and…

Grandmother Coresidence, Maternal Orphans, and School Enrollment in Sub-Saharan Africa

ERIC Educational Resources Information Center

Parker, Erin M.; Short, Susan E.

2009-01-01

The HIV/AIDS pandemic in sub-Saharan Africa has brought renewed attention to the role of grandmothers as caregivers of children. Using 2004 Lesotho Demographic and Health Survey data, the authors examine the relationship between coresidence with a grandmother and child schooling in Lesotho, a country with one of the highest rates of HIV infection.…

Sexuality Education in Rural Lesotho Schools: Challenges and Possibilities

ERIC Educational Resources Information Center

Khau, Mathabo

2012-01-01

The aim of this paper is to present and discuss some of the obstacles to effective sexuality education in rural Lesotho schools and offer some suggestions that could facilitate positive change in the current status of sexuality education. The call for education as a "vaccine" against new HIV infections places teachers at the forefront of…

The Lesotho Curriculum and Assessment Policy: Opportunities and Threats

ERIC Educational Resources Information Center

Raselimo, Mohaeka; Mahao, Mahao

2015-01-01

The end of British colonial rule in 1966 provided an impetus for curriculum reform in Lesotho. Since then, a number of curriculum and assessment reforms have been attempted, albeit with a little success. In all cases, the aim has been to achieve the goals of education for national development. The "Curriculum and Assessment Policy" 2009…

What Does It Mean to Be a Boy? Implications for Girls' and Boys' Schooling Experiences in Lesotho Rural Schools

ERIC Educational Resources Information Center

Morojele, Pholoho

2011-01-01

A doctoral study on constructions of gender in Lesotho rural primary schools has found that meanings attached to children's identities play a role in undermining gender equality in schools. The study employed the social constructionist paradigm as its theoretical framework. Drawing from ethnographic data (conversations, observations and informal…

"There's No Place Like Home": Perceptions of Home-Based HIV Testing in Lesotho

ERIC Educational Resources Information Center

Mantell, J. E.; DiCarlo, A. L.; Remien, R. H.; Zerbe, A.; Morris, D.; Pitt, B.; Nkonyana, J. P.; Abrams, E. J.; El-Sadr, W.

2014-01-01

HIV testing has the potential to reduce HIV transmission by identifying and counseling individuals with HIV, reducing risk behaviors, linking persons with HIV to care and earlier treatment, and reducing perinatal transmission. In Lesotho, a high HIV prevalence country in which a large proportion of the population has never tested for HIV,…

An Analysis of the Information Behaviour of Geography Teachers in a Developing African Country--Lesotho

ERIC Educational Resources Information Center

Bitso, Constance

2012-01-01

Information behaviour studies have the potential to inform the design of effective information services that incorporate the information needs, information-seeking and preferences for information sources of target users; hence a doctoral study was conducted on the information behaviour of geography teachers in Lesotho with the aim of guiding the…

Supporting Lesotho Teachers to Develop Resilience in the Face of the HIV and AIDS Pandemic

ERIC Educational Resources Information Center

Wood, Lesley; Ntaote, Grace Makeletso; Theron, Linda

2012-01-01

HIV and AIDS threaten to erode the wellbeing of teachers who are faced with an increasing number of children rendered vulnerable by the pandemic. This article explores the usefulness of a supportive group intervention, Resilient Educators (REds), in supporting Lesotho teachers to respond to the HIV and AIDS-related challenges. A time-series pre-…

English Teaching Profiles from the British Council: Burma, Cyprus, Czechoslovakia, Ethiopia, Ghana, India, Lesotho, New Zealand, Pakistan, Qatar, Malaysia.

ERIC Educational Resources Information Center

British Council, London (England). English Language and Literature Div.

The role of English and the status of English language instruction is reported for Burma, Cyprus, Czechoslovakia, Ethiopia, Ghana, India, Lesotho, New Zealand, Pakistan, Qatar, and Malaysia. The profile for each country contains a summary of English instruction within and outside of the educational system, teacher supply and qualifications,…

Child Participation in School Governance: The Case of Prefects at a Primary School in Lesotho

ERIC Educational Resources Information Center

Morojele, Pholoho; Muthukrishna, Nithi

2011-01-01

This paper draws on literature that has theorised child participation within the sociology of childhood framework to examine how children participate in governance within school spaces. Four children aged between 13 and 17 (in grades six and seven) who serve as prefects at a primary school in Lesotho were participants in this study. Data was…

The Cost-Effectiveness of Interactive Radio Instruction for Improving Primary School Instruction in Honduras, Bolivia and Lesotho.

ERIC Educational Resources Information Center

Tilson, Thomas D.; And Others

Findings are presented from studies on the use of radio for teaching primary school children mathematics in Honduras and Bolivia and English as a Second Language in Lesotho. Interactive radio instruction (IRI) is so called because of the active participation of the students. Although lessons are presented by conventional radio, scripts are written…

Situation Report--Barbados, Finland, German Democratic Republic, Italy, Lesotho, Luxembourg, Malagasy Republic (Madagascar), Malaysia (West), Netherlands, Poland, Portugal, Singapore, Sweden, Syrian Arab Republic, and Yugoslavia.

ERIC Educational Resources Information Center

International Planned Parenthood Federation, London (England).

Data relating to population and family planning in 15 foreign countries are presented in these situation reports. Countries included are Barbados, Finland, German Democratic Republic, Italy, Lesotho, Luxembourg, Malagasy Republic, Malaysia (West), Netherlands, Poland, Portugal, Singapore, Sweden, Syrian Arab Republic, and Yogoslavia. Information…

Selection for Higher Education in Developing Countries--the Use of Tests in Admission for Pre-Entry Science Upgrading Courses in Botswana, Swaziland and Lesotho.

ERIC Educational Resources Information Center

Altink, Wieby M. M.

The degree of predictive validity and the relationship with previous learning conditions were studied for measures used in admission procedures for upgrading courses in science and mathematics in Botswana, Lesotho, and Swaziland. School results, achievement tests, aptitude tests, and ability tests were evaluated for students leaving secondary…

Policy as Practice: Local Appropriation of Language and Education Policies in Lesotho Primary Schools

ERIC Educational Resources Information Center

Backman, Stephen

2009-01-01

This dissertation study sets out to take a close look at the complex mix of factors on the ground, which influence the appropriation of language and education policies by local education stakeholders at Lesotho primary schools. I argue that much of the research in language policy and planning (LPP) has focused too largely on the macro-level…

Examining Secondary School Physics Teachers' Beliefs about Teaching and Classroom Practices in Lesotho as a Foundation for Professional Development

ERIC Educational Resources Information Center

Qhobela, Makomosela; Kolitsoe Moru, Eunice

2014-01-01

The classroom practices of science teachers are indicative of their beliefs and pedagogical content knowledge (PCK). PCK is an amalgam of knowledge about subject matter, pedagogy, and contextual issues. This article identifies areas where physics teachers in Lesotho may need professional development support by addressing the research question: How…

Low-cost small scale parabolic trough collector design for manufacturing and deployment in Africa

NASA Astrophysics Data System (ADS)

Orosz, Matthew; Mathaha, Paul; Tsiu, Anadola; Taele, B. M.; Mabea, Lengeta; Ntee, Marcel; Khakanyo, Makoanyane; Teker, Tamer; Stephens, Jordan; Mueller, Amy

2016-05-01

Concentrating Solar Power is expanding its deployment on the African subcontinent, highlighting the importance of efforts to indigenize manufacturing of this technology to increase local content and therefore local economic benefits of these projects. In this study a design for manufacturing (DFM) exercise was conducted to create a locally produced parabolic trough collector (the G4 PTC). All parts were sourced or fabricated at a production facility in Lesotho, and several examples of the design were prototyped and tested with collaborators in the Government of Lesotho's Appropriate Technology Services division and the National University of Lesotho. Optical and thermal performance was simulated and experimentally validated, and pedagogical pre-commercial versions of the PTC have been distributed to higher education partners in Lesotho and Europe. The cost to produce the PTC is 180 USD/m2 for a locally manufactured heat collection element (HCE) capable of sustaining 250C operation at ~65% efficiency. A version with an imported evacuated HCE can operate at 300°C with 70% efficiency. Economically relevant applications for this locally produced PTC include industrial process heat and distributed generation scenarios where cogeneration is required.

Conserving Conflict? Transfrontier Conservation, Development Discourses and Local Conflict Between South Africa and Lesotho

PubMed Central

Büscher, Bram

2010-01-01

This paper describes and analyses how discourses of conservation and development as well as migrant labour practices can be understood as transnational dynamics that both cement and complicate transnational relations. It also looks into how these dynamics articulate with, shape and are being shaped by ‘the local’. Focusing on the north-eastern boundary of Lesotho in the area of the ‘Maloti-Drakensberg transfrontier conservation and development project’, we show how conflictual situations put the ethnographic spotlight on the ways in which ‘local people’ in Lesotho deal with dual forces of localisation and transnationalisation. We argue that they accommodate, even appropriate, these dual pressures by adopting an increasingly flexible stance in terms of identity, alliances, livelihood options and discourses. PMID:21258433

Implementation of Regional and International HIV and AIDS Prevention, Treatment, Care and Support Conventions and Declarations in Lesotho, Malawi and Mozambique

ERIC Educational Resources Information Center

Kalanda, Boniface; Mamimine, Patrick; Taela, Katia; Chingandu, Louis; Musuka, Godfrey

2010-01-01

The governments across the world have endorsed numerous international Conventions and Declarations (C&Ds) that enhance interventions to reduce the impact of HIV and AIDS. The objective of this study was to assess the extent to which the governments of Lesotho, Malawi and Mozambique have implemented HIV and AIDS international and regional…

Maloti Drakensberg Transfrontier Park joint management: Sehlabathebe National Park (Lesotho) and the uKhahlamba Drakensberg Park World Heritage Site (South Africa)

Treesearch

John M. Crowson

2011-01-01

On 8 April 2005, the first Joint Management Committee meeting was held at Qacha's Nek, Lesotho. This was to ensure co-operative management through joint management. The formation of a Joint Management Committee was part of the Bilateral Maloti Drakensberg Transfrontier Project agreement and consisted of officials from the Ministry of Tourism, Environment and...

School Violence in Lesotho: The Perceptions, Experiences and Observations of a Group of Learners

ERIC Educational Resources Information Center

de Wet, Corene

2007-01-01

School violence is a subject of great public and media interest that has stimulated a comprehensive body of research. Academic consideration of the subject began in the USA and Scandinavia in the mid-1960s and early 1970s but little evidence could be found of publications on the subject in the small landlocked Kingdom of Lesotho. To address this…

Human immunodeficiency virus seroprevalence in an occupational cohort in a South African community.

PubMed

Kravitz, J D; Mandel, R; Petersen, E A; Nyaphisis, M; Human, D

In the early years of the worldwide pandemic, there were no reported cases of acquired immunodeficiency syndrome in Lesotho, a small, mountainous country in South Africa. Since 1986, when the first case of acquired immunodeficiency syndrome was identified, reported diagnoses have risen precipitously. The initiation of the Lesotho Highlands Water Project has resulted in the influx of a migrant workforce of predominantly single males into a relatively isolated, mountainous area where human immunodeficiency virus (HIV) was previously unknown. To ascertain the HIV seroprevalence among a cohort of laborers at the Katse Dam construction site in Bokong, Lesotho. During the 5-week study period in late 1992, construction workers (age range, 15 to 59 years) who were first-time clinic users for any chief complaint were randomly selected for serological study. Surveillance complied with the Lesotho National AIDS Control Programme guidelines, which required unlinked, anonymous testing. Serum samples were screened by an enzyme-linked immunosorbent assay; the results were confirmed by the Western blot technique. Unlinked, anonymous HIV testing of 486 persons revealed a seroprevalence of 5.3% (26/486; 95% confidence interval, 3.3% to 7.3%). These data contrasted with a 0.8% seroprevalence in a similar age group in nearby villages that surrounded the construction project. Lesotho, in the early phase of the HIV/acquired immunodeficiency syndrome epidemic in Africa in the 1980s, was seemingly protected by its relative isolation. Grave concern is now warranted as the country is destined to experience a rapid rise in HIV seroprevalence. Increased surveillance, health education opportunities, and aggressive prevention activities at the Katse Dam construction site are imperative to arrest the spread of HIV from construction workers to nearby villagers.

Prevalence of goitre and urinary iodine status of primary-school children in Lesotho.

PubMed Central

Sebotsa, Masekonyela Linono Damane; Dannhauser, Andre; Jooste, Pieter L.; Joubert, Gina

2003-01-01

OBJECTIVE: To estimate the prevalence of goitre, urinary iodine status, coverage of supplementation of iodized oil capsules, and current use of iodized salt in children in Lesotho. METHODS: Cross-sectional study of children from 50 primary schools in Lesotho. Thyroid glands of children aged 8-12 years were measured by palpation and graded according to the WHO, UNICEF, and the International Council for the Control of Iodine Deficiency's (ICCIDD) joint criteria. The use of iodized oil capsules was determined by a structured questionnaire and verified with the children's health booklets. Iodine content of household salt samples was analysed. Casual urine samples were analysed for urinary iodine. FINDINGS: Median urinary iodine concentrations of 26.3 microg/l (range 22.3-47.9 microg/l) indicated moderate iodine deficiency. More children in the mountains than in the lowlands were severely iodine deficient (17.7% vs 1.9%). Adjusted prevalence of goitre (4.9%) increased with age, was higher in girls than boys, and ranged from 2.2% to 8.8% in the different districts; this indicated no public health problem. Overall, 94.4% of salt samples were iodized, and coverage of supplementation with iodized oil capsules was 55.1%. CONCLUSION: Mild-to-moderate iodine deficiency exists in Lesotho. Iodine deficiency was more severe in the mountains than the lowlands and is still a concern for public health. Use of iodized salt coupled with iodized oil supplementation effectively controls iodine deficiency disorders. Effective monitoring programmes would ensure the use of adequately iodized salt throughout Lesotho and serve to evaluate progress towards optimal iodine nutrition. Iodized oil capsule supplementation should continue in the mountains. PMID:12640473

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.

PubMed

Logie, Carmen H; Dias, Lisa V; Jenkinson, Jesse; Newman, Peter A; MacKenzie, Rachel K; Mothopeng, Tampose; Madau, Veli; Ranotsi, Amelia; Nhlengethwa, Winnie; Baral, Stefan D

2018-03-01

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.

Assessment of Computer Literacy of Nurses in Lesotho.

PubMed

Mugomeri, Eltony; Chatanga, Peter; Maibvise, Charles; Masitha, Matseliso

2016-11-01

Health systems worldwide are moving toward use of information technology to improve healthcare delivery. However, this requires basic computer skills. This study assessed the computer literacy of nurses in Lesotho using a cross-sectional quantitative approach. A structured questionnaire with 32 standardized computer skills was distributed to 290 randomly selected nurses in Maseru District. Univariate and multivariate logistic regression analyses in Stata 13 were performed to identify factors associated with having inadequate computer skills. Overall, 177 (61%) nurses scored below 16 of the 32 skills assessed. Finding hyperlinks on Web pages (63%), use of advanced search parameters (60.2%), and downloading new software (60.1%) proved to be challenging to the highest proportions of nurses. Age, sex, year of obtaining latest qualification, computer experience, and work experience were significantly (P < .05) associated with inadequate computer skills in univariate analysis. However, in multivariate analyses, sex (P = .001), year of obtaining latest qualification (P = .011), and computer experience (P < .001) emerged as significant factors. The majority of nurses in Lesotho have inadequate computer skills, and this is significantly associated with having many years since obtaining their latest qualification, being female, and lack of exposure to computers. These factors should be considered during planning of training curriculum for nurses in Lesotho.

Characteristics of men who have sex with men in southern Africa who seek sex online: a cross-sectional study.

PubMed

Stahlman, Shauna; Grosso, Ashley; Ketende, Sosthenes; Mothopeng, Tampose; Taruberekera, Noah; Nkonyana, John; Mabuza, Xolile; Sithole, Bhekie; Mnisi, Zandile; Baral, Stefan

2015-05-25

Use of the Internet for finding sexual partners is increasing, particularly among men who have sex with men (MSM). In particular, MSM who seek sex online are an important group to target for human immunodeficiency virus (HIV)/sexually transmitted infection (STI) interventions because they tend to have elevated levels of sexual risk behavior and because the Internet itself may serve as a promising intervention delivery mechanism. However, few studies have examined the correlates of online sexual partner seeking among MSM in sub-Saharan Africa. These analyses aim to describe the prevalence of using the Internet to find new male sexual partners among MSM in two southern African countries. In addition, these analyses examine the sociodemographic characteristics, experiences of discrimination and stigma, mental health and substance use characteristics, and HIV-related knowledge, attitudes, and behaviors among MSM associated with meeting sex partners online. MSM were enrolled into a cross-sectional study across two sites in Lesotho (N=530), and one in Swaziland (N=322) using respondent-driven sampling. Participants completed a survey and HIV testing. Data were analyzed using bivariate and multivariable logistic regression models to determine which factors were associated with using the Internet to meet sex partners among MSM. The prevalence of online sex-seeking was high, with 39.4% (209/530) of MSM in Lesotho and 43.8% (141/322) of MSM in Swaziland reporting meeting a new male sexual partner online. In the multivariable analysis, younger age (adjusted odds ratio [aOR] 0.37, 95% confidence interval [CI] 0.27-0.50 per 5 years in Lesotho; aOR 0.68, 95% CI 0.49-0.93 in Swaziland), having more than a high school education (aOR 18.2, 95% CI 7.09-46.62 in Lesotho; aOR 4.23, 95% CI 2.07-8.63 in Swaziland), feeling scared to walk around in public places (aOR 1.89, 95% CI 1.00-3.56 in Lesotho; aOR 2.06, 95% CI 1.23-3.46 in Swaziland), and higher numbers of male anal sex partners within the past 12 months (aOR 1.27, 95% CI 1.01-1.59 per 5 partners in Lesotho; aOR 2.98, 95% CI 1.51-5.89 in Swaziland) were significantly associated with meeting sex partners online in both countries. Additional country-specific associations included increasing knowledge about HIV transmission, feeling afraid to seek health care services, thinking that family members gossiped, and having a prevalent HIV infection among MSM in Lesotho. Overall, a high proportion of MSM in Lesotho and Swaziland reported meeting male sex partners online, as in other parts of the world. The information in this study can be used to tailor interventions or to suggest modes of delivery of HIV prevention messaging to these MSM, who represent a young and highly stigmatized group. These data suggest that further research assessing the feasibility and acceptability of online interventions will be increasingly critical to addressing the HIV epidemic among MSM across sub-Saharan Africa.

The Lesotho Hospital PPP experience: catalyst for integrated service delivery.

PubMed

Coelho, Carla Faustino; O'Farrell, Catherine Commander

2011-01-01

For many years, Lesotho urgently needed to replace its main public hospital, Queen Elizabeth II. The project was initially conceived as a single replacement hospital, but eventually included the design and construction of a new 425 bed public hospital and adjacent primary care clinic, the renovation and expansion of three strategically located primary care clinics in the region and the management of all facilities, equipment and delivery of all clinical services in the health network by a private operator under contract for 18 years. The project's design was influenced by the recognition that a new facility alone would not address the underlying issues in service provision. The creation of this PPP health network and the contracting mechanism has increased accountability for service quality, shifted Government to a more strategic role and may also benefit other public facilities and providers in Lesotho. The county is considering the PPP approach for other health facilities.

Difficulties facing healthcare workers in the era of AIDS treatment in Lesotho.

PubMed

Koto, Masebeo Veronica; Maharaj, Pranitha

2016-01-01

Sub-Saharan Africa is most affected by the AIDS pandemic and Lesotho is no exception. In many countries, healthcare workers are at the forefront of the fight against AIDS. This study explores the difficulties facing healthcare workers in Lesotho using a combination of qualitative methods--focus group discussions and in-depth interviews. The findings suggest that healthcare workers are afraid of contracting HIV from their patients and this affects their delivery of services. In addition, the results revealed that poor infrastructure and shortage of supplies at the facilities hinder healthcare workers from performing their duties effectively. The other concern was the heavy workload and severe time constraints which puts enormous stress on healthcare workers. Stigma and discrimination emerged as major problems for healthcare workers. Addressing the challenges facing healthcare workers is essential in effectively managing the AIDS pandemic facing the continent.

Good governance and budget reform in Lesotho Public Hospitals: performance, root causes and reality.

PubMed

Vian, Taryn; Bicknell, William J

2014-09-01

Lesotho has been implementing financial management reforms, including performance-based budgeting (PBB) since 2005 in an effort to increase accountability, transparency and effectiveness in governance, yet little is known about how these efforts are affecting the health sector. Supported by several development partners and $24 million in external resources, the PBB reform is intended to strengthen government capacity to manage aid funds directly and to target assistance to pressing social priorities. This study designed and tested a methodology for measuring implementation progress for PBB reform in the hospital sector in Lesotho. We found that despite some efforts on the national level to promote and support reform implementation, staff at the hospital level were largely unaware of the purpose of the reform and had made almost no progress in transforming institutions and systems to fully realize reform goals. Problems can be traced to a complex reform design, inadequate personnel and capacity to implement, professional boundaries between financial and clinical personnel and weak leadership. The Lesotho reform experience suggests that less complex designs for budget reform, better adapted to the context and realities of health sectors in developing countries, may be needed to improve governance. It also highlights the importance of measuring reform implementation at the sectoral level. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013; all rights reserved.

The impact of the declining extended family support system on the education of orphans in Lesotho

PubMed Central

Tanga, Pius T

2013-01-01

This paper examines the impact of the weakening of the extended family on the education of double orphans in Lesotho through in-depth interviews with participants from 3 of the 10 districts in Lesotho. The findings reveal that in Lesotho the extended family has not yet disintegrated as the literature suggests. However, it shows signs of rupturing, as many orphans reported that they are being taken into extended family households, the incentive for these households being, presumably, the financial and other material assistance that they receive from the government and non-governmental organisations (NGOs) which supplements household income and material wellbeing. The findings show that financial and other assistance given by the government and NGOs have resulted in conflict between the orphans and caregivers. This has also prompted many extended families to shift responsibilities to the government and NGOs. Most of the extended households provided the orphans with poor living conditions, such as unhygienic houses, poor nutrition, and little or no provision of school materials, which has had a negative impact on the education of the orphans. The combined effects of economic crisis and HIV and AIDS have resulted in extended families not being able to care for the needs of the orphans adequately, whilst continuing to accept them into their households. It is recommended that although extended families are still accepting orphans, the government should strengthen and recognise the important role played by families and the communities in caring for these vulnerable children. The government should also introduce social grants for orphans and other vulnerable children and review the current meagre public assistance (R100) it provides for orphans and vulnerable children in Lesotho. Other stakeholders should concentrate on strengthening the capacity of families and communities through programmes and projects which could be more sustainable than the current handouts given by many NGOs. PMID:24587791

What lies behind gender inequalities in HIV/AIDS in sub-Saharan African countries: evidence from Kenya, Lesotho and Tanzania

PubMed Central

Sia, Drissa; Onadja, Yentéma; Nandi, Arijit; Foro, Anne; Brewer, Timothy

2014-01-01

Within sub-Saharan Africa, women are disproportionately at risk for acquiring and having human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). It is important to clarify whether gender inequalities in HIV prevalence in this region are explained by differences in the distributions of HIV risk factors, differences in the effects of these risk factors or some combination of both. We used an extension of the Blinder–Oaxaca decomposition approach to explain gender inequalities in HIV/AIDS in Kenya, Lesotho and Tanzania using data from the demographic and health and AIDS indicator surveys. After adjusting for covariates using Poisson regression models, female gender was associated with a higher prevalence of HIV/AIDS in Kenya [prevalence ratio (PR) = 1.73, 95% confidence interval (CI) = 1.33, 2.23 in 2003] and Lesotho (PR = 1.39, 95% CI = 1.20, 1.62 in 2004/05), but not in Tanzania. Decomposition analyses demonstrated two distinct patterns over time. In Tanzania, the gender inequality in HIV/AIDS was explained by differences in the distributions of HIV risk factors between men and women. In contrast, in Kenya and Lesotho, this inequality was partly explained by differences in the effects across men and women of measured HIV/AIDS risk factors, including socio-demographic characteristics (age and marital status) and sexual behaviours (age at first sex); these results imply that gender inequalities in HIV/AIDS would persist in Kenya and Lesotho even if men and women had similar distributions of HIV risk factors. The production of gender inequalities may vary across countries, with inequalities attributable to the unequal distribution of risk factors among men and women in some countries and the differential effect of these factors between groups in others. These different patterns have important implications for policies to reduce gender inequalities in HIV/AIDS. PMID:24345343

Women's rights, the family, and organisational culture: a Lesotho case study.

PubMed

Everett, E

1997-02-01

Traditional cultural norms have had significant implications for the work and internal structure of Lesotho Save the Children (LSC). From 1964-90, the organization's work focused entirely on the needs of neglected and abandoned boys, for whom it provided residential care. After consultation with the Department of Social Welfare, it was decided to make the residential center a haven for girls as well as boys in need of protection. Many girls in Lesotho experience physical and sexual abuse within their families; moreover, daughters in poor families are often placed in households of wealthier extended family as domestics, where further abuse occurs. Cultural discomfort acknowledging and discussing sexuality extended to Children's Village staff responsible for the care of child rape victims. Coercive sex is often a prelude to marriage in Lesotho, where many women are kidnapped and raped by their prospective bridegrooms. In-service training has enabled staff to overcome their reticence regarding sexual issues and view rape as a criminal act. Although LSC is unable to challenge the oppression of women and children implicit in the traditional family, it continues to encourage girls and women to protest sexual violence, the abuse of their daughters, and the unequal distribution of labor within the family. All children in the LSC residence perform both male- and female-defined duties and attempts are being made to reduce the division of labor among staff in which females are caretakers and males are authority figures.

Earth Observations

NASA Image and Video Library

2010-08-28

ISS024-E-012749 (28 Aug. 2010) --- Maseru, Lesotho is featured in this image photographed by an Expedition 24 crew member on the International Space Station. Maseru is the capital city of the Kingdom of Lesotho and is located along the northwestern border of the country with the Republic of South Africa. The footprint of the urban area, recognizable by street grids and distinctive blue-roofed industrial buildings at center, is only just visible against the surrounding landscape. The city has expanded eightfold (to 230,000 today) since independence from the United Kingdom of Great Britain and Northern Ireland in 1966, and is now home to one in five inhabitants in the country. The Caledon (or Mohokare) River flows adjacent to Maseru and forms a part of the border between Lesotho and South Africa. Locally, the border extends from approximately top center left to bottom center right, with the cities of Ladybrand and Manyatseng located in South Africa. Moshoeshoe I International Airport (left) provides access to the capital. Major industries in the city include flour mills, and footwear and textile companies. Tourism is also a growing part of the local economy. The Kingdom of Lesotho is completely landlocked by the surrounding Republic of South Africa. Major landforms visible in the image near Maseru include the Qeme and Berea Plateaus to the south and east respectively; these are erosional remnants of widespread horizontally layered sedimentary rocks that formed in the Karoo Basin during the Upper Triassic Period (approximately 200–229 million years ago), according to scientists.

Palliative care for HIV in the era of antiretroviral therapy availability: perspectives of nurses in Lesotho

PubMed Central

Kell, Megan E; Walley, John D

2009-01-01

Background Southern Africa is disproportionately affected by the HIV/AIDS epidemic. In Lesotho 23% of adults are HIV-positive, and only 26% of those in need are accessing antiretroviral treatment (ART). Consequently, about 18,000 people die from AIDS each year. In this situation, palliative care is needed towards the end of life, but is also recommended throughout the HIV disease trajectory. The World Health Organisation (WHO) has produced the Integrated Management of Adolescent and Adult Illness (IMAI) guidelines, which includes a palliative care guidebook (as well as acute and chronic ART guidebooks). IMAI aims to facilitate the implementation of integrated HIV/AIDS care in resource-poor areas. The opinions of health workers towards this integrated approach to care and the use of IMAI has not been considered in previous research studies. This paper therefore aims to address some of these issues. Methods Semi-structured interviews were conducted with six key informants and ten nurses in Lesotho. The interviews were transcribed verbatim and analysed using content thematic analysis. Results Many nurses described palliative care as synonymous with chronic care and felt that palliative care is necessary for HIV-positive patients despite the introduction of ART. It was thought that the approach taken should be holistic and integrated throughout the disease trajectory. Pain management was noted to be a particular area of need for palliative care, and it was suggested that this could be improved in Lesotho. The IMAI guidelines were thought to be useful, but knowledge of the palliative care booklet was limited. Conclusion Palliative care remains necessary for HIV despite the increasing availability of ART. However, it is currently significantly lacking in Lesotho and many other sub-Saharan African countries. Greater understanding of palliative care amongst health workers is required, as well as strong political will from the Ministry of Health. The IMAI guidelines are a useful tool for holistic HIV care, including palliative care, but they need to be used more effectively. As ART is becoming increasingly available worldwide, the complex chronic care issues for patients with HIV/AIDS should not be neglected. PMID:19682391

A 30-year bibliometric analysis of research coverage on HIV and AIDS in Lesotho.

PubMed

Mugomeri, Eltony; Bekele, Bisrat S; Mafaesa, Mamajoin; Maibvise, Charles; Tarirai, Clemence; Aiyuk, Sunny E

2017-03-21

Given the well documented undesired impacts of HIV/AIDS globally, there is a need to create a statistical inventory of research output on HIV/AIDS. This need is particularly important for a country such as Lesotho, whose HIV/AIDS prevalence is one of the highest globally. Research on HIV/AIDS in sub-Saharan Africa continues to trail behind that of other regions, especially those of the developed countries. Lesotho, a sub-Saharan country, is a developing country with lower research output in this area when longitudinally compared to other countries. This study reviewed the volume and scope of the general research output on HIV/AIDS in Lesotho and assessed the coverage of the national research agenda on HIV/AIDS, making recourse to statistical principles. A bibliometric review of studies on HIV/AIDS retrieved from the SCOPUS and PubMed databases, published within the 30-year period between 1985 and 2016, was conducted. The focus of each of the studies was analysed and the studies were cross-matched with the national research agenda in accordance with bibliometric methodologies. In total, 1280 studies comprising 1181 (92.3%) journal articles, 91 (7.1%) books and 8 (0.6%) conference proceedings were retrieved. By proportion, estimation of burden of infection (40.7%) had the highest research volume, while basic (5.5%) and preventive measures (24.4%) and national planning (29.4%) had the lowest. Out of the total studies retrieved, only 516 (40.3%) matched the national research agenda. Research on maternal and child health quality of care, viral load point-of-care devices, and infant point-of-care diagnosis had hardly any publications in the high priority research category of the agenda. Notwithstanding a considerable research output on HIV/AIDS for Lesotho, there is insufficient coverage of the national research agenda in this research area. The major research gaps on general research output are in basic and preventive measures as well as national planning. There is also a need to increase targeted funding for HIV/AIDS research to appropriately address the most compelling gaps and national needs.

MEDICINAL HERBS USED BY HIV-POSITIVE PEOPLE IN LESOTHO

PubMed Central

Mugomeri, Eltony; Chatanga, Peter; Chakane, Ntema

2016-01-01

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. PMID:28852728

MEDICINAL HERBS USED BY HIV-POSITIVE PEOPLE IN LESOTHO.

PubMed

Mugomeri, Eltony; Chatanga, Peter; Chakane, Ntema

2016-01-01

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. 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. 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. 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.

‘Men usually say that HIV testing is for women’: Gender dynamics & perceptions of HIV testing in Lesotho

PubMed Central

DiCarlo, Abby L.; Mantell, Joanne E.; Remien, Robert H.; Zerbe, Allison; Morris, Danielle; Pitt, Blanche; Abrams, Elaine J.; El-Sadr, Wafaa

2014-01-01

In Lesotho, men have lower HIV testing rates, less contact with HIV clinical settings, and less knowledge of HIV prevention than women. However, women’s HIV prevalence has consistently remained higher than men’s. This paper explores gender norms, sexual decision-making, and perceptions of HIV among a sample of Basotho men and women in order to understand how these factors influence HIV testing and prevention. Two hundred women and 30 men were interviewed in Lesotho between April–July 2011. Participants reported reluctance among women to share information about HIV prevention and testing with men, and resistance of men to engage with testing and/or prevention services. Findings demonstrate a critical need for educational initiatives for men, among other strategies to engage men with HIV testing and prevention. This study highlights how gender issues shape perceptions of HIV and sexual decision-making and underlines the importance of engaging men along with women in HIV prevention efforts. More studies are needed to determine the most effective strategies to inform and engage men. PMID:24854495

'Men usually say that HIV testing is for women': gender dynamics and perceptions of HIV testing in Lesotho.

PubMed

DiCarlo, Abby L; Mantell, Joanne E; Remien, Robert H; Zerbe, Allison; Morris, Danielle; Pitt, Blanche; Abrams, Elaine J; El-Sadr, Wafaa M

2014-01-01

In Lesotho, men have lower HIV testing rates, less contact with HIV clinical settings and less knowledge of HIV prevention than women. However, women's HIV prevalence has consistently remained higher than men's. This paper explores gender norms, sexual decision-making and perceptions of HIV among a sample of Basotho men and women in order to understand how these factors influence HIV testing and prevention. A total of 200 women and 30 men were interviewed in Lesotho between April and July 2011. Participants reported reluctance among women to share information about HIV prevention and testing with men, and resistance of men to engage with testing and/or prevention services. Findings demonstrate a critical need for educational initiatives for men, among other strategies, to engage men with HIV testing and prevention. This study highlights how gender issues shape perceptions of HIV and sexual decision-making and underlines the importance of engaging men along with women in HIV prevention efforts. More studies are needed to determine the most effective strategies to inform and engage men.

Flexible kinship: caring for AIDS orphans in rural Lesotho

PubMed Central

Block, Ellen

2015-01-01

HIV/AIDS has devastated families in rural Lesotho, leaving many children orphaned. Families have adapted to the increase in the number of orphans and HIV-positive children in ways that provide children with the best possible care. Though local ideas about kinship and care are firmly rooted in patrilineal social organization, in practice, maternal caregivers, often grandmothers, are increasingly caring for orphaned children. Negotiations between affinal kin capitalize on flexible kinship practices in order to legitimate new patterns of care, which have shifted towards a model that often favours matrilocal practices of care in the context of idealized patrilineality. PMID:25866467

Knowledge, attitude and practice of infant feeding in the first 6 months among HIV-positive mothers at the Queen Mamohato Memorial hospital clinics, Maseru, Lesotho

PubMed Central

Dudley, Lilian

2018-01-01

Background The balance between the risks of transmission of human immunodeficiency virus (HIV) through breastfeeding and its life-saving benefits complicates decisions about infant feeding among HIV-positive mothers in the first 6 months. Objective The aim of this study was to assess the knowledge, attitude and practice of infant feeding among HIV-positive mothers attending the prevention of mother-to-child transmission services in Maseru, Lesotho. Method and setting This observational cross-sectional study was done by collecting data from HIV-positive mothers attending the filter clinics of Queen Mamohato Memorial hospital in Maseru, Lesotho. HIV-positive mothers with infants below the age of 6 months attending the clinics at the time of the study were interviewed using a standardised questionnaire. We described the sociodemographic profile of the mothers, the information and education received on prevention of mother-to-child transmission (PMTCT) infant feeding options, the mothers’ knowledge, attitudes and practices of infant feeding, and assessed risk factors for improved knowledge, attitudes and practices. Results The majority (96%) of the 191 HIV-positive mothers who participated in the survey knew about the PMTCT programme and related breastfeeding services. Most of the participants chose to breastfeed (89%), while only 8% formula-fed their infants. Knowledge received during the PMTCT programme was significantly associated with the decision to exclusively breastfeed their infants. Earlier infant feeding counselling and education was associated with more exclusively breastfeeding as compared to late infant feeding counselling (p < 0.001). Conclusion The study found that HIV-positive mothers attending health clinics in Maseru, Lesotho, had high knowledge, and appropriate attitudes and practices with respect to infant feeding; and that early counselling and education improved infant feeding methods among these mothers. PMID:29781690

Aviation and the delivery of medical care in remote regions: the Lesotho HIV experience.

PubMed

Furin, Jennifer; Shutts, Mike; Keshavjee, Salmaan

2008-02-01

In many regions of the world plagued by high burdens of disease, there is difficulty in accessing basic medical care. This is often due to logistical constraints and a lack of infrastructure such as roads. Medical aviation can play a major role in addressing some of these crucial issues as it allows for the rapid transport of patients, personnel, and medications to remote-and sometimes otherwise inaccessible-areas. Lesotho is a mountainous nation of 2 million people that provides a good example of medical aviation as a cornerstone in the delivery of health care. The population has a reported HIV seroprevalence of 25%, and many patients live in rural areas that are inaccessible by road. Mission Aviation Fellowship has joined forces with a medical team from the nongovernmental organization Partners In Health in an effort to launch a comprehensive program to address HIV and related problems in rural Lesotho. This medical aviation partnership has allowed for the provision of HIV prevention and treatment services to thousands of people living in the mountains. This commentary describes how medical aviation has been crucial in developing models to address complex, serious health problems in remote settings.

Brief report: Mobility and circular migration in Lesotho: implications for transmission, treatment, and control of a severe HIV epidemic.

PubMed

Palk, Laurence; Blower, Sally

2015-04-15

We analyzed georeferenced data on mobility and HIV infection from the 2009 Demographic and Health Survey of Lesotho. We found ∼50% of the population traveled in the preceding year. By constructing gender-specific mobility maps, we discovered that travel is highest in the urban areas bordering South Africa and in the mountainous interior of the country. For both genders, increased mobility was associated with increased levels of "recent" sexual behavior. Notably, mobility was only associated with an increased risk of HIV infection for men who traveled frequently. We discuss the implications of our results for designing effective treatment programs and HIV interventions.

Fires in South Africa, snow in Lesotho

NASA Technical Reports Server (NTRS)

2002-01-01

The precipitation that brought snow fall to the Drakensberg Mountains in Lesotho in southern Africa was not enough to quench the numerous fires (marked with red dots) burning throughout the Republic of South Africa. These Moderate Resolution Imaging Spectroradiometer (MODIS) images from June 18, 2002, and July 2, 2002, show the snowfall in landlocked Lesotho contrasting sharply with the country's brown, mountainous terrain. (In the false-color image, vegetation is bright green, bare soil is brown, and burned areas are reddish-brown. In northeast Republic of South Africa, right along the border with Mozambique, the smooth, gray-brown terrain shows the boundaries of Kruger National Park. The Park was established in the late 1800s to protect game species, such as elephants, antelope, and bison, which were being hunted in great numbers. In this image, dark brown patches reveal the location of previous fires. The vegetation has yet to come back, and the landscape is virtually bare. NASA scientists study fire behavior in Kruger as part of the SAFARI field campaign. Running southward through Mozambique and into the Indian Ocean is the muddy Limpopo River--known to many through Rudyard Kipling's 'Just-so' story about how the elephant got its trunk. Credit: Jacques Descloitres, MODIS Land Rapid Response Team, NASA/GSFC

Sexual identity stigma and social support among men who have sex with men in Lesotho: a qualitative analysis.

PubMed

Stahlman, Shauna; Bechtold, Kali; Sweitzer, Stephanie; Mothopeng, Tampose; Taruberekera, Noah; Nkonyana, John; Baral, Stefan

2015-11-01

Men who have sex with men (MSM) face sexual identity stigma in many settings, which can increase risk for HIV by limiting access to care. This paper examines the roles of social support, sexual identity stigma, and sexual identity disclosure among MSM in Lesotho, a lower-middle income country within South Africa. Qualitative data were collected from 23 in-depth interview and six focus group participants and content analysis was performed to extract themes. Four primary themes emerged: 1) Verbal abuse from the broader community is a major challenge faced by MSM in Lesotho, 2) participants who were open about their sexual identity experienced greater stigma but were more self-sufficient and had higher self-confidence, 3) relationships between MSM tend to be conducted in secrecy, which can be associated with unhealthy relationships between male couples and higher risk sexual practices, and 4) MSM community organisations provide significant social and emotional support. Friends and family members from outside the MSM community also offer social support, but this support cannot be utilised by MSM until the risk of disclosing their sexual identity is reduced. Greater acceptance of same-sex practices would likely result in more open, healthy relationships and greater access to social support for MSM. Copyright © 2015 Elsevier Inc. All rights reserved.

Documentary evidence of climate variability during cold seasons in Lesotho, southern Africa, 1833-1900

NASA Astrophysics Data System (ADS)

Grab, Stefan W.; Nash, David J.

2010-03-01

This study presents the first 19th century cold season climate chronology for the Kingdom of Lesotho in southern Africa. The chronology is constructed using a variety of documentary sources including letters, diaries, reports, monographs and newspaper articles obtained from southern African and British archives. Information relating to cold season weather phenomena during the austral autumn, winter and early spring months were recorded verbatim. Each of the cold seasons from 1833 to 1900 was then classified as “very severe”, “severe” or “normal/mild”, with a confidence rating ranging from low (1) to high (3) awarded against each annual classification. The accuracy of the document-derived chronology was verified against temperature data for Maseru for the period 1893-1900. Excellent correspondence of the document-derived chronology with the Maseru instrumental data and also with other global proxy temperature records for the 19th century is achieved. The results indicate 12 (18% of the total) very severe, 16 (23%) severe and 40 (59%) normal/mild cold seasons between 1833 and 1900. The overall trend is for more severe and snow-rich cold seasons during the early part of the study period (1833-1854) compared with the latter half of the 19th century (with the exception of the 1880s). A reduction in the duration of the frost season by over 20 days during the 19th century is also tentatively identified. Several severe to very severe cold seasons in Lesotho follow after major tropical and SH volcanic eruptions; such years are usually characterized by early frosts, and frequent and heavy snowfalls. The blocking of solar radiation and the enhanced northward displacement of polar fronts that are directly or indirectly associated with volcanic events, may account for many of the most severe Lesotho winters during the 19th century.

Voluntary medical male circumcision: a cross-sectional study comparing circumcision self-report and physical examination findings in Lesotho.

PubMed

Thomas, Anne Goldzier; Tran, Bonnie Robin; Cranston, Marcus; Brown, Malerato Cecilia; Kumar, Rajiv; Tlelai, Matsotetsi

2011-01-01

Overwhelming evidence, including three clinical trials, shows that male circumcision (MC) reduces the risk of HIV infection among men. However, data from recent Lesotho Demographic and Health Surveys do not demonstrate MC to be protective against HIV. These contradictory findings could partially be due to inaccurate self-reported MC status used to estimate MC prevalence. This study describes MC characteristics among men applying for Lesotho Defence Force recruitment and seeks to assess MC self-reported accuracy through comparison with physical-examination-based data. During Lesotho Defence Force applicant screening in 2009, 241 (77%) of 312 men, aged 18-25 y, consented to a self-administered demographic and MC characteristic survey and physician-performed genital examination. The extent of foreskin removal was graded on a scale of 1 (no evidence of MC) to 4 (complete MC). MC was self-reported by 27% (n = 64/239) of participants. Of the 64 men self-reporting being circumcised, physical exam showed that 23% had no evidence of circumcision, 27% had partial circumcision, and 50% had complete circumcision. Of the MCs reportedly performed by a medical provider, 3% were Grade 1 and 73% were Grade 4. Of the MCs reportedly performed by traditional circumcisers, 41% were Grade 1, while 28% were Grade 4. Among participants self-reporting being circumcised, the odds of MC status misclassification were seven times higher among those reportedly circumcised by initiation school personnel (odds ratio = 7.22; 95% CI = 2.29-22.75). Approximately 27% of participants self-reported being circumcised. However, only 50% of these men had complete MC as determined by a physical exam. Given this low MC self-report accuracy, countries scaling up voluntary medical MC (VMMC) should obtain physical-exam-based MC data to guide service delivery and cost estimates. HIV prevention messages promoting VMMC should provide comprehensive education regarding the definition of VMMC.

Community health workers in Lesotho: Experiences of health promotion activities.

PubMed

Seutloali, Thato; Napoles, Lizeka; Bam, Nomonde

2018-02-27

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

Metabolic syndrome in patients on first-line antiretroviral therapy containing zidovudine or tenofovir in rural Lesotho, Southern Africa.

PubMed

Labhardt, Niklaus Daniel; Müller, Urs Franz; Ringera, Isaac; Ehmer, Jochen; Motlatsi, Mokete M; Pfeiffer, Karolin; Hobbins, Michael A; Muhairwe, Josephine A; Muser, Juergen; Hatz, Christoph

2017-06-01

To assess the prevalence of metabolic syndrome (MetS) among patients in rural Lesotho who are taking first-line antiretroviral therapy (ART) containing either zidovudine or tenofovir disoproxil. Cross-sectional survey in 10 facilities in Lesotho among adult (≥16 years) patients on non-nucleoside reverse transcriptase inhibitor (NNRTI)-based first-line ART for ≥6 months. MetS was defined according to the International Diabetes Federation criteria. Among 1166 patients (65.8% female), 22.2% (95% CI: 19.3-25.3) of women and 6.3% (4.1-9.1) of men met the IDF definition of MetS (P < 0.001). In both sexes, there was no significant difference in MetS prevalence between NNRTIs. However, in women taking zidovudine as nucleoside reverse transcriptase inhibitor (NRTI), MetS prevalence was 27.9%, vs. 18.8% in those taking tenofovir. In the multivariate logistic regression allowing for socio-demographic and clinical covariates, ART containing zidovudine was associated with MetS in women (aOR 2.17 (1.46-3.22), P < 0.001) but not in men. In this study, taking ART containing zidovudine instead of tenofovir disoproxil was an independent predictor of MetS in women but not in men. This finding endorses WHO's recommendation of tenofovir as preferred NRTI. © 2017 John Wiley & Sons Ltd.

Outcomes of antiretroviral treatment programmes in rural Lesotho: health centres and hospitals compared

PubMed Central

Labhardt, Niklaus Daniel; Keiser, Olivia; Sello, Motlalepula; Lejone, Thabo Ishmael; Pfeiffer, Karolin; Davies, Mary-Ann; Egger, Matthias; Ehmer, Jochen; Wandeler, Gilles

2013-01-01

Introduction Lesotho was among the first countries to adopt decentralization of care from hospitals to nurse-led health centres (HCs) to scale up the provision of antiretroviral therapy (ART). We compared outcomes between patients who started ART at HCs and hospitals in two rural catchment areas in Lesotho. Methods The two catchment areas comprise two hospitals and 12 HCs. Patients ≥16 years starting ART at a hospital or HC between 2008 and 2011 were included. Loss to follow-up (LTFU) was defined as not returning to the facility for ≥180 days after the last visit, no follow-up (no FUP) as not returning after starting ART, and retention in care as alive and on ART at the facility. The data were analysed using logistic regression, competing risk regression and Kaplan-Meier methods. Multivariable analyses were adjusted for sex, age, CD4 cell count, World Health Organization stage, catchment area and type of ART. All analyses were stratified by gender. Results Of 3747 patients, 2042 (54.5%) started ART at HCs. Both women and men at hospitals had more advanced clinical and immunological stages of disease than those at HCs. Over 5445 patient-years, 420 died and 475 were LTFU. Kaplan-Meier estimates for three-year retention were 68.7 and 69.7% at HCs and hospitals, respectively, among women (p=0.81) and 68.8% at HCs versus 54.7% at hospitals among men (p<0.001). These findings persisted in adjusted analyses, with similar retention at HCs and hospitals among women (odds ratio (OR): 0.89, 95% confidence interval (CI): 0.73–1.09) and higher retention at HCs among men (OR: 1.53, 95% CI: 1.20–1.96). The latter result was mainly driven by a lower proportion of patients LTFU at HCs (OR: 0.68, 95% CI: 0.51–0.93). Conclusions In rural Lesotho, overall retention in care did not differ significantly between nurse-led HCs and hospitals. However, men seemed to benefit most from starting ART at HCs, as they were more likely to remain in care in these facilities compared to hospitals. PMID:24267671

Outcomes of antiretroviral treatment programmes in rural Lesotho: health centres and hospitals compared.

PubMed

Labhardt, Niklaus Daniel; Keiser, Olivia; Sello, Motlalepula; Lejone, Thabo Ishmael; Pfeiffer, Karolin; Davies, Mary-Ann; Egger, Matthias; Ehmer, Jochen; Wandeler, Gilles

2013-11-21

Lesotho was among the first countries to adopt decentralization of care from hospitals to nurse-led health centres (HCs) to scale up the provision of antiretroviral therapy (ART). We compared outcomes between patients who started ART at HCs and hospitals in two rural catchment areas in Lesotho. The two catchment areas comprise two hospitals and 12 HCs. Patients ≥16 years starting ART at a hospital or HC between 2008 and 2011 were included. Loss to follow-up (LTFU) was defined as not returning to the facility for ≥180 days after the last visit, no follow-up (no FUP) as not returning after starting ART, and retention in care as alive and on ART at the facility. The data were analysed using logistic regression, competing risk regression and Kaplan-Meier methods. Multivariable analyses were adjusted for sex, age, CD4 cell count, World Health Organization stage, catchment area and type of ART. All analyses were stratified by gender. Of 3747 patients, 2042 (54.5%) started ART at HCs. Both women and men at hospitals had more advanced clinical and immunological stages of disease than those at HCs. Over 5445 patient-years, 420 died and 475 were LTFU. Kaplan-Meier estimates for three-year retention were 68.7 and 69.7% at HCs and hospitals, respectively, among women (p=0.81) and 68.8% at HCs versus 54.7% at hospitals among men (p<0.001). These findings persisted in adjusted analyses, with similar retention at HCs and hospitals among women (odds ratio (OR): 0.89, 95% confidence interval (CI): 0.73-1.09) and higher retention at HCs among men (OR: 1.53, 95% CI: 1.20-1.96). The latter result was mainly driven by a lower proportion of patients LTFU at HCs (OR: 0.68, 95% CI: 0.51-0.93). In rural Lesotho, overall retention in care did not differ significantly between nurse-led HCs and hospitals. However, men seemed to benefit most from starting ART at HCs, as they were more likely to remain in care in these facilities compared to hospitals.

Depression and Social Stigma Among MSM in Lesotho: Implications for HIV and Sexually Transmitted Infection Prevention.

PubMed

Stahlman, Shauna; Grosso, Ashley; Ketende, Sosthenes; Sweitzer, Stephanie; Mothopeng, Tampose; Taruberekera, Noah; Nkonyana, John; Baral, Stefan

2015-08-01

Social stigma is common among men who have sex with men (MSM) across Sub-Saharan Africa, and may influence risks for HIV and sexually transmitted infections (STIs) via its association with depression. We conducted a cross-sectional study of 530 MSM in Lesotho accrued via respondent-driven sampling. Using generalized structural equation models we examined associations between stigma, social capital, and depression with condom use and testing positive for HIV/STIs. Depression was positively associated with social stigma experienced or perceived as a result of being MSM. In contrast, increasing levels of social cohesion were negatively associated with depression. Social stigma was associated with testing positive for HIV; however, this association did not appear to be mediated by depression or condom use. These data suggest a need for integrated HIV and mental health care that addresses stigma and discrimination and facilitates positive social support for MSM.

Depression and Social Stigma among MSM in Lesotho: Implications for HIV and Sexually Transmitted Infection Prevention

PubMed Central

Stahlman, Shauna; Grosso, Ashley; Ketende, Sosthenes; Sweitzer, Stephanie; Mothopeng, Tampose; Taruberekera, Noah; Nkonyana, John; Baral, Stefan

2016-01-01

Social stigma is common among men who have sex with men (MSM) across Sub-Saharan Africa, and may influence risks for HIV and sexually transmitted infections (STIs) via its association with depression. We conducted a cross-sectional study of 530 MSM in Lesotho accrued via respondent-driven sampling. Using generalized structural equation models we examined associations between stigma, social capital, and depression with condom use and testing positive for HIV/STIs. Depression was positively associated with social stigma experienced or perceived as a result of being MSM. In contrast, increasing levels of social cohesion were negatively associated with depression. Social stigma was associated with testing positive for HIV; however, this association did not appear to be mediated by depression or condom use. These data suggest a need for integrated HIV and mental health care that addresses stigma and discrimination and facilitates positive social support for MSM. PMID:25969182

Adoption of new HIV treatment guidelines and drug substitutions within first-line as a measure of quality of care in rural Lesotho: health centers and hospitals compared.

PubMed

Labhardt, Niklaus D; Sello, Motlalepula; Lejone, Thabo; Ehmer, Jochen; Mokhantso, Mohlaba; Lynen, Lutgarde; Pfeiffer, Karolin

2012-10-01

In 2007, Lesotho launched new national antiretroviral treatment (ART) guidelines, prioritising tenofovir and zidovudine over stavudine as a backbone together with lamivudine. We compared the rate of adoption of these new guidelines and substitution of first-line drugs by health centers (HC) and hospitals in two catchment areas in rural Lesotho. Retrospective cohort analysis. Patients aged ≥16 years were stratified into a HC- and a hospital-group. Type of backbone at ART-initiation (i), substitutions within first line (ii) and type of backbone among patients retained by December 2010 (iii). A multiple logistic regression model including HC vs. hospital, patient characteristics (sex, age, WHO-stage, baseline CD4-count, concurrent pregnancy, concurrent tuberculosis treatment) and year of ART-start, was used. Of 3936 adult patients initiated on ART between 2007 and 2010, 1971 started at hospitals and 1965 at HCs. Hospitals were more likely to follow the new guidelines as measured by prescription of backbones without stavudine (Odds-ratio 1.55; 95%CI: 1.32-1.81) and had a higher rate of drug substitutions while on first-line ART (2.39; 1.83-3.13). By December 2010, patients followed at health centres were more likely to still receive stavudine (2.28; 1.83-2.84). Health centers took longer to adopt the new guidelines and substituted drugs less frequently. Decentralised ART-programmes need close support, supervision and mentoring to absorb new guidelines and to adhere to them. © 2012 Blackwell Publishing Ltd.

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

PubMed

Moteetee, A; Seleteng Kose, L

2016-12-24

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. 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. 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. 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. 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. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Assessment of Permian coalbed gas resources of the Karoo Basin Province, South Africa and Lesotho, 2016

USGS Publications Warehouse

Schenk, Christopher J.; Brownfield, Michael E.; Tennyson, Marilyn E.; Klett, Timothy R.; Mercier, Tracey J.; Hawkins, Sarah J.; Gaswirth, Stephanie B.; Marra, Kristen R.; Finn, Thomas M.; Le, Phuong A.; Leathers-Miller, Heidi M.

2017-02-21

Using a geology-based assessment methodology, the U.S. Geological Survey estimated undiscovered, technically recoverable mean resources of 5.27 trillion cubic feet of coalbed gas in the Karoo Basin Province.

From modeling to morals: imagining the future of HIV PREP in Lesotho.

PubMed

Kenworthy, Nora J; Bulled, Nicola

2013-08-01

Amidst growing global endorsements of new biomedical HIV prevention strategies, ARV-based pre-exposure prophylaxis (ARV PrEP) has garnered considerable attention as a potentially promising prevention strategy. Though it may offer more effective protection for certain at-risk groups than conventional prevention strategies (such as sexual partner reduction, condom use, and prevention of mother-to-child transmission), PrEP is more costly. PrEP requires more ongoing contact between individuals and providers, and a level of surveillance from the health system that is not necessary with other preventive measures. In this sense, it represents a new bio-technology for HIV prevention that poses particular challenges for worldwide implementation, given developing countries' struggling health systems and incomplete HIV treatment programs. Since the emergence of PrEP has stimulated ethical discussions premised on incomplete knowledge of efficacy and implementation, this paper explores the ethical parameters of a likely scenario for PrEP usage in a single, resource-poor country. We first develop a plausible model for PrEP deployment and utilization based on current PrEP research, while carefully considering the reigning institutional values of feasibility and effectiveness in global health approaches. Drawing on ethnographic research of HIV treatment and prevention approaches in Lesotho, we address ethical questions arising from this scenario of PrEP delivery. Lesotho presents a compelling and emblematic case study of PrEP's potential successes and pitfalls in a developing country, given the country's high HIV prevalence, struggles to achieve universal access to HIV treatment regimes, continued existence of stigma around the epidemic, and difficulties in addressing persistent social inequalities that fuel infections. © 2013 John Wiley & Sons Ltd.

HIV-related discrimination among grade six students in nine Southern African countries.

PubMed

Maughan-Brown, Brendan; Spaull, Nicholas

2014-01-01

HIV-related stigmatisation and discrimination by young children towards their peers have important consequences at the individual level and for our response to the epidemic, yet research on this area is limited. We used nationally representative data to examine discrimination of HIV-positive children by grade six students (n = 39,664) across nine countries in Southern Africa: Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia and Zimbabwe. Descriptive statistics are used to compare discrimination by country, gender, geographic location and socioeconomic status. Multivariate logistic regression is employed to assess potential determinants of discrimination. The levels and determinants of discrimination varied significantly between the nine countries. While one in ten students in Botswana, Malawi, South Africa and Swaziland would "avoid or shun" an HIV positive friend, the proportions in Lesotho, Mozambique, Zambia and Zimbabwe were twice as high (approximately 20%). A large proportion of students believed that HIV positive children should not be allowed to continue to attend school, particularly in Zambia (33%), Lesotho (37%) and Zimbabwe (42%). The corresponding figures for Malawi and Swaziland were significantly lower at 13% and 12% respectively. Small differences were found by gender. Children from rural areas and poorer schools were much more likely to discriminate than those from urban areas and wealthier schools. Importantly, we identified factors consistently associated with discrimination across the region: students with greater exposure to HIV information, better general HIV knowledge and fewer misconceptions about transmission of HIV via casual contact were less likely to report discrimination. Our study points toward the need for early interventions (grade six or before) to reduce stigma and discrimination among children, especially in schools situated in rural areas and poorer communities. In particular, interventions should focus on correcting misconceptions that HIV can be transmitted via casual contact.

The implementation of a global fund grant in Lesotho: applying a framework on knowledge absorptive capacity.

PubMed

Biesma, Regien; Makoa, Elsie; Mpemi, Regina; Tsekoa, Lineo; Odonkor, Philip; Brugha, Ruairi

2012-02-01

One of the biggest challenges in scaling up health interventions in sub-Saharan Africa for government recipients is to effectively manage the rapid influx of aid from different donors, each with its own requirements and conditions. However, there is little empirical evidence on how governments absorb knowledge from new donors in order to satisfy their requirements. This case study applies Cuellar and Gallivan's (2006) framework on knowledge absorptive capacity (AC) to illustrate how recipient government organisations in Lesotho identified, assimilated and utilised knowledge on how to meet the disbursement and reporting requirements of Lesotho's Round 5 grant from the Global Fund to Fight AIDS, TB and Malaria (Global Fund). In-depth topic guided interviews with 22 respondents and document reviews were conducted between July 2008 and February 2009. Analysis focused on six organisational determinants that affect an organisation's absorptive capacity: prior-related knowledge, combinative capabilities, motivation, organisational structure, cultural match, and communication channels. Absorptive capacity was mostly evident at the level of the Principal Recipient, the Ministry of Finance, who established a new organisational unit to meet the requirements of Global Fund Grants, while the level of AC was less advanced among the Ministry of Health (Sub-Recipient) and district level implementers. Recipient organisations can increase their absorptive capacity, not only through prior knowledge of donor requirements, but also by deliberately changing their organisational form and through combinative capabilities. The study also revealed how vulnerable African governments are to loss of staff capacity. The application of organisational theory to analyse the interactions of donor agencies with public and non-public country stakeholders illustrates the complexity of the environment that aid recipient governments have to manage. Copyright © 2011 Elsevier Ltd. All rights reserved.

Fairness and equity in the provision of anti-retroviral therapy: some reflections from Lesotho.

PubMed

Armstrong, Russell

2010-12-01

The number of people in immediate need of anti-retroviral treatment (ART) in the southern African region continues to significantly exceed the capacity of health systems there to provide it. Approaches to this complex rationing dilemma have evolved in different directions. The ethical concepts of fairness and equity have been suggested as a basis to guide the development of approaches to select patients for ART. This article reports the results of a case study on patient selection at a rural ART clinic in Lesotho. The purpose of the study was to examine whether or not such concepts had relevance or operative value for a treatment team providing ART in rural Lesotho. The study found that while concepts of fairness and equity were relevant to the work of the treatment team, patient selection practices did not necessarily reflect what these concepts entail. The idea of fairness as a structured, formalized selection process did not figure in the approach to ART provision at the site. A less formal, 'first-come-first-served' approach was adopted. While there was knowledge among some team members that social, economic or geographic conditions inhibit individuals and groups from gaining access to ART and that this was inequitable, it was felt that there was little they could do to try to mediate the impact of these conditions. The study's findings pose importance questions about the approach to ART programming in resource constrained settings. The findings also question the relevance of trying to achieve fairness and equity when the gap between need for care and capacity to provide it remains so large. © 2009 Blackwell Publishing Ltd.

Re-focusing the Gender Lens: Caregiving Women, Family Roles and HIV/AIDS Vulnerability in Lesotho

PubMed Central

Harrison, Abigail; Short, Susan E.; Tuoane-Nkhasi, Maletela

2013-01-01

Gender and HIV risk have been widely examined in southern Africa, generally with a focus on dynamics within sexual relationships. Yet the social construction of women’s lives reflects their broader engagement with a gendered social system, which influences both individual-level risks and social and economic vulnerabilities to HIV/AIDS. Using qualitative data from Lesotho, we examine women’s lived experiences of gender, family and HIV/AIDS through three domains: 1) marriage; 2) kinship and social motherhood, and 3) multigenerational dynamics. These data illustrate how women caregivers negotiate their roles as wives, mothers, and household heads, serving as the linchpins of a gendered family system that both affects, and is affected by, the HIV/AIDS epidemic. HIV/AIDS interventions are unlikely to succeed without attention to the larger context of women’s lives, namely their kinship, caregiving, and family responsibilities, as it is the family and kinship system in which gender, economic vulnerability and HIV risk are embedded. PMID:23686152

Entrepreneurial training for girls empowerment in Lesotho: A process evaluation of a model programme

PubMed Central

Berry, Mary O'Neill; Kuriansky, Judy; Lytle, Megan; Vistman, Bozhena; Mosisili, ‘Mathato S.; Hlothoane, Lieketso; Matlanyane, Mapeo; Mokobori, Thabang; Mosuhli, Silas; Pebane, Jane

2014-01-01

A Girls Empowerment Programme held in 2010 in Lesotho, Sub-Saharan Africa, focused on HIV/AIDS risk reduction and prevention, life skills and entrepreneurial training (income-generating activities). Entrepreneurial training was a crucial part of equipping the camp attendees with basic skills to help them develop sustainable livelihoods. Such skills and financial independence are essential to enable rural girls to complete their secondary schooling (in a fee-based educational system) and to pursue a career, as well as to further help them be less susceptible to transactional sex and its significant risks. The results of a brief process evaluation with some nested supporting data showed considerable improvement in the girls' knowledge about income-generating activities. In addition, almost half of the camp attendees participated in further entrepreneurial training and about half of these girls went on to develop small businesses. Replication of this model of camp training is recommended and being explored in other African countries. PMID:25505804

Entrepreneurial training for girls empowerment in Lesotho: A process evaluation of a model programme.

PubMed

Berry, Mary O'Neill; Kuriansky, Judy; Lytle, Megan; Vistman, Bozhena; Mosisili, 'Mathato S; Hlothoane, Lieketso; Matlanyane, Mapeo; Mokobori, Thabang; Mosuhli, Silas; Pebane, Jane

2013-12-01

A Girls Empowerment Programme held in 2010 in Lesotho, Sub-Saharan Africa, focused on HIV/AIDS risk reduction and prevention, life skills and entrepreneurial training (income-generating activities). Entrepreneurial training was a crucial part of equipping the camp attendees with basic skills to help them develop sustainable livelihoods. Such skills and financial independence are essential to enable rural girls to complete their secondary schooling (in a fee-based educational system) and to pursue a career, as well as to further help them be less susceptible to transactional sex and its significant risks. The results of a brief process evaluation with some nested supporting data showed considerable improvement in the girls' knowledge about income-generating activities. In addition, almost half of the camp attendees participated in further entrepreneurial training and about half of these girls went on to develop small businesses. Replication of this model of camp training is recommended and being explored in other African countries.

Re-focusing the gender lens: caregiving women, family roles and HIV/AIDS vulnerability in Lesotho.

PubMed

Harrison, Abigail; Short, Susan E; Tuoane-Nkhasi, Maletela

2014-03-01

Gender and HIV risk have been widely examined in southern Africa, generally with a focus on dynamics within sexual relationships. Yet the social construction of women's lives reflects their broader engagement with a gendered social system, which influences both individual-level risks and social and economic vulnerabilities to HIV/AIDS. Using qualitative data from Lesotho, we examine women's lived experiences of gender, family and HIV/AIDS through three domains: (1) marriage; (2) kinship and social motherhood, and (3) multigenerational dynamics. These data illustrate how women caregivers negotiate their roles as wives, mothers, and household heads, serving as the linchpins of a gendered family system that both affects, and is affected by, the HIV/AIDS epidemic. HIV/AIDS interventions are unlikely to succeed without attention to the larger context of women's lives, namely their kinship, caregiving, and family responsibilities, as it is the family and kinship system in which gender, economic vulnerability and HIV risk are embedded.

A Public-Private Partnership Improves Clinical Performance In A Hospital Network In Lesotho.

PubMed

McIntosh, Nathalie; Grabowski, Aria; Jack, Brian; Nkabane-Nkholongo, Elizabeth Limakatso; Vian, Taryn

2015-06-01

Health care public-private partnerships (PPPs) between a government and the private sector are based on a business model that aims to leverage private-sector expertise to improve clinical performance in hospitals and other health facilities. Although the financial implications of such partnerships have been analyzed, few studies have examined the partnerships' impact on clinical performance outcomes. Using quantitative measures that reflected capacity, utilization, clinical quality, and patient outcomes, we compared a government-managed hospital network in Lesotho, Africa, and the new PPP-managed hospital network that replaced it. In addition, we used key informant interviews to help explain differences in performance. We found that the PPP-managed network delivered more and higher-quality services and achieved significant gains in clinical outcomes, compared to the government-managed network. We conclude that health care public-private partnerships may improve hospital performance in developing countries and that changes in management and leadership practices might account for differences in clinical outcomes. Project HOPE—The People-to-People Health Foundation, Inc.

New material and revision of Melanorosaurus thabanensis, a basal sauropodomorph from the Upper Triassic of Lesotho

PubMed Central

Allain, Ronan

2016-01-01

Melanorosaurus is a genus of basal sauropodomorph that currently includes two species from Southern Africa. In this paper, we redescribe the holotype femur of Melanorosaurus thabanensis from the Elliot Formation of Lesotho, as well as associated remains. The stratigraphic position of this taxon is reviewed, and it is clear that it comes from the Lower Elliot Formation being, therefore, Late Triassic in age, and not Early Jurassic as originally described. The knowledge of the anatomy of the basal sauropodomorph of Thabana Morena is enhanced by the description of six new skeletal elements from the type locality. The femur and the ilium from Thabana Morena are diagnostic and characterized by unusual proportions. The first phylogenetic analysis including both this specimen and Melanorosaurus is conducted. This analysis leads to the conclusion that the femur described in the original publication of Melanorosaurus thabanensis can no longer be referred to Melanorosaurus. For these reasons, we hereby create Meroktenos gen. nov. to encompass Meroktenos thabanensis comb. nov. PMID:26855874

A manufactu(RED) ethics: labor, HIV, and the body in Lesotho's "sweat-free" garment industry.

PubMed

Kenworthy, Nora J

2014-12-01

Employing mostly women and producing for major U.S. labels, Lesotho's primarily foreign-owned garment industry undertook efforts to become "sweat-free" in 2006; simultaneously, it also began producing for the Product(RED) campaign. This article explores the parameters and ethical challenges of an industry-wide, public-private partnership providing HIV prevention and treatment services in this industry. Here, HIV services are intimately bound up in emerging patterns of humanitarian consumption and the production of an ethical industry. Within this ethical production zone, all is not what it seems: Labor violations persist, workers confront occupational hazards, and an elaborate theatrics of ethical practice plays out on the factory floor during routine inspections. This article explores the place and purpose of HIV treatment in the context of such humanitarian fetishism, highlighting the uses to which worker bodies are put and the conceptions of bodily well-being that prevail in these new "moral" economies. © 2014 by the American Anthropological Association.

Implementing Educational Policies in Sub-Saharan Africa--Review Essay.

ERIC Educational Resources Information Center

Thakur, Dan S.

1991-01-01

Reviews a series of 10 World Bank documents examining policy implementation activity in Ethiopia, Kenya, Tanzania, Lesotho, Swaziland, Uganda, Zambia, and Zimbabwe. The reports are concise and well documented and show a great conceptualization of education issues (such as deteriorating enrollments contracting educational finances) and policy…

When patients fail UNAIDS' last 90 - the "failure cascade" beyond 90-90-90 in rural Lesotho, Southern Africa: a prospective cohort study.

PubMed

Labhardt, Niklaus Daniel; Ringera, Isaac; Lejone, Thabo Ishmael; Cheleboi, Molisana; Wagner, Sarah; Muhairwe, Josephine; Klimkait, Thomas

2017-07-19

HIV-infected individuals on first-line antiretroviral therapy (ART) in resource-limited settings who do not achieve the last "90" (viral suppression) enter a complex care cascade: enhanced adherence counselling (EAC), repetition of viral load (VL) and switch to second-line ART aiming to achieve resuppression. This study describes the "failure cascade" in patients in Lesotho. Patients aged ≥16 years on first-line ART at 10 facilities in rural Lesotho received a first-time VL in June 2014. Those with VL ≥80 copies/mL were included in a cohort. The care cascade was assessed at four points: attendance of EAC, result of follow-up VL after EAC, switch to second-line in case of sustained unsuppressed VL and outcome 18 months after the initial unsuppressed VL. Multivariate logistic regression was used to assess predictors of being retained in care with viral resuppression at follow-up. Out of 1563 patients who underwent first-time VL, 138 (8.8%) had unsuppressed VL in June 2014. Out of these, 124 (90%) attended EAC and 116 (84%) had follow-up VL (4 died, 2 transferred out, 11 lost, 5 switched to second-line before follow-up VL). Among the 116 with follow-up VL, 36 (31%) achieved resuppression. Out of the 80 with sustained unsuppressed VL, 58 were switched to second-line, the remaining continued first line. At 18 months' follow-up in December 2015, out of the initially 138 with unsuppressed VL, 56 (41%) were in care and virally suppressed, 37 (27%) were in care with unsuppressed VL and the remaining 45 (33%) were lost, dead, transferred to another clinic or without documented VL. Achieving viral resuppression after EAC (adjusted odds ratio (aOR): 5.02; 95% confidence interval: 1.14-22.09; p  = 0.033) and being switched to second-line in case of sustained viremia after EAC (aOR: 7.17; 1.90-27.04; p  = 0.004) were associated with being retained in care and virally suppressed at 18 months of follow-up. Age, gender, education, time on ART and level of VL were not associated. In this study in rural Lesotho, outcomes along the "failure cascade" were poor. To improve outcomes in this vulnerable patient group who fails the last "90", programmes need to focus on timely EAC and switch to second line for cases with continuous viremia despite EAC.

Polygyny as myth. Towards understanding extramarital relations in Lesotho.

PubMed

Spiegel, A D

1991-01-01

The nature and extent of "bonyatsi" (marital infidelity) in Lesotho is presented through the images of population. Because the practice is not morally normative, it cannot be readily explained as part of an earlier custom or as arising from the exigencies of dependency on migrant labor, but as images of the past which are regarded as their own "traditional extramarital relations." This gives meaning and cultural continuity to the present practice, and legitimizes the experience without condoning it. Thus there can be ideological control over a practice which was the result of political economic constraints. The account is in the tradition of rehumanization of ethnography and relates folk explanations to notions of the past. It is based on the author's experiences in Lesotho from the early 1970s to the 1980s. The exercise exemplifies Malinowski's notion of myth as social charter and Spiegel's idea that reformulated traditions are a response to changes in modern practices. Extramarital relations appeared widespread throughout Lesotho, and Bonyatsi individuals could be easily identified in Qacha's Nek villages where the author lived. The practice was recognized as a normal state of affairs only in private rather than in a public forum. Folk songs made reference to it. Bonyatsi is the abstract form, while nyatsi means paramour of any gender and linyatsi is the plural. The definition is one of a relationship, which may be longterm, between already married persons. Gifts may be exchanged between linyatsi, but this is different from the prostitute, who is an unattached woman who loves anyone anytime usually in urban areas, or botekatse (prostitution). The origins of bonyatsi were explained as being part of the Creation and a feature of all human social life. The ministers explained that the practice was a result of labor migration that might last for as long as 2 years. Women argued that this absence of regular sexual intercourse created severe psychological effects such as stopping the blood flow or losing one's sanity. There was an element of inevitability. Births were not uncommon. Other explanations are given as part of polygyny where a husband had access to other women; this was important during abstinence periods after a birth. The practice of clientship among chiefs was another, explanation, or exchange of wives for favors among chiefs. Political alliances were sometimes formed in this manner to establish friendly relations. The story of Moshoeshoe is related. Not all that was permissible is explained.

Improving early childhood care and development, HIV-testing, treatment and support, and nutrition in Mokhotlong, Lesotho: study protocol for a cluster randomized controlled trial.

PubMed

Tomlinson, Mark; Skeen, Sarah; Marlow, Marguerite; Cluver, Lucie; Cooper, Peter; Murray, Lynne; Mofokeng, Shoeshoe; Morley, Nathene; Makhetha, Moroesi; Gordon, Sarah; Esterhuizen, Tonya; Sherr, Lorraine

2016-11-09

Since 1990, the lives of 48 million children under the age of 5 years have been saved because of increased investments in reducing child mortality. However, despite these unprecedented gains, 250 million children younger than 5 years in low- and middle-income countries (LMIC) cannot meet their developmental potential due to poverty, poor health and nutrition, and lack of necessary stimulation and care. Lesotho has high levels of poverty, HIV, and malnutrition, all of which affect child development outcomes. There is a unique opportunity to address these complex issues through the widespread network of informal preschools in rural villages in the country, which provide a setting for inclusive, integrated Early Childhood Care and Development (ECCD) and HIV and nutrition interventions. We are conducting a cluster randomised controlled trial in Mokhotlong district, Lesotho, to evaluate a newly developed community-based intervention program to integrate HIV-testing and treatment services, ECCD, and nutrition education for caregivers with children aged 1-5 years living in rural villages. Caregivers and their children are randomly assigned by village to intervention or control condition. We select, train, and supervise community health workers recruited to implement the intervention, which consists of nine group-based sessions with caregivers and children over 12 weeks (eight weekly sessions, and a ninth top-up session 1 month later), followed by a locally hosted community health outreach day event. Group-based sessions focus on using early dialogic book-sharing to promote cognitive development and caregiver-child interaction, health-related messages, including motivation for HIV-testing and treatment uptake for young children, and locally appropriate nutrition education. All children aged 1-5 years and their primary caregivers living in study villages are eligible for participation. Caregivers and their children will be interviewed and assessed at baseline, after completion of the intervention, and 12 months post intervention. This study provides a unique opportunity to assess the potential of an integrated early childhood development intervention to prevent or mitigate developmental delays in children living in a context of extreme poverty and high HIV rates in rural Lesotho. This paper presents the intervention content and research protocol for the study. The Mphatlalatsane: Early Morning Star trial is registered on the International Standard Randomized Controlled Trial Number database, registration number ISRCTN16654287 ; the trial was registered on 3 July 2015.

Opportunities for Distance Education in the Commonwealth African Countries.

ERIC Educational Resources Information Center

INTELECON Research & Consultancy Ltd., Vancouver (British Columbia).

The geo-demographic, economic, and infrastructural makeup of 12 African countries (Botswana. Gambia, Kenya, Lesotho, Malawi, Nigeria, Sierra Leone, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe) were compared to determine the potential benefits to them of a Commonwealth of Learning (COL) distance education initiative. Data were collected on…

Computer-Mediated Communications for Distance Education and Training: Literature Review and International Resources

DTIC Science & Technology

1991-01-01

in Part Two on Educational Aplications . 3 A basic issue when evaluating an institution’s dropout rate is whether non-starters are included in the...Association. Africa (Botswana, Lesotho, and Swaziland) ERASMUS: (European Community Action Scheme for the Mobility of University Students) Among its

Rehabilitating Ex-Offenders through Non-Formal Education in Lesotho

ERIC Educational Resources Information Center

Ngozwana, Nomazulu

2017-01-01

This paper reports on the rehabilitation of ex-offenders through non-formal education. It examines how non-formal education has addressed the ex-offenders' adaptive and transformative needs. Using an interpretive paradigm and qualitative approach, individual interviews were conducted with five ex-offenders who were chosen through purposive and…

Language Policy and Practice in the Multilingual Southern African Development Community

ERIC Educational Resources Information Center

Mooko, Theophilus

2009-01-01

This study explores the language policy and practice of the Southern African Development Community (SADC), an African regional economic organisation made up of 14 member states (Angola, Botswana, Democratic Republic of Congo, Lesotho, Madagascar, Malawi, Mauritius, Mozambique, Namibia, South Africa, Swaziland, United Republic of Tanzania, Zambia…

Higher Education and Community Service: Developing the National University of Lesotho's Third Mission

ERIC Educational Resources Information Center

Preece, Julia

2011-01-01

Universities have traditionally embraced three missions: teaching, research and community service. The latter usually receives lower status than the other two missions. There has, however, been a revival of interest in community service as a policy oriented exercise for universities and regional development, partly stimulated by international…

The Journey to School: Space, Geography and Experiences of Rural Children

ERIC Educational Resources Information Center

Morojele, Pholoho; Muthukrishna, Nithi

2012-01-01

This paper gives prominence to rural children's accounts of their journey to school. Twelve children (male = 6; female = 6) from three different rural villages in Lesotho participated in the study. Individual and focus group interviews were used to generate data, and these were preceded by three participatory research techniques: family drawings,…

77 FR 53917 - Report on Countries That Are Candidates for Millennium Challenge Account Eligibility in Fiscal...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-04

... poverty reduction. The Act requires the Millennium Challenge Corporation (MCC) to take a number of steps... its people; and (b) considering the opportunity to reduce poverty and generate economic growth in the... India Indonesia Iraq Kenya Kiribati Kyrgyz Republic Lao PDR Lesotho Liberia Malawi Mauritania Micronesia...

76 FR 55419 - Report on Countries That Are Candidates for Millennium Challenge Account Eligibility in Fiscal...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-07

... programs that advance the progress of such countries to achieve lasting economic growth and poverty [[Page...) investments in its people; and (b) considering the opportunity to reduce poverty and generate economic growth...; Ghana, Guinea, Haiti, Honduras, India, Kenya, Kyrgyz Republic, Lao PDR, Lesotho, Liberia, Malawi, Mali...

Basotho Teachers' Constructions of Gender: Implications on Gender Equality in the Schools

ERIC Educational Resources Information Center

Morojele, P. J.

2012-01-01

This paper gives prominence to rural teachers' own accounts of gender in three co-educational primary schools in Lesotho. The paper employs the social constructionist paradigm as its theoretical framework. Drawing from ethnographic data (observations and informal discussions), it discusses factors that inform teachers' constructions of gender and…

Survey of Basic Education in Eastern Africa. UNESCO/UNICEF Co-Operation Programme.

ERIC Educational Resources Information Center

United Nations Educational, Scientific, and Cultural Organization, Nairobi (Kenya). Regional Office of Science and Technology for Africa.

A survey of basic education in 13 Eastern African countries (Madagascar, Burundi, Comores, Ethiopia, Mauritius, Botswana, Kenya, Lesotho, Swaziland, Tanzania, Zambia, Malawi, and Somalia) covers basic education programs and UNICEF's supporting role. Basic education is seen as a concept evolved in the region, involving formal school systems and…

Variations in Reading Achievement across 14 Southern African School Systems: Which Factors Matter?

ERIC Educational Resources Information Center

Hungi, Njora; Thuku, Florence W.

2010-01-01

In this study the authors employed a multilevel analysis procedure in order to examine the pupil and school levels factors that contributed to variation in reading achievement among Grade 6 primary school pupils in 14 southern African school systems (Botswana, Kenya, Lesotho, Malawi, Mauritius, Mozambique, Namibia, Seychelles, South Africa,…

Expanding the Field of Inquiry: A Cross-Country Study of Higher Education Institutions' Responses to HIV and AIDS

ERIC Educational Resources Information Center

United Nations Educational, Scientific and Cultural Organization (UNESCO), 2006

2006-01-01

This report compares, analyses, and summarises findings from twelve case studies commissioned by the United Nations Education, Scientific, and Cultural Organization (UNESCO) in higher education institutions in Brazil, Burkina Faso, China, Democratic Republic of the Congo (DRC), Dominican Republic, Haiti, Jamaica, Lebanon, Lesotho, Suriname,…

Sexual practices, identities and health among women who have sex with women in Lesotho - a mixed-methods study.

PubMed

Poteat, Tonia; Logie, Carmen; Adams, Darrin; Lebona, Judith; Letsie, Puleng; Beyrer, Chris; Baral, Stefan

2014-01-01

Despite the high prevalence of HIV and STIs among women in Africa and the growing literature on HIV and STIs among women who have sex with women, research on the sexual health of women who have sex with women in Africa is scant. This study used mixed methods to describe sexual identity, practices and health among women who have sex with women in Lesotho. Most respondents (48%) described themselves as lesbian, 29% as bisexual and 23% as heterosexual. Almost half (45%) had disclosed their same-sex attraction to family, but only 25% had done so with healthcare workers. A total of 8% reported having HIV. Self-reported HIV was associated with having three or more male partners, having male and female partners at the same time and having a history of STIs. Gender norms, the criminalisation of homosexuality, varied knowledge of, and access to, safer-sex strategies, and mixed experiences of HIV/STI testing and sexual healthcare provided social and structural contexts for HIV- and STI-related vulnerability.

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

PubMed

Workman, Cassandra L; Ureksoy, Heather

2017-04-01

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. Copyright © 2017 Elsevier Ltd. All rights reserved.

HIV-Related Discrimination among Grade Six Students in Nine Southern African Countries

PubMed Central

Maughan-Brown, Brendan; Spaull, Nicholas

2014-01-01

Background HIV-related stigmatisation and discrimination by young children towards their peers have important consequences at the individual level and for our response to the epidemic, yet research on this area is limited. Methods We used nationally representative data to examine discrimination of HIV-positive children by grade six students (n = 39,664) across nine countries in Southern Africa: Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia and Zimbabwe. Descriptive statistics are used to compare discrimination by country, gender, geographic location and socioeconomic status. Multivariate logistic regression is employed to assess potential determinants of discrimination. Results The levels and determinants of discrimination varied significantly between the nine countries. While one in ten students in Botswana, Malawi, South Africa and Swaziland would “avoid or shun” an HIV positive friend, the proportions in Lesotho, Mozambique, Zambia and Zimbabwe were twice as high (approximately 20%). A large proportion of students believed that HIV positive children should not be allowed to continue to attend school, particularly in Zambia (33%), Lesotho (37%) and Zimbabwe (42%). The corresponding figures for Malawi and Swaziland were significantly lower at 13% and 12% respectively. Small differences were found by gender. Children from rural areas and poorer schools were much more likely to discriminate than those from urban areas and wealthier schools. Importantly, we identified factors consistently associated with discrimination across the region: students with greater exposure to HIV information, better general HIV knowledge and fewer misconceptions about transmission of HIV via casual contact were less likely to report discrimination. Conclusions Our study points toward the need for early interventions (grade six or before) to reduce stigma and discrimination among children, especially in schools situated in rural areas and poorer communities. In particular, interventions should focus on correcting misconceptions that HIV can be transmitted via casual contact. PMID:25105728

HIV risks and needs related to the Sustainable Development Goals among female sex workers who were commercially sexually exploited as children in Lesotho.

PubMed

Grosso, Ashley; Busch, Shianne; Mothopeng, Tampose; Sweitzer, Stephanie; Nkonyana, John; Mpooa, Nkomile; Taruberekera, Noah; Baral, Stefan

2018-02-01

Sustainable Development Goals (SDGs) about gender equality; decent work; and peace, justice, and strong institutions include a focus on eradicating trafficking and sexual exploitation of and violence against women and children. In Lesotho, 86% of women have experienced gender-based violence. In addition, overall HIV prevalence is among the highest globally, and higher among adolescent girls than boys. Moreover, nearly three quarters of female sex workers (FSW) are estimated to be living with HIV in Lesotho. In this context, sexually exploited children may be particularly vulnerable to violence and HIV acquisition risks. This study's objective is to examine the prevalence and correlates of experiencing sexual exploitation as a child among FSW in Lesotho. FSW (≥18 years) recruited through respondent-driven sampling in Maseru and Maputsoe from February to September 2014 completed HIV and syphilis testing and an interviewer-administered survey, including a question about the age at which they started providing sex for money. This study examined correlates of experiencing sexual exploitation as a child (<18 years) through multivariable logistic regression analyses for each city, controlling for current age. Across both cities, 20.0% (142/710) of participants were sexually exploited as children. Among them, 65.5% (93/142) tested positive for HIV and 31.0% (44/142) for syphilis, which was similar to those who started selling sex as adults, after adjusting for current age. Participants who experienced child sexual exploitation were more likely to have been forced to have sex before age 18 than those who started selling sex as adults (Maseru-adjusted odds ratio (aOR): 3.52, 95% Confidence Interval (CI): 1.61 to 7.66, p = 0.002; Maputsoe-aOR: 4.39, 95% CI: 1.22 to 15.75, p = 0.023). In Maseru, participants who were sexually exploited as children were more likely to avoid carrying condoms to prevent trouble with police (aOR: 3.18, 95% CI: 1.50 to 6.75, p = 0.003). Risk determinants for HIV and violence among sexually exploited children can be studied retrospectively through research with adult FSW. Further research working directly with sexually exploited children will improve understanding of their needs. Preventing commercial sexual exploitation of children and addressing the social and healthcare needs of those who are exploited are necessary to fully achieve SDGs 5, 8 and 16 and an AIDS-Free Generation. © 2018 The Authors. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of the International AIDS Society.

The Prevalence of Bullying at High Schools in Lesotho: Perspectives of Teachers and Students

ERIC Educational Resources Information Center

Mosia, Paseka Andrew

2015-01-01

This article seeks to explore the concept of bullying through the eyes of teachers and students. Although teachers are very important in monitoring and controlling students' behaviour, they can also unwittingly reinforce aggression by the manner in which they react to students who are either perpetrators or victims of aggression. Similarly,…

Poverty Diagnostics Using Poor Data: Strengthening the Evidence Base for Pro-Poor Policy Making in Lesotho

ERIC Educational Resources Information Center

May, Julian; Roberts, Benjamin

2005-01-01

Increasingly national statistical agencies are being called upon to provide high quality data on a regular basis, to be used by governments for evidence-based policy development. Poverty Reduction Strategy Papers (PRSPs) give impetus to this, and bring a prerequisite for comprehensive "poverty diagnosis." Often the data that are required…

Educating Handicapped Young People in Eastern and Southern Africa in 1981-83.

ERIC Educational Resources Information Center

Ross, D. H.

This publication compiles the findings and conclusions of the 3-year first phase (1980-83) of the Unesco Sub-regional Project for Special Education in Eastern and Southern Africa. It presents the state of the art of special education and prospects for future development in Botswana, Ethiopia, Kenya, Lesotho, Malawi, Mauritius, Seychelles, Somalia,…

Secondary School Teachers' Pedagogical Content Knowledge of Some Common Student Errors and Misconceptions in Sets

ERIC Educational Resources Information Center

Kolitsoe Moru, Eunice; Qhobela, Makomosela

2013-01-01

The study investigated teachers' pedagogical content knowledge of common students' errors and misconceptions in sets. Five mathematics teachers from one Lesotho secondary school were the sample of the study. Questionnaires and interviews were used for data collection. The results show that teachers were able to identify the following students'…

The Impact of an Unconditional Cash Transfer on Early Child Development: The Zambia Child Grant Program

ERIC Educational Resources Information Center

Seidenfeld, David; Prencipe, Leah; Handa, Sudhanshu; Hawkinson, Laura

2015-01-01

Little research has been conducted on unconditional cash transfers (UCTs) despite their growing prevalence in Africa, including South Africa, Zambia, Zimbabwe, Kenya, Malawi, Lesotho, and Uganda. In this study, researchers implemented a randomized control trial with over 2,500 households to investigate the impact of Africa's child grant program on…

In-Service Teachers' Sense of Agency after Participation in a Research Master Course

ERIC Educational Resources Information Center

Impedovo, Maria Antonietta

2016-01-01

In this paper, we investigate the in-service teachers "sense of agency" after their participation in a research master course. A semi-structured interview was administrated to nine in-service science teachers, coming from three different African countries: Zimbabwe, Lesotho, and Burkina Faso. All of them attended a European master course…

Perceived Gender Differences in Performance in Science: The Case of Lesotho Secondary Schools

ERIC Educational Resources Information Center

Khanyane, Marethabile; Mokuku, Tšepo; Nthathakane, Malefu C.

2016-01-01

The paper reports on a study aimed at investigating perceived gender differences in performance in science at secondary school level, as well as beliefs on possible underlying causes for these differences. The study is situated within the interpretivist paradigm and uses a typology of factors drawn from the Educational Effectiveness Research model…

Tlokoeng Valley Community's Conceptions of Wetlands: Prospects for More Sustainable Water Resources Management

ERIC Educational Resources Information Center

Mokuku, Tšepo; Taylor, Jim

2015-01-01

This article explores prospects for community-based water resources management in Tlokoeng Valley, in the northern district of Lesotho. A qualitative survey was conducted to establish the pre-knowledge of the valley community. This provided a basis for a community education programme on wetlands conservation. Fifteen focus group interviews (FGIs)…

Traditional Assessment as a Subjectification Tool in Schools in Lesotho

ERIC Educational Resources Information Center

Khalanyane, Tankie; Hala-hala, Mokhoele

2014-01-01

The concept of assessment is one of the most important practices in any education system across the globe. Tracing the concept probably to the time immemorial through the Chinese Imperial Examination System in the fifteenth century, the notion of assessment seems to have proved to be one of the indispensable markers of selection, placement and…

Draft Plan of Operation for a Functional Literacy Pilot Program in Swaziland June-July 1971.

ERIC Educational Resources Information Center

Sebenta National Inst. (Swaziland).

A planned full-time "functional literacy" course that was to be held during June and July 1971 in Ekuhlamukeni and Nqabaneni (Swaziland) is discussed. The experimental pilot project was to be sponsored by the Sebenta National Institute, the University of Botswana, Lesotho and Swaziland Division of Extra Mural Services, and by the…

Sub-Saharan Africa Report.

DTIC Science & Technology

1987-01-14

Crisis Forcing Farmers To Face Change (Editorial; VOLKSBLAD, 24 Oct 86) 65 - c - Use of Nuclear Technology in Agriculture Foreseen (DIE BURGER, 7...requires the participation of all the countries concerned. Even the most enthusiastic supporters of sanctions recognize that the results can only be... result in the asphyxiation of the front-line countries. Objectively speaking, Lesotho, Botswana, and Zimbabwe are forced to compromise. But are Zaire

Access to What? Creating a Composite Measure of Educational Quantity and Educational Quality for 11 African Countries

ERIC Educational Resources Information Center

Spaull, Nicholas; Taylor, Stephen

2015-01-01

The aim of the current study is to create a composite statistic of educational quantity and educational quality by combining household data (Demographic and Health Survey) on grade completion and survey data (Southern and Eastern African Consortium for Monitoring Educational Quality) on cognitive outcomes for 11 African countries: Kenya, Lesotho,…

Bringing Water to a Lesotho Village: A Classroom Simulation. Water in Africa.

ERIC Educational Resources Information Center

Ray, Dany M.

The Water in Africa Project was realized over a 2-year period by a team of Peace Corps volunteers, World Wise Schools (WWS) classroom teachers, and WWS staff members. As part of an expanded, detailed design, resources were collected from over 90 volunteers serving in African countries, photos and stories were prepared, and standards-based learning…

Doing Things Differently: Using the ABCD Method to Negotiate with Local Leaders in Community Engagement Projects

ERIC Educational Resources Information Center

Chinyowa, Kennedy C.; Sirayi, Mziwoxolo; Mokuku, Selloane

2016-01-01

The Laedza Batanani Project has been regarded as the pioneering experiment that paved the way for other prominent African Theatre for Development (TFD) projects such as Kamiriithu in Kenya, Murewa in Zimbabwe, Kumba in Cameroon and Marotholi Travelling Theatre in Lesotho. Laedza Batanani (1974-6) aimed at awakening the creative potential of…

Using Examinations To Improve Education: A Study in Fourteen African Countries. World Bank Technical Paper Number 165. Africa Technical Department Series.

ERIC Educational Resources Information Center

Kellaghan, Thomas; Greaney, Vincent

A detailed description is presented of the types, functions, performance levels, governance, administration, and funding of public examinations in 14 Sub-Saharan African countries with different educational traditions, based on English, French, or other backgrounds. The countries are: (1) Kenya; (2) Lesotho; (3) Mauritius; (4) Swaziland; (5)…

The Dynamics and Intricacy of Budgeting in Secondary Schools in Lesotho: Case Studies of Three High Schools

ERIC Educational Resources Information Center

Mncube, V. S.; Makhasane, Sekitla

2013-01-01

This paper reports on the qualitative study that used in-depth interviews and document reviews on financial management practices in their schools. The participants were school principals of the case study schools. The findings of the study highlighted problems regarding the implementation of the policy--despite the Manual for Principals of…

On-the-Spot Course in Maseru, Lesotho on Income-Generating Projects for Rural Women: Framework of Community Development. July 10-30, 1983. Report.

ERIC Educational Resources Information Center

Mount Carmel International Training Centre for Community Development, Haifa (Israel).

This report describes a community development course focusing on income-generating projects for rural women. The first section outlines the schedule of activities for each day of the 16-day course. The second section defines course objectives, including purpose and methodology, planning, group dynamics, cooperation, communication, negotiation, and…

Reconsidering the orphan problem: the emergence of male caregivers in Lesotho.

PubMed

Block, Ellen

2016-01-01

Care for AIDS orphans in southern Africa is frequently characterized as a "crisis", where kin-based networks of care are thought to be on the edge of collapse. Yet these care networks, though strained by AIDS, are still the primary mechanisms for orphan care, in large part because of the essential role grandmothers play in responding to the needs of orphans. Ongoing demographic shifts as a result of HIV/AIDS and an increasingly feminized labor market continue to disrupt and alter networks of care for orphans and vulnerable children. This paper examines the emergence of a small but growing number of male caregivers who are responding to the needs of the extended family. While these men are still few in number, the strength of gendered ideologies of female care means that this group of men is socially, if not statistically significant. Men continue to be considered caregivers of last resort, but their care will close a small but growing gap that threatens to undermine kin-based networks of care in Lesotho and across the region. The adaptation of gender roles reinforces the strength and resilience of kinship networks even when working against deeply entrenched ideas about gendered division of domestic labor.

The first megatheropod tracks from the Lower Jurassic upper Elliot Formation, Karoo Basin, Lesotho

PubMed Central

Bordy, E. M.; Abrahams, M.; Knoll, F.; McPhee, B. W.

2017-01-01

A palaeosurface with one megatheropod trackway and several theropod tracks and trackways from the Lower Jurassic upper Elliot Formation (Stormberg Group, Karoo Supergroup) in western Lesotho is described. The majority of the theropod tracks are referable to either Eubrontes or Kayentapus based on their morphological characteristics. The larger megatheropod tracks are 57 cm long and have no Southern Hemisphere equivalent. Morphologically, they are more similar to the Early Jurassic Kayentapus, as well as the much younger Upper Cretaceous ichnogenus Irenesauripus, than to other contemporaneous ichnogenera in southern Africa. Herein they have been placed within the ichnogenus Kayentapus and described as a new ichnospecies (Kayentapus ambrokholohali). The tracks are preserved on ripple marked, very fine-grained sandstone of the Lower Jurassic upper Elliot Formation, and thus were made after the end-Triassic mass extinction event (ETE). This new megatheropod trackway site marks the first occurrence of very large carnivorous dinosaurs (estimated body length >8–9 meters) in the Early Jurassic of southern Gondwana, an evolutionary strategy that was repeatedly pursued and amplified in the following ~135 million years, until the next major biotic crisis at the end-Cretaceous. PMID:29069093

Alcohol use and depression: link with adherence and viral suppression in adult patients on antiretroviral therapy in rural Lesotho, Southern Africa: a cross-sectional study.

PubMed

Cerutti, Bernard; Broers, Barbara; Masetsibi, Motlomelo; Faturiyele, Olatunbosun; Toti-Mokoteli, Likabelo; Motlatsi, Mokete; Bader, Joelle; Klimkait, Thomas; Labhardt, Niklaus D

2016-09-08

Depression and alcohol use disorder have been shown to be associated with poor adherence to antiretroviral therapy (ART). Studies examining their association with viral suppression in rural Africa are, however, scarce. This study reports prevalence of depressive symptoms and alcohol use disorder, and their potential association with adherence and viral suppression in adult patients on ART in ten clinics in rural Lesotho, Southern Africa. Among 1,388 adult patients (69 % women), 80.7 % were alcohol abstinent, 6.3 % were hazardous drinkers (men: 10.7 %, women: 4.4 %, p < 0.001). The prevalence of depressive symptoms was 28.8 % (men 20.2 %, women 32.7 %, p < 0.001). Both alcohol consumption (adjusted odds-ratio: 2.09, 95 % CI: 1.58-2.77) and alcohol use disorder (2.73, 95 % CI: 1.68-4.42) were significantly associated with poor adherence. There was, however, no significant association with viral suppression. Whereas the results of this study confirm previously reported association of alcohol use disorder with adherence to ART, there was no association with viral suppression. April 28th 2014; NCT02126696 .

The Use of Discourse in Enabling Access Physics Students to Construct Meaning of Magnetic Field Patterns

ERIC Educational Resources Information Center

Qhobela, Makomosela; Rollnick, Marissa

2010-01-01

This paper analyses discourse produced in a larger study aimed at encouraging students in Lesotho to talk the language of science as a meaningful way of learning. The paper presents a semiotic and activity based analysis of discourses of students learning to talk physics while enrolled in a pre-tertiary access programme. Prior to the access…

Compiling an Evidence-Based Improvement Plan for the Support of Distance-Education Students at a Southern African University

ERIC Educational Resources Information Center

Makhakhane, Bothephana; Wilkinson, Annette C.; Ndeya-Ndereya, Charity N.

2016-01-01

This article illustrates how an event guide can be used to organise, systematise and prioritise the large amount of findings from an extensive study. The study aimed to enhance student support at a distance-education institute in a Southern African country (Lesotho). In this case study an improvement-oriented evaluation of the strengths,…

Interplay between economic empowerment and sexual behaviour and practices of migrant workers within the context of HIV and AIDS in the Lesotho textile industry.

PubMed

Tanga, Pius Tangwe; Tangwe, Magdaline Nji

2014-01-01

Economic empowerment brings with it a wide range of consequences, both positive and negative. The objective of this paper was to examine the relationship between economic empowerment and the sexual behaviour and practices of migrant workers within the context of HIV and AIDS in the Lesotho textile industry. Data for this paper were extracted from the findings of a larger study which had been conducted concerning HIV and AIDS in the textile industry in Lesotho. Using in-depth interviews, data were collected from 40 participants who were purposively selected from five factories which had been chosen randomly. Empowerment theory was used as a lens to provide meanings for the experiences of the participants. The findings show that the participants were empowered only in certain respects in terms of Kabeer's empowerment model of 'power to' and 'power within', on one hand, and in terms of Malhotra's comprehensive empowerment framework at the household level, on the other, as being employed in the industry enabled them to participate in the economy. Employment in the sector provided the participants with the means to be able to acquire basic needs and the ability to participate in household decision-making: for the female participants, the ability to make independent sexual decisions was also enhanced. These improvements were greeted enthusiastically, particularly by the female participants, given their previously disadvantaged status as a result of coming from rural patriarchal villages with gender-defined hegemonic notions of respectability. The findings also indicate that environmental factors and others, such as meagre salaries, encouraged some of the female workers to engage in transactional sex, while some of the male participants tended to increase their sexual relationships as a result of acquiring employment and income from the industry. It is the contention of the authors of this study that true empowerment requires both vital resources and individual and collective participation, particularly for the women, who are more vulnerable than men. Finally, we conclude that the opportunities provided by economic empowerment have given the participants a new social meaning for their situation and an awareness about their place in power relations.

Coordination and Improvement of National Information Services. Mbabane and Maseru Workshop Papers (Mbabane, Swaziland, February 24-28, 1986 and Maseru, Lesotho, March 3-7, 1986).

ERIC Educational Resources Information Center

Huttemann, Lutz, Ed.

Seven papers from the Mbabane workshop are presented in the first part of this report: (1) "An Overview of the Supply of Information in Swaziland" (E. Wamala); (2) "The Place of a Documentation Centre in the Supply of Information in Swaziland: Problems and Prospects" (M. M. Nhlapo); (3) "The Concept of Cooperation in…

Sub-Saharan Africa Report, No. 2817.

DTIC Science & Technology

1983-07-06

between the two countries. During his visit to Montevideo, he will deliver a personal message from the head of state, El Hadj Omar Bongo , to his...inception. The spokesman said that unless (Khaketla) could manage to attract the minimum affection from the people of Lesotho he would never have the...socialist countries would affect religion adversely. [Text] [MB180718 Maseru Domestic Service in English 0500 GMT 18 Jun 83] JONATHAN TOUR—The

A comparative study of adoloscents' perceived stress and health outcomes among adolescent mothers and their infants in Lesotho.

PubMed

Yako, E M

2007-03-01

The purpose of this study was to compare perceived stress in general, stress due to pregnancy, and post partum complications between a group of unmarried adolescent first-time mothers and a group of married adolescent first-time mothers. Never-pregnant adolescents served as a comparison group on perceived stress. Health outcomes of infants of the two groups of adolescent mothers were also compared on birth weight, nutritional status (weight gain) and immunization status. The study design was non-experimental, comparative and descriptive. A convenience sample of dyads of 64 unmarried adolescent mothers and their infants, 64 married adolescents and their infants, and 64 high school students participated in this study. Data were collected in 3 hospitals, 2 health centres (clinics) and a high school in Lesotho. The differences between the three groups of adolescents in perceived stress, were determined using ANOVA. The t-test was used to determine the differences between the group of unmarried adolescent mothers and the group of married mothers on stress due to pregnancy. The difference in postpartum complications between these two groups of adolescent mothers was determined using Chi-square. The t-test was also used to determine differences in birth weight, nutritional status and immunization status between the group of infants of unmarried mothers and infants of married mothers. Findings of this study revealed significant differences in perceived stress between both groups of adolescent mothers and the group of never pregnant adolescents (p < .0001). The Chaffe' test revealed that never pregnant adolescents had lowest levels of perceived stress than both groups of adolescent mothers (p < .0001). Both groups of adolescent mothers had high levels of stress due to pregnancy and the difference between the two groups was non-significant. No differences were observed between infant health outcomes of unmarried mothers and infants of married mothers. The infants of both groups were generally healthy and the majority of them had appropriate type and doses of immunizations six weeks post birth. Adolescent mothers in the low lands of Lesotho perceive pregnancy to be a stressful event despite marriage. Therefore adolescents should be discourage from early childbirth. Policy makers need to come up with gender sensitive policies that will make it easier for girls who get pregnant to continue with their education, so that they may be productive and self-reliant.

The costs and benefits of nurse migration on families: A Lesotho experience.

PubMed

Ntlale, Matsola E; Duma, Sinegugu E

2012-02-22

The present day migration of nurses from developing countries, to more developed countries,depletes these countries of this vital human resource, which is necessary to provide optimum quality nursing care to their populations. If nurse migration persists, the health systems of these countries face collapse.It is important that a nurse understands the costs and benefits of migration to their families, whom they leave behind. This is not only to curb the problems that may occur, but to help the migrant nurses to realise how migration affects their families, especially their children and spouses, before they decide to leave their home countries to work in foreign lands.The purpose of this study, which was exploratory, descriptive and qualitative, was to investigate and describe the experiences of family members, of migrant nurses, from the Maseru district of Lesotho, about the costs and benefits of nurse migration. The objectives were to explore and describe the disadvantageous costs and the benefits gained by the families of migrant nurses. These were explored through the research question 'What are the experiences of family members of migrating nurses with regard to the costs and benefits of nurse migration?'The target population of the study was families of migrant nurses from Lesotho. Using purposive sampling the families of two migrant nurses, who were colleagues of the researcher, were identified and approached to participate in the study. Snowball sampling was next utilised to recruit the remainder of the participants. In total, six families were identified and included in the study.The semi-structured interviews and field notes were the two data collection methods that were implemented. The Giorgi's (1970) steps for data analysis, as outlined in (Burns & Grove 2001:610), were followed and seven themes were discovered as findings. The themes that relate to the costs of nurse migration are: emotional instability, weaker family connections and increased responsibility. The themes that relate to the benefits of nurse migration for their families are: better household income, improved quality of life, essential skills development and travelling opportunities.The use of communication technology is recommended to increase contact across borders in order to reduce the emotional costs of nurse migration on the families of migrant nurses. The article provides a balanced view of the costs and benefits of nurse migration on their families.

Occupational segregation, gender essentialism and male primacy as major barriers to equity in HIV/AIDS caregiving: Findings from Lesotho.

PubMed

Newman, Constance J; Fogarty, Linda; Makoae, Lucia Nthabiseng; Reavely, Erik

2011-06-08

Gender segregation of occupations, which typically assigns caring/nurturing jobs to women and technical/managerial jobs to men, has been recognized as a major source of inequality worldwide with implications for the development of robust health workforces. In sub-Saharan Africa, gender inequalities are particularly acute in HIV/AIDS caregiving (90% of which is provided in the home), where women and girls make up the informal (and mostly unpaid) workforce. Men's and boy's entry into HIV/AIDS caregiving in greater numbers would both increase the equity and sustainability of national and community-level HIV/AIDS caregiving and mitigate health workforce shortages, but notions of gender essentialism and male primacy make this far from inevitable.In 2008 the Capacity Project partnered with the Lesotho Ministry of Health and Social Welfare in a study of the gender dynamics of HIV/AIDS caregiving in three districts of Lesotho to account for men's absence in HIV/AIDS caregiving and investigate ways in which they might be recruited into the community and home-based care (CHBC) workforce. The study used qualitative methods, including 25 key informant interviews with village chiefs, nurse clinicians, and hospital administrators and 31 focus group discussions with community health workers, community members, ex-miners, and HIV-positive men and women. Study participants uniformly perceived a need to increase the number of CHBC providers to deal with the heavy workload from increasing numbers of patients and insufficient new entries. HIV/AIDS caregiving is a gender-segregated job, at the core of which lie stereotypes and beliefs about the appropriate work of men and women. This results in an inequitable, unsustainable burden on women and girls. Strategies are analyzed for their potential effectiveness in increasing equity in caregiving. HIV/AIDS and human resources stakeholders must address occupational segregation and the underlying gender essentialism and male primacy if there is to be more equitable sharing of the HIV/AIDS caregiving burden and any long-term solution to health worker shortages. Policymakers, activists and programmers must redress the persistent disadvantages faced by the mostly female caregiving workforce and the gendered economic, psychological, and social impacts entailed in HIV/AIDS caregiving. Research on gender desegregation of HIV/AIDS caregiving is needed.

Occupational segregation, gender essentialism and male primacy as major barriers to equity in HIV/AIDS caregiving: Findings from Lesotho

PubMed Central

2011-01-01

Background Gender segregation of occupations, which typically assigns caring/nurturing jobs to women and technical/managerial jobs to men, has been recognized as a major source of inequality worldwide with implications for the development of robust health workforces. In sub-Saharan Africa, gender inequalities are particularly acute in HIV/AIDS caregiving (90% of which is provided in the home), where women and girls make up the informal (and mostly unpaid) workforce. Men's and boy's entry into HIV/AIDS caregiving in greater numbers would both increase the equity and sustainability of national and community-level HIV/AIDS caregiving and mitigate health workforce shortages, but notions of gender essentialism and male primacy make this far from inevitable. In 2008 the Capacity Project partnered with the Lesotho Ministry of Health and Social Welfare in a study of the gender dynamics of HIV/AIDS caregiving in three districts of Lesotho to account for men's absence in HIV/AIDS caregiving and investigate ways in which they might be recruited into the community and home-based care (CHBC) workforce. Methods The study used qualitative methods, including 25 key informant interviews with village chiefs, nurse clinicians, and hospital administrators and 31 focus group discussions with community health workers, community members, ex-miners, and HIV-positive men and women. Results Study participants uniformly perceived a need to increase the number of CHBC providers to deal with the heavy workload from increasing numbers of patients and insufficient new entries. HIV/AIDS caregiving is a gender-segregated job, at the core of which lie stereotypes and beliefs about the appropriate work of men and women. This results in an inequitable, unsustainable burden on women and girls. Strategies are analyzed for their potential effectiveness in increasing equity in caregiving. Conclusions HIV/AIDS and human resources stakeholders must address occupational segregation and the underlying gender essentialism and male primacy if there is to be more equitable sharing of the HIV/AIDS caregiving burden and any long-term solution to health worker shortages. Policymakers, activists and programmers must redress the persistent disadvantages faced by the mostly female caregiving workforce and the gendered economic, psychological, and social impacts entailed in HIV/AIDS caregiving. Research on gender desegregation of HIV/AIDS caregiving is needed. PMID:21651798

Interplay between economic empowerment and sexual behaviour and practices of migrant workers within the context of HIV and AIDS in the Lesotho textile industry

PubMed Central

Tanga, Pius Tangwe; Tangwe, Magdaline Nji

2014-01-01

Abstract Economic empowerment brings with it a wide range of consequences, both positive and negative. The objective of this paper was to examine the relationship between economic empowerment and the sexual behaviour and practices of migrant workers within the context of HIV and AIDS in the Lesotho textile industry. Data for this paper were extracted from the findings of a larger study which had been conducted concerning HIV and AIDS in the textile industry in Lesotho. Using in-depth interviews, data were collected from 40 participants who were purposively selected from five factories which had been chosen randomly. Empowerment theory was used as a lens to provide meanings for the experiences of the participants. The findings show that the participants were empowered only in certain respects in terms of Kabeer's empowerment model of ‘power to’ and ‘power within’, on one hand, and in terms of Malhotra's comprehensive empowerment framework at the household level, on the other, as being employed in the industry enabled them to participate in the economy. Employment in the sector provided the participants with the means to be able to acquire basic needs and the ability to participate in household decision-making: for the female participants, the ability to make independent sexual decisions was also enhanced. These improvements were greeted enthusiastically, particularly by the female participants, given their previously disadvantaged status as a result of coming from rural patriarchal villages with gender-defined hegemonic notions of respectability. The findings also indicate that environmental factors and others, such as meagre salaries, encouraged some of the female workers to engage in transactional sex, while some of the male participants tended to increase their sexual relationships as a result of acquiring employment and income from the industry. It is the contention of the authors of this study that true empowerment requires both vital resources and individual and collective participation, particularly for the women, who are more vulnerable than men. Finally, we conclude that the opportunities provided by economic empowerment have given the participants a new social meaning for their situation and an awareness about their place in power relations. PMID:25383704

Worldwide Report Telecommunications Policy, Research and Development No. 274.

DTIC Science & Technology

1983-06-07

Text] [Lima EL COMERCIO in Spanish 27 Apr 83 p 3] 8143 CSO: 5500/2071 ARGENTINA BRIEFS SATELLITE GROUND STATION—Buenos Aires, 5 May (TELAM...Iquitos, Arequipa, lea, Huaraz, Cuzco and Tacna. [TextJ [.Lima EL COMERCIO in Spanish 3 May 83 p a 8 PY] CSO; 5500/2074 ST LUCIA DETAILED REVIEW OF...anniversary of the World International Telecommunications day. According to Mr (Khabele), Lesotho is also to introduce a new digital exchange for

Southern Africa: A Study of the Educational Systems of Botswana, Lesotho, South Africa, Southwest Africa/Namibia and Swaziland with an Addendum on Zimbabwe-Rhodesia: A Guide to the Academic Placement of Students in Educational Institutions of the United States.

ERIC Educational Resources Information Center

Cranmer, David J.; Woolston, Valerie A.

The educational systems of Southern African countries are described, and guidelines concerning the placement of students who wish to study in U.S. institutions are provided. Information is provided on educational levels (primary, secondary, and higher education); and types of programs (technical/vocational education, teacher training, and…

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.

PubMed

Amoah, Isaac Dennis; Reddy, Poovendhree; Seidu, Razak; Stenström, Thor Axel

2018-05-01

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.

Intra-seasonal rainfall variability during the maize growing season in the northern lowlands of Lesotho

NASA Astrophysics Data System (ADS)

Tongwane, Mphethe Isaac; Moeletsi, Mokhele Edmond

2015-05-01

Intra-seasonal rainfall distribution was identified as a priority gap that needs to be addressed for southern Africa to cope with agro-meteorological risks. The region in the northwest of Lesotho is appropriate for crop cultivation due to its relatively favourable climatic conditions and soils. High rainfall variability is often blamed for poor agricultural production in this region. This study aims to determine the onset of rains, cessation of rains and rainy season duration using historical climate data. Temporal variability of these rainy season characteristics was also investigated. The earliest and latest onset dates of the rainy season are during the last week of October at Butha-Buthe and the third week of November at Mapoteng, respectively. Cessation of the season is predominantly in the first week of April making the season approximately 137-163 days long depending on the location. Average seasonal rainfall ranged from 474 mm at Mapoteng to 668 mm at Butha-Buthe. Onset and cessation of the rainfall season vary by 4-7 weeks and 1 week, respectively. Mean coefficient of variation of seasonal rainfall is 39 %, but monthly variations are higher. These variations make annual crop management and planning difficult each year. Trends show a decrease in the rainfall amounts but improvements in both the temporal distribution of annual rainfall, onset and cessation dates.

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

PubMed Central

Kravitz, J. D.; Nyaphisi, M.; Mandel, R.; Petersen, E.

1999-01-01

Reported are the results of an examination of domestic water supplies for microbial contamination in the Lesotho Highlands, the site of a 20-year-old hydroelectric project, as part of a regional epidemiological survey of baseline health, nutritional and environmental parameters. The population's hygiene and health behaviour were also studied. A total of 72 village water sources were classified as unimproved (n = 23), semi-improved (n = 37), or improved (n = 12). Based on the estimation of total coliforms, which is a nonspecific bacterial indicator of water quality, all unimproved and semi-improved water sources would be considered as not potable. Escherichia coli, a more precise indicator of faecal pollution, was absent (P < 0.001) in most of the improved water sources. Among 588 queried households, only 38% had access to an "improved" water supply. Sanitation was a serious problem, e.g. fewer than 5% of villagers used latrines and 18% of under-5-year-olds had suffered a recent diarrhoeal illness. The study demonstrates that protection of water sources can improve the hygienic quality of rural water supplies, where disinfection is not feasible. Our findings support the WHO recommendation that E. coli should be the principal microbial indicator for portability of untreated water. Strategies for developing safe water and sanitation systems must include public health education in hygiene and water source protection, practical methods and standards for water quality monitoring, and a resource centre for project information to facilitate programme evaluation and planning. PMID:10593031

Depressive symptoms and hazardous/harmful alcohol use are prevalent and correlate with stigma among TB-HIV patients in Lesotho.

PubMed

Hayes-Larson, E; Hirsch-Moverman, Y; Saito, S; Frederix, K; Pitt, B; Maama-Maime, L; Howard, A A

2017-11-01

Limited data exist on the prevalence and correlates, including stigma, of mental health conditions, including depressive symptoms and alcohol use, among patients co-infected with tuberculosis (TB) and the human immunodeficiency virus (HIV) in sub-Saharan Africa, despite their negative impact on health outcomes. To assess the prevalence and correlates of depressive symptoms and hazardous/harmful alcohol use among TB-HIV patients in the Start TB patients on ART and Retain on Treatment (START) study. START, a mixed-methods cluster-randomized trial, evaluated a combination intervention package vs. standard of care (SOC) to improve treatment outcomes in TB-HIV co-infected patients in Lesotho. Moderate/severe depressive symptoms and hazardous/harmful alcohol use were measured using baseline questionnaire data collected from April 2013 to March 2015. Demographic, psychosocial, and TB- and HIV-related knowledge and attitudes, including stigma, were assessed for association with both conditions using generalized linear mixed models. Among 371 participants, 29.8% reported moderate/severe depressive symptoms, and 24.7% reported hazardous/harmful alcohol use; 7% reported both. Depressive symptoms were significantly associated with less education, more difficulty understanding written medical information, non-disclosure of TB, greater TB stigma, and the SOC study arm. Hazardous/harmful alcohol use was significantly associated with male sex, as well as greater TB and external HIV stigma. Prevalence of depressive symptoms and hazardous/harmful alcohol use were high, suggesting a need for routine screening for, and treatment of, mental health disorders in TB-HIV patients.

A cross-sectional assessment of population demographics, HIV risks and human rights contexts among men who have sex with men in Lesotho.

PubMed

Baral, Stefan; Adams, Darrin; Lebona, Judith; Kaibe, Bafokeng; Letsie, Puleng; Tshehlo, Relebohile; Wirtz, Andrea; Beyrer, Chris

2011-07-04

Evidence is increasing of high HIV risks among southern African men who have sex with men (MSM). This represents the first study of HIV risks and human rights contexts among MSM in Lesotho. Two hundred and fifty-two men who reported ever having anal sex with another man were accrued with snowball sampling and were administered a structured quantitative instrument in October and November 2009. Of the participants, 96.4% (240/249) were ethnic Basotho with a mean age of 26.3 years (range 18-56), 49.6% (124/250) were currently employed, and 95.2% (238/250) had at least a secondary-level education. Self-reported HIV prevalence was 11.6% (22/190); 54.5% (128/235) reported being tested for HIV in the last year. HIV knowledge was low; only 3.7% (8/212) of MSM knew that receptive anal intercourse was the highest risk for HIV and that a water-based lubricant was most appropriate to use with condoms.Bivariate associations of wearing condoms during last intercourse with men include: having easy access to condoms (OR 3.1, 95% CI 1.2-8.5, p < 0.05); being older than 26 years (OR 2.3, 95% CI 1.3-4.2, p < 0.01); knowing that receptive anal intercourse is higher risk than insertive anal intercourse (OR 2.6, 95% CI 1.2-5.9, p < 0.05); wearing condoms with female sexual partners (OR 3.5, 95% 1.4-8.3, p < 0.01); using water-based lubricants (OR 2.8, 95% CI 1.4-5.5, p < 0.01); being less likely to report having been diagnosed with a sexually transmitted infecton (OR 0.21, 95% CI 0.06-0.76, p < 0.05); and being more likely to have been tested for HIV in the last year (OR 2.0, 95% CI 1.2-3.6, p > 0.05).Human rights abuses were common: 76.2% (170/223) reported at least one abuse, including rape (9.8%, 22/225), blackmail (21.3%, 47/221), fear of seeking healthcare (22.2%, 49/221), police discrimination (16.4%, 36/219), verbal or physical harassment (59.8%, 140/234), or having been beaten (18.9%, 43/228). MSM in Lesotho are at high risk for HIV infection and human rights abuses. Evidence-based and rights-affirming HIV prevention programmes supporting the needs of MSM should be developed and implemented.

A field and glacier modelling based approach to determine the timing and extent of glaciation in southern Africa

NASA Astrophysics Data System (ADS)

Mills, Stephanie C.; Rowan, Ann V.; Barrow, Timothy T.; Plummer, Mitchell A.; Smith, Michael; Grab, Stefan W.; Carr, Simon J.; Fifield, L. Keith

2014-05-01

Moraines identified at high-altitude sites in southern Africa and dated to the last glacial maximum (LGM) indicate that the climate in this region was cold enough to support glaciers. Small glaciers are very sensitive to changes in temperature and precipitation and the identification of LGM moraines in southern Africa has important palaeoclimatic implications concerning the magnitude of temperature change and the seasonality of precipitation during the last glacial cycle. This paper presents a refined time-frame for likely glaciations based on surface exposure dating using Cl-36 at sites in Lesotho and reports results of a 2D glacier energy balance and ice flow modelling approach (Plummer and Phillips, 2003) to evaluate the most likely climatic scenarios associated with mapped moraine limits. Samples for surface exposure dating were collected from glacially eroded bedrock at several locations and yield ages within the timescale of the LGM. Scatter in the ages may be due to insufficient erosion of the bedrock surface due to the small and relatively thin nature of the glaciers. To determine the most likely climatic conditions that may have caused the glaciers to reach their mapped extent, we use a glacier-climate model, driven by data from local weather stations and a 30m (ASTER) DEM (sub-sampled to 10m) representation of the topographic surface. The model is forced using modern climate data for primary climatic controls (temperature and precipitation) and for secondary climatic parameters (relative humidity, cloudiness, wind speed). Various sensitivity tests were run by dropping temperature by small increments and by varying the amount of precipitation and its seasonality relative to present-day values. Results suggest that glaciers could have existed in the Lesotho highlands with a temperature depression of ~5-6 ºC and that the glaciers were highly sensitive to small changes in temperature. The additional accumulation of mass through wind redistribution appears to have been important at all but a few sites, suggesting that this must be taken into account when trying to determine a regional climate signal from small glaciers. Our dating and glacier-climate model simulations reinforce the idea that small glaciers existed in the Lesotho Highlands during the LGM, under climatic scenarios that are consistent with other proxy records. Plummer, M.A. and Phillips, F.M. (2003) 2-D numerical model of snow/ice energy balance and ice flow for paleoclimatic interpretation of glacial geomorphic features. Quaternary Science Reviews, 22, 1389-1406.

A cross-sectional assessment of population demographics, HIV risks and human rights contexts among men who have sex with men in Lesotho

PubMed Central

2011-01-01

Background Evidence is increasing of high HIV risks among southern African men who have sex with men (MSM). This represents the first study of HIV risks and human rights contexts among MSM in Lesotho. Methods Two hundred and fifty-two men who reported ever having anal sex with another man were accrued with snowball sampling and were administered a structured quantitative instrument in October and November 2009. Results Of the participants, 96.4% (240/249) were ethnic Basotho with a mean age of 26.3 years (range 18-56), 49.6% (124/250) were currently employed, and 95.2% (238/250) had at least a secondary-level education. Self-reported HIV prevalence was 11.6% (22/190); 54.5% (128/235) reported being tested for HIV in the last year. HIV knowledge was low; only 3.7% (8/212) of MSM knew that receptive anal intercourse was the highest risk for HIV and that a water-based lubricant was most appropriate to use with condoms. Bivariate associations of wearing condoms during last intercourse with men include: having easy access to condoms (OR 3.1, 95% CI 1.2-8.5, p < 0.05); being older than 26 years (OR 2.3, 95% CI 1.3-4.2, p < 0.01); knowing that receptive anal intercourse is higher risk than insertive anal intercourse (OR 2.6, 95% CI 1.2-5.9, p < 0.05); wearing condoms with female sexual partners (OR 3.5, 95% 1.4-8.3, p < 0.01); using water-based lubricants (OR 2.8, 95% CI 1.4-5.5, p < 0.01); being less likely to report having been diagnosed with a sexually transmitted infecton (OR 0.21, 95% CI 0.06-0.76, p < 0.05); and being more likely to have been tested for HIV in the last year (OR 2.0, 95% CI 1.2-3.6, p > 0.05). Human rights abuses were common: 76.2% (170/223) reported at least one abuse, including rape (9.8%, 22/225), blackmail (21.3%, 47/221), fear of seeking healthcare (22.2%, 49/221), police discrimination (16.4%, 36/219), verbal or physical harassment (59.8%, 140/234), or having been beaten (18.9%, 43/228). Conclusions MSM in Lesotho are at high risk for HIV infection and human rights abuses. Evidence-based and rights-affirming HIV prevention programmes supporting the needs of MSM should be developed and implemented. PMID:21726457

Where to deploy pre-exposure prophylaxis (PrEP) in sub-Saharan Africa?

PubMed

Verguet, Stéphane; Stalcup, Meg; Walsh, Julia A

2013-12-01

Two randomised controlled trials showed that pre-exposure prophylaxis (PrEP) reduces HIV transmission between heterosexual men and women. We model the potential impact on transmission and cost-effectiveness of providing PrEP in sub-Saharan Africa. We use a deterministic, compartmental model of HIV transmission to evaluate the potential of a 5-year PrEP intervention targeting the adult population of 42 sub-Saharan African countries. We examine the incremental impact of adding PrEP at pre-existing levels of male circumcision and antiretroviral therapy (ART). The base case assumes efficacy of 68%; adherence at 80%; country coverage at 10% of the HIV-uninfected adult population; and annual costs of PrEP and ART at US$200 and US$880 per person, respectively. After 5 years, 390,000 HIV infections (95% UR 190,000 to 630,000) would be prevented, 24% of these in South Africa. HIV infections averted per 100 000 people (adult) would range from 500 in Lesotho to 10 in Somalia. Incremental cost-effectiveness would be US$5800/disability-adjusted life year (DALY) (95% UR 3100 to 13500). Cost-effectiveness would range from US$500/DALY in Lesotho to US$44 600/DALY in Eritrea. In a general adult population, PrEP is a high-cost intervention which will have maximum impact and be cost-effective only in countries that have high levels of HIV burden and low levels of male circumcision in the population. Hence, PrEP will likely be most effective in Southern Africa as a targeted intervention added to existing strategies to control the HIV pandemic.

Emplacement of inflated Pāhoehoe flows in the Naude's Nek Pass, Lesotho remnant, Karoo continental flood basalt province: use of flow-lobe tumuli in understanding flood basalt emplacement

NASA Astrophysics Data System (ADS)

Jay, Anne E.; Marsh, Julian S.; Fluteau, Frédéric; Courtillot, Vincent

2018-02-01

Physical volcanological features are presented for a 710-m-thick section, of the Naude's Nek Pass, within the lower part of the Lesotho remnant of the Karoo Large Igneous Province. The section consists of inflated pāhoehoe lava with thin, impersistent sedimentary interbeds towards the base. There are seven discreet packages of compound and hummocky pāhoehoe lobes containing flow-lobe tumuli, making up approximately 50% of the section. Approximately 45% of the sequence consists of 14 sheet lobes, between 10 and 52-m-thick. The majority of the sheet lobes are in two packages indicating prolonged periods of lava supply capable of producing thick sheet lobes. The other sheet lobes are as individual lobes or pairs, within compound flows, suggesting brief increases in lava supply rate. We suggest, contrary to current belief, that there is no evidence that compound flows are proximal to source and sheet lobes (simple flows) are distal to source and we propose that the presence of flow-lobe tumuli in compound flows could be an indicator that a flow is distal to source. We use detailed, previously published, studies of the Thakurvadi Formation (Deccan Traps) as an example. We show that the length of a lobe and therefore the sections that are `medial or distal to source' are specific to each individual lobe and are dependent on the lava supply of each eruptive event, and as such flow lobe tumuli can be used as an indicator of relative distance from source.

Natural resources research and development in Lesotho using LANDSAT imagery

NASA Technical Reports Server (NTRS)

Jackson, A. A. (Principal Investigator)

1976-01-01

The author has identified the following significant results. A map of the drainage of the whole country to include at least third order streams was constructed from LANDSAT imagery. This was digitized and can be plotted at any required scale to provide base maps for other cartographic projects. A suite of programs for the interpretation of digital LANDSAT data is under development for a low cost programmable calculator. Initial output from these programs has proved to have better resolution and detail than the standard photographic products, and was to update the standard topographic map of a particular region.

Conventional early infant diagnosis in Lesotho from specimen collection to results usage to manage patients: Where are the bottlenecks?

PubMed Central

Hoffman, Heather J.; Isavwa, Anthony; Mokone, Mafusi; Foso, Matokelo; Safrit, Jeffrey T.; Mofenson, Lynne M.; Tylleskär, Thorkild

2017-01-01

Introduction Early infant diagnosis is an important step in identifying children infected with HIV during the perinatal period or in utero. Multiple factors contribute to delayed antiretroviral treatment initiation for HIV-infected children, including delays in the early infant HIV diagnosis cascade. Methods We conducted a retrospective study to evaluate early infant diagnosis turnaround times in Lesotho. Trained staff reviewed records of HIV-exposed infants (aged-6-8 weeks) who received an HIV test during 2011. Study sites were drawn from Highlands, Foothills and Lowlands regions of Lesotho. Central laboratory database data were linked to facility and laboratory register information. Turnaround time geometric means (with 95% CI) were calculated and compared by region using linear mixed models. Results 1,187 individual infant records from 25 facilities were reviewed. Overall, early infant diagnosis turnaround time was 61.7 days (95%CI: 55.3–68.7). Mean time from specimen collection to district laboratory was 14 days (95%CI: 12.1–16.1); from district to central laboratory, 2 days (95%CI 0.8–5.2); results from central laboratory to district hospital, 23.3 days (95%CI: 18.7–29.0); from district hospital to health facility, 3.2 days (95%CI 1.9–5.5); and from health facility to caregiver, 10.4 days (95%CI, 7.9–13.5). Mean times from specimen transfer to the central laboratory and for result transfer from central laboratory to district hospital were significantly shorter in the Lowlands Region (0.9 and 16.2 days, respectively), compared to Highlands Region (6.0 [P = 0.030] and 34.3 days [P = 0.0099]. Turnaround time from blood draw to receipt of results was significantly shorter for HIV infected infants compared to HIV uninfected infants [p = 0.0036] at an average of 47.1 days (95%CI: 38.9–56.9) and 62 days (95%CI: 55.9–68.7) respectively. Of 47 HIV-infected infants, 36 were initiated on antiretroviral therapy at an average of 1.3 days (95%CI: 0.3, 5.7) after caregiver received the result. Conclusion HIV-infected infants received results earlier and were rapidly initiated on antiretroviral therapy once the result was delivered to caregiver. However, average early infant diagnosis turnaround time was two months; the longest period of delay was transfer of results from central laboratory to district hospital. Turnaround time of results based on geographical regions or between hospitals and health centres varied but did not reach statistical significance. PMID:29016634

Using mHealth for HIV/TB Treatment Support in Lesotho: Enhancing Patient–Provider Communication in the START Study

PubMed Central

Hirsch-Moverman, Yael; Daftary, Amrita; Yuengling, Katharine A.; Saito, Suzue; Ntoane, Moeketsi; Frederix, Koen; Maama, Llang B.; Howard, Andrea A.

2017-01-01

Background: mHealth is a promising means of supporting adherence to treatment. The Start TB patients on ART and Retain on Treatment (START) study included real-time adherence support using short-text messaging service (SMS) text messaging and trained village health workers (VHWs). We describe the use and acceptability of mHealth by patients with HIV/tuberculosis and health care providers. Methods: Patients and treatment supporters received automated, coded medication and appointment reminders at their preferred time and frequency, using their own phones, and $3.70 in monthly airtime. Facility-based VHWs were trained to log patient information and text message preferences into a mobile application and were given a password-protected mobile phone and airtime to communicate with community-based VHWs. The use of mHealth tools was analyzed from process data over the study course. Acceptability was evaluated during monthly follow-up interviews with all participants and during qualitative interviews with a subset of 30 patients and 30 health care providers at intervention sites. Use and acceptability were contextualized by monthly adherence data. Findings: From April 2013 to August 2015, the automated SMS system successfully delivered 39,528 messages to 835 individuals, including 633 patients and 202 treatment supporters. Uptake of the SMS intervention was high, with 92.1% of 713 eligible patients choosing to receive SMS messages. Patient and provider interviews yielded insight into barriers and facilitators to mHealth utilization. The intervention improved the quality of health communication between patients, treatment supporters, and providers. HIV-related stigma and technical challenges were identified as potential barriers. Conclusions: The mHealth intervention for HIV/tuberculosis treatment support in Lesotho was found to be a low-tech, user-friendly intervention, which was acceptable to patients and health care providers. PMID:27930610

Using mHealth for HIV/TB Treatment Support in Lesotho: Enhancing Patient-Provider Communication in the START Study.

PubMed

Hirsch-Moverman, Yael; Daftary, Amrita; Yuengling, Katharine A; Saito, Suzue; Ntoane, Moeketsi; Frederix, Koen; Maama, Llang B; Howard, Andrea A

2017-01-01

mHealth is a promising means of supporting adherence to treatment. The Start TB patients on ART and Retain on Treatment (START) study included real-time adherence support using short-text messaging service (SMS) text messaging and trained village health workers (VHWs). We describe the use and acceptability of mHealth by patients with HIV/tuberculosis and health care providers. Patients and treatment supporters received automated, coded medication and appointment reminders at their preferred time and frequency, using their own phones, and $3.70 in monthly airtime. Facility-based VHWs were trained to log patient information and text message preferences into a mobile application and were given a password-protected mobile phone and airtime to communicate with community-based VHWs. The use of mHealth tools was analyzed from process data over the study course. Acceptability was evaluated during monthly follow-up interviews with all participants and during qualitative interviews with a subset of 30 patients and 30 health care providers at intervention sites. Use and acceptability were contextualized by monthly adherence data. From April 2013 to August 2015, the automated SMS system successfully delivered 39,528 messages to 835 individuals, including 633 patients and 202 treatment supporters. Uptake of the SMS intervention was high, with 92.1% of 713 eligible patients choosing to receive SMS messages. Patient and provider interviews yielded insight into barriers and facilitators to mHealth utilization. The intervention improved the quality of health communication between patients, treatment supporters, and providers. HIV-related stigma and technical challenges were identified as potential barriers. The mHealth intervention for HIV/tuberculosis treatment support in Lesotho was found to be a low-tech, user-friendly intervention, which was acceptable to patients and health care providers.

Trends in Loss to Follow-Up among Migrant Workers on Antiretroviral Therapy in a Community Cohort in Lesotho

PubMed Central

Bygrave, Helen; Kranzer, Katharina; Hilderbrand, Katherine; Whittall, Jonathan; Jouquet, Guillaume; Goemaere, Eric; Vlahakis, Nathalie; Triviño, Laura; Makakole, Lipontso; Ford, Nathan

2010-01-01

Background The provision of antiretroviral therapy (ART) to migrant populations raises particular challenges with respect to ensuring adequate treatment support, adherence, and retention in care. We assessed rates of loss to follow-up for migrant workers compared with non-migrant workers in a routine treatment programme in Morjia, Lesotho. Design All adult patients (≥18 years) initiating ART between January 1, 2008, and December 31, 2008, and followed up until the end of 2009, were included in the study. We described rates of loss to follow-up according to migrant status by Kaplan-Meier estimates, and used Poisson regression to model associations between migrant status and loss to follow-up controlling for potential confounders identified a priori. Results Our cohort comprised 1185 people, among whom 12% (148) were migrant workers. Among the migrant workers, median age was 36.1 (29.6–45.9) and the majority (55%) were male. We found no statistically significant differences between baseline characteristics and migrant status. Rates of lost to follow up were similar between migrants and non-migrants in the first 3 months but differences increased thereafter. Between 3 and 6 months after initiating antiretroviral therapy, migrants had a 2.78-fold increased rate of defaulting (95%CI 1.15–6.73); between 6 and 12 months the rate was 2.36 times greater (95%CI 1.18–4.73), whereas after 1 year the rate was 6.69 times greater (95%CI 3.18–14.09). Conclusions Our study highlights the need for programme implementers to take into account the specific challenges that may influence continuity of antiretroviral treatment and care for migrant populations. PMID:20976289

Mapping Soil Organic Carbon Resources Across Agricultural Land Uses in Highland Lesotho Using High Resolution Satellite Imagery

NASA Astrophysics Data System (ADS)

Knight, J.; Adam, E.

2015-12-01

Mapping spatial patterns of soil organic carbon (SOC) using high resolution satellite imagery is especially important in inaccessible or upland areas that have limited field measurements, where land use and land cover (LULC) are changing rapidly, or where the land surface is sensitive to overgrazing and high rates of soil erosion and thus sediment, nutrient and carbon export. Here we outline the methods and results of mapping soil organic carbon in highland areas (~2400 m) of eastern Lesotho, southern Africa, across different land uses. Bedrock summit areas with very thin soils are dominated by xeric alpine grassland; terrace agriculture with strip fields and thicker soils is found within river valleys. Multispectral Worldview 2 imagery was used to map LULC across the region. An overall accuracy of 88% and kappa value of 0.83 were achieved using a support vector machine model. Soils were examined in the field from different LULC areas for properties such as soil depth, maturity and structure. In situ soils in the field were also evaluated using a portable analytical spectral device (ASD) in order to ground truth spectral signatures from Worldview. Soil samples were examined in the lab for chemical properties including organic carbon. Regression modeling was used in order to establish a relationship between soil characteristics and soil spectral reflectance. We were thus able to map SOC across this diverse landscape. Results show that there are notable differences in SOC between upland and agricultural areas which reflect both soil thickness and maturity, and land use practices such as manuring of fields by cattle. Soil erosion and thus carbon (nutrient) export is significant issue in this region, which this project will now be examining.

Access to curriculum for students with disabilities at higher education institutions: How does the National University of Lesotho fare?

PubMed Central

2017-01-01

Background Creating access to curricula at institutions of higher education for students with disabilities requires a concerted effort from management and other key stakeholders to identify students’ needs and create opportunities for success. Objectives This paper presents the findings of a study which examined students with disabilities’ access to curricula at a higher education institution in Lesotho. Method Data for this qualitative study were collected using three methods: in-depth interviews, focus group discussions and document analysis. Eleven students with various types of impairments and 15 academic and non-academic staff members currently working in close proximity to students with disabilities participated in this study. Results The findings reveal inconsistencies between the institution’s admission policy of non-discrimination according to disability status and its practices. These inconsistencies are discussed under the following themes: (1) access at admission level, (2) management of disability data, (3) support by the special education unit, (4) teaching strategies, (5) support by lecturers, (6) availability of assistive technology, (7) special concessions and (8) students’ coping mechanisms. Conclusion We recommend that a clear policy concerning the support of students with disabilities be developed with the following aims: guide decisions on how disability data should be used, define roles that different university departments must play in facilitating access to curricula for all students, influence suitable development of teaching and learning resources, stimulate research on success and completion rates of students with disabilities and mandate restructuring of programmes that are currently inaccessible to students with disabilities. Key stakeholders, including students with disabilities, disabled persons’ organisations, disability rights activists, and staff should be involved in such policy design. PMID:28730064

“The Luggage that isn’t Theirs is Too Heavy…”:Understandings of Orphan Disadvantage in Lesotho

PubMed Central

Goldberg, Rachel E.; Short, Susan E.

2012-01-01

In Southern Africa, high adult HIV prevalence has fueled concern about the welfare of children losing parents to the epidemic. A growing body of evidence indicates that parental, particularly maternal, death is negatively associated with child outcomes. However, a better understanding of the mechanisms is needed. In addition, the way orphan disadvantage and the mechanisms giving rise to it are understood on the ground is essential for the successful translation of research into policies and programs. This study employs data from 89 in-depth interviews with caregivers and key informants in Lesotho, a setting where approximately one-quarter of adults is infected with HIV, to elaborate understandings of orphan disadvantage. Our analysis focuses on two questions: (i) Do local actors perceive orphans to be disadvantaged compared to non-orphans, and if so, in what ways; and (ii) How do they explain orphans’ differential disadvantage? Analyses suggest that orphans were widely perceived to be disadvantaged; respondents described this disadvantage in material as well as affective domains. Thematic analyses reveal five broad categories of explanation: poverty, love and kin connection, caregiver character, perceptions of orphans, and community norms related to orphan care. These results underscore the need for research and policy to address (i) multiple types of disadvantage, including deficits in kindness and attention; and (ii) the social embeddedness of disadvantage, recognizing that poverty, kinship, and community interact with individual attributes to shape caregiving relationships and child experiences. The findings suggest limited success for programs and policies that do not address the emotional needs of children, or that focus on child or caregiver support to the exclusion of community outreach. PMID:22865946

Sm-Nd, K-Ar and petrologic study of some kimberlites from eastern United States and their implication for mantle evolution

USGS Publications Warehouse

Basu, A.R.; Rubury, E.; Mehnert, H.; Tatsumoto, M.

1984-01-01

We provide new data on Sm-Nd systematics, K-Ar dating and the major element chemistry of kimberlites from the eastern United States (mostly from central New York State) and their constituent mineral phases of olivine, clinopyroxene, garnet, phlogopite and perovskite. In addition, we report Nd-isotopes in a few kimberlites from South Africa, Lesotho and from the eastern part of China. The major element compositions of the New York dike rocks and of their constituent minerals including a xenolith of eclogite are comparable with those from the Kimberley area in South Africa. The K-Ar age of emplacement of the New York dikes is further established to be 143 Ma. We have analyzed the Nd-isotopic composition of the following kimberlites and related rocks: Nine kimberlite pipes from South Africa and Lesotho, two from southern India; one from the U.S.S.R., fifteen kimberlite pipes and related dike rocks from eastern and central U.S. and two pipes from the Shandong Province of eastern China. The age of emplacement of these kimberlites ranges from 1300 million years to 90 million years. The initial Nd-isotopic compositions of these kimberlitic rocks expressed as e{open}NdIwith respect to a chondritic bulk-earth growth-curve show a range between 0 and +4, with the majority of the kimberlites being in the range 0 to +2. This range is not matched by any other suite of mantle-derived igneous rocks. This result strengthens our earlier conclusion that kimberlitic liquids are derived from a relatively primeval and unique mantle reservoir with a nearly chondritic Sm/Nd ratio. ?? 1984 Springer-Verlag.

"Health for all" in a least-developed country.

PubMed Central

Shonubi, Aderibigbe M. O.; Odusan, Olatunde; Oloruntoba, David O.; Agbahowe, Solomon A.; Siddique, M. A.

2005-01-01

The World Health Organization's (WHO) concept of primary healthcare as the basis for comprehensive healthcare delivery for developing countries has not been effectively applied in many of these countries. The Kingdom of Lesotho, one of the world's least-developed countries, has been able to provide a fairly comprehensive healthcare system for its citizenry based on prmary healthcare principles and a strong commitment on the part of the government despite severe limitations of finance and human resource capacity as well as difficult mountainous terrains. This paper presents the highlights of this system of healthcare delivery with the hope that other developing countries would draw some lessons from the model. PMID:16080673

Use of ERTS imagery for natural resources research and development in Lesotho. [Southern Africa

NASA Technical Reports Server (NTRS)

Nixon, P. H. (Principal Investigator); Jackson, A. A.

1974-01-01

The author has identified the following significant results. As far as the geological aspects of the project were concerned, the project was a success. It was concluded that: (1) It is possible to trace the lithological boundaries between sedimentary rocks and basaltic rocks, both extrusive and intrusive. (2) It was possible to localize sponges in the mountain areas, some of which may conceal undiscovered diamond pipes. (3) Possible main structural axes were localized within the framework of lineaments. Due to drought which occured at the time the images were gathered by ERTS-1, the usefulness of the data was limited for agricultural purposes.

Detrital minerals from source to sink : tracing Orange River sand from Lesotho to Angola

NASA Astrophysics Data System (ADS)

Garzanti, Eduardo; Vermeesch, Pieter; Andò, Sergio; Resentini, Alberto; Vezzoli, Giovanni; Lustrino, Michele; Padoan, Marta; Pereira, Alcides

2015-04-01

Quantitative provenance analysis based on high-resolution bulk-petrography and heavy-mineral data on beach and dune sands, integrated with detrital-zircon geochronology and chemical analyses of pyroxene, garnet and staurolite, demonstrates that sand carried by the Orange River and derived from Lesotho and South Africa is carried by powerful and persistent longshore currents as far as southern Angola (Garzanti et al., 2014a). This is the longest cell of littoral sand transport documented so far on Earth, and a great test case for investigating physical controls on sand texture and composition. We have monitored textural, mineralogical and geochemical variability of beach and eolian-dune sands along a 1750 km stretch of the Atlantic coast of southern Africa by using an integrated set of techniques, including image analysis, laser granulometry, optical microscopy, Raman spectroscopy and bulk-sediment geochemistry (Garzanti et al., 2014b). Our results contrast with previous reports that feldspars and volcanic detritus break down during transport, that sand grains are rounded rapidly in shallow-marine environments, and that quartzose sands may be produced by physical processes alone. We demonstrate that basaltic rock fragments and pyroxenes, traditionally believed to be rapidly destroyed, survive healthily the 4000 km-long multistep hazardous journey from Lesotho volcanic highlands to Angola. Feldspar abundance remains remarkably constant from the Orange mouth to southern Angola, and quartz increases only very slightly, possibly as a result of local recycling. Among sedimentary and metasedimentary rock fragments, unconsolidated or strongly foliated types are readily comminuted when they enter the high-energy marine environment, but cemented sandstone/siltstone grains can survive the travel from the Karoo Basin of South Africa to northern Namibia and beyond. No detrital mineral displays a significant increase in grain roundness after 300-350 km of longshore transport in high-energy littoral environments from the Orange mouth to south of the Namib Erg, but all minerals get rapidly rounded after passing into the Namib dunefield. Pyroxene and opaques get rounded faster than harder quartz and garnet, but sand mineralogy remains unchanged. Excepting strong transient selective-entrainment effects, physical processes are unable to modify sand composition significantly. Mechanical wear and selective mechanical breakdown can thus be largely neglected in provenance studies even in the case of ultra-long distance transport in high-energy environments dominated by waves or winds. This is particularly true for ancient sandstones, where chemical dissolution during diagenesis exerts an incomparably stronger control on mineralogical assemblages. REFERENCES Garzanti. E., Vermeesch, P., Andò, S., Lustrino, M., Padoan, M., Vezzoli, G., 2014a. Ultra-long distance littoral transport of Orange sand and provenance of the Skeleton Coast Erg (Namibia). Marine Geology, 357, 25-36. Garzanti, E., Resentini, A., Andò, S., Vezzoli, G., Vermeesch, P., 2014b. Physical controls on sand composition and relative durability of detrital minerals during long-distance littoral and eolian transport (coastal Namibia). Sedimentology, DOI: 10.1111/sed.12169.

Reaching the end of the line: Operational issues with implementing phone-based unannounced pill counts in resource-limited settings.

PubMed

Hirsch-Moverman, Yael; Burkot, Camilla; Saito, Suzue; Frederix, Koen; Pitt, Blanche; Melaku, Zenebe; Gadisa, Tsigereda; Howard, Andrea A

2017-01-01

Accurate measurement of adherence is necessary to ensure that therapeutic outcomes can be attributed to the recommended treatment. Phone-based unannounced pill counts were shown to be feasible and reliable measures of adherence in developed settings; and have been further used as part of medication adherence interventions. However, it is not clear whether this method can be implemented successfully in resource-limited settings, where cellular network and mobile phone coverage may be low. Our objective is to describe operational issues surrounding the use of phone-based unannounced pill counts in Lesotho and Ethiopia. Phone-based monthly unannounced pill counts, using an adaptation of a standardized protocol from previous US-based studies, were utilized to measure anti-TB and antiretroviral medication adherence in two implementation science studies in resource-limited settings, START (Lesotho) and ENRICH (Ethiopia). In START, 19.6% of calls were completed, with 71.9% of participants reached at least once; majority of failed call attempts were due to phones not being available (54.8%) or because participants were away from the pills (32.7%). In ENRICH, 33.5% of calls were completed, with 86.7% of participants reached at least once; the main reasons for failed call attempts were phones being switched off (31.5%), participants not answering (27.3%), participants' discomfort speaking on the phone (15.4%), and network problems (13.2%). Structural, facility-level, participant-level, and data collection challenges were encountered in these settings. Phone-based unannounced pill counts were found to be challenging, and response rates suboptimal. While some of these challenges were specific to local contexts, most of them are generalizable to resource-limited settings. In a research study context, a possible solution to ease operational challenges may be to focus phone-based unannounced pill count efforts on a randomly selected sample from participants who are provided with study phones and rigorously ensure that call attempts are made for these participants.

A Geographic Information Systems (GIS)-based analysis of modern South African rodent distributions, habitat use, and environmental tolerances.

PubMed

Campbell, Timothy L; Lewis, Patrick J; Thies, Monte L; Williams, Justin K

2012-11-01

GOALS OF THIS STUDY WERE TO: (1) develop distributional maps of modern rodent genera throughout the countries of South Africa, Lesotho, and Swaziland by georeferencing museum specimens; (2) assess habitat preferences for genera by cross-referencing locality position with South African vegetation; and (3) identify mean annual precipitation and temperature range where the genera are located. Conterminous South Africa including the countries of Lesotho and Swaziland Digital databases of rodent museum specimens housed in the Ditsong National Museum of Natural History, South Africa (DM), and the Division of Mammals, National Museum of Natural History, Smithsonian Institution, United States (NMNH), were acquired and then sorted into a subset of specimens with associated coordinate data. The coordinate data were then used to develop distributional maps for the rodent genera present within the study area. Percent habitat occupation and descriptive statistics for six climatic variables were then determined for each genus by cross-referencing locality positions with vegetation and climatic maps. This report presents a series of maps illustrating the distribution of 35 rodent genera based on 19,471 geo-referenced specimens obtained from two major collections. Inferred habitat use by taxon is provided for both locality and specimen percent occurrence at three hierarchical habitat levels: biome, bioregion, and vegetation unit. Descriptive statistics for six climatic variables are also provided for each genus based on locality and specimen percent incidence. As rodent faunas are commonly used in paleoenvironmental reconstructions, an accurate assessment of rodent environmental tolerance ranges is necessary before confidence can be placed in an actualistic model. While the data presented here represent only a subset of the modern geographic distributions for many of the taxa examined, a wide range of environmental regimes are observed, suggesting that more research is necessary in order to accurately reconstruct an environmental signature when these taxa are found in the fossil record.

The microbial quality of drinking water in Manonyane community: Maseru District (Lesotho).

PubMed

Gwimbi, P

2011-09-01

Provision of good quality household drinking water is an important means of improving public health in rural communities especially in Africa; and is the rationale behind protecting drinking water sources and promoting healthy practices at and around such sources. To examine the microbial content of drinking water from different types of drinking water sources in Manonyane community of Lesotho. The community's hygienic practices around the water sources are also assessed to establish their contribution to water quality. Water samples from thirty five water sources comprising 22 springs, 6 open wells, 6 boreholes and 1 open reservoir were assessed. Total coliform and Escherichia coli bacteria were analyzed in water sampled. Results of the tests were compared with the prescribed World Health Organization desirable limits. A household survey and field observations were conducted to assess the hygienic conditions and practices at and around the water sources. Total coliform were detected in 97% and Escherichia coli in 71% of the water samples. The concentration levels of Total coliform and Escherichia coli were above the permissible limits of the World Health Organization drinking water quality guidelines in each case. Protected sources had significantly less number of colony forming units (cfu) per 100 ml of water sample compared to unprotected sources (56% versus 95%, p < 0.05). Similarly in terms of Escherichia coli, protected sources had less counts (7% versus 40%, p < 0.05) compared with those from unprotected sources. Hygiene conditions and practices that seemed to potentially contribute increased total coliform and Escherichia coli counts included non protection of water sources from livestock faeces, laundry practices, and water sources being down slope of pit latrines in some cases. These findings suggest source water protection and good hygiene practices can improve the quality of household drinking water where disinfection is not available. The results also suggest important lines of inquiry and provide support and input for environmental and public health programmes, particularly those related to water and sanitation.

A comparative review of governments' views on objectives and policy instruments in the field of population and development.

PubMed

1982-01-01

It is possible to assess population policies through statements and decisions taken by governments as they reflect the views and commitments of political authorities in the field of population and development. Cases in the following African countries are reviewed with focus on objectives and policy instruments: Algeria; Angola; Benin; Botswana; Cape Verde; Central African Republic; Congo; Djibouti; Egypt; Ethiopia; Guinea; Gabon; Gambia; Ghana; Equatorial Guinea; Guinea-Bissau; Ivory Coast; Kenya; Lesotho; Liberia; Libyan Arab Jamahiriya; Madagascar; Malawi; Mali; Mauritania; Mauritius; Morocco; Mozambique; Niger; Nigeria; Rwanda; Sao Tome and Principe; Senegal; Seychelles; Sierra Leone; Somalia; Sudan; Swaziland; Togo; Tunisia; Uganda; United Republic of Cameroon; Tanzania; Upper Volta; Zaire; Zambia; and Zimbabwe. The information presented was drawn from the following publications: UN Population Division, "Population Policy Briefs: Current Situation in Developing Countries and Selected Territories," and UNFPA, "Population Programs and Projects," Volume 2, 1980-1981. On the basis of this review the following conclusions are drawn, which could indicate areas in which technical assistance to the Economic Commission for Africa (ECA) member States would be required: among the 50 country members of ECA, 34 countries (68%) have as a development objective the reduction of mortality, and in particular, maternal and child mortality; the 2nd important objective is stabilizing or improving spatial distribution of population, and 44% of the 50 countries have adopted this objective which involves the distribution of population from 1 place to another within a country; the 3rd important objective consists of restricting the migratory flow from rural areas to urban areas; the countries of Botswana, Egypt, Ghana, Kenya, Lesotho, Mauritius, Morocco, Rwanda, Seychelles, Swaziland, and Tunisia adopted the objective of reducing the rate of population growth; 34% of African countries have decided to integrate family planning programs with health services; and only 20% of African countries have announced socioeconomic development as an instrument to solve their population problems.

Effect of Offering Same-Day ART vs Usual Health Facility Referral During Home-Based HIV Testing on Linkage to Care and Viral Suppression Among Adults With HIV in Lesotho: The CASCADE Randomized Clinical Trial.

PubMed

Labhardt, Niklaus D; Ringera, Isaac; Lejone, Thabo I; Klimkait, Thomas; Muhairwe, Josephine; Amstutz, Alain; Glass, Tracy R

2018-03-20

Home-based HIV testing is a frequently used strategy to increase awareness of HIV status in sub-Saharan Africa. However, with referral to health facilities, less than half of those who test HIV positive link to care and initiate antiretroviral therapy (ART). To determine whether offering same-day home-based ART to patients with HIV improves linkage to care and viral suppression in a rural, high-prevalence setting in sub-Saharan Africa. Open-label, 2-group, randomized clinical trial (February 22, 2016-September 17, 2017), involving 6 health care facilities in northern Lesotho. During home-based HIV testing in 6655 households from 60 rural villages and 17 urban areas, 278 individuals aged 18 years or older who tested HIV positive and were ART naive from 268 households consented and enrolled. Individuals from the same household were randomized into the same group. Participants were randomly assigned to be offered same-day home-based ART initiation (n = 138) and subsequent follow-up intervals of 1.5, 3, 6, 9, and 12 months after treatment initiation at the health facility or to receive usual care (n = 140) with referral to the nearest health facility for preparatory counseling followed by ART initiation and monthly follow-up visits thereafter. Primary end points were rates of linkage to care within 3 months (presenting at the health facility within 90 days after the home visit) and viral suppression at 12 months, defined as a viral load of less than 100 copies/mL from 11 through 14 months after enrollment. Among 278 randomized individuals (median age, 39 years [interquartile range, 28.0-52.0]; 180 women [65.7%]), 274 (98.6%) were included in the analysis (137 in the same-day group and 137 in the usual care group). In the same-day group, 134 (97.8%) indicated readiness to start ART that day and 2 (1.5%) within the next few days and were given a 1-month supply of ART. At 3 months, 68.6% (94) in same-day group vs 43.1% (59) in usual care group had linked to care (absolute difference, 25.6%; 95% CI, 13.8% to 36.3%; P < .001). At 12 months, 50.4% (69) in the same-day group vs 34.3% (47) in usual care group achieved viral suppression (absolute difference, 16.0%; 4.4%-27.2%; P = .007). Two deaths (1.5%) were reported in the same-day group, none in usual care group. Among adults in rural Lesotho, a setting of high HIV prevalence, offering same-day home-based ART initiation to individuals who tested positive during home-based HIV testing, compared with usual care and standard clinic referral, significantly increased linkage to care at 3 months and HIV viral suppression at 12 months. These findings support the practice of offering same-day ART initiation during home-based HIV testing. clinicaltrials.gov Identifier: NCT02692027.

Prevalence, distribution, and social determinants of tobacco use in 30 sub-Saharan African countries.

PubMed

Sreeramareddy, Chandrashekhar T; Pradhan, Pranil Mansingh; Sin, Shwe

2014-12-18

Although the Framework Convention on Tobacco Control prioritizes monitoring of tobacco use by population-based surveys, information about the prevalence and patterns of tobacco use in sub-Saharan Africa is limited. We provide country-level prevalence estimates for smoking and smokeless tobacco (SLT) use and assess their social determinants. We analyzed population-based data of the most recent Demographic Health Surveys performed between 2006 and 2013 involving men and women in 30 sub-Saharan African countries. Weighted country-level prevalence rates were estimated for 'current smoking' (cigarettes, pipe, cigars, etc.) and 'current SLT use' (chewing, snuff, etc.). From the pooled datasets for men and women, social determinants of smoking and SLT use were assessed through multivariate analyses using a dummy country variable as a control and by including a within-country sample weight for each country. Among men, smoking prevalence rates were high in Sierra Leone (37.7%), Lesotho (34.1%), and Madagascar (28.5%); low (<10%) in Ethiopia, Benin, Ghana, Nigeria, and Sao Tome & Principe; the prevalence of SLT use was <10% in all countries except for Madagascar (24.7%) and Mozambique (10.9%). Among women, smoking and SLT prevalence rates were <5% in most countries except for Burundi (9.9%), Sierra Leone (6%), and Namibia (5.9%) (smoking), and Madagascar (19.6%) and Lesotho (9.1%) (SLT use). The proportion of females who smoked was lower than SLT users in most countries. Older age was strongly associated with both smoking and SLT use among men and women. Smoking among both men and women was weakly associated, but SLT use was strongly associated, with education. Similarly, smoking among men and women was weakly associated, but SLT use was strongly associated, with the wealth index. Smoking and SLT use were also associated with marital status among both men and women, as well as with occupation (agriculturists and unskilled workers). Prevalence of smoking among women was much lower than in men, although the social patterns of tobacco use were similar to those in men. Tobacco control strategies should target the poor, not/least educated, and agricultural and unskilled workers, who are the most vulnerable social groups in sub-Saharan Africa.

SESOTHO trial ("Switch Either near Suppression Or THOusand") - switch to second-line versus WHO-guided standard of care for unsuppressed patients on first-line ART with viremia below 1000 copies/mL: protocol of a multicenter, parallel-group, open-label, randomized clinical trial in Lesotho, Southern Africa.

PubMed

Amstutz, Alain; Nsakala, Bienvenu Lengo; Vanobberghen, Fiona; Muhairwe, Josephine; Glass, Tracy Renée; Achieng, Beatrice; Sepeka, Mamorena; Tlali, Katleho; Sao, Lebohang; Thin, Kyaw; Klimkait, Thomas; Battegay, Manuel; Labhardt, Niklaus Daniel

2018-02-12

The World Health Organization (WHO) recommends viral load (VL) measurement as the preferred monitoring strategy for HIV-infected individuals on antiretroviral therapy (ART) in resource-limited settings. The new WHO guidelines 2016 continue to define virologic failure as two consecutive VL ≥1000 copies/mL (at least 3 months apart) despite good adherence, triggering switch to second-line therapy. However, the threshold of 1000 copies/mL for defining virologic failure is based on low-quality evidence. Observational studies have shown that individuals with low-level viremia (measurable but below 1000 copies/mL) are at increased risk for accumulation of resistance mutations and subsequent virologic failure. The SESOTHO trial assesses a lower threshold for switch to second-line ART in patients with sustained unsuppressed VL. In this multicenter, parallel-group, open-label, randomized controlled trial conducted in Lesotho, patients on first-line ART with two consecutive unsuppressed VL measurements ≥100 copies/mL, where the second VL is between 100 and 999 copies/mL, will either be switched to second-line ART immediately (intervention group) or not be switched (standard of care, according to WHO guidelines). The primary endpoint is viral resuppression (VL < 50 copies/mL) 9 months after randomization. We will enrol 80 patients, giving us 90% power to detect a difference of 35% in viral resuppression between the groups (assuming two-sided 5% alpha error). For our primary analysis, we will use a modified intention-to-treat set, with those lost to care, death, or crossed over considered failure to resuppress, and using logistic regression models adjusted for the prespecified stratification variables. The SESOTHO trial challenges the current WHO guidelines, assessing an alternative, lower VL threshold for patients with unsuppressed VL on first-line ART. This trial will provide data to inform future WHO guidelines on VL thresholds to recommend switch to second-line ART. ClinicalTrials.gov ( NCT03088241 ), registered May 05, 2017.

Same day ART initiation versus clinic-based pre-ART assessment and counselling for individuals newly tested HIV-positive during community-based HIV testing in rural Lesotho - a randomized controlled trial (CASCADE trial).

PubMed

Labhardt, Niklaus Daniel; Ringera, Isaac; Lejone, Thabo Ishmael; Masethothi, Phofu; Thaanyane, T'sepang; Kamele, Mashaete; Gupta, Ravi Shankar; Thin, Kyaw; Cerutti, Bernard; Klimkait, Thomas; Fritz, Christiane; Glass, Tracy Renée

2016-04-14

Achievement of the UNAIDS 90-90-90 targets in Sub-Sahara Africa is challenged by a weak care-cascade with poor linkage to care and retention in care. Community-based HIV testing and counselling (HTC) is widely used in African countries. However, rates of linkage to care and initiation of antiretroviral therapy (ART) in individuals who tested HIV-positive are often very low. A frequently cited reason for non-linkage to care is the time-consuming pre-ART assessment often requiring several clinic visits before ART-initiation. This two-armed open-label randomized controlled trial compares in individuals tested HIV-positive during community-based HTC the proposition of same-day community-based ART-initiation to the standard of care pre-ART assessment at the clinic. Home-based HTC campaigns will be conducted in catchment areas of six clinics in rural Lesotho. Households where at least one individual tested HIV positive will be randomized. In the standard of care group individuals receive post-test counselling and referral to the nearest clinic for pre-ART assessment and counselling. Once they have started ART the follow-up schedule foresees monthly clinic visits. Individuals randomized to the intervention group receive on the spot point-of-care pre-ART assessment and adherence counselling with the proposition to start ART that same day. Once they have started ART, follow-up clinic visits will be less frequent. First primary outcome is linkage to care (individual presents at the clinic at least once within 3 months after the HIV test). The second primary outcome is viral suppression 12 months after enrolment in the study. We plan to enrol a minimum of 260 households with 1:1 allocation and parallel assignment into both arms. This trial will show if in individuals tested HIV-positive during community-based HTC campaigns the proposition of same-day ART initiation in the community, combined with less frequent follow-up visits at the clinic could be a pragmatic approach to improve the care cascade in similar settings. NCT02692027 , registered February 21, 2016.

Prevalence, patterns, and correlates of HIV disclosure among TB-HIV patients initiating antiretroviral therapy in Lesotho.

PubMed

Hayes-Larson, Eleanor; Hirsch-Moverman, Yael; Saito, Suzue; Frederix, Koen; Pitt, Blanche; Maama, Bridget Llang; Howard, Andrea A

2017-08-01

Disclosure of HIV-positive status has important implications for patient outcomes and preventing HIV transmission, but has been understudied in TB-HIV patients. We assessed disclosure patterns and correlates of non-disclosure among adult TB-HIV patients initiating ART enrolled in the START Study, a mixed-methods cluster-randomized trial conducted in Lesotho, which evaluated a combination intervention package (CIP) versus standard of care. Interviewer-administered questionnaire data were analyzed to describe patterns of disclosure. Patient-related factors were assessed for association with non-disclosure to anyone other than a health-care provider and primary partners using generalized linear mixed models. Among 371 participants, 95% had disclosed their HIV diagnosis to someone other than a health-care provider, most commonly a spouse/primary partner (76%). Age, TB knowledge, not planning to disclose TB status, greater perceived TB stigma, and CIP were associated with non-disclosure in unadjusted models (p < .1). In adjusted models, all point estimates were similar and greater TB knowledge (adjusted odds ratio [aOR] 0.59, 95% confidence interval [CI] 0.39-0.90) and CIP (aOR 0.20, 95% CI 0.05-0.79) remained statistically significant. Among 220 participants with a primary partner, 76% had disclosed to that partner. Significant correlates of partner non-disclosure (p < .1) in unadjusted analyses included being female, married/cohabitating, electricity at home, not knowing if partner was HIV-positive, and TB knowledge. Adjusted point estimates were largely similar, and being married/cohabitating (aOR 0.03, 95% CI 0.01-0.12), having electricity at home (aOR 0.38, 95% CI 0.17-0.85) and greater TB knowledge (aOR 0.76, 95% CI 0.59-0.98) remained significant. In conclusion, although nearly all participants reported disclosing their HIV status to someone other than a health-care provider at ART initiation, nearly a quarter of participants with a primary partner had not disclosed to their partner. Additional efforts to support HIV disclosure (e.g., counseling) may be needed for TB-HIV patients, particularly for women and those unaware of their partners' status.

Programmatic management of multidrug-resistant tuberculosis: models from three countries.

PubMed

Furin, J; Bayona, J; Becerra, M; Farmer, P; Golubkov, A; Hurtado, R; Joseph, J K; Keshavjee, S; Ponomarenko, O; Rich, M; Shin, S

2011-10-01

Although multidrug-resistant tuberculosis (MDR-TB) is a major global health problem, there is a gap in programmatic treatment implementation. This study describes MDR-TB treatment models in three countries--Peru, Russia and Lesotho-- using qualitative data collected over a 13-year period. A program analysis is presented for each country focusing on baseline medical care, initial implementation and program evolution. A pattern analysis revealed six overarching themes common to all three programs: 1) importance of baseline assessments, 2) early identification of key collaborators, 3) identification of initial locus of care, 4) minimization of patient-incurred costs, 5) targeted interventions for vulnerable populations and 6) importance of technical assistance and funding. Site commonalities and differences in each of these areas were analyzed. It is recommended that all programs providing MDR-TB treatment address these six areas during program development and implementation.

HIV Stigma and Nurse Job Satisfaction in Five African Counties

PubMed Central

Chirwa, Maureen L.; Greeff, Minrie; Kohi, Thecla W.; Naidoo, Joanne R.; Makoae, Lucy N.; Dlamini, Priscilla S.; Kaszubski, Christopher; Cuca, Yvette P.; Uys, Leana R.; Holzemer, William L.

2009-01-01

This study explored the demographic and social factors, including perceived HIV stigma, that influence job satisfaction in nurses from 5 African countries. A cross-sectional survey was conducted of nurses (n = 1,384) caring for patients living with HIV infection in Lesotho, Malawi, South Africa, Swaziland, and Tanzania. Total job satisfaction in this sample was lower than 2 comparable studies in South Africa and the United Kingdom. The subscale, Personal Satisfaction, was the highest in this sample as in the other 2. Job Satisfaction scores differed significantly among the 5 countries and these differences were consistent across all subscales. A hierarchical regression demonstrated that mental and physical health, marital status, education level, urban/rural setting, and perceived HIV stigma had significant influences on job satisfaction. Perceived HIV stigma was the strongest predictor of job dissatisfaction. These findings provide new areas for intervention strategies that might enhance the work environment for nurses in these countries. PMID:19118767

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

PubMed Central

2013-01-01

In the area of disability studies, models have been at the centre of debates, influencing social policies, practices and legal frameworks. The former Ministry of Health and Social Welfare in the Kingdom of Lesotho was not an exception. In its efforts to tackle issues of disability, it produced The National Disability and Rehabilitation Policy: Mainstreaming persons with disabilities into society in 2011. This policy document is rooted in the social model and seeks to address long-standing problems and challenges of people with disabilities in the Kingdom. Using ideas from Foucault, particularly the technologies and regimes of power, which work through language and practice, this article examined ways in which people with disabilities are constituted through state knowledge and government policies, and concluded that these constructions form the basis for alienation and marginalisation in society. PMID:28729987

Eruptive history of the Karoo lava flows and their impact on early Jurassic environmental change

NASA Astrophysics Data System (ADS)

Moulin, M.; Fluteau, F.; Courtillot, V.; Marsh, J.; Delpech, G.; Quidelleur, X.; Gérard, M.

2017-02-01

This paper reports new paleomagnetic and geochronologic data from a 1500 m thick composite section belonging to the Drakensberg group, the thickest remnant of the Karoo lavas in Northern Lesotho. Flow-by-flow analysis of paleomagnetic directions reveals 21 magnetic directional groups, corresponding to single eruptive events, and 16 individual lava flows. The new age determinations of lava flows range from 180.1 ± 1.4 to 182.8 ± 2.6 Ma. These data, combined with previous results, allow us to propose that the main part of the Drakensberg group and the Karoo intrusive complex dated around 181-183 Ma may have been erupted over a period as short as 250 kyr and may have coincided with the two main phases of extinction in the Early Toarcian. This scenario agrees well with the discontinuous rhythm of environmental and biotic perturbations in the Late Pliensbachian-Toarcian interval.

Improving cold chain systems: Challenges and solutions.

PubMed

Ashok, Ashvin; Brison, Michael; LeTallec, Yann

2017-04-19

While a number of new vaccines have been rolled out across the developing world (with more vaccines in the pipeline), cold chain systems are struggling to efficiently support national immunization programs in ensuring the availability of safe and potent vaccines. This article reflects on the Clinton Health Access Initiative, Inc. (CHAI) experience working since 2010 with national immunization programs and partners to improve vaccines cold chains in 10 countries-Ethiopia, Nigeria, Kenya, Malawi, Tanzania, Uganda, Cameroon, Mozambique, Lesotho and India - to identify the root causes and solutions for three common issues limiting cold chain performance. Key recommendations include: Collectively, the solutions detailed in this article chart a path to substantially improving the performance of the cold chain. Combined with an enabling global and in-country environment, it is possible to eliminate cold chain issues as a substantial barrier to effective and full immunization coverage over the next few years. Copyright © 2017. Published by Elsevier Ltd.

THE WEIGHT OF SUCCESS: THE BODY MASS INDEX AND ECONOMIC WELL-BEING IN SOUTHERN AFRICA.

PubMed

Wittenberg, Martin

2013-10-01

We show that body mass increases with economic resources among most Southern Africans, although not all. Among Black South Africans the relationship is non-decreasing over virtually the entire range of incomes/wealth. Furthermore in this group other measures of "success" (e.g., employment and education) are also associated with increases in body mass. This is true in both 1998 (the Demographic and Health Survey) and 2008 (National Income Dynamics Survey). A similar relationship holds among residents of Lesotho, Swaziland, Mozambique, Malawi, and Namibia. This suggests that body mass can be used as a crude measure of well-being. This allows us to examine the vexed question in South African labor economics whether there is involuntary unemployment. The fact that the unemployed are lighter than the employed, even when we control for household fixed effects, suggests that they are not choosing this state.

THE WEIGHT OF SUCCESS: THE BODY MASS INDEX AND ECONOMIC WELL-BEING IN SOUTHERN AFRICA

PubMed Central

Wittenberg, Martin

2015-01-01

We show that body mass increases with economic resources among most Southern Africans, although not all. Among Black South Africans the relationship is non-decreasing over virtually the entire range of incomes/wealth. Furthermore in this group other measures of “success” (e.g., employment and education) are also associated with increases in body mass. This is true in both 1998 (the Demographic and Health Survey) and 2008 (National Income Dynamics Survey). A similar relationship holds among residents of Lesotho, Swaziland, Mozambique, Malawi, and Namibia. This suggests that body mass can be used as a crude measure of well-being. This allows us to examine the vexed question in South African labor economics whether there is involuntary unemployment. The fact that the unemployed are lighter than the employed, even when we control for household fixed effects, suggests that they are not choosing this state. PMID:26199456

Cryptococcal antigen screening by lay cadres using a rapid test at the point of care: A feasibility study in rural Lesotho.

PubMed

Rick, Fernanda; Niyibizi, Aline Aurore; Shroufi, Amir; Onami, Kazumi; Steele, Sarah-Jane; Kuleile, Malehlohonolo; Muleya, Innocent; Chiller, Tom; Walker, Tiffany; Van Cutsem, Gilles

2017-01-01

Cryptococcal meningitis is one of the leading causes of death among people with HIV in Africa, primarily due to delayed presentation, poor availability and high cost of treatment. Routine cryptococcal antigen (CrAg) screening of patients with a CD4 count less than 100 cells/mm3, followed by pre-emptive therapy if positive, might reduce mortality in high prevalence settings. Using the cryptococcal antigen (CrAg) lateral flow assay (LFA), screening is possible at the point of care (POC). However, critical shortages of health staff may limit adoption. This study investigates the feasibility of lay counsellors conducting CrAg LFA screening in rural primary care clinics in Lesotho. From May 2014 to June 2015, individuals who tested positive for HIV were tested for CD4 count and those with CD4 <100 cells/mm3 were screened with CrAg LFA. All tests were performed by lay counsellors. CrAg-positive asymptomatic patients received fluconazole, while symptomatic patients were referred to hospital. Lay counsellors were trained and supervised by a laboratory technician and counsellor activity supervisor. Additionally, nurses and doctors were trained on CrAg screening and appropriate treatment. During the study period, 1,388 people were newly diagnosed with HIV, of whom 129 (9%) presented with a CD4 count <100 cells/mm3. Of these, 128 (99%) were screened with CrAg LFA and 14/128 (11%) tested positive. Twelve of the 14 (86%) were asymptomatic, and received outpatient fluconazole. All commenced ART with a median time to initiation of 15.5 days [IQR: 14-22]. Of the asymptomatic patients, nine (75%) remained asymptomatic after a median time of 5 months [IQR; 3-6] of follow up. One (8%) became co-infected with tuberculosis and died and two were transferred out. The two patients with symptomatic cryptococcal meningitis (CM) were referred to hospital, where they later died. CrAg LFA screening by lay counsellors followed by pre-emptive fluconazole treatment for asymptomatic cases, or referral to hospital for symptomatic cases, proved feasible. However, regular follow-up to ensure proper management of cryptococcal disease was needed. These early results support the wider use of CrAg LFA screening in remote primary care settings where upper cadres of healthcare staff may be in short supply.

Cryptococcal antigen screening by lay cadres using a rapid test at the point of care: A feasibility study in rural Lesotho

PubMed Central

Rick, Fernanda; Niyibizi, Aline Aurore; Shroufi, Amir; Onami, Kazumi; Steele, Sarah-Jane; Kuleile, Malehlohonolo; Muleya, Innocent; Chiller, Tom; Walker, Tiffany; Van Cutsem, Gilles

2017-01-01

Introduction Cryptococcal meningitis is one of the leading causes of death among people with HIV in Africa, primarily due to delayed presentation, poor availability and high cost of treatment. Routine cryptococcal antigen (CrAg) screening of patients with a CD4 count less than 100 cells/mm3, followed by pre-emptive therapy if positive, might reduce mortality in high prevalence settings. Using the cryptococcal antigen (CrAg) lateral flow assay (LFA), screening is possible at the point of care (POC). However, critical shortages of health staff may limit adoption. This study investigates the feasibility of lay counsellors conducting CrAg LFA screening in rural primary care clinics in Lesotho. Methods From May 2014 to June 2015, individuals who tested positive for HIV were tested for CD4 count and those with CD4 <100 cells/mm3 were screened with CrAg LFA. All tests were performed by lay counsellors. CrAg-positive asymptomatic patients received fluconazole, while symptomatic patients were referred to hospital. Lay counsellors were trained and supervised by a laboratory technician and counsellor activity supervisor. Additionally, nurses and doctors were trained on CrAg screening and appropriate treatment. Results During the study period, 1,388 people were newly diagnosed with HIV, of whom 129 (9%) presented with a CD4 count <100 cells/mm3. Of these, 128 (99%) were screened with CrAg LFA and 14/128 (11%) tested positive. Twelve of the 14 (86%) were asymptomatic, and received outpatient fluconazole. All commenced ART with a median time to initiation of 15.5 days [IQR: 14–22]. Of the asymptomatic patients, nine (75%) remained asymptomatic after a median time of 5 months [IQR; 3–6] of follow up. One (8%) became co-infected with tuberculosis and died and two were transferred out. The two patients with symptomatic cryptococcal meningitis (CM) were referred to hospital, where they later died. Conclusions CrAg LFA screening by lay counsellors followed by pre-emptive fluconazole treatment for asymptomatic cases, or referral to hospital for symptomatic cases, proved feasible. However, regular follow-up to ensure proper management of cryptococcal disease was needed. These early results support the wider use of CrAg LFA screening in remote primary care settings where upper cadres of healthcare staff may be in short supply. PMID:28877182

More than just talk: the framing of transactional sex and its implications for vulnerability to HIV in Lesotho, Madagascar and South Africa

PubMed Central

2011-01-01

Background 'Transactional sex' was regarded by the mid-1990s as an important determinant of HIV transmission, particularly in sub-Saharan Africa. Little attention has been paid to what the terms used to denote transactional sex suggest about how it is understood. This study provides a nuanced set of descriptions of the meaning of transactional sex in three settings. Furthermore, we discuss how discourses around transactional sex suggest linkages to processes of globalization and hold implications for vulnerability to HIV. Methods The analysis in this article is based on three case studies conducted as part of a multi-country research project that investigated linkages between economic globalization and HIV. In this analysis, we contextualize and contrast the 'talk' about transactional sex through the following research methods in three study sites: descriptions revealed through semi-structured interviews with garment workers in Lesotho; focus groups with young women and men in Antananarivo, Madagascar; and focus groups and in-depth interviews with young women and men in Mbekweni, South Africa. Results Participants' talk about transactional sex reveals two themes: (1) 'The politics of differentiation' reflects how participants used language to demarcate identities, and distance themselves from contextually-based marginalized identities; and (2) 'Gender, agency and power' describes how participants frame gendered-power within the context of transactional sex practices, and reflects on the limitations to women's power as sexual agents in these exchanges. Talk about transactional sex in our study settings supports the assertion that emerging transactional sexual practices are linked with processes of globalization tied to consumerism. Conclusions By focusing on 'talk' about transactional sex, we locate definitions of transactional sex, and how terms used to describe transactional sex are morally framed for people within their local context. We take advantage of an opportunity to comparatively explore such talk across three different study sites, and contribute to a better understanding of both emerging sexual practices and their implications for HIV vulnerability. Our work underlines that transactional sex needs to be reflected as it is perceived: something very different from, but of at least equal concern to, formal sex work in the efforts to curb HIV transmission. PMID:21961516

Comparing Estimates of Multiple and Concurrent Partnerships Across Population Based Surveys: Implications for Combination HIV Prevention

PubMed Central

Morris, Martina; Leslie-Cook, Ayn; Akom, Eniko; Stephen, Aloo; Sherard, Donna

2014-01-01

We compare estimates of multiple and concurrent sexual partnerships from Demographic and Health Surveys (DHS) with comparable Population Services International (PSI) surveys in four African countries (Kenya, Lesotho, Uganda, Zambia). DHS data produce significantly lower estimates of all indicators for both sexes in all countries. PSI estimates of multiple partnerships are 1.7 times higher [1.4 for men (M), 3.0 for women (W)], cumulative prevalence of concurrency is 2.4 times higher (2.2 M, 2.7 W), the point prevalence of concurrency is 3.5 times higher (3.5 M, 3.3 W), and the fraction of multi-partnered persons who report concurrency last year is 1.4 times higher (1.6 M, 0.9 W). These findings provide strong empirical evidence that DHS surveys systematically underestimate levels of multiple and concurrent partnerships. The underestimates will contaminate both empirical analyses of the link between sexual behavior and HIV infection, and theoretical models for combination prevention that use these data for inputs. PMID:24077973

Comparing Estimates of Multiple and Concurrent Partnerships Across Population Based Surveys: Implications for Combination HIV Prevention.

PubMed

Morris, Martina; Vu, Lung; Leslie-Cook, Ayn; Akom, Eniko; Stephen, Aloo; Sherard, Donna

2014-04-01

We compare estimates of multiple and concurrent sexual partnerships from Demographic and Health Surveys (DHS) with comparable Population Services International (PSI) surveys in four African countries (Kenya, Lesotho, Uganda, Zambia). DHS data produce significantly lower estimates of all indicators for both sexes in all countries. PSI estimates of multiple partnerships are 1.7 times higher [1.4 for men (M), 3.0 for women (W)], cumulative prevalence of concurrency is 2.4 times higher (2.2 M, 2.7 W), the point prevalence of concurrency is 3.5 times higher (3.5 M, 3.3 W), and the fraction of multi-partnered persons who report concurrency last year is 1.4 times higher (1.6 M, 0.9 W). These findings provide strong empirical evidence that DHS surveys systematically underestimate levels of multiple and concurrent partnerships. The underestimates will contaminate both empirical analyses of the link between sexual behavior and HIV infection, and theoretical models for combination prevention that use these data for inputs.

Renewable Energy Zones for the Africa Clean Energy Corridor

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wu, Grace C.; Deshmukh, Ranjit; Ndhlukula, Kudakwashe

Multi-criteria Analysis for Planning Renewable Energy (MapRE) is a study approach developed by the Lawrence Berkeley National Laboratory with the support of the International Renewable Energy Agency (IRENA). The approach combines geospatial, statistical, energy engineering, and economic methods to comprehensively identify and value high-quality wind, solar PV, and solar CSP resources for grid integration based on techno-economic criteria, generation profiles (for wind), and socio-environmental impacts. The Renewable Energy Zones for the Africa Clean Energy Corridor study sought to identify and comprehensively value high-quality wind, solar photovoltaic (PV), and concentrating solar power (CSP) resources in 21 countries in the East andmore » Southern Africa Power Pools to support the prioritization of areas for development through a multi-criteria planning process. These countries include Angola, Botswana, Burundi, Djibouti, Democratic Republic of Congo, Egypt, Ethiopia, Kenya, Lesotho, Libya, Malawi, Mozambique, Namibia, Rwanda, South Africa, Sudan, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe. The study includes the methodology and the key results including renewable energy potential for each region.« less

Marriage, widowhood, divorce and HIV risks among women in sub-Saharan Africa.

PubMed

Tenkorang, Eric Y

2014-03-01

Studies on associations between marriage and HIV infection among women in sub-Saharan Africa are generally inconclusive. Not enough is known about HIV risks among divorced and widowed women. This study examined the relationship between marital status and HIV infection among women in seven sub-Saharan African countries. Retrospective data from the Demographic and Health Surveys were combined with HIV biomarker data from the AIDS Indicator Survey (AIS) for analysis. Random-effects complementary log-log models were applied to examine the relationship between marital status and HIV risks controlling for theoretically relevant covariates. Compared to never-married women, widowed women were significantly more likely to be HIV positive. Similarly, married women were more likely to be infected with HIV, compared to never-married women in Lesotho and Zimbabwe. In Tanzania and Zimbabwe, divorced women had higher risks of HIV infection, compared to never-married women. Findings suggest that specific HIV programs be directed at vulnerable women, in particular those widowed. Similar programs are needed for both poorer and wealthier women.

Seeing the light: The SpecUP educational spectrophotometer

NASA Astrophysics Data System (ADS)

Forbes, P. B. C.

2016-09-01

Spectrophotometry is a cross-cutting analytical technique, which finds use in disciplines ranging from chemistry to pharmacy, biochemistry, food science and physics. The SpecUP (Spectrophotometer of the University of Pretoria) is an educational spectrophotometer which was developed so that students could build their own instruments from components in a kit, and then utilise it to generate analytically useful results. This initiative allows for institutions to have more spectroscopy equipment available, as the SpecUP costs less than 40 as opposed to 2 000 which is the cost of an entry-level commercial instrument. This is of particular importance in a developing country context, where student numbers are typically high and resources are scarce. In addition, the SpecUP has moving parts and an open design which allows users to understand what is inside the "black box" of commercial instruments and to discover what happens when they adjust components, allowing for active, inquiry-based learning. The SpecUP user network currently spans South Africa, Tunisia, Namibia, Lesotho, Botswana, Kenya, Swaziland, Zimbabwe, Zambia, Ivory Coast, Egypt, Turkey and Italy.

Participation, decentralisation and déjà vu: Remaking democracy in response to AIDS?

PubMed

Kenworthy, Nora J

2014-01-01

Participation, decentralisation and community partnership have served as prominent motifs and driving philosophies in the global scale-up of HIV programming. Given the fraught histories of these ideas in development studies, it is surprising to encounter their broad appeal as benchmarks and moral practices in global health work. This paper examines three intertwined, government-endorsed projects to deepen democratic processes of HIV policy-making in Lesotho: (1) the 'Gateway Approach' for decentralising and coordinating local HIV responses; (2) the implementation of a community council-driven priority-setting process; and (3) the establishment of community AIDS councils. Taken together, these efforts are striking and well intentioned, but nonetheless struggle in the face of powerful global agendas to establish meaningful practices of participation and decentralisation. Examining these efforts shows that HIV scale-up conveys formidable lessons for citizens about the politics of global health and their place in the world. As global health initiatives continue to remake important dimensions of political functioning, practitioners, agencies and governments implementing similar democratising projects may find the warnings of earlier development critics both useful and necessary.

Variations in Reading Achievement Across 14 Southern African School Systems: Which Factors Matter?

NASA Astrophysics Data System (ADS)

Hungi, Njora; Thuku, Florence W.

2010-02-01

In this study the authors employed a multilevel analysis procedure in order to examine the pupil and school levels factors that contributed to variation in reading achievement among Grade 6 primary school pupils in 14 southern African school systems (Botswana, Kenya, Lesotho, Malawi, Mauritius, Mozambique, Namibia, Seychelles, South Africa, Swaziland, Tanzania, Uganda, Zambia, and Zanzibar). The data for this study were collected in 2002 as part of a major project known as the Southern and Eastern Africa Consortium for Monitoring Educational Quality (SACMEQ) that sought to examine the quality of education offered in primary schools in these countries. The most important factors affecting variation in pupil achievement across most of these school systems were grade repetition, pupil socioeconomic background, speaking the language of instruction at home, and Pupil age. South Africa, Uganda and Namibia were among the school systems with the largest between-school variation while Seychelles and Mauritius had the largest within-school variation. Low social equity in reading achievement was evident in Mauritius, Seychelles and Tanzania. Policy implications of the findings are discussed.

Digital reconstruction of the mandible of an adult Lesothosaurus diagnosticus with insight into the tooth replacement process and diet

PubMed Central

Knoll, Fabien; Bordy, Emese M.; de Kock, Michiel O.; Redelstorff, Ragna

2017-01-01

Fragmentary caudal ends of the left and right mandible assigned to Lesothosaurus diagnosticus, an early ornithischian, was recently discovered in the continental red bed succession of the upper Elliot Formation (Lower Jurassic) at Likhoele Mountain (Mafeteng District) in Lesotho. Using micro-CT scanning, this mandible could be digitally reconstructed in 3D. The replacement teeth within the better preserved (left) dentary were visualised. The computed tomography dataset suggests asynchronous tooth replacement in an individual identified as an adult on the basis of bone histology. Clear evidence for systematic wear facets created by attrition is lacking. The two most heavily worn teeth are only apically truncated. Our observations of this specimen as well as others do not support the high level of dental wear expected from the semi-arid palaeoenvironment in which Lesothosaurus diagnosticus lived. Accordingly, a facultative omnivorous lifestyle, where seasonality determined the availability, quality, and abundance of food is suggested. This would have allowed for adaptability to episodes of increased environmental stress. PMID:28265518

Amietia angolensis and A. fuscigula (Anura: Pyxicephalidae) in southern Africa: a cold case reheated.

PubMed

Channing, Alan; Baptista, Ninda

2013-01-01

A study combining DNA sequences of the mitochondrial 16S rRNA gene, advertisement calls and morphology of some southern African river frogs confirms Amietia vandijki (Visser & Channing, 1997) as a good species. The form presently referred to as Amietia angolensis in southern Africa is shown to comprise two species: Amietia angolensis (Bocage, 1866) known from Angola, and Amietia quecketti (Boulenger, 1895) known from South Africa, Zimbabwe and Lesotho. Junior synonyms of A. quecketti include Rana theileri Mocquard, 1906 and Afrana dracomontana Channing, 1978. The form presently known as Amietia fuscigula is shown to consist of two distantly related taxa: Amietia fuscigula (Duméril & Bibron, 1841) from the south-western Cape and an undescribed species that we here name Amietia poyntoni sp. nov. Channing & Baptista, known from the rest of South Africa and Namibia. These five species have large differences in 16S sequences, as well as differences in morphology and advertisement call. Call and molecular data are both diagnostic, while morphology shows some overlap between taxa. An extended study of the genus across Africa is in preparation.

Regional Variations in Composition of Cr-spinel Xenocrysts From Kimberlite

NASA Astrophysics Data System (ADS)

Schulze, D. J.

2001-05-01

Important information on the composition of the upper mantle can be obtained by studying mantle xenocrysts in kimberlite, especially in situations in which intact mantle xenoliths are rare to absent. Spinel-group minerals are especially useful as they can coexist with garnet or represent regions of the mantle shallower than garnet-facies rocks, and chromites can exist in rocks too Al-depleted to form garnet. Xenolith studies have shown that along most typical cratonic geothermal gradients, the maximum Cr/(Cr+Al) (cr#) of spinel coexisting with garnet is 0.88. Cr-spinels with cr# > 0.88 are from Al-depleted rocks or from assemblages in which Al is partitioned into another phase (e.g., metasomatic phlogopite). Approximately 2500 Cr-spinel xenocrysts from 36 kimberlites in southern Africa and North America have been analysed (and some published data used) and evaluated, primarily in terms of cr# and Fe2/(Fe2+Mg) (fe#). Differences from pipe to pipe within and between cratons reflect variations in geologic history and fertility/depletion, only some of which can be related to mantle age. Within southern Africa, pipe average values of spinel xenocryst cr# are highest on the Kaapvaal Craton (0.80-0.89) where fe# varies from 0.36 to 0.47. Suites from the craton margin (e.g., in Lesotho) indicate a less depleted mantle (cr# = 0.75-0.80), similar to those from the Zimbabwe Craton (Orapa and Letlhakane, cr# = 0.80-0.81). Jwaneng (Kaapvaal Craton) is similar to the Zimbabwe Craton pipes (cr# = 0.83). Off-craton South African suites (Kalkput and Rietfontein) have lower cr# (0.72-0.75). Most southern African suites contain a significant population of Cr-spinel with cr# > 0.88 (including off-craton Rietfontein) except Liqhobong on the craton margin in Lesotho. Cr-spinel suites from North American kimberlites are quite different, with most suites being significantly more aluminous than African populations. Most Kirkland Lake kimberlites on the Superior Craton have a very restricted fe# (0.41-0.43) at cr# values below those from Kaapvaal and Zimbabwe Cratons (0.67-0.78). Wyoming Craton kimberlites (Sloan and Kelsey Lake) also have aluminous spinel populations (cr# = 0.70-0.76). High-Cr spinel xenocrysts (cr# > 0.88) are common in Superior Craton populations but less abundant on the Wyoming Craton. Off-craton kimberlites (on Grenville basement) in Kentucky and Pennsylvania are much more aluminous (cr# = 0.62) and have almost no xenocrysts with cr# > 0.88. The general increase in fertility (lower cr# in spinel) from craton centre to margin to off-craton is confirmed, but Cr-spinel populations from all tectonic settings in North American kimberlites appear to be less depleted on average than their equivalents in southern Africa.

Higher rates of metabolic syndrome among women taking zidovudine as compared to tenofovir in rural Africa: preliminary data from the CART-1 study.

PubMed

Labhardt, Niklaus Daniel; Cheleboi, Molisana; Faturyiele, Olatunbosun; Motlatsi, Mokete M; Pfeiffer, Karolin; Lejone, Thabo Ismael; Cerutti, Bernard; Muser, Jürgen; Gupta, Ravi Shankar; Lynen, Lutgarde; Hatz, Christoph

2014-01-01

Due to its side effects stavudine (D4T) has been replaced by zidovudine (AZT) and tenofovir (TDF) in most low- and middle-income countries (LMICs). In 2014 about 38% of adult first-line regimens contain AZT and 62% TDF [1]. Whereas the unfavourable metabolic outcomes of D4T in comparison to TDF have been described extensively, studies from LMICs comparing metabolic profiles between patients on AZT and TDF are scarce. Given the high number of patients in LMICs still taking AZT, data on their metabolic profile are needed. We present rates of metabolic syndrome (MS) in adult patients taking either AZT- or TDF-containing first-line, non-nucleoside reverse transcriptase (NNRTI)-based regimens. Data derived from a cross-sectional multi-disease screening conducted in ten facilities in two rural districts of Lesotho, Southern Africa [2]. Patients were eligible if aged ≥25 years and on NNRTI-containing first-line ART ≥6 months. The MS definition for Africa of the International Diabetes Federation was applied [3]. Assessed potential predictors for MS were age, time on ART, virologic suppression, body-mass index (BMI), alcohol consumption, wealth quintile, NNRTI (nevirapine (NVP) or Efavirenz (EFV)), history of previous D4T exposure and ART-backbone (AZT or TDF). Statistical analyses - stratified for sex - comprised univariate logistic regression for each predictor variable with subsequent construction of a multivariate model including all predictors with an association to MS at a significance level<0.1 in univariate analysis. Out of 1026 patients, 660 (64.3%) were female. MS prevalence was 9.8% (95% CI 6.9-13.4) in men and 22.9% (19.7-26.3) in women. In women, aged ≥35 years, AZT-backbone, NVP-base, BMI ≥25kg/m2 and taking ART for ≥4.5 years were associated with MS in univariate analysis. In the multivariate model only AZT (adjusted odds-ratio: 2.2, 95% CI 1.4-3.6; p=0.001) and BMI ≥25kg/m2 (9.8; 2.8-34.1, p<0.001) were associated with MS. For men, age, higher wealth quintile, history of D4T exposure and BMI were associated with MS in univariate analysis. In the multivariate model only a BMI ≥25kg/m2 was associated with MS (8.9; 3.8-20.9, p<0.001). In rural Lesotho, Southern Africa, the use of AZT instead of TDF among women who are on ART for ≥6 months predisposes to the development of metabolic syndrome. Given that, still 38% of first-line regimens in LMIC contain AZT, this finding needs to be verified in other settings in Sub-Saharan Africa.

Development of tuberculosis infection control guidelines in a pediatric HIV clinic in sub-Saharan Africa.

PubMed

Carlucci, J G; Jin, L; Sanders, J E; Mohapi, E Q; Mandalakas, A M

2015-03-21

A well-established pediatric human immunodeficiency virus (HIV) clinic in Lesotho with initial infection control (IC) measures prioritizing blood-borne disease. In line with international recommendations, services have been expanded to include the management of patients with tuberculosis (TB). The creation of comprehensive IC guidelines with an emphasis on TB has become a priority. To provide a model for developing and implementing IC guidelines in ambulatory care facilities in limited-resource settings with high HIV and TB prevalence. Activities: An IC plan that includes guidance covering both general IC measures and TB-specific guidelines was created by integrating local and international recommendations and emphasizing the importance of administrative measures, environmental controls, and disease-specific precautions. An interdisciplinary committee was established to oversee its implementation, monitoring, and evaluation. Development and implementation of IC guidelines in resource-limited settings are feasible and should be a priority in high HIV and TB prevalence areas. Education should be the cornerstone of such endeavors. Many interventions can be implemented with minimal expertise and material resources. Administrative support and institutional investment are essential to the sustainability of an effective IC program.

Mole-rats from higher altitudes have greater thermoregulatory capabilities.

PubMed

Broekman, Marna; Bennett, Nigel C; Jackson, Craig R; Scantlebury, Michael

2006-12-30

Subterranean mammals (those that live and forage underground) inhabit a challenging microenvironment, with high levels of carbon dioxide and low levels of oxygen. Consequently, they have evolved specialised morphological and physiological adaptations. For small mammals that inhabit high altitudes, the effects of cold are compounded by low oxygen partial pressures. Hence, subterranean mammals living at high altitudes are faced with a uniquely demanding physiological environment, which presumably necessitates additional physiological adjustments. We examined the thermoregulatory capabilities of two populations of Lesotho mole-rat Cryptomys hottentotus mahali that inhabit a 'low' (1600 m) and a 'high' (3200 m) altitude. Mole-rats from the high altitude had a lower temperature of the lower critical point, a broader thermoneutral zone, a lower thermal conductance and greater regulatory non-shivering thermogenesis than animals from the lower altitude. However, minimum resting metabolic rate values were not significantly different between the populations and were low compared with allometric predictions. We suggest that thermoregulatory costs may in part be met by animals maintaining a low resting metabolic rate. High-altitude animals may adjust to their cooler, more oxygen-deficient environment by having an increased non-shivering thermogenesis whilst maintaining low thermal conductance.

Worldwide actions to combat abuse.

PubMed

1998-01-01

This paper reports several developments on the global efforts to combat abuse and violence against women and children. It is noted that in South Africa, Belem, Brazil, and Lesotho, protest actions were conducted against women and child abuse. Although the protests were made separately, the protests generally called for implementation of initiatives from the government to address the issue of child and women abuse. In the context of preventing abusive behaviors, a study by the University of Cape Town in South Africa on the appropriateness and feasibility of short-term community-based group therapy concluded that such an approach might be effective in treating delinquent behavior. In Indonesia, the Rifka Annisa Women's Crisis Centre is working to combat violence against women by providing services to victims; while in Israel, a media campaign is aiming to increase awareness and support for women's help centers. In addition, the government of Bangladesh has established a Cell Against Violence Against Women that provides legal counseling and assistance for civil and criminal cases related to violence against women. Furthermore, the WHO and the International Federation of Obstetricians and Gynecologists have collaborated to conduct a joint workshop to explore how violence against women can be eliminated.

The Seismotectonic Model of Southern Africa

NASA Astrophysics Data System (ADS)

Midzi, Vunganai; Mulabisana, Thifelimbulu; Manzunzu, Brassnavy

2013-04-01

Presented in this report is a summary of the major structures and seismotectonic zones in Southern Africa (Botswana, Lesotho, Namibia, South Africa and Swaziland), which includes available information on fault plane solutions and stress data. Reports published by several experts contributed much to the prepared zones. The work was prepared as part of the requirements for the SIDA/IGCP Project 601 titled "Seismotectonics and Seismic Hazards in Africa" as well as part of the seismic source characterisation of the GEM-Africa Seismic hazard study. The seismic data used are part of the earthquake catalogue being prepared for the GEM-Africa project, which includes historical and instrumental records as collected from various agencies. Seventeen seismic zones/sources were identified and demarcated using all the available information. Two of the identiied sources are faults with reliable evidence of their activity. Though more faults have been identified in unpublished material as being active, more work is being carried out to obtain information that can be used to characterise them before they are included in the seismotectonic model. Explanations for the selected boundaries of the zones are also given in the report. It should be noted that this information is the first draft of the seismic source zones of the region. Futher interpreation of the data is envisaged which might result in more than one version of the zones.

Assessing Very Early Infant Diagnosis Turnaround Times: Findings from a Birth Testing Pilot in Lesotho

PubMed Central

Hoffman, Heather J.; Mokone, Majoalane; Tukei, Vincent J.; Nchephe, Matsepeli; Phalatse, Mamakhetha; Tiam, Appolinaire; Guay, Laura; Mofenson, Lynne

2017-01-01

Very early infant diagnosis (VEID) (testing within two weeks of life), combined with rapid treatment initiation, could reduce early infant mortality. Our study evaluated turnaround time (TAT) to receipt of infants' HIV test results and ART initiation if HIV-infected, with and without birth testing availability. Data from facility records and national databases were collected for 12 facilities offering VEID, as part of an observational prospective cohort study, and 10 noncohort facilities. HIV-exposed infants born in January–June 2016 and any cohort infant diagnosed as HIV-infected at birth or six weeks were included. The median TAT from blood draw to caregiver result receipt was 76.5 days at birth and 63 and 70 days at six weeks at cohort and noncohort facilities, respectively. HIV-exposed infants tested at birth were approximately one month younger when their caregivers received results versus those tested at six weeks. Infants diagnosed at birth initiated ART about two months earlier (median 6.4 weeks old) than those identified at six weeks (median 14.8 weeks). However, the long TAT for testing at both birth and six weeks illustrates the prolonged process for specimen transport and result return that could compromise the effectiveness of adding VEID to existing overburdened EID systems. PMID:29410914

New species of the Afrotropical spider genus Cheiramiona Lotz & Dippenaar-Schoeman (Araneae: Eutichuridae).

PubMed

Lotz, L N

2015-07-02

Twenty-three new species of the Afrotropical sac spider genus Cheiramiona Lotz & Dippenaar-Schoeman, 1999 are described: C. baviaan sp. nov. (♀, South Africa), C. boschrandensis sp. nov. (♀, South Africa), C. debeeri sp. nov. (♂, South Africa), C. haddadi sp. nov. (♂, South Africa), C. hlathikulu sp. nov. (♂, South Africa), C. hogsbackensis sp. nov. (♀, ♂, South Africa), C. ibayaensis sp. nov. (♂, Tanzania), C. jakobsbaaiensis sp. nov. (♂, South Africa), C. kirkspriggsi sp. nov. (♀, ♂, South Africa), C. kivuensis sp. nov. (♀, ♂, Democratic Republic of Congo & Rwanda), C. lamorali sp. nov. (♂, Namibia), C. lindae sp. nov. (♂, South Africa), C. malawiensis sp. nov. (♀, ♂, Malawi), C. mkhambathi sp. nov. (♀, ♂, South Africa), C. mohalensis sp. nov. (♀, Lesotho), C. musosaensis sp. nov. (♀, Democratic Republic of Congo), C. nyungwensis sp. nov. (♂, Rwanda), C. plaatbosensis sp. nov. (♀, ♂, South Africa), C. qachasneki sp. nov. (♂, South Africa), C. robinae sp. nov. (♂, South Africa), C. saniensis sp. nov. (♀, ♂, South Africa), C. tembensis sp. nov. (♂, South Africa) and C. upperbyensis sp. nov. (♀, South Africa). The females of C. lajuma Lotz, 2002 and C. mlawula Lotz, 2002 are described for the first time.

Experiences of selected countries in the use of public-private partnership in hospital services provision.

PubMed

Sadeghi, Ahmad; Barati, Omid; Bastani, Peivand; Jafari, Davood Danesh; Etemadian, Masoud

2016-11-01

To review the experiences of selected countries in the use of public-private partnership in the provision of hospital services. This comparative study was conducted in 2015 in Iran. To collect data, valid databases as well as articles, theses, reports and related books in the field of private-sector partnership in hospital services were employed. Using purposive sampling, countries such as the United Kingdom, Spain, Canada, Turkey, Australia and Lesotho, which had successful experiences in the field of application of the public-private partnership in hospital services, were included. Likewise, the only experience in Iran in this field was also reviewed. Studies done between 1980 and 2015 were examined. The results obtained from each country were compared. Implementing public-private partnership had great and valuable outcomes and achievements for governmental hospitals. Moreover, clinical and nonclinical service delivery, hospital utilisation and management along with building, repairing and supportive operations through public-private partnership contracts can be differently divided among the partners. Furthermore, duration of the projects ranged from 12 to 40 years in different countries, depending on the type of the model used. A successful experience in the use of the public-private partnership in the provision of hospital services was observed.

Government-NGO collaboration and sustainability of orphans and vulnerable children projects in southern Africa.

PubMed

Rosenberg, Alana; Hartwig, Kari; Merson, Michael

2008-02-01

Given current donor attention to orphans and children made vulnerable by HIV/AIDS, and the need for a new framework that recognizes the complementary roles of nations and non-governmental organizations (NGOs), this analysis reviews NGO-operated community-based orphans and vulnerable children (OVC) projects in Botswana, Lesotho, Namibia, South Africa, and Swaziland. There has been a lack of attention within the field of evaluation to inter-organizational relationships, specifically those with government agencies, as a factor in sustainability. We analyzed evaluations of nine OVC projects funded by the Bristol-Myers Squibb Foundation for the influence of government-NGO collaboration on project sustainability. For eight of the nine projects, evaluations provided evidence of the importance of the government partnership for sustainability. Government collaboration was important in projects designed to help families access government grants, initiate community-based solutions, and advocate for OVC rights through legislation. Government partnerships were also critical to the sustainability of two projects involved in placing children in foster care, but these showed signs of tension with government partners. In addition to the more common factors associated with sustainability, such as organizational characteristics, donors and NGOs should concentrate on developing strong partnerships with local and national government agencies for the sustainability of their projects.

The production of consumption: addressing the impact of mineral mining on tuberculosis in southern Africa

PubMed Central

Basu, Sanjay; Stuckler, David; Gonsalves, Gregg; Lurie, Mark

2009-01-01

Background Miners in southern Africa experience incident rates of tuberculosis up to ten times greater than the general population. Migration to and from mines may be amplifying tuberculosis epidemics in the general population. Discussion Migration to and from mineral mines contributes to HIV risks and associated tuberculosis incidence. Health and safety conditions within mines also promote the risk of silicosis (a tuberculosis risk factor) and transmission of tuberculosis bacilli in close quarters. In the context of migration, current tuberculosis prevention and treatment strategies often fail to provide sufficient continuity of care to ensure appropriate tuberculosis detection and treatment. Reports from Lesotho and South Africa suggest that miners pose transmission risks to other household or community members as they travel home undetected or inadequately treated, particularly with drug-resistant forms of tuberculosis. Reducing risky exposures on the mines, enhancing the continuity of primary care services, and improving the enforcement of occupational health codes may mitigate the harmful association between mineral mining activities and tuberculosis incidence among affected communities. Summary Tuberculosis incidence appears to be amplified by mineral mining operations in southern Africa. A number of immediately-available measures to improve continuity of care for miners, change recruitment and compensation practices, and reduce the primary risk of infection may critically mitigate the negative association between mineral mining and tuberculosis. PMID:19785769

Garnet peridotite xenoliths in a Montana, U.S.A., kimberlite

USGS Publications Warehouse

Carter, Hearn B.; Boyd, F.R.

1975-01-01

Within a swarm of late middle Eocene subsilicic-alkalic diatremes, one diatreme 270 by 370 m and an associated dike contain common xenoliths of granulite and rare xenoliths of spinel peridotite and garnet peridotite. Six garnet lherzolite xenoliths have been found and these show a range of textures. Four are granular, and two are intensely sheared. Phlogopite is absent from the intensely sheared xenoliths and is thought to be primary in part in the granular xenoliths. Estimated temperatures and depths of equilibration of xenolith pyroxenes range from 920??C, 106 km (32 kbar) to 1315??C, 148 km (47 kbar). The xenoliths show increasing amounts of deformation with greater inferred depths of origin. The temperature-depth points suggest a segment of an Eocene geotherm for Montana which is similar in slope to the steep portion of the pyroxene-determined Lesotho geotherm (Boyd and Nixon, this volume) and is considerably steeper than typical calculated shield and continental geotherms at present. The steep trend could be a result of plate-tectonic shearing and magma ascension within an Eocene low-velocity zone. Preservation of intensely sheared textures requires rapid transport of material from about 150 km depth during active deformation of relatively dry rock. The occurrence of monticellite peridotite in this kimberlite diatreme suggests that magmas which crystallized to monticellite peridotite at relatively shallow depth could be one of the primitive types of kimberlite magma. ?? 1975.

Prevalence of rheumatoid arthritis in Dublin, Ireland: a population based survey.

PubMed

Power, D; Codd, M; Ivers, L; Sant, S; Barry, M

1999-01-01

The prevalence of Rheumatoid Arthritis (RA) in Ireland has never been established. Studies from different countries show varying rates, being almost 100 per cent greater in the highlands of Scotland (10/1,000) than in rural Lesotho (6/1,000). A recent study also suggests a fall in the prevalence of RA among women in the London urban area. Given these variations the validity of extrapolating prevalence rates established for other countries to Ireland is questionable. This study aimed to establish a prevalence rate for RA in a defined Dublin population. A self-administered questionnaire was sent to 2,500 people chosen at random from the electoral register. The questionnaire was designed to select out both undiagnosed patients and those with definite arthritis. Respondents whose replies indicated an arthritic process, but in whom no diagnosis had been made, were asked to attend for further assessment and investigations as appropriate. Those who responded that they had been diagnosed with arthritis were asked for consent to inspect their hospital or general practitioner records. A diagnosis of RA was based on American Rheumatism Association (ARA) criteria. Valid responses were received from 1,227 people surveyed (response rate = 49 per cent). Six cases of RA were identified including 2 previously undiagnosed cases. A prevalence rate of 5/1,000 has been estimated based on these findings.

Dynamic locomotor capabilities revealed by early dinosaur trackmakers from southern Africa.

PubMed

Wilson, Jeffrey A; Marsicano, Claudia A; Smith, Roger M H

2009-10-06

A new investigation of the sedimentology and ichnology of the Early Jurassic Moyeni tracksite in Lesotho, southern Africa has yielded new insights into the behavior and locomotor dynamics of early dinosaurs. The tracksite is an ancient point bar preserving a heterogeneous substrate of varied consistency and inclination that includes a ripple-marked riverbed, a bar slope, and a stable algal-matted bar top surface. Several basal ornithischian dinosaurs and a single theropod dinosaur crossed its surface within days or perhaps weeks of one another, but responded to substrate heterogeneity differently. Whereas the theropod trackmaker accommodated sloping and slippery surfaces by gripping the substrate with its pedal claws, the basal ornithischian trackmakers adjusted to the terrain by changing between quadrupedal and bipedal stance, wide and narrow gauge limb support (abduction range = 31 degrees ), and plantigrade and digitigrade foot posture. The locomotor adjustments coincide with changes in substrate consistency along the trackway and appear to reflect 'real time' responses to a complex terrain. It is proposed that these responses foreshadow important locomotor transformations characterizing the later evolution of the two main dinosaur lineages. Ornithischians, which shifted from bipedal to quadrupedal posture at least three times in their evolutionary history, are shown to have been capable of adopting both postures early in their evolutionary history. The substrate-gripping behavior demonstrated by the early theropod, in turn, is consistent with the hypothesized function of pedal claws in bird ancestors.

Transgressing the norm: Transformative agency in community-based learning for sustainability in southern African contexts

NASA Astrophysics Data System (ADS)

Lotz-Sisitka, Heila; Mukute, Mutizwa; Chikunda, Charles; Baloi, Aristides; Pesanayi, Tichaona

2017-12-01

Environment and sustainability education processes are often oriented to change and transformation, and frequently involve the emergence of new forms of human activity. However, not much is known about how such change emerges from the learning process, or how it contributes to the development of transformative agency in community contexts. The authors of this article present four cross-case perspectives of expansive learning and transformative agency development in community-based education in southern Africa, studying communities pursuing new activities that are more socially just and sustainable. The four cases of community learning and transformative agency focus on the following activities: (1) sustainable agriculture in Lesotho; (2) seed saving and rainwater harvesting in Zimbabwe; (3) community-based irrigation scheme management in Mozambique; and (4) biodiversity conservation co-management in South Africa. The case studies all draw on cultural-historical activity theory to guide learning and change processes, especially third-generation cultural-historical activity theory (CHAT), which emphasises expansive learning in collectives across interacting activity systems. CHAT researchers, such as the authors of this article, argue that expansive learning can lead to the emergence of transformative agency. The authors extend their transformative agency analysis to probe if and how expansive learning might also facilitate instances of transgressing norms - viewed here as embedded practices which need to be reframed and changed in order for sustainability to emerge.

Twenty-five years of change in southern African passerine diversity: nonclimatic factors of change.

PubMed

Péron, Guillaume; Altwegg, Res

2015-09-01

We analysed more than 25 years of change in passerine bird distribution in South Africa, Swaziland and Lesotho, to show that species distributions can be influenced by processes that are at least in part independent of the local strength and direction of climate change: land use and ecological succession. We used occupancy models that separate species' detection from species' occupancy probability, fitted to citizen science data from both phases of the Southern African Bird Atlas Project (1987-1996 and 2007-2013). Temporal trends in species' occupancy probability were interpreted in terms of local extinction/colonization, and temporal trends in detection probability were interpreted in terms of change in abundance. We found for the first time at this scale that, as predicted in the context of bush encroachment, closed-savannah specialists increased where open-savannah specialists decreased. In addition, the trend in the abundance of species a priori thought to be favoured by agricultural conversion was negatively correlated with human population density, which is in line with hypotheses explaining the decline in farmland birds in the Northern Hemisphere. In addition to climate, vegetation cover and the intensity and time since agricultural conversion constitute important predictors of biodiversity changes in the region. Their inclusion will improve the reliability of predictive models of species distribution. © 2015 John Wiley & Sons Ltd.

Interpersonal violence: patterns in a Basotho community.

PubMed

van Geldermalsen, A A; Van der Stuyft, P

1993-04-01

This study was conducted to quantify the importance of trauma and death due to interpersonal violence in rural Lesotho and to gain an insight into the profile of the assault victims, the circumstances of the violent incidents and the type of weapons wielded and wounds inflicted. During a one-year period starting June 1988 information was recorded on all patients with assault trauma attending Quthing District Hospital. The annual incidence rate of assault on men between 20 and 49, the most affected age group, was estimated to be as high as 30 per 1000. The crude homicide rate could reliably be calculated as 44 per 100,000 per year. The male to female sex ratio amongst the 506 identified victims was 1.7:1. The assailants were male in 89% of the incidents; other men were their victim in 68% of these events. Only 26% of the consulting women suffered at the hands of their husband or partner. Over 55% of injuries (and deaths) inflicted by men were caused by beating with traditional sticks; 15% were due to stabbing. Women used stones, teeth or bare hands and feet equally frequently. The limited presence of firearms may have prevented higher death rates. It is suggested that the disruption of the social structure of the Basotho society through its dependence on migrant labour leads to weakened normative reference, the moral net, which is the underlying cause for the serious violence problem of the country.

The majority legal status of women in southern Africa: implications for women and families.

PubMed

Van Hook, M P; Ngwenya, B N

1996-01-01

The introduction to this article, which provides an overview of the legal status of women in southern Africa, notes that the legal majority status of women is an important social policy issue with broad implications for the socioeconomic welfare of women and their families. The dual legal system (general law and customary law) which arose from colonization is a complicating factor in the legal life of women in the region. The colonial legal system legitimized the subordination of women, and during the colonial period the customary system was reinvented to the detriment of women by male African leaders working in collusion with colonial authorities. The next section of this article presents a brief description of the legal standing of women in terms of majority/minority status, marriage arrangements, and right to own immovable property in the states of Botswana, Lesotho, South Africa, Swaziland, Zambia, and Zimbabwe. The implications of the majority/minority status of women are then explored through consideration of the economic effects of majority rights, of family relationships, and of efforts to change the legal system (by changing the content and implementation of laws and by empowering women to take advantage of their rights). The barriers that impede women from asserting their rights point to the need for removal of broad-based economic, educational, and cultural constraints. Granting majority rights is an important step toward the goals of eliminating poverty and ending the marginalization of women.

Dynamic Locomotor Capabilities Revealed by Early Dinosaur Trackmakers from Southern Africa

PubMed Central

Wilson, Jeffrey A.; Marsicano, Claudia A.; Smith, Roger M. H.

2009-01-01

Background A new investigation of the sedimentology and ichnology of the Early Jurassic Moyeni tracksite in Lesotho, southern Africa has yielded new insights into the behavior and locomotor dynamics of early dinosaurs. Methodology/Principal Findings The tracksite is an ancient point bar preserving a heterogeneous substrate of varied consistency and inclination that includes a ripple-marked riverbed, a bar slope, and a stable algal-matted bar top surface. Several basal ornithischian dinosaurs and a single theropod dinosaur crossed its surface within days or perhaps weeks of one another, but responded to substrate heterogeneity differently. Whereas the theropod trackmaker accommodated sloping and slippery surfaces by gripping the substrate with its pedal claws, the basal ornithischian trackmakers adjusted to the terrain by changing between quadrupedal and bipedal stance, wide and narrow gauge limb support (abduction range = 31°), and plantigrade and digitigrade foot posture. Conclusions/Significance The locomotor adjustments coincide with changes in substrate consistency along the trackway and appear to reflect ‘real time’ responses to a complex terrain. It is proposed that these responses foreshadow important locomotor transformations characterizing the later evolution of the two main dinosaur lineages. Ornithischians, which shifted from bipedal to quadrupedal posture at least three times in their evolutionary history, are shown to have been capable of adopting both postures early in their evolutionary history. The substrate-gripping behavior demonstrated by the early theropod, in turn, is consistent with the hypothesized function of pedal claws in bird ancestors. PMID:19806213

Mobilising indigenous resources for anthropologically designed HIV-prevention and behaviour-change interventions in southern Africa.

PubMed

Green, Edward C; Dlamini, Cedza; D'Errico, Nicole C; Ruark, Allison; Duby, Zoe

2009-12-01

HIV prevention is often implemented as if African culture were either nonexistent or a series of obstacles to overcome in order to achieve an effective, gender-equitable, human rights-based set of interventions. Similarly, traditional or indigenous leaders, such as chiefs and members of royal families, have been largely excluded from HIV/AIDS responses in Africa. This qualitative study used focus group discussions and in-depth interviews with traditional leaders and 'ritual specialists' to better understand cultural patterns and ways of working with, rather than against, culture and traditional leaders in HIV-prevention efforts. The research was carried out in four southern African countries (Botswana, Lesotho, South Africa and Swaziland). The purpose was to discover what aspects of indigenous leadership and cultural resources might be accessed and developed to influence individual behaviour as well as the prevailing community norms, values, sanctions and social controls that are related to sexual behaviour. The indigenous leaders participating in the research largely felt bypassed and marginalised by organised efforts to prevent HIV infections and also believed that HIV-prevention programmes typically confronted, circumvented, criticised or condemned traditional culture. However, indigenous leaders may possess innovative ideas about ways to change individuals' sexual behaviour in general. The participants discussed ways to revive traditional social structures and cultural mechanisms as a means to incorporate HIV-prevention and gender-sensitivity training into existing cultural platforms, such as rites of passage, chiefs' councils and traditional courts.

Health governance: principal-agent linkages and health system strengthening.

PubMed

Brinkerhoff, Derick W; Bossert, Thomas J

2014-09-01

Governance is increasingly recognized as an important factor in health system performance, yet conceptually and practically it remains poorly understood and subject to often vague and competing notions of both what its role is and how to address its weaknesses. This overview article for the symposium on health governance presents a model of health governance that focuses on the multiplicity of societal actors in health systems, the distribution of roles and responsibilities among them and their ability and willingness to fulfil these roles and responsibilities. This focus highlights the principal-agent linkages among actors and the resulting incentives for good governance and health system performance. The discussion identifies three disconnects that constitute challenges for health system strengthening interventions that target improving governance: (1) the gap between the good governance agenda and existing capacities, (2) the discrepancy between formal and informal governance and (3) the inattention to sociopolitical power dynamics. The article summarizes the three country cases in the symposium and highlights their governance findings: health sector reform in China, financial management of health resources in Brazilian municipalities and budget reform in hospitals in Lesotho. The concluding sections clarify how the three cases apply the model's principal-agent linkages and highlight the importance of filling the gaps remaining between problem diagnosis and the development of practical guidance that supports 'best fit' solutions and accommodates political realities in health systems strengthening. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013; all rights reserved.

The Influence of Infant Feeding Practices on Infant Mortality in Southern Africa.

PubMed

Motsa, Lungile F; Ibisomi, Latifat; Odimegwu, Clifford

2016-10-01

Objective To examine the adjusted and unadjusted effects of infant feeding practices on infant mortality in Southern Africa. Methods A merged dataset from the most recent Demographic and Health Surveys for Lesotho, Swaziland, Zambia and Zimbabwe was analysed using the Cox Proportional Hazard Model. A total number of 13,218 infants born in 5 years preceding all the surveys with information on infant feeding practices constituted the study population. Infant mortality was the outcome variable and infant feeding practices categorised into; no breastfeeding, partial breastfeeding and exclusive breastfeeding were the main explanatory variables. Maternal demographic and socio-economic characteristics and infants' bio-demographic characteristics were also studied. Results Although, exclusive breastfeeding was quite low (12 %), exclusively breastfed infants exhibited a 97 % lower risk of dying during infancy compared to infants not breastfed in the region. Variations existed by country in the levels and patterns of both infant mortality and infant feeding practices. Mother's country, highest level of education and marital status; child's sex, birth weight and preceding birth interval were the significant predictors of infant mortality in Southern Africa. Conclusions Any form of breastfeeding whether exclusive or partial breastfeeding greatly reduces the risk of infant mortality with the greatest mortality reduction effect observed among exclusively breastfed infants in Southern Africa. To reduce the upsurge of infant mortality, there is the need to step up the effectiveness of child nutrition programmes that promote breastfeeding and put emphasis on exclusive breastfeeding of infants in the region.

EXPERIENCES OF HIV/AIDS STIGMA OF PERSONS LIVING WITH HIV/AIDS AND NURSES INVOLVED IN THEIR CARE FROM FIVE AFRICAN COUNTRIES

PubMed Central

Greeff, Minrie; Uys, Leana R; Holzemer, William L; Makoae, Lucia N; Dlamini, Priscilla S; Kohi, Thecla W; Chirwa, Maureen L; Naidoo, Joanne R; Phetlhu, Rene D.

2009-01-01

The concept of stigma has received significant attention in recent years in the HIV/AIDS literature. Although there is some change towards the positive, AIDS still remains a significantly stigmatized condition. AIDS stigma and discrimination continue to influence people living with and affected by HIV (PLWA), as well as their health-care providers. Unless stigma is conquered, the illness will not be defeated. Due to the burden that HIV/AIDS places on people living in Africa, a five-year project entitled Perceived AIDS Stigma: A Multinational African Study was undertaken. The focus of the first phase of this project was on exploring and describing the meaning and effect of stigma on PLWA from the experiences of PLWA and the nurses involved in their care in five African countries: Lesotho, Swaziland, Malawi, South Africa and Tanzania. An exploratory descriptive qualitative research design was used to explore and describe the experience of stigma through the critical incident method. Purposive voluntary sampling was utilized. Forty-three focus group discussions were held with respondents to relate incidences which they themselves observed, as well as those that they themselves experienced in the community and in families. The transcribed data was analyzed through the technique of open coding using the NVivo 2.0 analysis package. Three types of stigma (received stigma, internal stigma and associated stigma) and several dimensions for each of these types of stigma emerged from the data. Recommendations were made to pursue these findings further. PMID:20052299

Distribution and diversity of Russian wheat aphid (Hemiptera: Aphididae) biotypes in South Africa and Lesotho.

PubMed

Jankielsohn, Astrid

2011-10-01

Russian wheat aphid, Diuraphis noxia (Kurdjumov) (Hemiptera: Aphididae) was recorded for the first time in South Africa in 1978. In 2005, a second biotype, RWASA2, emerged, and here we report on the emergence of yet another biotype, found for the first time in 2009. The discovery of new Russian wheat aphid biotypes is a significant challenge to the wheat, Triticum aestivum L., industry in South Africa. Russian wheat aphid resistance in wheat, that offered wheat producers a long-term solution to Russian wheat aphid control, may no longer be effective in areas where the new biotypes occur. It is therefore critical to determine the diversity and extent of distribution of biotypes in South Africa to successfully deploy Russian wheat aphid resistance in wheat. Screening of 96 Russian wheat aphid clones resulted in identification of three Russian wheat aphid biotypes. Infestations of RWASA1 caused susceptible damage symptoms only in wheat entries containing the Dn3 gene. Infestations of RWASA2 caused susceptible damage symptoms in wheat entries containing Dn1, Dn2, Dn3, and Dn9 resistant genes. Based on the damage-rating scores for the seven resistance sources, a new biotype, which caused damage rating scores different from those for RWASA1 and RWASA2, was evident among the Russian wheat aphid populations tested. This new biotype is virulent to the same resistance sources as RWASA2 (Dn1, Dn2, Dn3, and Dn9), but it also has added virulence to Dn4, whereas RWASA2 is avirulent to this resistance source.

Alien Phytogeographic Regions of Southern Africa: Numerical Classification, Possible Drivers, and Regional Threats

PubMed Central

Hugo, Sanet; Van Rensburg, Berndt J.; Van Wyk, Abraham E.; Steenkamp, Yolande

2012-01-01

The distributions of naturalised alien plant species that have invaded natural or semi-natural habitat are often geographically restricted by the environmental conditions in their new range, implying that alien species with similar environmental requirements and tolerances may form assemblages and characterise particular areas. The aim of this study was to use objective numerical techniques to reveal any possible alien phytogeographic regions (i.e. geographic areas with characteristic alien plant assemblages) in southern Africa. Quarter degree resolution presence records of naturalised alien plant species of South Africa, Lesotho, Swaziland, Namibia and Botswana were analysed through a divisive hierarchical classification technique, and the output was plotted on maps for further interpretation. The analyses revealed two main alien phytogeographic regions that could be subdivided into eight lower level phytogeographic regions. Along with knowledge of the environmental requirements of the characteristic species and supported by further statistical analyses, we hypothesised on the main drivers of alien phytogeographic regions, and suggest that environmental features such as climate and associated biomes were most important, followed by human activities that modify climatic and vegetation features, such as irrigation and agriculture. Most of the characteristic species are not currently well-known as invasive plant species, but many may have potential to become troublesome in the future. Considering the possibility of biotic homogenization, these findings have implications for predicting the characteristics of the plant assemblages of the future. However, the relatively low quality of the dataset necessitates further more in-depth studies with improved data before the findings could be directly beneficial for management. PMID:22574145

Sustaining the future of HIV counselling to reach 90-90-90: a regional country analysis.

PubMed

Bemelmans, Marielle; Baert, Saar; Negussie, Eyerusalem; Bygrave, Helen; Biot, Marc; Jamet, Christine; Ellman, Tom; Banda, Amanda; van den Akker, Thomas; Ford, Nathan

2016-01-01

Counselling services are recommended by the World Health Organization and have been partially adopted by national HIV guidelines. In settings with a high HIV burden, patient education and counselling is often performed by lay workers, mainly supported with international funding. There are few examples where ministries of health have been able to absorb lay counsellors into their health systems or otherwise sustain their work. We document the role of lay cadres involved in HIV testing and counselling and adherence support and discuss approaches to sustainability. We focused on a purposive sample of eight sub-Saharan African countries where Médecins Sans Frontières supports HIV programmes: Guinea, Lesotho, Malawi, Mozambique, South Africa, Swaziland, Zambia and Zimbabwe. We reviewed both published and grey literature, including national policies and donor proposals, and interviewed key informants, including relevant government staff, donors and non-governmental organizations. Lay counsellors play a critical role in scaling up HIV services and addressing gaps in the HIV testing and treatment cascade by providing HIV testing and counselling and adherence support at both the facility and community levels. Countries have taken various steps in recognizing lay counsellors, including harmonizing training, job descriptions and support structures. However, formal integration of this cadre into national health systems is limited, as lay counsellors are usually not included in national strategies or budgeting. The current trend of reduced donor support for lay counsellors, combined with lack of national prioritization, threatens the sustainability of this cadre and thereby quality HIV service delivery.

Diversity and biogeographical patterns of legumes (Leguminosae) indigenous to southern Africa

PubMed Central

Trytsman, Marike; Westfall, Robert H.; Breytenbach, Philippus J. J.; Calitz, Frikkie J.; van Wyk, Abraham E.

2016-01-01

Abstract The principal aim of this study was to establish biogeographical patterns in the legume flora of southern Africa so as to facilitate the selection of species with agricultural potential. Plant collection data from the National Herbarium, South Africa, were analysed to establish the diversity and areas covered by legumes (Leguminosae/Fabaceae) indigenous to South Africa, Lesotho and Swaziland. A total of 27,322 records from 1,619 quarter degree grid cells, representing 1,580 species, 122 genera and 24 tribes were included in the analyses. Agglomerative hierarchical clustering was applied to the presence or absence of legume species in quarter degree grid cells, the resultant natural biogeographical regions (choria) being referred to as leguminochoria. The description of the 16 uniquely formed leguminochoria focuses on defining the associated bioregions and biomes, as well as on the key climate and soil properties. Legume species with a high occurrence in a leguminochorion are listed as key species. The dominant growth form of key species, species richness and range within each leguminochorion is discussed. Floristic links between the leguminochoria are established, by examining and comparing key species common to clusters, using a vegetation classification program. Soil pH and mean annual minimum temperature were found to be the main drivers for distinguishing among legume assemblages. This is the first time that distribution data for legumes has been used to identify biogeographical areas covered by leguminochoria on the subcontinent. One potential application of the results of this study is to assist in the selection of legumes for pasture breeding and soil conservation programs, especially in arid and semi-arid environments. PMID:27829799

TYPES OF ALBINISM IN THE BLACK SOUTHERN AFRICA POPULATION.

PubMed

Kromberg, J G R; Bothwell, J; Kidson, S H; Manga, P; Kerr, R; Jenkins, T

2012-01-01

Oculocutaneous albinism (OCA) is the most common inherited disorder in Southern African blacks and several types have been described. Molecular techniques, where available, can be used to confirm a clinical diagnosis and the type of OCA, if necessary, and for prenatal diagnosis. To investigate and classify the different types of albinism commonly found and to determine the clinical implications for each type. A descriptive survey. Gauteng province, South Africa, and Lesotho. Three groups of subjects with OCA (96 from a genetics clinic, 62 from a dermatology clinic, and 31 from community surveys) from the black African population participated. Subjects underwent clinical and/or dermatological examinations and were then classified according to type of OCA. Four forms of OCA were identified: most (82%) subjects had OCA2 (a tyrosinase- positive type) with three sub-types: those without large freckles (ephelides) on exposed areas (named OCA 2a in this study), those with such freckles (named OCA 2b), and those with brown albinism (BOCA); the remainder had red/rufous albinism, ROCA (OCA 3). The four forms could be distinguished from each other clinically without using molecular genetic testing. The most common types of albinism found in the black population of Southern Africa are OCA2 and OCA3. Given the high prevalence of the disorder, together with the high risk of skin cancer, and the recent persecution of affected individuals in certain East African countries, these findings and their clinical implications have significance in terms of both education and awareness for health professionals and lay people caring for those with albinism.

Reflections on the maternal mortality millennium goal.

PubMed

Lawson, Gerald W; Keirse, Marc J N C

2013-06-01

Nearly every 2 minutes, somewhere in the world, a woman dies because of complications of pregnancy and childbirth. Every such death is an overwhelming catastrophe for everyone confronted with it. Most deaths occur in developing countries, especially in Africa and southern Asia, but a significant number also occur in the developed world. We examined the available data on the progress and the challenges to the United Nations' fifth Millennium Development Goal of achieving a 75 percent worldwide reduction in the maternal mortality by 2015 from what it was in 1990. Some countries, such as Belarus, Egypt, Estonia, Honduras, Iran, Lithuania, Malaysia, Romania, Sri Lanka and Thailand, are likely to meet the target by 2015. Many poor countries with weak health infrastructures and high fertility rates are unlikely to meet the goal. Some, such as Botswana, Cameroon, Chad, Congo, Guyana, Lesotho, Namibia, Somalia, South Africa, Swaziland and Zimbabwe, had worse maternal mortality ratios in 2010 than in 1990, partially because of wars and civil strife. Worldwide, the leading causes of maternal death are still hemorrhage, hypertension, sepsis, obstructed labor, and unsafe abortions, while indirect causes are gaining in importance in developed countries. Maternal death is especially distressing if it was potentially preventable. However, as there is no single cause, there is no silver bullet to correct the problem. Many countries also face new challenges as their childbearing population is growing in age and in weight. Much remains to be done to make safe motherhood a reality. © 2013, Copyright the Authors, Journal compilation © 2013, Wiley Periodicals, Inc.

Evaluation of the community response to HIV and AIDS: learning from a portfolio approach.

PubMed

Rodriguez-García, Rosalía; Wilson, David; York, Nick; Low, Corinne; N'Jie, N'Della; Bonnel, Rene

2013-01-01

While communities have played a large role in the HIV/AIDS response, their contributions and innovative approaches to HIV prevention, treatment, care and support have not always been the focus of systematic and rigorous evaluations. To address this gap, the World Bank led an evaluation of the impact of the community response to HIV, including country studies in Burkina Faso, India, Kenya, Lesotho, Nigeria, Senegal, South Africa and Zimbabwe over a three-year period. Due to the complexity and varied nature of community responses, the evaluation attempted to determine the results that investments have produced at the community level by applying a mixed method approach: Randomized Controlled Trials, quasi-experimental studies, qualitative studies and analytical studies including financial data. Specifically, the studies examined a typology of community response and the flow of funds to community-based organizations, while investigating the impact of the community responses on (1) knowledge and behavior, (2) use of services, (3) social transformation, and (4) HIV incidence. This editorial summarizes the results of this evaluation portfolio, finding that investments in communities have produced significant results, including, improved knowledge and behavior, and increased use of health services, and even decreased HIV incidence. Evidence on social transformation was more mixed, with community groups found to be effective only in some settings. Each study in the evaluation provides a partial view of how communities shape the local response; however, taken together they corroborate the common wisdom that communities can be a vital part of the global HIV/AIDS response.

Diversity and biogeographical patterns of legumes (Leguminosae) indigenous to southern Africa.

PubMed

Trytsman, Marike; Westfall, Robert H; Breytenbach, Philippus J J; Calitz, Frikkie J; van Wyk, Abraham E

2016-01-01

The principal aim of this study was to establish biogeographical patterns in the legume flora of southern Africa so as to facilitate the selection of species with agricultural potential. Plant collection data from the National Herbarium, South Africa, were analysed to establish the diversity and areas covered by legumes (Leguminosae/Fabaceae) indigenous to South Africa, Lesotho and Swaziland. A total of 27,322 records from 1,619 quarter degree grid cells, representing 1,580 species, 122 genera and 24 tribes were included in the analyses. Agglomerative hierarchical clustering was applied to the presence or absence of legume species in quarter degree grid cells, the resultant natural biogeographical regions (choria) being referred to as leguminochoria. The description of the 16 uniquely formed leguminochoria focuses on defining the associated bioregions and biomes, as well as on the key climate and soil properties. Legume species with a high occurrence in a leguminochorion are listed as key species. The dominant growth form of key species, species richness and range within each leguminochorion is discussed. Floristic links between the leguminochoria are established, by examining and comparing key species common to clusters, using a vegetation classification program. Soil pH and mean annual minimum temperature were found to be the main drivers for distinguishing among legume assemblages. This is the first time that distribution data for legumes has been used to identify biogeographical areas covered by leguminochoria on the subcontinent. One potential application of the results of this study is to assist in the selection of legumes for pasture breeding and soil conservation programs, especially in arid and semi-arid environments.

Control of hypertension with medication: a comparative analysis of national surveys in 20 countries.

PubMed

Ikeda, Nayu; Sapienza, David; Guerrero, Ramiro; Aekplakorn, Wichai; Naghavi, Mohsen; Mokdad, Ali H; Lozano, Rafael; Murray, Christopher J L; Lim, Stephen S

2014-01-01

To examine hypertension management across countries and over time using consistent and comparable methods. A systematic search identified nationally representative health examination surveys from 20 countries containing data from 1980 to 2011 on blood pressure measurements, the diagnosis and treatment of hypertension and its control with antihypertensive drugs. For each country, the prevalence of hypertension (i.e. systolic blood pressure ≥ 140 mmHg or antihypertensive use) and the proportion of hypertensive individuals whose condition was diagnosed, treated or controlled with medications (i.e. systolic pressure < 140 mmHg) were estimated. The age-standardized prevalence of hypertension varied between countries: for individuals aged 35 to 49 years, it ranged from around 12% in Bangladesh, Egypt and Thailand to around 30% in Armenia, Lesotho and Ukraine; for those aged 35 to 84 years, it ranged from 20% in Bangladesh to more than 40% in Germany, the Russian Federation and Turkey. The age-standardized percentage of hypertensive individuals whose condition was diagnosed, treated or controlled was highest in the United States of America: for those aged 35 to 49 years, it was 84%, 77% and 56%, respectively. Percentages were especially low in Albania, Armenia, the Islamic Republic of Iran and Turkey. Although recent trends in prevalence differed in England, Japan and the United States, treatment coverage and hypertension control improved over time, particularly in England. Globally the proportion of hypertensive individuals whose condition is treated or controlled with medication remains low. Greater efforts are needed to improve hypertension control, which would reduce the burden of noncommunicable diseases.

Tropical Africa: Land use, biomass, and carbon estimates for 1980

DOE Office of Scientific and Technical Information (OSTI.GOV)

Brown, S.; Gaston, G.; Daniels, R.C.

1996-06-01

This document describes the contents of a digital database containing maximum potential aboveground biomass, land use, and estimated biomass and carbon data for 1980 and describes a methodology that may be used to extend this data set to 1990 and beyond based on population and land cover data. The biomass data and carbon estimates are for woody vegetation in Tropical Africa. These data were collected to reduce the uncertainty associated with the possible magnitude of historical releases of carbon from land use change. Tropical Africa is defined here as encompassing 22.7 x 10{sup 6} km{sup 2} of the earth`s landmore » surface and includes those countries that for the most part are located in Tropical Africa. Countries bordering the Mediterranean Sea and in southern Africa (i.e., Egypt, Libya, Tunisia, Algeria, Morocco, South Africa, Lesotho, Swaziland, and Western Sahara) have maximum potential biomass and land cover information but do not have biomass or carbon estimate. The database was developed using the GRID module in the ARC/INFO{sup TM} geographic information system. Source data were obtained from the Food and Agriculture Organization (FAO), the U.S. National Geophysical Data Center, and a limited number of biomass-carbon density case studies. These data were used to derive the maximum potential and actual (ca. 1980) aboveground biomass-carbon values at regional and country levels. The land-use data provided were derived from a vegetation map originally produced for the FAO by the International Institute of Vegetation Mapping, Toulouse, France.« less

"It Keeps Us from Putting Drugs in Pockets": How a Public-Private Partnership for Hospital Management May Help Curb Corruption.

PubMed

Vian, Taryn; Mcintosh, Nathalie; Grabowski, Aria

2017-01-01

Health care sector corruption diverts resources that could otherwise be used to improve access to health services. Use of private-sector practices such as a public-private partnership (PPP) model for hospital governance and management may reduce corruption. In 2011, a government-run hospital in Lesotho was replaced by a PPP hospital, offering an opportunity to compare hospital systems and practices. To assess whether a PPP model in a hospital can help curb corruption. We conducted 36 semistructured interviews with key informants between February 2013 and April 2013. We asked about hospital operations and practices at the government-run and PPP hospitals. We performed content analysis of interview data using a priori codes derived from the Corruption in the Health Sector framework and compared themes related with corruption between the hospitals. Corrupt practices that were described at the government-run hospital (theft, absenteeism, and shirking) were absent in the PPP hospital. In the PPP hospital, anticorruption mechanisms (controls on discretion, transparency, accountability, and detection and enforcement) were described in four management subsystems: human resources, facility and equipment management, drug supply, and security. The PPP hospital appeared to reduce corruption by controlling discretion and increasing accountability, transparency, and detection and enforcement. Changes imposed new norms that supported personal responsibility and minimized opportunities, incentives, and pressures to engage in corrupt practices. By implementing private-sector management practices, a PPP model for hospital governance and management may curb corruption. To assess the feasibility of a PPP, administrators should account for cost savings resulting from reduced corruption.

The impact of taking or not taking ARVs on HIV stigma as reported by persons living with HIV infection in five African countries.

PubMed

Makoae, Lucy N; Portillo, Carmen J; Uys, Leana R; Dlamini, Priscilla S; Greeff, Minrie; Chirwa, Maureen; Kohi, Thecla W; Naidoo, Joanne; Mullan, Joseph; Wantland, Dean; Durrheim, Kevin; Holzemer, William L

2009-11-01

This study examined the impact of taking or not taking antiretroviral (ARV) medications on stigma, as reported by people living with HIV infection in five African countries. A two group (taking or not taking ARVs) by three (time) repeated measures analysis of variance examined change in reported stigma in a cohort sample of 1454 persons living with HIV infection in Lesotho, Malawi, South Africa, Swaziland, and Tanzania. Participants self-reported taking ARV medications and completed a standardized stigma scale validated in the African context. Data were collected at three points in time, from January 2006 to March 2007. Participants taking ARV medications self-reported a mean CD4 count of 273 and those not taking ARVs self-reported a mean CD4 count of 418. Both groups reported significant decreases in total HIV stigma over time; however, people taking ARVs reported significantly higher stigma at Time 3 compared to those not taking ARVs. This study documents that this sample of 1454 HIV infected persons in five countries in Africa reported significantly less HIV stigma over time. In addition, those participants taking ARV medications experienced significantly higher HIV stigma over time compared to those not taking ARVs. This finding contradicts some authors' opinions that when clients enroll in ARV medication treatment it signifies that they are experiencing less stigma. This work provides caution to health care providers to alert clients new to ARV treatment that they may experience more stigma from their families and communities when they learn they are taking ARV medications.

Do unsafe tetanus toxoid injections play a significant role in the transmission of HIV/AIDS? Evidence from seven African countries.

PubMed

de Walque, D

2008-04-01

Although sexual transmission is generally considered to be the main factor driving the HIV/AIDS epidemic in Africa, recent studies have claimed that iatrogenic transmission should be considered as an important source of HIV infection. In particular, receipt of tetanus toxoid injections during pregnancy has been reported to be associated with HIV infection in Kenya. The objective of this paper is to assess the robustness of this association among women in nationally representative HIV surveys in seven African countries. The association between prophylactic tetanus toxoid injections during pregnancy and HIV infection was analysed, using individual-level data from women who gave birth in the past five years. These data are from the nationally representative Demographic and Health Surveys, which included HIV testing in seven African countries: Burkina Faso 2003 (N = 2424), Cameroon 2004 (N = 2600), Ethiopia 2005 (N = 2886), Ghana 2003 (N = 2560), Kenya 2003 (N = 1617), Lesotho 2004 (N = 1278) and Senegal 2005 (N = 2126). Once the odds ratios (OR) were adjusted for five-year age groups and for ethnic, urban and regional indicators, the association between prophylactic tetanus toxoid injections during pregnancy and HIV infection was never statistically significant in any of the seven countries. Only in Cameroon was there an association between previous tetanus toxoid injection and HIV positivity but it became weaker (OR 1.53, 95% CI 0.91 to 2.57) once urban location and ethnic group were adjusted for. Although the risk of HIV infection through unsafe injections and healthcare should not be ignored and should be reduced, it does not seem that there is, at present and in the seven countries studied, strong evidence supporting the claim that unsafe tetanus toxoid injections are a major factor driving the HIV epidemic.

Nd-isotopes in selected mantle-derived rocks and minerals and their implications for mantle evolution

USGS Publications Warehouse

Basu, A.R.; Tatsumoto, M.

1980-01-01

The Sm-Nd systematics in a variety of mantle-derived samples including kimberlites, alnoite, carbonatite, pyroxene and amphibole inclusions in alkali basalts and xenolithic eclogites, granulites and a pyroxene megacryst in kimberlites are reported. The additional data on kimberlites strengthen our earlier conclusion that kimberlites are derived from a relatively undifferentiated chondritic mantle source. This conclusion is based on the observation that the e{open}Nd values of most of the kimberlites are near zero. In contrast with the kimberlites, their garnet lherzolite inclusions show both time-averaged Nd enrichment and depletion with respect to Sm. Separated clinopyroxenes in eclogite xenoliths from the Roberts Victor kimberlite pipe show both positive and negative e{open}Nd values suggesting different genetic history. A whole rock lower crustal scapolite granulite xenolith from the Matsoku kimberlite pipe shows a negative e{open}Nd value of -4.2, possibly representative of the base of the crust in Lesotho. It appears that all inclusions, mafic and ultramafic, in kimberlites are unrelated to their kimberlite host. The above data and additional Sm-Nd data on xenoliths in alkali basalts, alpine peridotite and alnoite-carbonatites are used to construct a model for the upper 200 km of the earth's mantle - both oceanic and continental. The essential feature of this model is the increasing degree of fertility of the mantle with depth. The kimberlite's source at depths below 200 km in the subcontinental mantle is the most primitive in this model, and this primitive layer is also extended to the suboceanic mantle. However, it is clear from the Nd-isotopic data in the xenoliths of the continental kimberlites that above 200 km the continental mantle is distinctly different from their suboceanic counterpart. ?? 1980 Springer-Verlag.

“It Keeps Us from Putting Drugs in Pockets”: How a Public-Private Partnership for Hospital Management May Help Curb Corruption

PubMed Central

Vian, Taryn; McIntosh, Nathalie; Grabowski, Aria

2017-01-01

Introduction Health care sector corruption diverts resources that could otherwise be used to improve access to health services. Use of private-sector practices such as a public-private partnership (PPP) model for hospital governance and management may reduce corruption. In 2011, a government-run hospital in Lesotho was replaced by a PPP hospital, offering an opportunity to compare hospital systems and practices. Objective To assess whether a PPP model in a hospital can help curb corruption. Methods We conducted 36 semistructured interviews with key informants between February 2013 and April 2013. We asked about hospital operations and practices at the government-run and PPP hospitals. We performed content analysis of interview data using a priori codes derived from the Corruption in the Health Sector framework and compared themes related with corruption between the hospitals. Results Corrupt practices that were described at the government-run hospital (theft, absenteeism, and shirking) were absent in the PPP hospital. In the PPP hospital, anticorruption mechanisms (controls on discretion, transparency, accountability, and detection and enforcement) were described in four management subsystems: human resources, facility and equipment management, drug supply, and security. Conclusion The PPP hospital appeared to reduce corruption by controlling discretion and increasing accountability, transparency, and detection and enforcement. Changes imposed new norms that supported personal responsibility and minimized opportunities, incentives, and pressures to engage in corrupt practices. By implementing private-sector management practices, a PPP model for hospital governance and management may curb corruption. To assess the feasibility of a PPP, administrators should account for cost savings resulting from reduced corruption. PMID:28746025

A regional-scale ecological risk framework for environmental flow evaluations

NASA Astrophysics Data System (ADS)

O'Brien, Gordon C.; Dickens, Chris; Hines, Eleanor; Wepener, Victor; Stassen, Retha; Quayle, Leo; Fouchy, Kelly; MacKenzie, James; Graham, P. Mark; Landis, Wayne G.

2018-02-01

Environmental flow (E-flow) frameworks advocate holistic, regional-scale, probabilistic E-flow assessments that consider flow and non-flow drivers of change in a socio-ecological context as best practice. Regional-scale ecological risk assessments of multiple stressors to social and ecological endpoints, which address ecosystem dynamism, have been undertaken internationally at different spatial scales using the relative-risk model since the mid-1990s. With the recent incorporation of Bayesian belief networks into the relative-risk model, a robust regional-scale ecological risk assessment approach is available that can contribute to achieving the best practice recommendations of E-flow frameworks. PROBFLO is a holistic E-flow assessment method that incorporates the relative-risk model and Bayesian belief networks (BN-RRM) into a transparent probabilistic modelling tool that addresses uncertainty explicitly. PROBFLO has been developed to evaluate the socio-ecological consequences of historical, current and future water resource use scenarios and generate E-flow requirements on regional spatial scales. The approach has been implemented in two regional-scale case studies in Africa where its flexibility and functionality has been demonstrated. In both case studies the evidence-based outcomes facilitated informed environmental management decision making, with trade-off considerations in the context of social and ecological aspirations. This paper presents the PROBFLO approach as applied to the Senqu River catchment in Lesotho and further developments and application in the Mara River catchment in Kenya and Tanzania. The 10 BN-RRM procedural steps incorporated in PROBFLO are demonstrated with examples from both case studies. PROBFLO can contribute to the adaptive management of water resources and contribute to the allocation of resources for sustainable use of resources and address protection requirements.

Land cover mapping for development planning in Eastern and Southern Africa

NASA Astrophysics Data System (ADS)

Oduor, P.; Flores Cordova, A. I.; Wakhayanga, J. A.; Kiema, J.; Farah, H.; Mugo, R. M.; Wahome, A.; Limaye, A. S.; Irwin, D.

2016-12-01

Africa continues to experience intensification of land use, driven by competition for resources and a growing population. Land cover maps are some of the fundamental datasets required by numerous stakeholders to inform a number of development decisions. For instance, they can be integrated with other datasets to create value added products such as vulnerability impact assessment maps, and natural capital accounting products. In addition, land cover maps are used as inputs into Greenhouse Gas (GHG) inventories to inform the Agriculture, Forestry and other Land Use (AFOLU) sector. However, the processes and methodologies of creating land cover maps consistent with international and national land cover classification schemes can be challenging, especially in developing countries where skills, hardware and software resources can be limiting. To meet this need, SERVIR Eastern and Southern Africa developed methodologies and stakeholder engagement processes that led to a successful initiative in which land cover maps for 9 countries (Malawi, Rwanda, Namibia, Botswana, Lesotho, Ethiopia, Uganda, Zambia and Tanzania) were developed, using 2 major classification schemes. The first sets of maps were developed based on an internationally acceptable classification system, while the second sets of maps were based on a nationally defined classification system. The mapping process benefited from reviews from national experts and also from technical advisory groups. The maps have found diverse uses, among them the definition of the Forest Reference Levels in Zambia. In Ethiopia, the maps have been endorsed by the national mapping agency as part of national data. The data for Rwanda is being used to inform the Natural Capital Accounting process, through the WAVES program, a World Bank Initiative. This work illustrates the methodologies and stakeholder engagement processes that brought success to this land cover mapping initiative.

Integrated package approach in delivering interventions during immunisation campaigns in a complex environment in Papua New Guinea: a case study.

PubMed

Vince, John David; Datta, Siddhartha Sankar; Toikilik, Steven; Lagani, William

2014-08-06

Papua New Guinea's difficult and varied topography, poor transport infrastructure, changing dynamics of population and economy in recent times and understaffed and poorly financed health service present major challenges for successful delivery of vaccination and other preventative health interventions to both the rural majority and urban populations, thereby posing risks for vaccine preventable disease outbreaks in the country. The country has struggled to meet the vaccination coverage targets required for the eradication of poliomyelitis and elimination of measles. Escalation of inter and intra country migration resulting from major industrial developments, particularly in extraction industries, has substantially increased the risk of infectious disease importation. This case study documents the evolution of immunisation programmes since the introduction of supplementary immunisation activities (SIAs). Single antigen SIAs have advantages and disadvantages. In situations in which the delivery of preventative health interventions is difficult, it is likely that the cost benefit is greater for multiple than for single intervention. The lessons learned from the conduct of single antigen SIAs can be effectively used for programmes delivering multiple SIA antigens, routine immunisations, and other health interventions. This paper describes a successful and cost effective multiple intervention programme in Papua New Guinea. The review of the last SIA in Papua New Guinea showed relatively high coverage of all the interventions and demonstrated the operational feasibility of delivering multiple interventions in resource constrained settings. Studies in other developing countries such as Lesotho and Ethiopia have also successfully integrated health interventions with SIA. In settings such as Papua New Guinea there is a strong case for integrating supplementary immunisation activity with routine immunisation and other health interventions through a comprehensive outreach programme. Copyright © 2014 World Health Organization. Published by Elsevier Ltd.. All rights reserved.

The impact of water on dislocation content and slip system activity in olivine constrained by HR-EBSD and visco-plastic self-consistent simulations

NASA Astrophysics Data System (ADS)

Wallis, D.; Hansen, L. N.; Tasaka, M.; Kumamoto, K. M.; Lloyd, G. E.; Parsons, A. J.; Kohlstedt, D. L.; Wilkinson, A. J.

2016-12-01

Changes in concentration of H+ ions in olivine have impacts on its rheological behaviour and therefore on tectonic processes involving mantle deformation. Deformation experiments on aggregates of wet olivine exhibit different evolution of crystal preferred orientations (CPO) and substructure from experiments on dry olivine, suggesting that elevated H+ concentrations impact activity of dislocation slip-systems. We use high angular-resolution electron backscatter diffraction (HR-EBSD) to map densities of different types of geometrically necessary dislocations (GND) in polycrystalline olivine deformed experimentally under wet and dry conditions and also in nature. HR-EBSD provides unprecedented angular resolution, resolving misorientations < 0.01°. We also employ visco-plastic self-consistent (VPSC) simulations to investigate changes in slip-system activity. HR-EBSD maps from experimental samples demonstrate that olivine deformed under hydrous conditions contains higher proportions of (001)[100] and (100)[001] edge dislocations than olivine deformed under anhydrous conditions. Furthermore, maps of wet olivine exhibit more polygonal subgrain boundaries indicative of enhanced recovery by dislocation climb. VPSC simulations with low critical resolved shear stresses for the (001)[100] and (100)[001] slip systems reproduce an unusual CPO with bimodal maxima of both [100] and [001] observed in wet olivine aggregates. Analysis of a mylonitic lherzolite xenolith from Lesotho reveals the same unusual CPO and similar proportions of dislocation types to `wet' experimental samples, supporting the applicability of these findings to natural deformation conditions. These results support suggestions that H+ impacts the flow properties of olivine by altering dislocation activity and climb, while also providing full quantification of GND content. In particular, the relative proportions of dislocation types may provide a basis for identifying olivine deformed under wet and dry conditions.

Validation of the HIV/AIDS Stigma Instrument - PLWA (HASI-P).

PubMed

Holzemer, William L; Uys, Leana R; Chirwa, Maureen L; Greeff, Minrie; Makoae, Lucia N; Kohi, Thecla W; Dlamini, Priscilla S; Stewart, Anita L; Mullan, Joseph; Phetlhu, René D; Wantland, Dean; Durrheim, Kevin

2007-09-01

This article describes the development and testing of a quantitative measure of HIV/AIDS stigma as experienced by people living with HIV/AIDS. This instrument is designed to measure perceived stigma, create a baseline from which to measure changes in stigma over time, and track potential progress towards reducing stigma. It was developed in three phases from 2003-2006: generating items based on results of focus group discussions; pilot testing and reducing the original list of items; and validating the instrument. Data for all phases were collected from five African countries: Lesotho, Malawi, South Africa, Swaziland and Tanzania. The instrument was validated with a sample of 1,477 persons living with HIV/AIDS from all of the five countries. The sample had a mean age of 36.1 years and 74.1% was female. The participants reported they knew they were HIV positive for an average of 3.4 years and 46% of the sample was taking antiretroviral medications. A six factor solution with 33 items explained 60.72% of the variance. Scale alpha reliabilities were examined and items that did not contribute to scale reliability were dropped. The factors included: Verbal Abuse (8 items, alpha=0.886); Negative Self-Perception (5 items, alpha=0.906); Health Care Neglect (7 items, alpha=0.832); Social Isolation (5 items, alpha=0.890); Fear of Contagion (6 items, alpha=0.795); and Workplace Stigma (2 items, alpha=0.758). This article reports on the development and validation of a new measure of stigma, HIV/AIDS Stigma Instrument - PLWA (HASI-P) providing evidence that supports adequate content and construct validity, modest concurrent validity, and acceptable internal consistency reliability for each of the six subscales and total score. The scale is available is several African languages.

Health promotion strategies for families with adolescents orphaned by HIV and AIDS.

PubMed

Peu, M D

2014-06-01

This paper aims to explore and describe health promotion strategies for adolescents orphaned by human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), as well as the evaluation thereof. Among the Sub-Saharan countries, such as Swaziland, Botswana and Lesotho, South Africa is rated as fourth in the list of countries with the highest number of people living with HIV and AIDS. The study employed phenomenological qualitative design. The population consisted of the purposively selected health promoters working in the Hammanskraal region, directly and indirectly involved with families with adolescents orphaned by HIV and AIDS. Following the focus group interviews, data were analysed using the seven steps of Colaizzi. Four categories and eight subcategories were concluded as the strategies for adolescents orphaned by HIV and AIDS as well as the evaluation thereof. The main categories identified were: the door-to-door outcome, workshop outputs, statistical data and community projects. It is evident that the health promotion strategies informed by the four themes will be implemented. The outcomes may raise an awareness in the community, support families and provide statistics on the impact of HIV and AIDS on families. The study was limited to one subdistrict and to health promoters in a rural area, therefore the results cannot be generalized to all other subdistricts including health promoters, especially those in urban areas. The successful evaluation programme will pin out the strong points and challenges while assisting in improving the quality of work provided in the communities. Continuing professional and practice development are required to maintain the standard of health care in South Africa. Therefore the policymakers need to include relevant information regarding health promotion strategies in reducing the statistics of people living with HIV and AIDS. © 2014 International Council of Nurses.

Nutritional status of rural children in the Lesotho Highlands.

PubMed

Jooste, P L; Langenhoven, M L; Kriek, J A; Kunneke, E; Nyaphisi, M; Sharp, B

1997-11-01

A baseline cross-sectional study was done to evaluate the nutritional status of the population of the Mohale Dam catchment area before construction of the dam commenced. In this article we report on the anthropometric, clinical and dietary assessment of the children less than 15 years of age in the study population. A two stage stratified sampling technique was used to randomly select 29 of the 83 villages in the study area. Children under 15 years of age from 395 households, representing approximately 50% of households in the selected villages, were included in the study. Anthropometric measurements of body height and weight in relation to age and sex indicated undernutrition varying, with few exceptions, from high to very high levels in children under 15 years. Stunting, indicating chronic undernutrition, was of particular concern in children, even from the first year of life. Very few clinical signs of nutritional deficiencies were found except for a goitre prevalence of 17.5% in 10 to 14 year old children. This was supported by the very low urinary iodine excretion (median 1.3 micrograms/dL) which indicated a severe iodine deficiency. Dietary evaluation showed high initiation rates of breastfeeding as well as a long duration of breastfeeding. Complementary foods were introduced at an early age, resulting in low exclusive breastfeeding rates. Regular meals were reported but qualitative analysis of the diet showed that a too small variety of foods were eaten, with an irregular intake of protein-rich foods and milk. Quantitative data on 3- < 5-year-old children showed that micro-nutrient intakes were low and that the energy intake of these children was inadequate. The results showed that these nutritionally vulnerable children should be monitored for the impact of the dam construction on their nutritional status.

AZT Impairs Immunological Recovery on First-line ART: Collaborative analysis of cohort studies in Southern Africa

PubMed Central

WANDELER, Gilles; GSPONER, Thomas; MULENGA, Lloyd; GARONE, Daniela; WOOD, Robin; MASKEW, Mhairi; PROZESKY, Hans; HOFFMANN, Christopher; EHMER, Jochen; DICKINSON, Diana; DAVIES, Mary-Ann; EGGER, Matthias; KEISER, Olivia

2013-01-01

Objectives Zidovudine (AZT) is recommended for first-line antiretroviral therapy (ART) in resource limited settings. AZT may, however, lead to anemia and impaired immunological response. We compared CD4 counts over 5 years between patients starting ART with and without AZT in Southern Africa. Design Cohort study Methods Patients aged ≥16 years who started first-line ART in South Africa, Botswana, Zambia or Lesotho were included. We used linear mixed-effect models to compare CD4 cell count trajectories between patients on AZT-containing regimens and patients on other regimens, censoring follow-up at first treatment change. Impaired immunological recovery, defined as a CD4 count below 100 cells/μl at 1 year, was assessed in logistic regression. Analyses were adjusted for baseline CD4 count and haemoglobin level, age, gender, type of regimen, viral load monitoring and calendar year. Results 72,597 patients starting ART, including 19,758 (27.2%) on AZT, were analysed. Patients on AZT had higher CD4 cell counts (150 vs.128 cells/μl) and haemoglobin level (12.0 vs. 11.0 g/dl) at baseline, and were less likely to be female than those on other regimens. Adjusted differences in CD4 counts between regimens containing and not containing AZT were −16 cells/μl (95% CI −18 to −14) at 1 year and −56 cells/μl (95% CI −59 to −52) at 5 years. Impaired immunological recovery was more likely with AZT compared to other regimens (odds ratio 1.40, 95% CI 1.22–1.61). Conclusions In Southern Africa AZT is associated with inferior immunological recovery compared to other backbones. Replacing AZT with another NRTI could avoid unnecessary switches to second-line ART. PMID:23660577

Bibliometric trends of health economic evaluation in Sub-Saharan Africa.

PubMed

Hernandez-Villafuerte, Karla; Li, Ryan; Hofman, Karen J

2016-08-24

Collaboration between Sub-Saharan African researchers is important for the generation and transfer of health technology assessment (HTA) evidence, in order to support priority-setting in health. The objective of this analysis was to evaluate collaboration patterns between countries. We conducted a rapid evidence assessment that included a random sample of health economic evaluations carried out in 20 countries (Angola, Botswana, Congo, Lesotho, Madagascar, Malawi, Mauritius, Mozambique, Namibia, Seychelles, South Africa, Swaziland, Tanzania, Zambia, Zimbabwe, Ghana, Kenya, Nigeria, Ethiopia, Uganda). We conducted bibliometric network analysis based on all first authors with a Sub-Saharan African academic affiliation and their co-authored publications ("network-articles"). Then we produced a connection map of collaboration patterns among Sub-Saharan African researchers, reflecting the number of network-articles and the country of affiliation of the main co-authors. The sample of 119 economic evaluations mostly related to treatments of communicable diseases, in particular HIV/AIDS (42/119, 35.29 %) and malaria (26/119, 21.85 %). The 39 first authors from Sub-Saharan African institutions together co-authored 729 network-articles. The network analysis showed weak collaboration between health economic researchers in Sub-Saharan Africa, with researchers being more likely to collaborate with Europe and North America than with other African countries. South Africa stood out as producing the highest number of health economic evaluations and collaborations. The development and evaluation of HTA research networks in Sub-Saharan Africa should be supported, with South Africa central to any such efforts. Organizations and institutions from high income countries interested in supporting priority setting in Sub-Saharan Africa should include promoting collaboration as part of their agendas, in order to take advantage of the potential transferability of results and methods of the available health economic analyses in Africa and internationally.

Subcalcic diopsides from kimberlites: Chemistry, exsolution microstructures, and thermal history

USGS Publications Warehouse

McCallister, R.H.; Nord, G.L.

1981-01-01

Twenty-six subcalcic diopside megacrysts (Ca/(Ca+ Mg)) = 0.280-0.349, containing approximately 10 mol% jadeite, from 15 kimberlite bodies in South Africa, Botswana, Tanzania, and Lesotho, have been characterized by electron microprobe analysis, X-ray-precession photography, and transmission electron microscopy. Significant exsolution of pigeonite was observed only in those samples for which Ca/(Ca+Mg)???0.320. The exsolution microstructure consists of coherent (001) lamellae with wavelengths ranging from 20 to 31 nm and compositional differences between the hosts and lamellae ranging from 10 to 30 mol% wollastonite. These observations suggest that the exsolution reaction mechanism was spinodal decomposition and that the megacrysts have been quenched at various stages of completion of the decomposition process. Annealing experiments in evacuated SiO2 glass tubes at 1,150?? C for 128 hours failed to homogenize microstructure, whereas, at 5 kbar and 1,150?? C for only 7.25 hours, the two lattices were homogenized. This "pressure effect" suggests that spinodal decomposition in the kimberlitic subcalcic diopside megacrysts can only occur at depths less than ???15 km; the cause of the effect may be the jadeite component in the pyroxene. "Apparent quench" temperatures for the exsolution process in the megacrysts range from 1,250?? C to 990?? C, suggesting that decomposition must have commenced at temperatures of more than ???1,000?? C. These P-T limits lead to the conclusion that, in those kimberlites where spinodal decomposition has occurred in subcalcic diopside megacrysts, such decomposition occurred at shallow levels (<15 km) and, at the present erosion level, temperatures must have been greater than 1,000?? C. ?? 1981 Springer-Verlag.

The highly neglected burden of resistant hypertension in Africa: a systematic review and meta-analysis

PubMed Central

Nansseu, Jobert Richie N; Noubiap, Jean Jacques N; Mengnjo, Michel K; Aminde, Leopold Ndemnge; Essouma, Mickael; Jingi, Ahmadou M; Bigna, Jean Joel R

2016-01-01

Objective The hypertension epidemic in Africa collectively with very low rates of blood pressure control may predict an incremented prevalence of resistant hypertension (RH) across the continent. The aim of this study was to determine the prevalence of RH and associated risk factors in Africa. Data sources We conducted a comprehensive search of electronic databases (PubMed, EMBASE, Africa Wide Information and Africa Index Medicus) completed by manual search of articles, regardless of language or publication date. Methods We included studies which have reported the prevalence and/or risk factors for RH in Africa from inception to 19 May 2016. Forest plots were drawn to visualise the combined prevalence of RH and extent of statistical heterogeneity between studies. Results Out of 259 retrieved studies, only 5 from Cameroon, Nigeria, Burkina Faso, Lesotho and Algeria with a total population of 4 068 patients were finally included in this review. There was no study from the Eastern part of Africa. Though the definition of RH was not similar across studies, its prevalence was respectively 11.7%, 4.9%, 14.6%, 14.3% and 19.0%, with an overall pooled prevalence of 12.1% (95% CI 8.0% to 17.7%). Potential risk factors were: non-compliance to treatment, ageing, male sex, dyslipidaemia, metabolic syndrome, previous cardiovascular events, physical inactivity and stress, but not excessive salt intake, alcohol and coffee ingestions. Moreover, diabetes, smoking, obesity and renal insufficiency yielded discrepant results. Conclusions There is a huge dearth of research on the epidemiology of RH in Africa. Thereby, an extensive study of RH prevalence and risk factors is still largely warranted to curtail the high and continuously increasing burden of hypertension across Africa. PMID:27650760

Lessons learned from stakeholder-driven sustainability analysis of six national HIV programmes.

PubMed

Katz, Itamar; Glandon, Douglas; Wong, Wendy; Kargbo, Brima; Ombam, Regina; Singh, Shanti; Ramsammy, Leslie; Tal-Dia, Anta; Seck, Ibrahima; Osika, John S

2014-05-01

In light of the decline in donor HIV funding, HIV programmes increasingly need to assess their available and potential resources and maximize their utilization. This article presents lessons learned related to how countries have addressed the sustainability of HIV programmes in a stakeholder-driven sustainability analysis. During HIV/AIDS Programme Sustainability Analysis Tool (HAPSAT) applications in six countries (Benin, Guyana, Kenya, Lesotho, Sierra Leone and South Sudan), stakeholders identified key sustainability challenges for their HIV responses. Possible policy approaches were prepared, and those related to prioritization and resource mobilization are analysed in this article. The need to prioritize evidence-based interventions and apply efficiency measures is being accepted by countries. Five of the six countries in this study requested that the HAPSAT team prepare 'prioritization' strategies. Countries recognize the need to prepare for an alternative to 'universal access by 2015', acknowledging that their capacity might be insufficient to reach such high-coverage levels by then. There is further acceptance of the importance of reaching the most-at-risk, marginalized populations, as seen, for example, in South Sudan and Sierra Leone. However, the pace at which resources are shifting towards these populations is slow. Finally, only two of the six countries, Kenya and Benin, chose to examine options for generating additional financial resources beyond donor funding. In Kenya, three non-donor sources were recommended, yet even if all were to be implemented, it would cover only 25% of the funding needed. Countries are increasingly willing to address the challenges of HIV programme sustainability, yet in different ways and with varying urgency. To secure achievements made to date and maximize future impact, countries would benefit from strengthening their strategic plans, operational plans and funding proposals with concrete timelines and responsibilities for addressing sustainability issues.

A Temnospondyl Trackway from the Early Mesozoic of Western Gondwana and Its Implications for Basal Tetrapod Locomotion

PubMed Central

Marsicano, Claudia A.; Wilson, Jeffrey A.; Smith, Roger M. H.

2014-01-01

Background Temnospondyls are one of the earliest radiations of limbed vertebrates. Skeletal remains of more than 190 genera have been identified from late Paleozoic and early Mesozoic rocks. Paleozoic temnospondyls comprise mainly small to medium sized forms of diverse habits ranging from fully aquatic to fully terrestrial. Accordingly, their ichnological record includes tracks described from many Laurasian localities. Mesozoic temnospondyls, in contrast, include mostly medium to large aquatic or semi-aquatic forms. Exceedingly few fossil tracks or trackways have been attributed to Mesozoic temnospondyls, and as a consequence very little is known of their locomotor capabilities on land. Methodology/Principal Findings We report a ca. 200 Ma trackway, Episcopopus ventrosus, from Lesotho, southern Africa that was made by a 3.5 m-long animal. This relatively long trackway records the trackmaker dragging its body along a wet substrate using only the tips of its digits, which in the manus left characteristic drag marks. Based on detailed mapping, casting, and laser scanning of the best-preserved part of the trackway, we identified synapomorphies (e.g., tetradactyl manus, pentadactyl pes) and symplesiomorphies (e.g., absence of claws) in the Episcopopus trackway that indicate a temnospondyl trackmaker. Conclusions/Significance Our analysis shows that the Episcopopus trackmaker progressed with a sprawling posture, using a lateral-sequence walk. Its forelimbs were the major propulsive elements and there was little lateral bending of the trunk. We suggest this locomotor style, which differs dramatically from the hindlimb-driven locomotion of salamanders and other extant terrestrial tetrapods can be explained by the forwardly shifted center of mass resulting from the relatively large heads and heavily pectoral girdles of temnospondyls. PMID:25099971

Molecular phylogeny of the Afroedura nivaria (Reptilia: Gekkonidae) species complex in South Africa provides insight on cryptic speciation.

PubMed

Makhubo, Buyisile G; Tolley, Krystal A; Bates, Michael F

2015-01-01

The Afroedura nivaria species complex (A. nivaria, A. karroica, A. amatolica, A. tembulica and A. halli) is a morphologically conservative group of medium-sized flat geckos endemic to South Africa and Lesotho. Species are allopatric, as are some populations within species that are separated by large expanses of unsuitable habitat. Because of this isolation of populations we hypothesised that several cryptic species may be present. To investigate this hypothesis we constructed a molecular phylogeny using multiple markers, and included representatives of other Afroedura species. Bayesian inference and maximum likelihood analyses (439bp 16S, 593bp ND4, 948bp RAG1) strongly supported the genetic distinctiveness of the five described species. However, the A. nivaria species complex as currently described is not monophyletic, as A. karroica was positioned outside a clade containing all other Afroedura species, and A. pondolia (which was presumed to belong to a different species complex) was recovered within the A. nivaria complex. Several distinct clades within A. halli and A. nivaria were also recovered, and the narrowly-distributed A. amatolica consisted of two highly divergent clades. We also conducted a multivariate analysis using 19 morphological characters to investigate whether the clades recovered by the phylogeny were distinct in terms of head, body and limb shape. The analysis showed some variation between clades in terms of locomotor apparatus (forelimbs and feet), head and body dimensions, but overall the morphological differences were minor. This morphological conservatism in the A. nivaria complex may be a result of adaptation to similar microhabitats. Exclusive of A. karroica, the results suggest that there are at least nine species in this complex, of which four are cryptic and undescribed. Copyright © 2014 Elsevier Inc. All rights reserved.

The second Southern African Bird Atlas Project: Causes and consequences of geographical sampling bias.

PubMed

Hugo, Sanet; Altwegg, Res

2017-09-01

Using the Southern African Bird Atlas Project (SABAP2) as a case study, we examine the possible determinants of spatial bias in volunteer sampling effort and how well such biased data represent environmental gradients across the area covered by the atlas. For each province in South Africa, we used generalized linear mixed models to determine the combination of variables that explain spatial variation in sampling effort (number of visits per 5' × 5' grid cell, or "pentad"). The explanatory variables were distance to major road and exceptional birding locations or "sampling hubs," percentage cover of protected, urban, and cultivated area, and the climate variables mean annual precipitation, winter temperatures, and summer temperatures. Further, we used the climate variables and plant biomes to define subsets of pentads representing environmental zones across South Africa, Lesotho, and Swaziland. For each environmental zone, we quantified sampling intensity, and we assessed sampling completeness with species accumulation curves fitted to the asymptotic Lomolino model. Sampling effort was highest close to sampling hubs, major roads, urban areas, and protected areas. Cultivated area and the climate variables were less important. Further, environmental zones were not evenly represented by current data and the zones varied in the amount of sampling required representing the species that are present. SABAP2 volunteers' preferences in birding locations cause spatial bias in the dataset that should be taken into account when analyzing these data. Large parts of South Africa remain underrepresented, which may restrict the kind of ecological questions that may be addressed. However, sampling bias may be improved by directing volunteers toward undersampled regions while taking into account volunteer preferences.

Measles resurgence in southern Africa: challenges to measles elimination.

PubMed

Shibeshi, Messeret E; Masresha, Balcha G; Smit, Sheilagh B; Biellik, Robin J; Nicholson, Jennifer L; Muitherero, Charles; Shivute, Nestor; Walker, Oladapo; Reggis, Katsande; Goodson, James L

2014-04-01

In seven southern African countries (Botswana, Lesotho, Malawi, Namibia, South Africa, Swaziland and Zimbabwe), following implementation of a measles mortality reduction strategy starting in 1996, the number of annually reported measles cases decreased sharply to less than one per million population during 2006-2008. However, during 2009-2010, large outbreaks occurred in these countries. In 2011, a goal for measles elimination by 2020 was set in the World Health Organization (WHO) African Region (AFR). We reviewed the implementation of the measles control strategy and measles epidemiology during the resurgence in the seven southern African countries. Estimated coverage with routine measles vaccination, supplemental immunization activities (SIA), annually reported measles cases by country, and measles surveillance and laboratory data were analyzed using descriptive analysis. In the seven countries, coverage with the routine first dose of measles-containing vaccine (MCV1) decreased from 80% to 65% during 1996-2004, then increased to 84% in 2011; during 1996-2011, 79,696,523 people were reached with measles vaccination during 45 SIAs. Annually reported measles cases decreased from 61,160 cases to 60 cases and measles incidence decreased to <1 case per million during 1996-2008. During 2009-2010, large outbreaks that included cases among older children and adults were reported in all seven countries, starting in South Africa and Namibia in mid-2009 and in the other five countries by early 2010. The measles virus genotype detected was predominantly genotype B3. The measles resurgence highlighted challenges to achieving measles elimination in AFR by 2020. To achieve this goal, high two-dose measles vaccine coverage by strengthening routine immunization systems and conducting timely SIAs targeting expanded age groups, potentially including young adults, and maintaining outbreak preparedness to rapidly respond to outbreaks will be needed. Published by Elsevier Ltd.

Alien plant invasions--incorporating emerging invaders in regional prioritization: a pragmatic approach for Southern Africa.

PubMed

Mgidi, Theresa N; Le Maitre, David C; Schonegevel, Lucille; Nel, Jeanne L; Rouget, Mathieu; Richardson, David M

2007-07-01

Plant invasions are a serious threat to natural and semi-natural ecosystems worldwide. Most management-orientated research on invasions focuses on invaders that are already widespread and often have major impacts. This paper deals with "emerging" invaders-those alien species with the potential to become important problems without timely intervention. A climate matching procedure was developed to define areas of South Africa, Lesotho and Swaziland that could be invaded by 28 plant species that had previously been classified as emerging invaders. Information on the location of populations of these species in the study area was combined with information on their distributions (as native or alien) in parts of Australia and the United States of America. These two countries had the best available distribution data for this study. They also share many invasive alien plant species with South Africa. Climatic data obtained for weather stations near points of known occurrence in these countries were used to define the climatically suitable areas for each species in the study area. Almost 80% of the remaining natural environment in southern Africa was found to be vulnerable to invasion by at least one of these species, 50% by six or more and 24% by 16 or more species. The most vulnerable areas are the highveld grasslands and the eastern escarpment. The emerging invaders with the greatest potential range included Acacia podalyriifolia and Cortaderia selloana. The globally important invaders Ulex europaeus and Lythrum salicaria had a more limited invasion potential but could still become major invaders. There was no relationship between the extent of the climatically suitable areas for the different species and an expert ranking of their invasion potential, emphasising the uncertainties inherent in making expert assessments based on very little information. The methods used in this analysis establish a protocol for future modelling exercises to assess the invasion potential of other emerging invaders.

Voluntary Medical Male Circumcision: Modeling the Impact and Cost of Expanding Male Circumcision for HIV Prevention in Eastern and Southern Africa

PubMed Central

Reed, Jason; Opuni, Marjorie; Bollinger, Lori; Heard, Nathan; Castor, Delivette; Stover, John; Farley, Timothy; Menon, Veena; Hankins, Catherine

2011-01-01

Background There is strong evidence showing that voluntary medical male circumcision (VMMC) reduces HIV incidence in men. To inform the VMMC policies and goals of 13 priority countries in eastern and southern Africa, we estimate the impact and cost of scaling up adult VMMC using updated, country-specific data. Methods and Findings We use the Decision Makers' Program Planning Tool (DMPPT) to model the impact and cost of scaling up adult VMMC in Botswana, Lesotho, Malawi, Mozambique, Namibia, Rwanda, South Africa, Swaziland, Tanzania, Uganda, Zambia, Zimbabwe, and Nyanza Province in Kenya. We use epidemiologic and demographic data from recent household surveys for each country. The cost of VMMC ranges from US$65.85 to US$95.15 per VMMC performed, based on a cost assessment of VMMC services aligned with the World Health Organization's considerations of models for optimizing volume and efficiencies. Results from the DMPPT models suggest that scaling up adult VMMC to reach 80% coverage in the 13 countries by 2015 would entail performing 20.34 million circumcisions between 2011 and 2015 and an additional 8.42 million between 2016 and 2025 (to maintain the 80% coverage). Such a scale-up would result in averting 3.36 million new HIV infections through 2025. In addition, while the model shows that this scale-up would cost a total of US$2 billion between 2011 and 2025, it would result in net savings (due to averted treatment and care costs) amounting to US$16.51 billion. Conclusions This study suggests that rapid scale-up of VMMC in eastern and southern Africa is warranted based on the likely impact on the region's HIV epidemics and net savings. Scaling up of safe VMMC in eastern and southern Africa will lead to a substantial reduction in HIV infections in the countries and lower health system costs through averted HIV care costs. Please see later in the article for the Editors' Summary. PMID:22140367

The mass media alone are not effective change agents.

PubMed

Ruijter, J M

1991-01-01

Social mobilization programs for immunization have been used by African leaders, however, coverage from 20% to 70% in capitals like Mogadishu, Maputo, and Dakar were the result of short campaigns rather than the consequence of knowledge, attitudes, and practices (KAP) improvement. One-party states relied on their network of cadres issuing decrees from the top down to enforce completion of these immunization campaigns. Sometimes resistance developed against these programs, as the military mobilized people (e.g., Somalia). These efforts became rather superficial once the temporary pressure evaporated. In Mogadishu coverage increased from 22% to 70% in 1985, and within a year it dropped back to 8% above the original level. Nigeria, Senegal, and Togo where they used regular mini campaigns had better results. Research data from Botswana, Kenya, Lesotho, Malawi, Mozambique, and Zambia were analyzed. In 1983 in Kenya 73% of health workers never advised their clients, and 82% were incompetent to do so. Data also showed that clinics provided the bulk of information to women aged 15-45 in lower income groups, but they rarely consulted village health workers. Radio and TV programs were not reaching people because radio ownership was not universal (47% in Zambia and 30% in Zimbabwe), and batteries were often not available. In addition, most people turned to the radio for entertainment. In 1989, vaccination coverage was 19% in Luanda, Angola, but only 5% of 232 respondents to an evaluation could name the immunizable diseases. An identical percentage was familiar with these diseases in a Zambian study in 1986. Media experts proposed dramas to raise interest, but innovative mass media programs of dissemination of the message advocated in the 1960s did not prove effective to bring about KAP changes. Training of health and paramedical personnel by mass organizations as initiated in Ethiopia may prove to be worthwhile.

Urbanization in Africa since independence.

PubMed

Tarver, J D

1994-01-01

Over 185 million inhabitants were added to the urban areas of Africa between 1950 and 1990. Botswana, Lesotho, Namibia, South Africa, and Swaziland is the most highly urbanized, with 55% in 1990; while less than a quarter of Eastern Africa's population is living in urban centers. By the year 2015 more than half of Africa's population will be living in urban areas. Many parts of Africa have suffered prolonged droughts, overgrazing, locust infestations, and desertification. Millions have become refugees from natural disasters, political oppression, and rural poverty. The large exodus from Africa's rural areas has gone to cities but the large cities have attracted disproportionately large numbers of destitute migrants. Alexandria (1 million), Cairo (2.4 million) and the Witwatersrand in South Africa were the only African urban agglomerations with at least one million inhabitants in 1950. By 1990 the two Egyptian cities together had 12.7 million inhabitants and the Witwatersrand some 5 million, whereas the other 25 urban agglomerations with a million inhabitants each in 1990 had a total population of about 51 million. Lagos, Kinshasa, and Algiers ranged from 3 to 7.7 million. The capitals are the largest cities in at least 54 of the 59 countries and territories. Lagos, Nairobi, and Dar es Salaam are disproportionately larger than the next most populous cities in their countries. The 28 urban agglomerations with at least one million inhabitants had a total population of 70 million in 1990, and are projected to reach 100 million in the year 2000. Overall, Africa's urban population is projected to increase by approximately 135 million in the 1990-2000 decade (from 217 million to 352 million). About 105 million of the growth probably will occur in the smaller urban centers. The total African urban population is likely to reach one billion inhabitants within the next 50 years. It stood at 32 million in 1950. Presently, the United Nations projects 912 million urban residents (57% of the total population) by 2025.

Workable solutions to FP in Africa.

PubMed

1991-12-01

The 3rd Pan African Conference on the Integrated Family Planning, Nutrition and Parasite Control Project (PANFRICO III) was held in October 1991 and organized by JOICFP, UNFPA and IPPF. The Ghana IP Steering Committee implemented it. In addition to the 5 IP implementing countries--Ethiopia, the Gambia, Ghana, Tanzania, and Zambia--other countries attending were: Kenya, Lesotho, Madagascar, Mali, Nigeria, Senegal, Sierra Leone, Swaziland, Togo, and Uganda. Governmental and nongovernmental organizations (NGOs) and international groups such as UNFPA, IPPF, FAO, and USAID also attended. The theme was seeking a strategic approach to family planning through primary health care. Participants resolved to increase the support and involvement of African governments in IP implementation. It was recognized that self-reliance, cost effectiveness, and efficient use of resources were important to sustainability. It was also agreed that IP should integrate family planning (FP) with Maternal and Child Health (MCH) and Primary Health Care (PHC) in order to overcome traditional and cultural obstacles to FP and to gain full participation of men in the communities. Horizontal integration was the primary thrust. there was agreement that there should be collaboration between UNFPA, IPPF, and JOICFP, and relevant governments and NGOs. Country-specific attention needs to be paid to expanding IP functions within the 5 IP countries. In Ghana, IP pilot areas have been successful in increasing the FP acceptance rate from 17.4% in 1988 to 51.9% in 1991. IP experiences in Indonesia were presented, including the concept of fee-charged PHC services in order to achieve self-reliance in FP/MCH projects. The response was the request for further technical cooperation between developing countries. The workshop activities were particularly beneficial, and requests were made for discussion of IEC, management, service delivery, nutrition, environmental sanitation, self-reliance, community participation, and evaluation. To further regional IP development within the country, it was suggested that national workshops be held. It was emphasized that FP and population are basic elements of socioeconomic development.

Snow In the Sahara

NASA Image and Video Library

2017-12-08

In December 2016, snow fell in the Sahara for the first time since 1979. In 1984, the charitable supergroup Band Aid sang: “There won’t be snow in Africa this Christmas time.” In fact, it does snow in Africa at high elevations. Kilimanjaro has long had a cap of snow and ice, though it has been shrinking. Skiiers travel for natural and manufactured snow in the Atlas Mountains of Morocco and Algeria, as well as a few spots in South Africa and Lesotho. Nonetheless, snow on the edge of the Sahara Desert is rare. On December 19, 2016, snow fell on the Algerian town of Ain Sefra, which is sometimes referred to as the “gateway to the desert.” The town of roughly 35,000 people sits between the Atlas Mountains and the northern edge of the Sahara. The last recorded snowfall in Ain Sefra occurred in February 1979. The Enhanced Thematic Mapper Plus (ETM+) on the Landsat 7 satellite acquired this natural-color image of snow in North Africa on December 19, 2016. This scene shows an area near the border of Morocco and Algeria, south of the city of Bouarfa and southwest of Ain Sefra. Though the news has been dominated by snow in the Saharan city, a review of several years of satellite data suggests that snow is also pretty rare in this section of the Atlas range. Read more: go.nasa.gov/2hIH4Xe NASA Earth Observatory image by Joshua Stevens, using Landsat data from the U.S. Geological Survey. Caption by Mike Carlowicz. b>NASA image use policy. NASA Goddard Space Flight Center enables NASA’s mission through four scientific endeavors: Earth Science, Heliophysics, Solar System Exploration, and Astrophysics. Goddard plays a leading role in NASA’s accomplishments by contributing compelling scientific knowledge to advance the Agency’s mission. Follow us on Twitter Like us on Facebook Find us on Instagram

Women, customary law and equality: lessons from research in southern Africa.

PubMed

Armstrong, A

1994-03-01

The Women and Law in Southern Africa Research Project (WSLA) has concluded, after 6 years of study in Zimbabwe, Zambia, Swaziland, Mozambique, Lesotho, and Botswana, that the deconstruction of customary law rather than an emphasis on the concept of equality represents the most promising strategy for producing justice for women. An historical analysis indicates that customary law was, before colonialism, a family-centered, flexible system of law that favored the negotiation and settlement of disputes rather than a rigid state-centered application of a rule. Traditionally, the unifying value base of customary law was preservation of the family and protection of women and children. Marriage was viewed as a joint partnership rather than a guardian-minor relationship. Polygyny, which today constitutes a source of female subordination, was originally developed to provide the protection of marriage to women at a time when there were not enough men to go around and an unmarried woman was vulnerable. Moreover, under true customary law, family property was the norm and widows remained on the land. The responsiveness of true customary law to changing socioeconomic conditions is illustrated by the newly developed practice of Chiefs in Botswana to allow women to speak and represent themselves in court; another example is the Chief's modification of seduction damages law to stipulate payment directly to the young mother rather than to her parents. After the introduction of colonialism, customary law was reconstructed to serve the political interests of capital; even now, post-independence governments use the law as a tool to oppress women. WLSA research suggests that an emphasis on gender-neutral, equality-based laws and statutes can lead to the further oppression of women. For example, such laws have made unemployed divorced women responsible for the maintenance of their ex-husband, and could be used to promote women, as well as men, having several spouses. Needed instead is an emphasis on the concept of social justice, including assurance that a women's choices are informed and her interests are promoted.

Migration in southern Africa: a comparative perspective.

PubMed

Solomon, H

1994-01-01

Population movement can be described as intra-state, East-West, South-North, and South-South. About 20 million persons globally are considered displaced, of which about 4.1 million are internally displaced persons in South Africa. East-West movement occurred for over 400 million when the Iron Curtain came down. South-North movements of asylum seekers were estimated at 442,000 in 1990. South-South movement amounted to 4 million official refugees in Africa in 1989 and 4.4 million in 1990. African has the largest concentration of refugees. This article does not address the 265,825 contract migrant workers in South Africa. South African migration is the South-South type and can be characterized as "brain-drain" of well-trained professionals in neighboring states and unskilled and illegal migrants from Mozambique and Angola. Movement is pushed or pulled according to sociocultural factors, communications and technology, geographic proximity, precedent, demographic factors, environmental factors, economic factors, and political factors. The effects of migration in South Africa include increased stress on housing, political and social tension, increased costs, overcrowding, transmission of disease, and marginalization of migrants into low status and low paid jobs. For Lesotho migrants in South Africa remittances are a major source of national wealth. South Africa has also experienced racial discord against Mozambicans and Chinese. Political right wing groups mobilize around anti-immigration platforms. Migrants can become policy tools, and many are used in wars of liberation. International attention may focus on mistreatment of refugees. Management can be construed as "carrot" or "stick" approaches. Stick approaches include forced repatriation, limiting immigration, housing in survival-level camps, public campaigns run by host countries in sending countries, or greater control of national borders. South Africa has extensively used stick approaches, which have been only partially successful. Carrot approaches rely on regional integration strategies designed to reduce wage differentials and promote global cooperation. Polycentric and ethnocentric nationalism affect management of migrants as assets or as liabilities.

Tobacco use and mass media utilization in sub-Saharan Africa.

PubMed

Achia, Thomas N O

2015-01-01

Media utilization has been identified as an important determinant of tobacco use. We examined the association between self-reported tobacco use and frequency of mass media utilization by women and men in nine low-to middle-income sub-Saharan African countries. Data for the study came from Demographic and Health Surveys conducted in Burkina Faso, Ethiopia, Liberia, Lesotho, Malawi, Swaziland, Uganda, Zambia and Zimbabwe over the period 2006-2011. Each survey population was a cross-sectional sample of women aged 15-49 years and men aged 15-59 years, with information on tobacco use and media access being obtained by face-to-face interviews. An index of media utilization was constructed based on responses to questions on the frequency of reading newspapers, frequency of watching television and frequency of listening to the radio. Demographic and socioeconomic variables were considered as potentially confounding covariates. Logistic regression models with country and cluster specific random effects were estimated for the pooled data. The risk of cigarette smoking increased with greater utilization to mass media. The use of smokeless tobacco and tobacco use in general declined with greater utilization to mass media. The risk of tobacco use was 5% lower in women with high media utilization compared to those with low media utilization [Adjusted Odds Ratio (AOR) = 0.95, 95% confidence interval (CI):0.82-1.00]. Men with a high media utilization were 21% less likely to use tobacco compared to those with low media utilization [AOR = 0.79, 95%CI = 0.73-0.85]. In the male sample, tobacco use also declined with the increased frequency of reading newspapers (or magazines), listening to radio and watching television. Mass media campaigns, conducted in the context of comprehensive tobacco control programmes, can reduce the prevalence of tobacco smoking in sub-Saharan Africa. The reach, intensity, duration and type of messages are important aspects of the campaigns but need to also address all forms of tobacco use.

Origins and ages of fracture fluids in the South African Crust

NASA Astrophysics Data System (ADS)

Heard, A. W.; Warr, O.; Borgonie, G.; Linage-Alvarez, B.; Kuloyo, O.; Magnabosco, C.; Lau, M.; Erasmus, M.; Cason, E. D.; van Heerden, E.; Kieft, T. L.; Mabry, J.; Onstott, T. C.; Sherwood Lollar, B.; Ballentine, C. J.

2017-12-01

Crustal fracture fluids can remain isolated for millions (Myr) to billions of years (Gyr), and contain information on paleohydrogeology, subsurface ecology, and conservative components that may elucidate the atmospheric evolution of the early Earth [1-3]. Stable isotope analyses of water combined with isotopic analyses of the dissolved noble gases provide insight into the history of aqueous fracture fluids. We report stable isotope and noble gas data for fracture fluids from 5 different sites in the Witwatersrand Basin and Bushveld Igneous Province, South Africa. We determine radiogenic noble gas residence times ranging from thousands of years to tens of millions of years. The oldest sample, from Masimong Mine, has a water stable isotopic composition close to the global meteoric water line (GMWL), indicating its preservation in the crust and making it one of the oldest recorded paleometeoric waters. The δ2H and δ18O of water in this sample and similar age samples from the same mining district [1,4] require isotopically depleted groundwater recharge compared to modern precipitation. This could reflect a recharge regime at a higher paleolatitude, elevation, or with higher rainfall, established up to tens of Myr ago, and perhaps similar to the recharge regime in the modern Lesotho Highlands [5]. These data suggest that groundwater isotopes may provide useful paleoclimatic information for many Myr. As hypothesized, such paleometeoric water samples lack 124-128Xe enrichments reported from Gyr age groundwaters discovered on the Canadian Shield [3] and in Archean fluid inclusions [6], providing an important control set and reaffirming that those samples record the evolution of ancient atmospheric Xe rather than subsurface alteration. [1] Lippmann, J. et al. (2003) GCA 67, 4597-4619. [2] Lin, L.-H. (2006) et al. Science 314, 479-482. [3] Holland, G. et al. (2013) Nature 497, 357-360. [4] Lippmann-Pipke, J. et al. (2011) Chem. Geol. 283, 287-296. [5] West, A. G. et al. (2014) J. Geochem. Explor. 145, 213-222. [6] Pujol, M. et al. (2011) EPSL 308,298-306.

Impact of mentorship on WHO-AFRO Strengthening Laboratory Quality Improvement Process Towards Accreditation (SLIPTA)

PubMed Central

Motebang, David; Mathabo, Lebina; Rotz, Philip J.; Wanyoike, Joseph; Peter, Trevor

2012-01-01

Background The improvment of the quality of testing services in public laboratories is a high priority in many countries. Consequently, initiatives to train laboratory staff on quality management are being implemented, for example, the World Health Organization Regional Headquarters for Africa (WHO-AFRO) Strengthening Laboratory Management Towards Accreditation (SLMTA). Mentorship may be an effective way to augment these efforts. Methods Mentorship was implemented at four hospital laboratories in Lesotho, three districts and one central laboratory, between June 2009 and December 2010. The mentorship model that was implemented had the mentor fully embedded within the operations of each of the laboratories. It was delivered in a series of two mentoring engagements of six and four week initial and follow-up visits respectively. In total, each laboratory received 10 weeks mentorship that was separated by 6–8 weeks. Quality improvements were measured at baseline and at intervals during the mentorship using the WHO-AFRO Strengthening Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist and scoring system. Results At the beginning of the mentorship, all laboratories were at the SLIPTA zero star rating. After the initial six weeks of mentorship, two of the three district laboratories had improved from zero to one (out of five) star although the difference between their baseline (107.7) and the end of the six weeks (136.3) average scores was not statistically significant (p = 0.25). After 10 weeks of mentorship there was a significant improvement in average scores (182.3; p = 0.034) with one laboratory achieving WHO-AFRO three out of a possible five star status and the two remaining laboratories achieving a two star status. At Queen Elizabeth II (QE II) Central Laboratory, the average baseline score was 44%, measured using a section-specific checklist. There was a significant improvement by five weeks (57.2%; p = 0.021). Conclusion The mentorship programme in this study resulted in significant measurable improvements towards preparation for the WHO-AFRO SLIPTA process in less than six months. We recommend that mentorship be incorporated into laboratory quality improvement and management training programmes such as SLMTA, in order to accelerate the progress of laboratories towards achieving accreditation. PMID:29062726

Prevalence of Arthritis in Africa: A Systematic Review and Meta-Analysis

PubMed Central

Usenbo, Anthony; Kramer, Veronika; Young, Taryn; Musekiwa, Alfred

2015-01-01

Objective In this systematic review, we estimate the prevalence of six types of arthritis in Africa; namely rheumatoid arthritis, osteoarthritis, juvenile arthritis, psoriatic arthritis, gout, and ankylosing spondylitis. Methods We comprehensively searched literature on 31 August 2014 in MEDLINE, EMBASE, Web of Science and the Cochrane Library to identify eligible studies from 1975 up to 31 July 2014. Two review authors independently selected studies, extracted data, and appraised studies. We carried out random effects meta-analysis of prevalence of arthritis and assessed heterogeneity through subgroup analyses. We performed separate analyses for population- and hospital-based studies, as well as rural and urban settings. Main Findings We included 27 cross-sectional studies (20 population-based and 7 hospital-based) from Africa reporting on the prevalence of arthritis. The majority of the studies were from South Africa (44.4%, 12/27). Rheumatoid arthritis in urban settings ranged from 0.1% in Algeria, 0.6% in the DRC, to a meta-analysis overall prevalence of 2.5% in South Africa, and in rural settings ranged from a meta-analysis overall prevalence of 0.07% in South Africa, 0.3% in Egypt, to 0.4% in Lesotho. Osteoarthritis was the most prevalent form of arthritis and in urban settings it was 55.1% in South Africa and in rural settings, all in South Africa, ranged from 29.5%, 29.7%, up to 82.7% among adults aged over 65 years. Other results include highest prevalence of 33.1% for knee osteoarthritis in rural South Africa, 0.1% for ankylosing spondylitis in rural South Africa, 4.4% for psoriatic arthritis in urban South Africa, 0.7% for gout in urban South Africa, and 0.3% for juvenile idiopathic arthritis in urban Egypt. A third of the included studies had a low risk of bias (33.3%, 9/27), 40.8% (11/27) moderate risk, and 25.9% (7/27) had a high risk of bias. Conclusions In this systematic review, we have identified the paucity of latest prevalence data on arthritis in Africa. More studies are needed to address the prevalence and the true burden of this disease in Africa. PMID:26241756

Prevalence of Arthritis in Africa: A Systematic Review and Meta-Analysis.

PubMed

Usenbo, Anthony; Kramer, Veronika; Young, Taryn; Musekiwa, Alfred

2015-01-01

In this systematic review, we estimate the prevalence of six types of arthritis in Africa; namely rheumatoid arthritis, osteoarthritis, juvenile arthritis, psoriatic arthritis, gout, and ankylosing spondylitis. We comprehensively searched literature on 31 August 2014 in MEDLINE, EMBASE, Web of Science and the Cochrane Library to identify eligible studies from 1975 up to 31 July 2014. Two review authors independently selected studies, extracted data, and appraised studies. We carried out random effects meta-analysis of prevalence of arthritis and assessed heterogeneity through subgroup analyses. We performed separate analyses for population- and hospital-based studies, as well as rural and urban settings. We included 27 cross-sectional studies (20 population-based and 7 hospital-based) from Africa reporting on the prevalence of arthritis. The majority of the studies were from South Africa (44.4%, 12/27). Rheumatoid arthritis in urban settings ranged from 0.1% in Algeria, 0.6% in the DRC, to a meta-analysis overall prevalence of 2.5% in South Africa, and in rural settings ranged from a meta-analysis overall prevalence of 0.07% in South Africa, 0.3% in Egypt, to 0.4% in Lesotho. Osteoarthritis was the most prevalent form of arthritis and in urban settings it was 55.1% in South Africa and in rural settings, all in South Africa, ranged from 29.5%, 29.7%, up to 82.7% among adults aged over 65 years. Other results include highest prevalence of 33.1% for knee osteoarthritis in rural South Africa, 0.1% for ankylosing spondylitis in rural South Africa, 4.4% for psoriatic arthritis in urban South Africa, 0.7% for gout in urban South Africa, and 0.3% for juvenile idiopathic arthritis in urban Egypt. A third of the included studies had a low risk of bias (33.3%, 9/27), 40.8% (11/27) moderate risk, and 25.9% (7/27) had a high risk of bias. In this systematic review, we have identified the paucity of latest prevalence data on arthritis in Africa. More studies are needed to address the prevalence and the true burden of this disease in Africa.

Elevated blood pressure and household solid fuel use in premenopausal women: Analysis of 12 Demographic and Health Surveys (DHS) from 10 countries.

PubMed

Arku, Raphael E; Ezzati, Majid; Baumgartner, Jill; Fink, Günther; Zhou, Bin; Hystad, Perry; Brauer, Michael

2018-01-01

Approximately three billion people are exposed to household air pollution (HAP) from solid fuel cookstoves. Studies from single settings have linked HAP with elevated blood pressure (BP), but no evidence exists from multi-country analyses. Using nationally representative and internationally comparable data, we examined the association between solid fuel use and BP in 77,605 largely premenopausal women (aged 15-49) from ten resource-poor countries. We obtained data on systolic and diastolic BP, self-reported primary cooking fuel, health and socio-demographic characteristics from 12 Demographic and Health Surveys conducted in Albania, Armenia, Azerbaijan, Bangladesh, Benin, Ghana, Kyrgyzstan, Lesotho, Namibia, and Peru. We estimated associations between history of fuel use [solid fuel (coal or biomass) versus clean fuel (electricity or gas)] with systolic and diastolic BP and hypertension using a meta-analytical approach. Overall, the country-level mean systolic and diastolic BP were 117 (range: 111-127) and 74 (71-83) mmHg, respectively. The country-level mean age of the women was 30.8 years (range: 28.4-32.9). The prevalence of solid fuel use was 46.0% (range: 4.1-95.8). In adjusted, pooled analyses, primary use of solid fuel was associated with 0.58mmHg higher systolic BP (95% CI: 0.23, 0.93) as compared to primary use of clean fuel. The pooled estimates for diastolic BP and pulse pressure were also positive, but the confidence intervals contained zero. The pooled odds of hypertension was [OR = 1.07 (95% CI: 0.99, 1.16)], an effect that was driven by rural participants for whom solid fuel use was associated with a 16% greater odds of hypertension [OR = 1.16 (95% CI: 1.01, 1.35)]. Cooking with solid fuels was associated with small increases in BP and odds of hypertension. Use of cleaner fuels like gas or electricity may reduce cardiovascular risk in developing countries, particularly among rural residents. Copyright © 2017 Elsevier Inc. All rights reserved.

Pioneering new approaches. Educating girls in Africa.

PubMed

Namuddu, K

1993-01-01

In Africa, the education of girls has varied with the history and development of countries. For instance, botswana, Lesotho, and Swaziland have higher enrollment of girls than boys, and in Nigeria the dropout rate for boys is higher than for girls. In Mozambique, girl's education is dependent on matrilineal or patrilineal family structure, urban or rural location, or religious preference. These and many other factors interfere with girl's access, survival, performance, and achievement in school. Strategies generally involve 1) improving access and increasing enrollment, 2) increasing survival in the school system, and 3) improving the quality of the learning environment. Most African countries are involved with the first strategy, but problems remain in selecting the appropriate age to begin school, retaining students and teachers, lowering absenteeism, providing adequate and appropriate teaching materials for students, and other factors that discourage female attendance. Solutions have involved establishing book banks and cardboard box libraries as a supplement to classroom learning. Gender stereotypes in curriculum materials are being introduced which show females in a positive and prominent way. In Zambia, an in-service training program aims to develop positive teacher attitudes toward girls, toward their work, and toward pupil's work. Program efforts in Kenya are attempting to educate parents about the importance of keeping their daughters in school, and about issues related to population, health, education, and a healthy environment. Traditional practices such as female circumcision, childhood marriages, early pregnancy, and nutritional taboos are discouraged. There are 43 district coordinators who conduct seminars and workshops to spread information to communities and households. Other countries are engaged in village meetings and workshops to persuade parents to examine their own interpersonal interaction with their daughters and the impact on their education. Women's groups are also questioning policies that bar girls from reentering school after a childhood pregnancy. Uganda has a program to help girls resume their studies after pregnancy, but not within the main educational system. Pioneering new approaches is occurring and the Rockefeller Foundation is taking the lead in an 18-member international donor group in supporting the promotion of female education.

Climate and Southern Africa's Water-Energy-Food Nexus

NASA Astrophysics Data System (ADS)

Conway, D.; Osborn, T.; Dorling, S.; Ringler, C.; Lankford, B.; Dalin, C.; Thurlow, J.; Zhu, T.; Deryng, D.; Landman, W.; Archer van Garderen, E.; Krueger, T.; Lebek, K.

2014-12-01

Numerous challenges coalesce to make Southern Africa emblematic of the connections between climate and the water-energy-food nexus. Rainfall and river flows in the region show high levels of variability across a range of spatial and temporal scales. Physical and socioeconomic exposure to climate variability and change is high, for example, the contribution of electricity produced from hydroelectric sources is over 30% in Madagascar and Zimbabwe and almost 100% in the DRC, Lesotho, Malawi, and Zambia. The region's economy is closely linked with that of the rest of the African continent and climate-sensitive food products are an important item of trade. Southern Africa's population is concentrated in regions exposed to high levels of hydro-meteorological variability, and will increase rapidly over the next four decades. The capacity to manage the effects of climate variability tends, however, to be low. Moreover, with climate change annual precipitation levels, soil moisture and runoff are likely to decrease and rising temperatures will increase evaporative demand. Despite high levels of hydro-meteorological variability, the sectoral and cross-sectoral water-energy-food linkages with climate in Southern Africa have not been considered in detail. Lack of data and questionable reliability are compounded by complex dynamic relationships. We review the role of climate in Southern Africa's nexus, complemented by empirical analysis of national level data on climate, water resources, crop and energy production, and economic activity. Our aim is to examine the role of climate variability as a driver of production fluctuations in the nexus, and to improve understanding of the magnitude and temporal dimensions of their interactions. We first consider national level exposure of food, water and energy production to climate in aggregate economic terms and then examine the linkages between interannual and multi-year climate variability and economic activity, focusing on food and hydropower production. We then review the potential for connecting areas with robust seasonal climate forecasting skill with key precursors of economic output and conclude by identifying knowledge gaps in our understanding of regional and national economic linkages in the climate and water-energy-food nexus.

Emissions of mercury in Southern Africa derived from long-term observations at Cape Point, South Africa

NASA Astrophysics Data System (ADS)

Brunke, E.-G.; Ebinghaus, R.; Kock, H. H.; Labuschagne, C.; Slemr, F.

2012-05-01

Mercury emissions in South Africa have so far been estimated only by a bottom-up approach from activities and emission factors for different processes. In this paper we derive GEM/CO (GEM being gaseous elemental mercury, Hg0), GEM/CO2, GEM/CH4, CO/CO2, CH4/CO2, and CH4/CO emission ratios from plumes observed during long-term monitoring of these species at Cape Point between March 2007 and December 2009. The average observed GEM/CO, GEM/CO2, GEM/CH4, CO/CO2, CH4/CO2, and CH4/CO emission ratios were 2.40 ± 2.65 pg m-3 ppb-1 (n = 47), 62.7 ± 80.2 pg m-3 ppb-1 (n = 44), 3.61 ± 4.66 pg m-3 ppb-1 (n = 46), 35.6 ± 25.4 ppb ppm-1 (n = 52), 20.2 ± 15.5 ppb ppm-1 (n=48), and 0.876 ± 1.106 ppb ppm-1 (n=42), respectively. The observed CO/CO2, CH4/CO2, and CH4/CO emission ratios agree within the combined uncertainties of the observations and emissions with the ratios calculated from EDGAR (version 4.2) CO2, CO, and CH4 inventories for South Africa and Southern Africa (South Africa, Lesotho, Swaziland, Namibia, Botswana, Zimbabwe, and Mozambique) in 2007 and 2008 (inventories for 2009 are not available yet). Total elemental mercury emission of 13.1, 15.2, and 16.1 t Hg yr-1 are estimated independently using the GEM/CO, GEM/CO2, and GEM/CH4 emission ratios and the annual mean CO, CO2, and CH4 emissions, respectively, of South Africa in 2007 and 2008. The average of these independent estimates of 14.8 ± 1.5 t GEM yr-1 is much less than the total emission of 257 t Hg yr-1 from older inventories. Considering that emission of GEM represents only 50-78% of all mercury emissions, our estimates come close to the total mercury emission estimates ranging between 40-50 t Hg yr-1 from more recent inventories.

Perceived HIV stigma and life satisfaction among persons living with HIV infection in five African countries: a longitudinal study.

PubMed

Greeff, Minrie; Uys, Leana R; Wantland, Dean; Makoae, Lucy; Chirwa, Maureen; Dlamini, Priscilla; Kohi, Thecla W; Mullan, Joseph; Naidoo, Joanne Rachel; Cuca, Yvette; Holzemer, William L

2010-04-01

Descriptive literature exists on the effects of HIV-related stigma on the lives of people living with HIV infection but few empirical studies have measured perceived HIV stigma nor explored its potential relationship to quality of life (QoL) over time in people living with HIV infection. A cohort study of a purposive convenient sample of 1457 HIV-positive persons was followed for one year in a longitudinal design that examined the effects of stigma and the life satisfaction dimension of the HIV/AIDS Targeted Quality of Life Instrument (HAT-QOL) over time, as well as the influence of other demographic and assessed social variables. Data were collected three times about six months apart from December 2005 to March 2007. The average age in this sample was 36.8 years (SD=8.78, n=1454) and 72.7% (n=1056) were female. The initial sample of participants was balanced among the five countries: Lesotho, Malawi, South Africa, Swaziland, and Tanzania. An attrition analysis demonstrated few demographic differences between those who remained in the study 12 months later compared with those at baseline. However, those who completed the study and who answered the QoL questions had significantly higher life satisfaction scores at baseline than those who left the study. There was a general increase in the report of life satisfaction QoL in all countries over the one-year period. However, as stigma scores increased over time there was a significant decrease in life satisfaction with differing rates of change by country. Certain factors had a positive influence on life satisfaction QoL: positive HIV media reports, taking antiretrovirals, reduced symptom intensity, and disclosure to a friend. This cohort study is the first to document empirically in a longitudinal sample, that perceived HIV stigma has a significantly negative and constant impact upon life satisfaction QoL for people with HIV infection. In the absence of any intervention to address and reduce stigmatization, individuals will continue to report poorer life satisfaction evidenced by reduced living enjoyment, loss of control in life, decreased social interactivity, and decreased perceived health status. Copyright 2009 Elsevier Ltd. All rights reserved.

Can local people also gain from benefit sharing in water resources development? Experiences from dam development in the Orange-Senqu River Basin

NASA Astrophysics Data System (ADS)

Mokorosi, Palesa Selloane; van der Zaag, Pieter

The concept of sharing benefits derived from beneficial uses of water is increasingly embraced in numerous international discourses in place of sharing water in volumes among nations riparian to common water bodies. Many benefit-sharing efforts involve building of dams and inter-basin transfer schemes. These infrastructures have been blamed to be posing environmental and social costs and directly affecting local people ( Gupta and van der Zaag, 2007) [Gupta, J., van der Zaag, P., 2007. Inter-basin water transfers and integrated water resources management: Where engineering, science and politics interlock. Physics and Chemistry of the Earth doi:10.1016/j.pce.2007.04.003]. This paper attempts to find attributes that lead towards recognising the rights of affected people and the mechanisms that may ensure access of direct benefits to them. Four theoretical factors are identified as key in recognising the rights of the affected people and were adopted as the analytical framework: a. Appropriate legal and policy framework, b. Public participation, c. Sustainable compensation measures, and d. Equitable access of derived benefits. In order to complement these theoretical factors, the study compared two large water development projects in the Orange-Senqu river basin: the Orange River Development Project and the Lesotho Highlands Water Project. In both projects, several large dams were constructed and water was transferred from one river into another. The following are the findings of the paper: a) the political environment through the legal and institutional framework plays a major role in protecting or marginalising the affected people; b) compensation measures for lost properties left many affected people destitute and food insecure; c) affected people mainly benefited from the indirect benefits of the projects instead of direct benefits. In order to ensure access to direct benefits for the affected people it is recommended that a) the national legislation must support the concept, b) mechanisms for allocating benefits to the affected people must be defined at project planning stage and should aim at long-term development goals, and c) local authorities must have sufficient capacity to ensure smooth operation.

Diamonds: Exploration, mines and marketing

NASA Astrophysics Data System (ADS)

Read, George H.; Janse, A. J. A. (Bram)

2009-11-01

The beauty, value and mystique of exceptional quality diamonds such as the 603 carat Lesotho Promise, recovered from the Letseng Mine in 2006, help to drive a multi-billion dollar diamond exploration, mining and marketing industry that operates in some 45 countries across the globe. Five countries, Botswana, Russia, Canada, South Africa and Angola account for 83% by value and 65% by weight of annual diamond production, which is mainly produced by four major companies, De Beers, Alrosa, Rio Tinto and BHP Billiton (BHPB), which together account for 78% by value and 72% by weight of annual diamond production for 2007. During the last twelve years 16 new diamond mines commenced production and 4 re-opened. In addition, 11 projects are in advanced evaluation and may begin operations within the next five years. Exploration for diamondiferous kimberlites was still energetic up to the last quarter of 2008 with most work carried out in Canada, Angola, Democratic Republic of the Congo (DRC) and Botswana. Many kimberlites were discovered but no new economic deposits were outlined as a result of this work, except for the discovery and possible development of the Bunder project by Rio Tinto in India. Exploration methods have benefitted greatly from improved techniques of high resolution geophysical aerial surveying, new research into the geochemistry of indicator minerals and further insights into the formation of diamonds and the relation to tectonic/structural events in the crust and mantle. Recent trends in diamond marketing indicate that prices for rough diamonds and polished goods were still rising up to the last quarter of 2008 and subsequently abruptly sank in line with the worldwide financial crisis. Most analysts predict that prices will rise again in the long term as the gap between supply and demand will widen because no new economic diamond discoveries have been made recently. The disparity between high rough and polished prices and low share prices of publicly traded diamond companies may be due to investors losing patience with the slow pace or absence of new promising discoveries and switching into shares of base metals and fertilizers for agriculture (potash and phosphates).

Emigration dynamics in Sub-Saharan Africa.

PubMed

Adepoju, A

1995-01-01

The introduction to this description of emigration dynamics in sub-Saharan Africa notes that the region is characterized by intensive migration caused by such factors as population growth, negative economic growth, ethnic conflict, and human rights abuses. The second section of the report discusses the fragmentary and incomplete nature of data on international migration in the region, especially data on conventional migration. Section 3 looks at demographic factors such as high population growth, illiteracy levels, HIV seroprevalence, and urbanization which lead to high unemployment and emigration. The fourth section considers the effects of the rapid expansion of education which is outstripping the absorptive capacity of the economies of many countries. Unemployment is a serious problem which is projected to become worse as increases in employment opportunities continue to lag behind increases in output. Sections five, six, and seven of the report describe relevant economic factors such as per capita income, income distribution, the economic resource base, and economic development; poverty; and the effects of economic adjustment programs, especially on employment opportunities and wages in the public and private sectors. The next section is devoted to sociocultural factors influencing migration both on the micro- and the macro-levels, including the influence of ethnicity and ethnic conflicts as well as the domination of leadership positions by members of minority groups. The political factors discussed in section 9 include women's status, repressive regimes, political instability which leads to underdevelopment, and the policies of the Organization of African Unity which broadened the definition of refugees and set inviolable borders of member states identical to those inherited upon independence. Section 10 outlines ecological factors contributing to migration, including the decline in acreage of arable land, soil deterioration, poor land management, and the effects of draught. The interaction of all of these factors has contributed to refugee flows of acute magnitude and complexity. The next major section of the report describes the migration situation in each subregion (Western Africa, Nigeria and Ghana, the Sahel, Mail, Eastern Africa, Southern Africa, and Lesotho). The report concludes that migration in response to socioeconomic conditions will continue until conditions improve in the countries of origin.

Analysis of human resources for health strategies and policies in 5 countries in Sub-Saharan Africa, in response to GFATM and PEPFAR-funded HIV-activities.

PubMed

Cailhol, Johann; Craveiro, Isabel; Madede, Tavares; Makoa, Elsie; Mathole, Thubelihle; Parsons, Ann Neo; Van Leemput, Luc; Biesma, Regien; Brugha, Ruairi; Chilundo, Baltazar; Lehmann, Uta; Dussault, Gilles; Van Damme, Wim; Sanders, David

2013-10-25

Global Health Initiatives (GHIs), aiming at reducing the impact of specific diseases such as Human Immunodeficiency Virus (HIV), have flourished since 2000. Amongst these, PEPFAR and GFATM have provided a substantial amount of funding to countries affected by HIV, predominantly for delivery of antiretroviral therapy (ARV) and prevention strategies. Since the need for additional human resources for health (HRH) was not initially considered by GHIs, countries, to allow ARV scale-up, implemented short-term HRH strategies, adapted to GHI-funding conditionality. Such strategies differed from one country to another and slowly evolved to long-term HRH policies. The processes and content of HRH policy shifts in 5 countries in Sub-Saharan Africa were examined. A multi-country study was conducted from 2007 to 2011 in 5 countries (Angola, Burundi, Lesotho, Mozambique and South Africa), to assess the impact of GHIs on the health system, using a mixed methods design. This paper focuses on the impact of GFATM and PEPFAR on HRH policies. Qualitative data consisted of semi-structured interviews undertaken at national and sub-national levels and analysis of secondary data from national reports. Data were analysed in order to extract countries' responses to HRH challenges posed by implementation of HIV-related activities. Common themes across the 5 countries were selected and compared in light of each country context. In all countries successful ARV roll-out was observed, despite HRH shortages. This was a result of mostly short-term emergency response by GHI-funded Non-Governmental Organizations (NGOs) and to a lesser extent by governments, consisting of using and increasing available HRH for HIV tasks. As challenges and limits of short-term HRH strategies were revealed and HIV became a chronic disease, the 5 countries slowly implemented mid to long-term HRH strategies, such as formalisation of pilot initiatives, increase in HRH production and mitigation of internal migration of HRH, sometimes in collaboration with GHIs. Sustainable HRH strengthening is a complex process, depending mostly on HRH production and retention factors, these factors being country-specific. GHIs could assist in these strategies, provided that they are flexible enough to incorporate country-specific needs in terms of funding, that they coordinate at global-level and minimise conditionality for countries.

A cross-country comparison of the prevalence of exposure to tobacco advertisements among adolescents aged 13-15 years in 20 low and middle income countries.

PubMed

Agaku, Israel T; Adisa, Akinyele O; Akinyamoju, Akindayo O; Agboola, Samuel O

2013-01-01

This study assessed the prevalence and influence of exposure to pro-tobacco advertisements among adolescents in 20 low and middle income countries (LMICs). The 2007-2008 Global Youth Tobacco Survey was analyzed for students aged 13-15 years in 20 LMICs. Overall and sex-specific prevalence of exposure to tobacco advertisements in several media, as well as the prevalence of smoking susceptibility (i.e., the lack of a firm commitment among never smokers not to smoke in the future or if offered a cigarette by a friend) were assessed. The variability of the point estimates was assessed using 95% confidence intervals (CI). Logistic regression was used to assess the effect of exposure to multiple (i.e., ≥2) pro-tobacco advertisements on current smoking, adjusting for age and sex (P < 0.05). Data were weighted and analyzed with Stata version 11. Overall country-specific prevalence for different advertisement sources ranged as follows: movies/videos (78.4% in Lesotho to 97.8% in Belize); television programs (48.7% in Togo to 91.7% in the Philippines); newspapers/magazines (29.5% in Togo to 89.7% in the Philippines); and outdoor community events (30.6% in Rwanda to 79.4% in the Philippines). The overall proportion of never smokers who were susceptible to cigarette smoking ranged from 3.7% in Sri Lanka to 70.1% in Kyrgyzstan. Exposure to ≥2 sources of pro-tobacco advertisements was associated with significantly increased odds of cigarette smoking among adolescents in several countries including South Africa (adjusted odds ratio, aOR = 4.11; 95% CI:2.26-7.47), Togo (aOR = 3.77; 95% CI:1.27-11.21), the Former Yugoslav Republic of Macedonia (aOR = 1.42; 95% CI:1.01-1.99), Republic of Moldova (aOR = 1.53; 95% CI:1.11-2.12), Belize (aOR = 13.95; 95% CI:1.91-102.02), Panama (aOR = 5.14; 95% CI: 2.37-11.14) and Mongolia (aOR = 1.52; 95% CI:1.19-1.94). Prevalence of exposure to various pro-tobacco advertisements was high among adolescents in the LMICs surveyed. Enhanced and sustained national efforts are needed to reduce exposure to all forms of tobacco advertising and promotional activities.

Analysis of human resources for health strategies and policies in 5 countries in Sub-Saharan Africa, in response to GFATM and PEPFAR-funded HIV-activities

PubMed Central

2013-01-01

Background Global Health Initiatives (GHIs), aiming at reducing the impact of specific diseases such as Human Immunodeficiency Virus (HIV), have flourished since 2000. Amongst these, PEPFAR and GFATM have provided a substantial amount of funding to countries affected by HIV, predominantly for delivery of antiretroviral therapy (ARV) and prevention strategies. Since the need for additional human resources for health (HRH) was not initially considered by GHIs, countries, to allow ARV scale-up, implemented short-term HRH strategies, adapted to GHI-funding conditionality. Such strategies differed from one country to another and slowly evolved to long-term HRH policies. The processes and content of HRH policy shifts in 5 countries in Sub-Saharan Africa were examined. Methods A multi-country study was conducted from 2007 to 2011 in 5 countries (Angola, Burundi, Lesotho, Mozambique and South Africa), to assess the impact of GHIs on the health system, using a mixed methods design. This paper focuses on the impact of GFATM and PEPFAR on HRH policies. Qualitative data consisted of semi-structured interviews undertaken at national and sub-national levels and analysis of secondary data from national reports. Data were analysed in order to extract countries’ responses to HRH challenges posed by implementation of HIV-related activities. Common themes across the 5 countries were selected and compared in light of each country context. Results In all countries successful ARV roll-out was observed, despite HRH shortages. This was a result of mostly short-term emergency response by GHI-funded Non-Governmental Organizations (NGOs) and to a lesser extent by governments, consisting of using and increasing available HRH for HIV tasks. As challenges and limits of short-term HRH strategies were revealed and HIV became a chronic disease, the 5 countries slowly implemented mid to long-term HRH strategies, such as formalisation of pilot initiatives, increase in HRH production and mitigation of internal migration of HRH, sometimes in collaboration with GHIs. Conclusion Sustainable HRH strengthening is a complex process, depending mostly on HRH production and retention factors, these factors being country-specific. GHIs could assist in these strategies, provided that they are flexible enough to incorporate country-specific needs in terms of funding, that they coordinate at global-level and minimise conditionality for countries. PMID:24160182

Composition of the earth's upper mantle-I. Siderophile trace elements in ultramafic nodules

USGS Publications Warehouse

Morgan, J.W.; Wandless, G.A.; Petrie, R.K.; Irving, A.J.

1981-01-01

Seven siderophile elements (Au, Ge, Ir, Ni, Pd, Os, Re) were determined by radiochemical neutron activation analysis in 19 ultramafic rocks, which are spinel lherzollites-xenoliths from North and Central America, Hawaii and Australia, and garnet Iherzolitexenoliths from Lesotho. Abundances of the platinum metals are very uniform in spinel lherzolites averaging 3.4 ?? 1.2 ppb Os, 3.7 ?? 1.1 ppb Ir, and 4.6 ?? 2.0 ppb Pd. Sheared garnet lherzolite PHN 1611 has similar abundances of these elements, but in 4 granulated garnet lherzolites, abundances are more variable. In all samples, the Pt metals retain cosmic ( Cl-chondrite) ratios. Abundances of Au and Re vary more than those of Pt metals, but the Au/Re ratio remains close to the cosmic value. The fact that higher values of Au and Re approach cosmic proportions with respect to the Pt metals, suggests that Au and Re have been depleted in some ultramafic rocks from an initially chondrite-like pattern equivalent to about 0.01 of Cl chondrite abundances. The relative enrichment of Au and Re in crustal rocks is apparently the result of crust-mantle fractionation and does not require a special circumstance of core-mantle partitioning. Abundances of moderately volatile elements Ni, Co and Ge are very uniform in all rocks, and are much higher than those of the highly siderophile elements Au, Ir, Pd, Os and Re. When normalized to Cl chondrites, abundances of Ni and Co are nearly identical, averaging 0.20 ?? 0.02 and 0.22 ?? 0.02, respectively; but Ge is only 0.027 ?? 0.004. The low abundance of Ge relative to Ni and Co is apparently a reflection of the general depletion of volatile elements in the Earth. The moderately siderophile elements cannot be derived from the same source as the highly siderophile elements because of the marked difference in Cl chondrite-normalized abundances and patterns. We suggest that most of the Ni, Co and Ge were enriched in the silicate by the partial oxidation of pre-existing volatile-poor Fe-Ni, whereas the corresponding highly siderophile elements remained sequestered by the surviving metal. The highly siderophile elements may have been introduced by a population of ~103 large (~1022 g) planetisimals, similar to those forming the lunar mare basins. ?? 1981.

Evaluating audio computer assisted self-interviews in urban South African communities: evidence for good suitability and reduced social desirability bias of a cross-sectional survey on sexual behaviour.

PubMed

Beauclair, Roxanne; Meng, Fei; Deprez, Nele; Temmerman, Marleen; Welte, Alex; Hens, Niel; Delva, Wim

2013-01-31

Efficient HIV prevention requires accurate identification of individuals with risky sexual behaviour. However, self-reported data from sexual behaviour surveys are prone to social desirability bias (SDB). Audio Computer-Assisted Self-Interviewing (ACASI) has been suggested as an alternative to face-to-face interviewing (FTFI), because it may promote interview privacy and reduce SDB. However, little is known about the suitability and accuracy of ACASI in urban communities with high HIV prevalence in South Africa. To test this, we conducted a sexual behaviour survey in Cape Town, South Africa, using ACASI methods. Participants (n = 878) answered questions about their sexual relationships on a touch screen computer in a private mobile office. We included questions at the end of the ACASI survey that were used to assess participants' perceived ease of use, privacy, and truthfulness. Univariate logistic regression models, supported by multivariate models, were applied to identify groups of people who had adverse interviewing experiences. Further, we constructed male-female ratios of self-reported sexual behaviours as indicators of SDB. We used these indicators to compare SDB in our survey and in recent FTFI-based Demographic and Health Surveys (DHSs) from Lesotho, Swaziland, and Zimbabwe. Most participants found our methods easy to use (85.9%), perceived privacy (96.3%) and preferred ACASI to other modes of inquiry (82.5%) when reporting on sexual behaviours. Unemployed participants and those in the 40-70 year old age group were the least likely to find our methods easy to use (OR 0.69; 95% CI: 0.47-1.01 and OR 0.37; 95% CI: 0.23-0.58, respectively). In our survey, the male-female ratio for reporting >2 sexual partners in the past year, a concurrent relationship in the past year, and > 2 sexual partners in a lifetime was 3.4, 2.6, and 1.2, respectively- far lower than the ratios observed in the Demographic and Health Surveys. Our analysis suggests that most participants in our survey found the ACASI modality to be acceptable, private, and user-friendly. Moreover, our results indicate lower SDB than in FTFI techniques. Targeting older and unemployed participants for ACASI training prior to taking the survey may help to improve their perception of ease and privacy.

Magnetostratigraphy of the Naude's Nek Section (Karoo Traps): News Constraints on the Eruptive Sequence

NASA Astrophysics Data System (ADS)

Moulin, M.; Jay, A. E.; Fluteau, F.; Marsh, J. S.; Courtillot, V.; Gerard, M.; Quidelleur, X.

2008-12-01

A causal relationship between large igneous provinces (LIP) and mass extinctions (ME) or oceanic anoxia events (OAE) is supported by an increasing data base of age determinations. Although the impact of recent (much smaller) volcanic eruptions on climate is understood as being largely due to injection of SO2 into the stratosphere, the environmental effects of LIP eruptions remain ill understood. Successful climate modelling requires high-resolution timing of volcanism, i.e. number, volume and duration of peak episodes. Chenet et al (2008, and in revision) have studied the Deccan traps, which correlate with the major KT crisis, combining geochronology (K-Ar), paleomagnetism (secular variation), volcanology (flow types) and analysis of alteration levels between flows (red boles); they have shown that emplacement occurred as a small number of discrete, very large and short-lived pulses (see Courtillot et al, same session). But mass extinctions are not all alike, in pattern or intensity. Some large igneous provinces are correlated with only minor crises, e.g. the Karoo traps formed near the Pliensbachian-Toarcian boundary (~180 Ma). Remnants of these traps outcrop over >2.5×106 km2. Jourdan et al. (2008) find that the Karoo traps were emplaced over some 4 Myr, significantly longer than the Deccan. However, the Karoo province does seem to comprise brief (<1-2 Myr), spatially and temporally distinct magmatic events. We report here our results from the Naude's Nek section (the lower 700 m of the traps), located in South Africa near the southern border of Lesotho. Our first determinations (40K-40Ar Cassignol-Gillot technique) yield ages of 180±1.8 Ma, in good agreement with previous studies. Detailed flow by flow magnetostratigraphy (site-mean directions based on thermal demagnetization) shows that the eruptive sequence can be divided into several volcanic pulses having likely lasted less than ~100 years. We have obtained a particularly detailed record of the only reversal found in the sequence and identified by van Zijl 50 years ago: 136 m of lava erupted over less than a few thousand years. Although our study is still preliminary, and other sections to the North complementing the full lava pile are in progress, the first results do provide some ideas as to why the Karoo traps resulted in a far less severe extinction than the Deccan.

Prevalence and risk factors for forced or coerced sex among school-going youth: national cross-sectional studies in 10 southern African countries in 2003 and 2007

PubMed Central

Paredes-Solís, Sergio; Milne, Deborah; Omer, Khalid; Marokoane, Nobantu; Laetsang, Ditiro; Cockcroft, Anne

2012-01-01

Objectives To study prevalence at two time points and risk factors for experience of forced or coerced sex among school-going youth in 10 southern African countries. Design Cross-sectional surveys, by facilitated self-administered questionnaire, of in-school youth in 2003 and 2007. Setting Schools serving representative communities in eight countries (Botswana, Lesotho, Malawi, Mozambique, Namibia, Swaziland, Zambia and Zimbabwe) in 2003 and with Tanzania and South Africa added in 2007. Participants Students aged 11–16 years present in the school classes. Main outcome measures Experience of forced or coerced sex, perpetration of forced sex. Results In 2007, 19.6% (4432/25 840) of female students and 21.1% (4080/21 613) of male students aged 11–16 years reported they had experienced forced or coerced sex. Rates among 16-year-olds were 28.8% in females and 25.4% in males. Comparing the same schools in eight countries, in an analysis age standardised on the 2007 Botswana male sample, there was no significant decrease between 2003 and 2007 among females in any country and inconsistent changes among males. In multilevel analysis using generalised linear mixed model, individual-level risk factors for forced sex among female students were age over 13 years and insufficient food in the household; school-level factors were a lower proportion of students knowing about child rights and higher proportions experiencing or perpetrating forced sex; and community-level factors were a higher proportion of adults in favour of transactional sex and a higher rate of intimate partner violence. Male risk factors were similar. Some 4.7% of female students and 11.7% of male students reported they had perpetrated forced sex. Experience of forced sex was strongly associated with perpetration and other risk factors for perpetration were similar to those for victimisation. Conclusions Forced or coerced sex remained common among female and male youth in 2007. Experience of sexual abuse in childhood is recognised to increase the risk of HIV infection. The association the authors found between forced sex and school-level factors suggests preventive interventions in schools could help to tackle the HIV epidemic in southern Africa. PMID:22389362

A cross-country comparison of the prevalence of exposure to tobacco advertisements among adolescents aged 13–15 years in 20 low and middle income countries

PubMed Central

2013-01-01

Background This study assessed the prevalence and influence of exposure to pro-tobacco advertisements among adolescents in 20 low and middle income countries (LMICs). Methods The 2007–2008 Global Youth Tobacco Survey was analyzed for students aged 13–15 years in 20 LMICs. Overall and sex-specific prevalence of exposure to tobacco advertisements in several media, as well as the prevalence of smoking susceptibility (i.e., the lack of a firm commitment among never smokers not to smoke in the future or if offered a cigarette by a friend) were assessed. The variability of the point estimates was assessed using 95% confidence intervals (CI). Logistic regression was used to assess the effect of exposure to multiple (i.e., ≥2) pro-tobacco advertisements on current smoking, adjusting for age and sex (P < 0.05). Data were weighted and analyzed with Stata version 11. Results Overall country-specific prevalence for different advertisement sources ranged as follows: movies/videos (78.4% in Lesotho to 97.8% in Belize); television programs (48.7% in Togo to 91.7% in the Philippines); newspapers/magazines (29.5% in Togo to 89.7% in the Philippines); and outdoor community events (30.6% in Rwanda to 79.4% in the Philippines). The overall proportion of never smokers who were susceptible to cigarette smoking ranged from 3.7% in Sri Lanka to 70.1% in Kyrgyzstan. Exposure to ≥2 sources of pro-tobacco advertisements was associated with significantly increased odds of cigarette smoking among adolescents in several countries including South Africa (adjusted odds ratio, aOR = 4.11; 95% CI:2.26-7.47), Togo (aOR = 3.77; 95% CI:1.27-11.21), the Former Yugoslav Republic of Macedonia (aOR = 1.42; 95% CI:1.01-1.99), Republic of Moldova (aOR = 1.53; 95% CI:1.11-2.12), Belize (aOR = 13.95; 95% CI:1.91-102.02), Panama (aOR = 5.14; 95% CI: 2.37-11.14) and Mongolia (aOR = 1.52; 95% CI:1.19-1.94). Conclusion Prevalence of exposure to various pro-tobacco advertisements was high among adolescents in the LMICs surveyed. Enhanced and sustained national efforts are needed to reduce exposure to all forms of tobacco advertising and promotional activities. PMID:23701716

Religious and cultural traits in HIV/AIDS epidemics in sub-Saharan Africa.

PubMed

Velayati, Ali-Akbar; Bakayev, Valerii; Bahadori, Moslem; Tabatabaei, Seyed-Javad; Alaei, Arash; Farahbood, Amir; Masjedi, Mohammad-Reza

2007-10-01

The pandemic of HIV/AIDS in sub-Saharan Africa and the rise of epidemics in Asia to the previously unforeseen level are likely to have global social, economic, and political impacts. In this emergency, it is vital to reappraise the weight of powerful religious and cultural factors in spreading the disease. The role of Islam in shaping values, norms, and public policies in North African states is to be appreciated for the lowest HIV prevalence in their populations. Yet, the place of religion in prevention of the disease diffusion is not fully understood nor worldwide acknowledged by the primary decision makers. Another topic, which has received little attention to date, despite the abundance of literature concerning the unfortunate Africa's anti-AIDS campaign, is an issue of colonial past. To better comprehend the share of both traits in diverse spread of HIV in sub-Saharan Africa, we studied the correlation between Muslim and Christian proportions in the state's population and HIV rate. By this method, Muslim percentage came out as a potential predictor of HIV prevalence in a given state. In another approach, most subcontinental countries were clustered by colocalization and similarity in their leading religion, colonial past, and HIV seroprevalence starting from barely noticeable (0.6 - 1.2%, for Mauritania, Senegal, Somalia, and Niger) and low levels (1.9 - 4.8%, for Mali, Eritrea, Djibouti, Guinea, Guinea-Bissau, Burkina-Faso, and Chad) for Muslim populated past possessions of France and Italy, in the northern part of the subcontinent. Former territories of France, Belgium, Portugal, and the UK formed two other groups of the countries nearing the equator with Catholic prevailing (Democratic Republic of Congo, Republic of Congo, Rwanda, Gabon, and Burundi) or mixed populations comprising Christian, Muslim, and indigenous believers (Benin, Ghana, Uganda, Togo, Angola, Nigeria, Liberia, Kenya, Cameroon, Côte d'Ivoire, and Sierra-Leone), which covered the HIV prevalence range from 1.9% to 7%. Albeit being traced by origin to the central part of the continent, HIV has reached the highest rates in the South, particularly Malawi (14.2%), Zambia (16.5%), South Africa (21.5%), Zimbabwe (24.6%), Lesotho (28.9%), Botswana (37.3%), and Swaziland (38.8%)-all former British colonies with dominating Christian population. In the group ranking list, a distinct North to South oriented incline in HIV rates related to prevailing religion and previous colonial history of the country was found, endorsing the preventive role of the Islam against rising HIV and the increased vulnerability to menace in states with particular colonial record.

Emissions of mercury in southern Africa derived from long-term observations at Cape Point, South Africa

NASA Astrophysics Data System (ADS)

Brunke, E.-G.; Ebinghaus, R.; Kock, H. H.; Labuschagne, C.; Slemr, F.

2012-08-01

Mercury emissions in South Africa have so far been estimated only by a bottom-up approach from activities and emission factors for different processes. In this paper we derive GEM/CO (GEM being gaseous elemental mercury, Hg0), GEM/CO2, GEM/CH4, CO/CO2, CH4/CO2, and CH4/CO emission ratios from plumes observed during long-term monitoring of these species at Cape Point between March 2007 and December 2009. The average observed GEM/CO, GEM/CO2, GEM/CH4, CO/CO2, CH4/CO2, and CH4/CO emission ratios were 2.40 ± 2.65 pg m-3 ppb-1 (n = 47), 62.7 ± 80.2 pg m-3 ppm-1 (n = 44), 3.61 ± 4.66 pg m-3 ppb-1 (n = 46), 35.6 ± 25.4 ppb ppm-1 (n = 52), 20.2 ± 15.5 ppb ppm-1 (n = 48), and 0.876 ± 1.106 ppb ppb-1 (n = 42), respectively. The observed CO/CO2, CH4/CO2, and CH4/CO emission ratios agree within the combined uncertainties of the observations and emissions with the ratios calculated from EDGAR (version 4.2) CO2, CO, and CH4 inventories for South Africa and southern Africa (South Africa, Lesotho, Swaziland, Namibia, Botswana, Zimbabwe, and Mozambique) in 2007 and 2008 (inventories for 2009 are not available yet). Total elemental mercury emission of 13.1, 15.2, and 16.1 t Hg yr-1 are estimated independently using the GEM/CO, GEM/CO2, and GEM/CH4 emission ratios and the annual mean CO, CO2, and CH4 emissions, respectively, of South Africa in 2007 and 2008. The average of these independent estimates of 14.8 t GEM yr-1 is much less than the total emission of 257 t Hg yr-1 shown by older inventories which are now considered to be wrong. Considering the uncertainties of our emission estimate, of the emission inventories, and the fact that emission of GEM represents 50-78 % of all mercury emissions, our estimate is comparable to the currently cited GEM emissions in 2004 and somewhat smaller than emissions in 2006. A further increase of mercury emissions due to increasing electricity consumption will lead to a more pronounced difference. A quantitative assessment of the difference and its significance, however, will require emission inventories for the years of observations (2007-2009) as well as better data on the speciation of the total mercury emissions in South Africa.

HIV prevalence and behavioral and psychosocial factors among transgender women and cisgender men who have sex with men in 8 African countries: A cross-sectional analysis.

PubMed

Poteat, Tonia; Ackerman, Benjamin; Diouf, Daouda; Ceesay, Nuha; Mothopeng, Tampose; Odette, Ky-Zerbo; Kouanda, Seni; Ouedraogo, Henri Gautier; Simplice, Anato; Kouame, Abo; Mnisi, Zandile; Trapence, Gift; van der Merwe, L Leigh Ann; Jumbe, Vicente; Baral, Stefan

2017-11-01

Sub-Saharan Africa bears more than two-thirds of the worldwide burden of HIV; however, data among transgender women from the region are sparse. Transgender women across the world face significant vulnerability to HIV. This analysis aimed to assess HIV prevalence as well as psychosocial and behavioral drivers of HIV infection among transgender women compared with cisgender (non-transgender) men who have sex with men (cis-MSM) in 8 sub-Saharan African countries. Respondent-driven sampling targeted cis-MSM for enrollment. Data collection took place at 14 sites across 8 countries: Burkina Faso (January-August 2013), Côte d'Ivoire (March 2015-February 2016), The Gambia (July-December 2011), Lesotho (February-September 2014), Malawi (July 2011-March 2012), Senegal (February-November 2015), Swaziland (August-December 2011), and Togo (January-June 2013). Surveys gathered information on sexual orientation, gender identity, stigma, mental health, sexual behavior, and HIV testing. Rapid tests for HIV were conducted. Data were merged, and mixed effects logistic regression models were used to estimate relationships between gender identity and HIV infection. Among 4,586 participants assigned male sex at birth, 937 (20%) identified as transgender or female, and 3,649 were cis-MSM. The mean age of study participants was approximately 24 years, with no difference between transgender participants and cis-MSM. Compared to cis-MSM participants, transgender women were more likely to experience family exclusion (odds ratio [OR] 1.75, 95% CI 1.42-2.16, p < 0.001), rape (OR 1.95, 95% CI 1.63-2.36, p < 0.001), and depressive symptoms (OR 1.30, 95% CI 1.12-1.52, p < 0.001). Transgender women were more likely to report condomless receptive anal sex in the prior 12 months (OR 2.44, 95% CI 2.05-2.90, p < 0.001) and to be currently living with HIV (OR 1.81, 95% CI 1.49-2.19, p < 0.001). Overall HIV prevalence was 25% (235/926) in transgender women and 14% (505/3,594) in cis-MSM. When adjusted for age, condomless receptive anal sex, depression, interpersonal stigma, law enforcement stigma, and violence, and the interaction of gender with condomless receptive anal sex, the odds of HIV infection for transgender women were 2.2 times greater than the odds for cis-MSM (95% CI 1.65-2.87, p < 0.001). Limitations of the study included sampling strategies tailored for cis-MSM and merging of datasets with non-identical survey instruments. In this study in sub-Saharan Africa, we found that HIV burden and stigma differed between transgender women and cis-MSM, indicating a need to address gender diversity within HIV research and programs.

South Africa

NASA Technical Reports Server (NTRS)

2002-01-01

This true-color image of South Africa was acquired on May 14, 2000, by NASA's Moderate-resolution Imaging Spectroradiometer, or MODIS. The image was produced using a combination of the sensor's 250-m and 500-m resolution visible wavelength bands. As part of the opening ceremony to begin the joint U.S.-South Africa SAFARI Field Experiment, NASA presented print copies of this image as GIFts to Dr. Ben Ngubane, Minister of Arts, Science and Technology, and Honorable Advocate Ngoaka Ramathlodi, Premier of the Northern Province, South Africa. The area shown in this image encompasses seven capital cities and a number of the region's distinctive geological features can be seen clearly. Toward the northern (top) central part of the image, the browns and tans comprise the Kalahari Desert of southern Botswana. The Tropic of Capricorn runs right through the heart of the Kalahari and the Botswanan capital city of Gaborone sits on the Limpopo River, southeast of the Kalahari. Along the western coastline of the continent is the country of Namibia, where the Namib Desert is framed against the sea by the Kaokoveld Mountains. The Namibian capital of Windhoek is obscured by clouds. Looking closely in the center of the image, the Orange River can be seen running from east to west, demarcating the boundary between Namibia and South Africa. On the southwestern corner of the continent is the hook-like Cape of Good Hope peninsula and Cape Town, the parliamentary capital of South Africa. Running west to east away from Cape Town are the Great Karroo Mountains. The shadow in this image conveys a sense of the very steep grade of the cliffs along the southern coast of South Africa. Port Elizabeth sits on the southeasternmost point of South Africa, and a large phytoplankton bloom can be seen in the water about 100 miles east of there. Moving northward along the east coast, the Drakensberg Mountains are visible. The two small nations of Lesotho and Swaziland are in this region, completely contained within South Africa's boundaries. In the upper righthand corner of the image is the Bay of Maputo, where sits Maputo, the capital of Mozambique. Fires are visible in the northeast corner of the image, near Maputo. Just north of Maputo is where the Limpopo River empties into the Indian Ocean. Tracing the Limpopo inland back toward the west, this river defines the northern boundary of South Africa with both Zimbabwe and Botswana. Johannesburg, the commercial capital of South Africa, can be seen as the greyish pixels in the northeastern region of the country. The country's legislative capital, Pretoria, is about 50 miles north of Johannesburg and 250 miles west of Maputo, in the heart of the Northern Province (formerly known as Transvaal). (Image courtesy Jacques Descloitres, MODIS Land Group, NASA Goddard Space Flight Center)

Global, regional, and national estimates of pneumonia burden in HIV-infected children in 2010: a meta-analysis and modelling study

PubMed Central

Theodoratou, Evropi; McAllister, David A; Reed, Craig; Adeloye, Davies O; Rudan, Igor; Muhe, Lulu M; Madhi, Shabir A; Campbell, Harry; Nair, Harish

2014-01-01

Summary Background Globally, pneumonia is a leading cause of mortality and morbidity in children younger than 5 years. Underlying HIV infection is an important risk factor for pneumonia morbidity and mortality in children. There are, however, no global or country level estimates of pneumonia burden in HIV-infected children. We assessed the role of HIV in pneumonia incidence and mortality and estimated the number of pneumonia cases and deaths in HIV-infected children younger than 5 years in 133 high pneumonia-burden countries in 2010. Methods We estimated the risk of hospital admission and case fatality rate caused by pneumonia in HIV-infected children compared with HIV-uninfected children from a systematic review of studies published in Medline, Embase, and Global Health between Jan 1, 1980, and Aug 31, 2013. We estimated nationwide pneumonia incidence and mortality with two different models that incorporated several risk factors for paediatric pneumonia hospital admission and mortality (including HIV infection). We then estimated the number of pneumonia episodes and deaths that occurred in HIV-infected children in 2010. Findings The odds ratio (OR) for hospital admission for all-cause pneumonia in HIV-infected children compared with HIV-uninfected children was 6·5 (95% CI 5·9–7·2). The risk of death was higher in children with pneumonia and HIV compared with those with pneumonia only (OR 5·9, 95% CI 2·7–12·7). In 2010, 1·4 million pneumonia episodes (uncertainty range [UR] 0·6 million to 3·3 million) and 88 000 pneumonia deaths (UR 47 400–153 000) occurred in HIV-infected children in low-income countries. Of these, 1·2 million pneumonia episodes (UR 0·5 million–2·7 million) and 85 400 deaths (UR 46 000–147 300) were directly attributable to HIV. 1·3 million (90%) pneumonia episodes and 82 400 (93%) pneumonia deaths in HIV-infected children aged younger than 5 years occurred in the WHO African region. Interpretation Globally, a small proportion of pneumonia episodes and pneumonia deaths occur in HIV-infected children. However, in the highest HIV-burden countries in sub-Saharan Africa (ie, Swaziland, Lesotho, and Zimbabwe) up to a fifth of all pneumonia cases and 60% of pneumonia deaths occur in HIV-infected children. In these countries, major reductions in child pneumonia mortality can be achieved only if the systemic challenges plaguing the health system (poor coverage of early infant testing for HIV, of antiretroviral drugs in pregnant women and young children, of co-trimoxazole prophylaxis, and of pneumococcal vaccination) can be overcome. Funding WHO. PMID:25455992

Mass wasting deposits in the upper Sehonghong valley, eastern Lesotho: Late Pleistocene climate implications

NASA Astrophysics Data System (ADS)

Mills, S. C.; Grab, S. W.

2009-04-01

Despite considerable research attention on apparent periglacial, glacial and sedimentary phenomena in the Maluti-Drakensberg alpine environment, knowledge on the Quaternary environmental history of this important watershed and climate-divide is still rather rudimentary. The dearth of Quaternary environmental indicators (proxy data) in the high Drakensberg is partly owing to the harsh climate (e.g. high wind speeds and high seasonal precipitation), which offers a poor preservation of past biological remains (e.g. bones, dung, middens, pollen). Possibly the best opportunity to reconstruct high Drakensberg palaeoenvironments is from sedimentary sequences exposed along fluvially-incised valley fills. The upper Sehonghong River (3000 to 3200 m a.s.l.) flows in a westerly direction and is flanked by north- and south-facing slopes reaching 3465 m a.s.l. Sediment is exposed on both the north- and south-facing slopes along the river. Despite uniform regional environmental conditions (geology, topography, climate, vegetation), there is a notable absence of similar north-facing deposits in adjacent upper valley catchments to the north and south of Sehonghong Valley. The upper Sehonghong Valley thus presents somewhat ‘unique' evidence for palaeo-slope mass movement in this alpine region. Thick colluvial deposits are most prominent on the south-facing slopes along the Sehonghong River and occur at altitudes between 3100 m a.s.l. and 3150 m a.s.l. The colluvial mantles are approximately 7 m in thickness, however reach up to 13 m in some areas. Although the north-facing lower valley side-slopes are generally absent of deposits, the notable exception is the thick stratified deposit located a few kilometres upstream. Whilst the south-facing deposits are relatively uniform in nature, the north-facing deposits consist of alternating units of gravel and organic sediment, dated to 36 600 ± 1400 14C yrs BP, and reflecting environmental changes during the Late Pleistocene. Mass wasting deposits support enhanced periglacial activity during the Late Pleistocene, particularly on south-facing slopes, and also where conditions were conducive to enhanced sediment transport on the adjacent north-facing slope of the Sehonghong River. Recent published work has suggested evidence for marginal glaciation in the high Drakensberg within 10 km of the Sehonghong Valley, suggesting that whilst particular environmental settings host deposits classified as glacial moraine, adjacent valleys are occupied by deep (~8 m) valley deposits flanking south-facing slopes. We demonstrate that the variable nature of adjacent valley slope deposits at similar altitudes is a product of a past climate that was within the glacial/periglacial equilibrium zone, and influenced by specific topographic and associated micro-climatic thresholds.

HIV prevalence and behavioral and psychosocial factors among transgender women and cisgender men who have sex with men in 8 African countries: A cross-sectional analysis

PubMed Central

Ackerman, Benjamin; Diouf, Daouda; Ceesay, Nuha; Mothopeng, Tampose; Odette, Ky-Zerbo; Kouanda, Seni; Ouedraogo, Henri Gautier; Simplice, Anato; Kouame, Abo; Trapence, Gift; van der Merwe, L. Leigh Ann; Jumbe, Vicente; Baral, Stefan

2017-01-01

Introduction Sub-Saharan Africa bears more than two-thirds of the worldwide burden of HIV; however, data among transgender women from the region are sparse. Transgender women across the world face significant vulnerability to HIV. This analysis aimed to assess HIV prevalence as well as psychosocial and behavioral drivers of HIV infection among transgender women compared with cisgender (non-transgender) men who have sex with men (cis-MSM) in 8 sub-Saharan African countries. Methods and findings Respondent-driven sampling targeted cis-MSM for enrollment. Data collection took place at 14 sites across 8 countries: Burkina Faso (January–August 2013), Côte d’Ivoire (March 2015–February 2016), The Gambia (July–December 2011), Lesotho (February–September 2014), Malawi (July 2011–March 2012), Senegal (February–November 2015), Swaziland (August–December 2011), and Togo (January–June 2013). Surveys gathered information on sexual orientation, gender identity, stigma, mental health, sexual behavior, and HIV testing. Rapid tests for HIV were conducted. Data were merged, and mixed effects logistic regression models were used to estimate relationships between gender identity and HIV infection. Among 4,586 participants assigned male sex at birth, 937 (20%) identified as transgender or female, and 3,649 were cis-MSM. The mean age of study participants was approximately 24 years, with no difference between transgender participants and cis-MSM. Compared to cis-MSM participants, transgender women were more likely to experience family exclusion (odds ratio [OR] 1.75, 95% CI 1.42–2.16, p < 0.001), rape (OR 1.95, 95% CI 1.63–2.36, p < 0.001), and depressive symptoms (OR 1.30, 95% CI 1.12–1.52, p < 0.001). Transgender women were more likely to report condomless receptive anal sex in the prior 12 months (OR 2.44, 95% CI 2.05–2.90, p < 0.001) and to be currently living with HIV (OR 1.81, 95% CI 1.49–2.19, p < 0.001). Overall HIV prevalence was 25% (235/926) in transgender women and 14% (505/3,594) in cis-MSM. When adjusted for age, condomless receptive anal sex, depression, interpersonal stigma, law enforcement stigma, and violence, and the interaction of gender with condomless receptive anal sex, the odds of HIV infection for transgender women were 2.2 times greater than the odds for cis-MSM (95% CI 1.65–2.87, p < 0.001). Limitations of the study included sampling strategies tailored for cis-MSM and merging of datasets with non-identical survey instruments. Conclusions In this study in sub-Saharan Africa, we found that HIV burden and stigma differed between transgender women and cis-MSM, indicating a need to address gender diversity within HIV research and programs. PMID:29112689

Population Health Impact and Cost-Effectiveness of Tuberculosis Diagnosis with Xpert MTB/RIF: A Dynamic Simulation and Economic Evaluation

PubMed Central

Menzies, Nicolas A.; Cohen, Ted; Lin, Hsien-Ho; Murray, Megan; Salomon, Joshua A.

2012-01-01

Background The Xpert MTB/RIF test enables rapid detection of tuberculosis (TB) and rifampicin resistance. The World Health Organization recommends Xpert for initial diagnosis in individuals suspected of having multidrug-resistant TB (MDR-TB) or HIV-associated TB, and many countries are moving quickly toward adopting Xpert. As roll-out proceeds, it is essential to understand the potential health impact and cost-effectiveness of diagnostic strategies based on Xpert. Methods and Findings We evaluated potential health and economic consequences of implementing Xpert in five southern African countries—Botswana, Lesotho, Namibia, South Africa, and Swaziland—where drug resistance and TB-HIV coinfection are prevalent. Using a calibrated, dynamic mathematical model, we compared the status quo diagnostic algorithm, emphasizing sputum smear, against an algorithm incorporating Xpert for initial diagnosis. Results were projected over 10- and 20-y time periods starting from 2012. Compared to status quo, implementation of Xpert would avert 132,000 (95% CI: 55,000–284,000) TB cases and 182,000 (97,000–302,000) TB deaths in southern Africa over the 10 y following introduction, and would reduce prevalence by 28% (14%–40%) by 2022, with more modest reductions in incidence. Health system costs are projected to increase substantially with Xpert, by US$460 million (294–699 million) over 10 y. Antiretroviral therapy for HIV represents a substantial fraction of these additional costs, because of improved survival in TB/HIV-infected populations through better TB case-finding and treatment. Costs for treating MDR-TB are also expected to rise significantly with Xpert scale-up. Relative to status quo, Xpert has an estimated cost-effectiveness of US$959 (633–1,485) per disability-adjusted life-year averted over 10 y. Across countries, cost-effectiveness ratios ranged from US$792 (482–1,785) in Swaziland to US$1,257 (767–2,276) in Botswana. Assessing outcomes over a 10-y period focuses on the near-term consequences of Xpert adoption, but the cost-effectiveness results are conservative, with cost-effectiveness ratios assessed over a 20-y time horizon approximately 20% lower than the 10-y values. Conclusions Introduction of Xpert could substantially change TB morbidity and mortality through improved case-finding and treatment, with more limited impact on long-term transmission dynamics. Despite extant uncertainty about TB natural history and intervention impact in southern Africa, adoption of Xpert evidently offers reasonable value for its cost, based on conventional benchmarks for cost-effectiveness. However, the additional financial burden would be substantial, including significant increases in costs for treating HIV and MDR-TB. Given the fundamental influence of HIV on TB dynamics and intervention costs, care should be taken when interpreting the results of this analysis outside of settings with high HIV prevalence. Please see later in the article for the Editors' Summary PMID:23185139

Seismotectonics of the Lwandle-Nubia plate boundary between South Africa and the Southwest Indian Ridge

NASA Astrophysics Data System (ADS)

Hartnady, Chris; Okal, Emile; Calais, Eric; Stamps, Sarah; Saria, Elifuraha

2013-04-01

The Lwandle (LW) plate shares a boundary with the Nubia (NU) plate, extending from a diffuse triple junction with the Rovuma plate in Southern Mozambique to a triple junction with the Antarctic plate along a segment of the Southwest Indian Ridge (SWIR). The LW-NU boundary terminates in the ~750 km-long, complex transform of the Andrew Bain Fracture Zone (ABFZ), but its exact locus is still unclear. Recent works locate it along the eastern boundary of the submarine Mozambique Ridge, parallel to the pre-existing, oceanic transform-fault fabric. However, an early concept of the LW block ('ambiguous region' of Hartnady, 1990, Fig. 2) indicates a more westerly trajectory in the north that includes parts of South Africa, with a southerly extension across old oceanic crust of the submarine Natal Valley and Transkei Basin. This proposed boundary is marked by several, aligned epicentres of moderate to strong earthquakes (1941, 1942, 1956, 1969, 1972, 1975, 1981 and 1989). Our re-examination of seismographic records from the 1975 'intraplate' earthquake (-37.62°N, 30.98°E, mb5.0), in the oceanic crust of the distal Transkei Basin, shows a thrust-faulting focal mechanism along a nodal plane striking N272°E. The largest (ML4.2) of a series of three small earthquakes in the Natal Valley in 2009, close to a zone of recent seafloor deformation mapped in 1992, has similar first-motion patterns at Southern African seismograph stations. When the 1975 slip-vector result (N173°E) is combined with a normal-faulting slip vector (N078°E) from a 1986 onland earthquake (-30.53°N, 28.84°E, mb5.0) near the Lesotho-KZN border, and both are incorporated into the wider data-set previously used to solve for East African Rift kinematics, they produce a LW-NU rotation pole that is located south of Africa, near the Agulhas Plateau, and approximately 950 km from the Natal Valley deformation zone. The modeled low rate of right-lateral, LW-NU slip (~0.50-0.75 mm/yr) across this LW-NU boundary segment suggests that the 1972, 1981 and nearby 2009 earthquakes are instances of a 'long aftershock sequence' in the source zone of the 1850 'i-Nyikima' event, which was felt over a very wide region of the Eastern Cape Colony, and the adjacent territories of British Kaffraria and Pondoland. This remarkable historic shaking appears to have been caused by a great (Mw8.0+), oceanic event along a segment of the LW-NU boundary, resembling the 1942 SWIR event along the ABFZ and the recent (2012 March 11) North Indian Ocean events along the incipient boundary between the Indian and Australian plates. This new interpretation has implications for the re-assessment of seismic and submarine-landslide (tsunami) hazard along the SE continental margin of South Africa. Reference Hartnady CJH (1990). Seismicity and plate boundary evolution in southeastern Africa. S. Afr. J. Geol. 93, 473 484.

Modern contraceptive use, unmet need, and demand satisfied among women of reproductive age who are married or in a union in the focus countries of the Family Planning 2020 initiative: a systematic analysis using the Family Planning Estimation Tool.

PubMed

Cahill, Niamh; Sonneveldt, Emily; Stover, John; Weinberger, Michelle; Williamson, Jessica; Wei, Chuchu; Brown, Win; Alkema, Leontine

2018-03-03

The London Summit on Family Planning in 2012 inspired the Family Planning 2020 (FP2020) initiative and the 120×20 goal of having an additional 120 million women and adolescent girls become users of modern contraceptives in 69 of the world's poorest countries by the year 2020. Working towards achieving 120 × 20 is crucial for ultimately achieving the Sustainable Development Goals of universal access and satisfying demand for reproductive health. Thus, a performance assessment is required to determine countries' progress. An updated version of the Family Planning Estimation Tool (FPET) was used to construct estimates and projections of the modern contraceptive prevalence rate (mCPR), unmet need for, and demand satisfied with modern methods of contraception among women of reproductive age who are married or in a union in the focus countries of the FP2020 initiative. We assessed current levels of family planning indicators and changes between 2012 and 2017. A counterfactual analysis was used to assess if recent levels of mCPR exceeded pre-FP2020 expectations. In 2017, the mCPR among women of reproductive age who are married or in a union in the FP2020 focus countries was 45·7% (95% uncertainty interval [UI] 42·4-49·1), unmet need for modern methods was 21·6% (19·7-23·9), and the demand satisfied with modern methods was 67·9% (64·4-71·1). Between 2012 and 2017 the number of women of reproductive age who are married or in a union who use modern methods increased by 28·8 million (95% UI 5·8-52·5). At the regional level, Asia has seen the mCPR among women of reproductive age who are married or in a union grow from 51·0% (95% UI 48·5-53·4) to 51·8% (47·3-56·5) between 2012 and 2017, which is slow growth, particularly when compared with a change from 23·9% (22·9-25·0) to 28·5% (26·8-30·2) across Africa. At the country level, based on a counterfactual analysis, we found that 61% of the countries that have made a commitment to FP2020 exceeded pre-FP2020 expectations for modern contraceptive use. Country success stories include rapid increases in Kenya, Mozambique, Malawi, Lesotho, Sierra Leone, Liberia, and Chad relative to what was expected in 2012. Whereas the estimate of additional users up to 2017 for women of reproductive age who are married or in a union would suggest that the 120 × 20 goal for all women is overly ambitious, the aggregate outcomes mask the diversity in progress at the country level. We identified countries with accelerated progress, that provide inspiration and guidance on how to increase the use of family planning and inform future efforts, especially in countries where progress has been poor. The Bill & Melinda Gates Foundation, through grant support to the University of Massachusetts Amherst and Avenir Health. Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Home-based versus mobile clinic HIV testing and counseling in rural Lesotho: a cluster-randomized trial.

PubMed

Labhardt, Niklaus Daniel; Motlomelo, Masetsibi; Cerutti, Bernard; Pfeiffer, Karolin; Kamele, Mashaete; Hobbins, Michael A; Ehmer, Jochen

2014-12-01

The success of HIV programs relies on widely accessible HIV testing and counseling (HTC) services at health facilities as well as in the community. Home-based HTC (HB-HTC) is a popular community-based approach to reach persons who do not test at health facilities. Data comparing HB-HTC to other community-based HTC approaches are very limited. This trial compares HB-HTC to mobile clinic HTC (MC-HTC). The trial was powered to test the hypothesis of higher HTC uptake in HB-HTC campaigns than in MC-HTC campaigns. Twelve clusters were randomly allocated to HB-HTC or MC-HTC. The six clusters in the HB-HTC group received 30 1-d multi-disease campaigns (five villages per cluster) that delivered services by going door-to-door, whereas the six clusters in MC-HTC group received campaigns involving community gatherings in the 30 villages with subsequent service provision in mobile clinics. Time allocation and human resources were standardized and equal in both groups. All individuals accessing the campaigns with unknown HIV status or whose last HIV test was >12 wk ago and was negative were eligible. All outcomes were assessed at the individual level. Statistical analysis used multivariable logistic regression. Odds ratios and p-values were adjusted for gender, age, and cluster effect. Out of 3,197 participants from the 12 clusters, 2,563 (80.2%) were eligible (HB-HTC: 1,171; MC-HTC: 1,392). The results for the primary outcomes were as follows. Overall HTC uptake was higher in the HB-HTC group than in the MC-HTC group (92.5% versus 86.7%; adjusted odds ratio [aOR]: 2.06; 95% CI: 1.18-3.60; p = 0. 011). Among adolescents and adults ≥ 12 y, HTC uptake did not differ significantly between the two groups; however, in children <12 y, HTC uptake was higher in the HB-HTC arm (87.5% versus 58.7%; aOR: 4.91; 95% CI: 2.41-10.0; p<0.001). Out of those who took up HTC, 114 (4.9%) tested HIV-positive, 39 (3.6%) in the HB-HTC arm and 75 (6.2%) in the MC-HTC arm (aOR: 0.64; 95% CI: 0.48-0.86; p = 0.002). Ten (25.6%) and 19 (25.3%) individuals in the HB-HTC and in the MC-HTC arms, respectively, linked to HIV care within 1 mo after testing positive. Findings for secondary outcomes were as follows: HB-HTC reached more first-time testers, particularly among adolescents and young adults, and had a higher proportion of men among participants. However, after adjusting for clustering, the difference in male participation was not significant anymore. Age distribution among participants and immunological and clinical stages among persons newly diagnosed HIV-positive did not differ significantly between the two groups. Major study limitations included the campaigns' restriction to weekdays and a relatively low HIV prevalence among participants, the latter indicating that both arms may have reached an underexposed population. This study demonstrates that both HB-HTC and MC-HTC can achieve high uptake of HTC. The choice between these two community-based strategies will depend on the objective of the activity: HB-HTC was better in reaching children, individuals who had never tested before, and men, while MC-HTC detected more new HIV infections. The low rate of linkage to care after a positive HIV test warrants future consideration of combining community-based HTC approaches with strategies to improve linkage to care for persons who test HIV-positive. ClinicalTrials.gov NCT01459120. Please see later in the article for the Editors' Summary.

A review of the stratigraphy and sedimentary environments of the Karoo-aged basins of Southern Africa

NASA Astrophysics Data System (ADS)

Smith, R. M. H.; Eriksson, P. G.; Botha, W. J.

1993-02-01

The Karoo Basin of South Africa was one of several contemporaneous intracratonic basins in southwestern Gondwana that became active in the Permo-Carboniferous (280 Ma) and continued to accumulate sediments until the earliest Jurassic, 100 million years later. At their maximum areal extent, during the early Permian, these basins covered some 4.5 million km 2. The present outcrop area of Karoo rocks in southern Africa is about 300 000 km 2 with a maximum thickness of some 8000 m. The economic importance of these sediments lies in the vast reserves of coal within the Ecca Group rocks of northern and eastern Transvaal and Natal, South Africa. Large reserves of sandstone-hosted uranium and molybdenum have been proven within the Beaufort Group rocks of the southern Karoo trough, although they are not mineable in the present market conditions. Palaeoenvironmental analysis of the major stratigraphic units of the Karoo succession in South Africa demonstrates the changes in depositional style caused by regional and localized tectonism within the basin. These depocentres were influenced by a progressive aridification of climate which was primarily caused by the northward drift of southwestern Gondwana out of a polar climate and accentuated by the meteoric drying effect of the surrounding land masses. Changing palaeoenvironments clearly influenced the rate and direction of vertebrate evolution in southern Gondwana as evidenced by the numerous reptile fossils, including dinosaurs, which are found in the Karoo strata of South Africa, Lesotho, Namibia and Zimbabwe. During the Late Carboniferous the southern part of Gondwana migrated over the South Pole resulting in a major ice sheet over the early Karoo basin and surrounding highlands. Glacial sedimentation in upland valleys and on the lowland shelf resulted in the Dwyka Formation at the base of the Karoo Sequence. After glaciation, an extensive shallow sea covered the gently subsiding shelf, fed by large volumes of meltwater. Marine clays and muds accumulated under cool climatic conditions (Lower Ecca Group) including the distinctive Mesosaurus-bearing carbonaceous shales of the Whitehill Formation. Subduction of the palaeo-Pacific plate reslted in an extensive chain of mountains which deformed and later truncated the southern rim of the main Karoo Basin. Material derived from these "Gondwanide" mountains as well as from the granitic uplands to the north-east, accumulated in large deltas that prograded into the Ecca sea (Upper Ecca Group). The relatively cool and humid climate promoted thick accumulations of peat on the fluvial and delta plains which now constitute the major coal reserves of southern Africa. As the prograding deltas coalesced, fluvio-lacustrine sediments of the Beaufort Group were laid down on broad gently subsiding alluvial plains. The climate by this time (Late Permian) had warmed to become semi-arid with highly seasonal rainfall. Vegetation alongside the meander belts and semi-permanent lakes supported a diverse reptilian fauna dominated by therapsids or "mammal-like reptiles". Pulses of uplift in the southern source areas combined with possible orographic effects resulted in the progadation of two coarse-grained alluvial fans into the central parts of the basin (Katberg Sandstone Member and Molteno Formation). In the upper Karoo Sequence, progressive aridification and tectonic deformation of the basin through the late Triassic and early Jurassic led to the accumulation, in four separate depositories, of "redbeds" which are interpreted as fluvial and flood-fan, playa and dune complexes (Elliot Formation). This eventually gave way to westerly wind-dominated sedimentation that choked the remaining depositories with fine-grained dune sand. The interdune areas were damp and occasionally flooded and provided a habitat for small dinosaurs and the earliest mammals. During this time (Early Jurassic), basinwide volcanic activity began as a precursor to the break-up of Gondwana in the late Jurassic and continued until the early Cretaceous. This extrusion of extensive flood basalts (Drakensberg Group) onto the Clarens landscape eventually brought Karoo sedimentation to a close.

Age-specific and sex-specific mortality in 187 countries, 1970-2010: a systematic analysis for the Global Burden of Disease Study 2010.

PubMed

Wang, Haidong; Dwyer-Lindgren, Laura; Lofgren, Katherine T; Rajaratnam, Julie Knoll; Marcus, Jacob R; Levin-Rector, Alison; Levitz, Carly E; Lopez, Alan D; Murray, Christopher J L

2012-12-15

Estimation of the number and rate of deaths by age and sex is a key first stage for calculation of the burden of disease in order to constrain estimates of cause-specific mortality and to measure premature mortality in populations. We aimed to estimate life tables and annual numbers of deaths for 187 countries from 1970 to 2010. We estimated trends in under-5 mortality rate (children aged 0-4 years) and probability of adult death (15-59 years) for each country with all available data. Death registration data were available for more than 100 countries and we corrected for undercount with improved death distribution methods. We applied refined methods to survey data on sibling survival that correct for survivor, zero-sibling, and recall bias. We separately estimated mortality from natural disasters and wars. We generated final estimates of under-5 mortality and adult mortality from the data with Gaussian process regression. We used these results as input parameters in a relational model life table system. We developed a model to extrapolate mortality to 110 years of age. All death rates and numbers have been estimated with 95% uncertainty intervals (95% UIs). From 1970 to 2010, global male life expectancy at birth increased from 56·4 years (95% UI 55·5-57·2) to 67·5 years (66·9-68·1) and global female life expectancy at birth increased from 61·2 years (60·2-62·0) to 73·3 years (72·8-73·8). Life expectancy at birth rose by 3-4 years every decade from 1970, apart from during the 1990s (increase in male life expectancy of 1·4 years and in female life expectancy of 1·6 years). Substantial reductions in mortality occurred in eastern and southern sub-Saharan Africa since 2004, coinciding with increased coverage of antiretroviral therapy and preventive measures against malaria. Sex-specific changes in life expectancy from 1970 to 2010 ranged from gains of 23-29 years in the Maldives and Bhutan to declines of 1-7 years in Belarus, Lesotho, Ukraine, and Zimbabwe. Globally, 52·8 million (95% UI 51·6-54·1 million) deaths occurred in 2010, which is about 13·5% more than occurred in 1990 (46·5 million [45·7-47·4 million]), and 21·9% more than occurred in 1970 (43·3 million [42·2-44·6 million]). Proportionally more deaths in 2010 occurred at age 70 years and older (42·8% in 2010 vs 33·1% in 1990), and 22·9% occurred at 80 years or older. Deaths in children younger than 5 years declined by almost 60% since 1970 (16·4 million [16·1-16·7 million] in 1970 vs 6·8 million [6·6-7·1 million] in 2010), especially at ages 1-59 months (10·8 million [10·4-11·1 million] in 1970 vs 4·0 million [3·8-4·2 million] in 2010). In all regions, including those most affected by HIV/AIDS, we noted increases in mean ages at death. Despite global and regional health crises, global life expectancy has increased continuously and substantially in the past 40 years. Yet substantial heterogeneity exists across age groups, among countries, and over different decades. 179 of 187 countries have had increases in life expectancy after the slowdown in progress in the 1990s. Efforts should be directed to reduce mortality in low-income and middle-income countries. Potential underestimation of achievement of the Millennium Development Goal 4 might result from limitations of demographic data on child mortality for the most recent time period. Improvement of civil registration system worldwide is crucial for better tracking of global mortality. Bill & Melinda Gates Foundation. Copyright © 2012 Elsevier Ltd. All rights reserved.

Measuring progress and projecting attainment on the basis of past trends of the health-related Sustainable Development Goals in 188 countries: an analysis from the Global Burden of Disease Study 2016.

PubMed

2017-09-16

The UN's Sustainable Development Goals (SDGs) are grounded in the global ambition of "leaving no one behind". Understanding today's gains and gaps for the health-related SDGs is essential for decision makers as they aim to improve the health of populations. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016), we measured 37 of the 50 health-related SDG indicators over the period 1990-2016 for 188 countries, and then on the basis of these past trends, we projected indicators to 2030. We used standardised GBD 2016 methods to measure 37 health-related indicators from 1990 to 2016, an increase of four indicators since GBD 2015. We substantially revised the universal health coverage (UHC) measure, which focuses on coverage of essential health services, to also represent personal health-care access and quality for several non-communicable diseases. We transformed each indicator on a scale of 0-100, with 0 as the 2·5th percentile estimated between 1990 and 2030, and 100 as the 97·5th percentile during that time. An index representing all 37 health-related SDG indicators was constructed by taking the geometric mean of scaled indicators by target. On the basis of past trends, we produced projections of indicator values, using a weighted average of the indicator and country-specific annualised rates of change from 1990 to 2016 with weights for each annual rate of change based on out-of-sample validity. 24 of the currently measured health-related SDG indicators have defined SDG targets, against which we assessed attainment. Globally, the median health-related SDG index was 56·7 (IQR 31·9-66·8) in 2016 and country-level performance markedly varied, with Singapore (86·8, 95% uncertainty interval 84·6-88·9), Iceland (86·0, 84·1-87·6), and Sweden (85·6, 81·8-87·8) having the highest levels in 2016 and Afghanistan (10·9, 9·6-11·9), the Central African Republic (11·0, 8·8-13·8), and Somalia (11·3, 9·5-13·1) recording the lowest. Between 2000 and 2016, notable improvements in the UHC index were achieved by several countries, including Cambodia, Rwanda, Equatorial Guinea, Laos, Turkey, and China; however, a number of countries, such as Lesotho and the Central African Republic, but also high-income countries, such as the USA, showed minimal gains. Based on projections of past trends, the median number of SDG targets attained in 2030 was five (IQR 2-8) of the 24 defined targets currently measured. Globally, projected target attainment considerably varied by SDG indicator, ranging from more than 60% of countries projected to reach targets for under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria, to less than 5% of countries projected to achieve targets linked to 11 indicator targets, including those for childhood overweight, tuberculosis, and road injury mortality. For several of the health-related SDGs, meeting defined targets hinges upon substantially faster progress than what most countries have achieved in the past. GBD 2016 provides an updated and expanded evidence base on where the world currently stands in terms of the health-related SDGs. Our improved measure of UHC offers a basis to monitor the expansion of health services necessary to meet the SDGs. Based on past rates of progress, many places are facing challenges in meeting defined health-related SDG targets, particularly among countries that are the worst off. In view of the early stages of SDG implementation, however, opportunity remains to take actions to accelerate progress, as shown by the catalytic effects of adopting the Millennium Development Goals after 2000. With the SDGs' broader, bolder development agenda, multisectoral commitments and investments are vital to make the health-related SDGs within reach of all populations. Bill & Melinda Gates Foundation. Copyright © 2017 The Authors. Published by Elsevier Ltd. This is an Open Access article published under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.

PubMed

2017-09-16

Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI). We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2016. We calculated DALYs by summing years of life lost and years of life lived with disability for each location, age group, sex, and year. We estimated HALE using age-specific death rates and years of life lived with disability per capita. We explored how DALYs and HALE differed from expected trends when compared with the SDI: the geometric mean of income per person, educational attainment in the population older than age 15 years, and total fertility rate. The highest globally observed HALE at birth for both women and men was in Singapore, at 75·2 years (95% uncertainty interval 71·9-78·6) for females and 72·0 years (68·8-75·1) for males. The lowest for females was in the Central African Republic (45·6 years [42·0-49·5]) and for males was in Lesotho (41·5 years [39·0-44·0]). From 1990 to 2016, global HALE increased by an average of 6·24 years (5·97-6·48) for both sexes combined. Global HALE increased by 6·04 years (5·74-6·27) for males and 6·49 years (6·08-6·77) for females, whereas HALE at age 65 years increased by 1·78 years (1·61-1·93) for males and 1·96 years (1·69-2·13) for females. Total global DALYs remained largely unchanged from 1990 to 2016 (-2·3% [-5·9 to 0·9]), with decreases in communicable, maternal, neonatal, and nutritional (CMNN) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). The exemplars, calculated as the five lowest ratios of observed to expected age-standardised DALY rates in 2016, were Nicaragua, Costa Rica, the Maldives, Peru, and Israel. The leading three causes of DALYs globally were ischaemic heart disease, cerebrovascular disease, and lower respiratory infections, comprising 16·1% of all DALYs. Total DALYs and age-standardised DALY rates due to most CMNN causes decreased from 1990 to 2016. Conversely, the total DALY burden rose for most NCDs; however, age-standardised DALY rates due to NCDs declined globally. At a global level, DALYs and HALE continue to show improvements. At the same time, we observe that many populations are facing growing functional health loss. Rising SDI was associated with increases in cumulative years of life lived with disability and decreases in CMNN DALYs offset by increased NCD DALYs. Relative compression of morbidity highlights the importance of continued health interventions, which has changed in most locations in pace with the gross domestic product per person, education, and family planning. The analysis of DALYs and HALE and their relationship to SDI represents a robust framework with which to benchmark location-specific health performance. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform health policies, health system improvement initiatives, targeted prevention efforts, and development assistance for health, including financial and research investments for all countries, regardless of their level of sociodemographic development. The presence of countries that substantially outperform others suggests the need for increased scrutiny for proven examples of best practices, which can help to extend gains, whereas the presence of underperforming countries suggests the need for devotion of extra attention to health systems that need more robust support. Bill & Melinda Gates Foundation. Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Detecting of the processes of the diamond formation using the monomineral thermobarometry .

NASA Astrophysics Data System (ADS)

Ashchepkov, Igor; Afanasiev, Valentin; Pokhilenko, Lyudmila; Logvinova, Alla; Vladykin, Nikolai

2010-05-01

The methods of the monomineral thermobarometry used for the reconstruction of the mantle sections beneath the kimberlite pipes (Ashchepkov et al., 2009) allow to determined PT range for the diamond inclusions (DI) and diamond bearing associations. They show various conditions for the crystallization of diamond for in mantle lithosphere beneath the Yakutia, Africa, and North America. In Yakutia most DI (Sobolev ea 1997, 2004; Logvinova ea., 2005 and ref their in) (Cr-pyropes, Mg -opx) form Mir and Udachnaya pipes are referred to the cold geotherms 35 (partly 33 mvm-2) at the pressure range from 35 to 80 kbar. Cr- pyropes (Ti-bearing) partly drops the on the heated area near convective branches 40-45 mvm-2 convective geotherms. Most Cr- rich pyroxenes refer to the coldest or heated (metasomatic type) at the deeper parts of the mantle columns while mildly Cr-rich varieties refer to the conditions of the crystallization from the melts related to the protokimberlites and associated carbonatites near the Graphite-Diamond boundary (G-D). They are more widely distributed in mantle beneath the Mir pipe where the essential part of mantle column from 50 to 35kbar was subjected to the refertilization. But chromite PT estimates mostly refer the heated conditions of the convective branch at the lithosphere base (~70-60kbar). They are most typical for the Alakite pipes. Diamond bearing eclogites show the some separate levels of crystallization with the high T-range reflecting conditions 35 to 45 mvm-2 mostly in the 60-50 kbar interval. They coincide with the levels of the intensive heating in the mantle columns. For the South Africa in the Mesozoic pipes beneath Lesotho - Jagersfontein (Viljoen ea. 2005), Finsch (Appleyard ea., 2004; Gurney, Switzer, 1973; She ea., 1983), Koffiefontein (Rickard ea., 1986), diamond bearing associations refer to three geotherm branches. The coldest (Cr-pyropes and Mg-Opx) is related to ancient subduction with the heating at 60 and 75 kbars. The 40 mvm-2 is related to the Diam-eclogites (To according to Krogh, 1988), Fe- Opx and chromites. And hottest (45mvm-2) refers to the magmatic type eclogites (cumulates) and some HT chromites (restites). In mantle columns beneath the Proterozoic pipes like Roberts Victor (Souter, Harte, 1988; Jacob ea, 2004), Premier (Gurney ea., 1985; Viljoin ea, 2009) the eclogitic DI trace mostly 40 mvm-2 geotherm but large amount of PT point drops onto advective hottest branch. Mostly eclogites are separated to several branches according to Mg#. The Fe- rich (ancient trondjemitic cumulates) are commonly low-To (LT). Conditions for the mantle beneath Tanzania (Stachel ea, 1998) and Ghana (Stachel ea, 1997) are close to 40mvm-2 geotherm from the deepest~80 kbar level to 35 kbar. The PT estimates for DI from Guinea (Denies, Harris, 2004), those from Angola kimberlites refer to colder geotherm branch. Similar but hotter conditions are detected for the V-Cm kimberlites from Botswana - Venetia (Viljoen ea 2009; Hin et al., 2009) which in mantle columns reveals subadiabatic branch from 1450oC (45mvm-2) but the Late Mesozoic pipes in this region like Letlhakane (Achtenbergh ea, 2001; Stienfenhofer ea, 1997; Deines, Harris, 2004), Orapa (Denies ea., 2009; Stachel ea., 2004) reveal conditions close to 42 mvm-2. PT for mantle xenoliths from the "of craton" Namibian pipes (Louwrensia, Hanous) (Mitchel, 1984; Boyd ea., 2004) trace the G-D boundary or are plotted above it and only relic associations are correspondent to the levels ~65-70 kbar. The PT for OPx and some Cpx in diamonds (Harris ea, 2004) from placers are close to this boundary but those for hot (1400oC) eclogites (magmatic type) are correspondent to the lower levels of mantle columns or coincides with the hottest PT conditions for peridotites. The location of the PT estimate for DI above the Diam -Graph boundary is probably due to metastable crystallization or mantle diapirism. In North America kimberlites the conditions for the DI are mostly LT. Garnet DI from the Diavic mine (Schultze ea, 2008) locate from 50 to 70 kbar near 36 mvm-2 geotherm. Hi-Mg eclogites demonstrate more LT conditions, while the conditions for Hi-Fe eclogite are close to convective 40 mvm-2 branch similar to those for Chromite DI and several points are lose to 45 mvm-2or locate slightly above Diam-Graph. DI from Panda (Tomlinson ea, 2006; Greighton ea, 2009) kimberlites from the same region reveals close PT but are slightly LT. The PT conditions for diamondiferous eclogites from Jericho (Lac De Gras) (Heaman ea, 2004) are most LT in Slave craton (33 -36 mvm-2) at 50-65 kbar range. The eclogitic Cpx and peridotitic pyrope DI (Aulbach et al., 2004) from Buffalo Heard (Banas ea., 2006) at the west of region also trace 36 heating to 40 mvm-2 geotherm at 70 kbar and some more hot PT points trace D-G line. In Wayoming craton the Cr-pyrope DI from low Paleozoic KL-1 pipe (Coopersmith ea ., 2004; Schultze ea 2008) reflect the range 35-40 mvm-2 of heating at lithosphere base 75-65 kbar and more Fe-rich Opx demonstrate HT conditions probably refer to cumulates. Thus the mantle inclusion in different part of the Earth mantle in general repeats the conditions of the whole mantle column. They reflect higher PT gradients in ancient time. In Africa they are hotter in general and often trace advective branches. While in the thicker and colder lithosphere beneath the Slave craton DI reveal colder and deeper in general conditions. In Siberia many of DI especially Chr as well as Diam- eclogites reflect the conditions of the heating and the influence of the protokimberlite melts.

Limits to the availability of groundwater in Africa

NASA Astrophysics Data System (ADS)

Edmunds, W. Mike

2012-06-01

The recent paper on Africa's groundwater by MacDonald et al (2012) has attracted much attention. This is good news, especially since groundwater has been widely ignored, misunderstood or abused, as a fundamental global resource. This important paper goes a long way to raising the profile of groundwater in Africa by providing first-order estimates of the available storage (taking account of saturated aquifer thickness and porosity) as well as mapping expected water yields (aquifer productivity) in that continent. Reliable estimates of groundwater resources can now be set against the far more widely reported surface water availability. The constraints of the methodology used to compile these maps are duly acknowledged, and are well within the hydrogeological state-of-the-art. The paper is backed by carefully reviewed sources of data and a considerable effort has been made to incorporate the extensive grey literature. It is important that this benchmark study is received with the acclaim it deserves. However, the headline—that groundwater storage is some 100 times the annual renewable surface waters—could be misconstrued as implying that groundwater is an abundant new resource, which it is not. Whilst groundwater is key to sustainable development, renewability and accessibility issues need to be addressed. The paper may therefore be seized upon to justify unsustainable groundwater exploitation, or to provide an argument against funding to NGOs and others, for water provision for needy communities. Some constraints that must be taken into account are elaborated here. The conclusions of the paper (MacDonald et al 2012) demonstrate that modest yields of groundwater are quite widely available at accessible depths and sufficient to sustain small communities and their development, but larger yields (>5 l s-1) suitable for urban development or major agricultural schemes are unlikely outside of the sedimentary terrain. The availability and accessibility of groundwater over much of Africa, therefore, is favourable to rural rather than urban development. One of the real opportunities presented in the paper is that groundwater should be more widely used for a revolution in rural development. To this end, the use of managed aquifer recharge (MAR), coupled with other forms of rainwater harvesting, can also locally conserve and augment groundwater resources and offer obvious advantages over building surface water storage. The large sedimentary aquifers of Africa contain some 0.66 million km3 in storage (MacDonald et al 2012); but most of this water (0.44 M km3) is contained beneath eight Saharan countries (see table 1, MacDonald et al 2012). This includes the Nubian Sandstone aquifer system, underlying Egypt, Libya, Sudan and Chad. In Libya this immense high yielding aquifer may be over 2.5 km thick (Pallas 1980) but considerable depths to the water table make for costly development. Water in Libya is currently being extracted (mined) from remote inland areas for transmission to the coast, from wells typically 300-500 m deep with estimated well-field lifetimes unlikely to exceed 50 years (Pallas and Salem 2001). This and the other Saharan aquifers are accessible only to a very small fraction of the African population. Groundwater extraction and transmission is possible only with the energy provided from the proximity of fossil fuels; large water transfer schemes are energy intensive and for most areas of Africa not an economic option, having also social and ecological consequences (Matete and Hassan 2005). Moreover a steady decline in water tables (typically from 0.5 to 2 m yr) has been taking place widely in semi-arid areas globally, mostly due to abstraction exceeding recharge, with consequences for both human requirements and ecosystems. Thus a major limiting factor is the need to identify whether the stored groundwater is a renewable or a non-renewable resource. In the case of deep basins such as the Saharan aquifers this water can be shown, from numerous studies, to be almost entirely non-renewable, 'fossil' water, recharged under wetter early Holocene or late Pleistocene climates, prior to onset of a more arid climate around 4500 years BP (Edmunds et al 2004). Small amounts of modern recharge (for example in the Atlas Mountains or Tibesti) are insufficient to have an impact on the drawdown of distant well fields. It is critical, therefore, to base resource estimates for any development on knowledge of the locally renewable amounts from rainfall and to consider mining palaeo-reserves only as a last resort. Hydrogeological techniques are available to quantify modern recharge (Scanlon and Cook 2002, Scanlon et al 2006) and rates can vary widely according to rock type and landscape; reliance on modelled estimates alone could be misleading. Water quality is also a limiting factor in quantifying usable fresh groundwater storage. In addition to the regional or local problems caused by fluoride, in areas of East and West Africa (MacDonald et al 2012), salinity, above all, will restrict the total usable storage for domestic use and food production, most notably in semi-arid or arid areas. Groundwater salinity arises from various sources, including lithologies containing evaporite minerals, residual sea water (especially in continental coastal margins) and evapotranspiration. As a general rule, salinity increases with depth (older waters tend to more saline), but an additional problem arises where salinity has built up due to aridification over several millennia. Playas and sebkhats are surface expressions of this salinity accumulation from surface water or groundwater discharge, but clearance of native vegetation also increases recharge and leads to salinity increase (George et al 1997). Near-surface salt accumulation may be drawn down into cones of depression in areas of development. One of the largest artesian aquifers, the Continental Intercalaire of Algeria and Tunisia, has groundwater discharge with a salinity of 1-3 g l-1, locally as high as 7 g l-1 in the Tunisian Chotts (Edmunds et al 2003, Zammouri et al 2007), limiting water for irrigated agriculture. The volumes of non-saline and groundwater in the total storage therefore need to be considered as part of the storage. References Edmunds W M, Dodo A, Djoret D, Gasse F, Gaye C B, Goni I B, Travi Y, Zouari K and Zuppi G M 2004 Groundwater as an archive of climatic and environmental change. The PEP-III traverse Past Climate Variability through Europe and Africa (Developments in Palaeoenvironmental Research Series) ed R W Battarbee, F Gasse and C E Stickley (Dordrecht: Kluwer) pp 279-306 Edmunds W M, Guendouz A H, Mamou A, Moulla A S, Shand P and Zouari K 2003 Groundwater evolution in the Continental Intercalaire aquifer of Southern Algeria and Tunisia: trace element and isotopic indicators Appl. Geochem. 18 805-22 George R, McFarlane D and Nulsen R 1997 Salinity threatens the viability of agriculture and ecosystems in Western Australia Hydrogeol. J. 5 6-21 MacDonald A M, Bonsor H C, O'Dochartaigh B E and Taylor R G 2012 Quantitative maps of groundwater resources in Africa Environ. Res. Lett. 7 024009 Matete M and Hassan R 2005 Anecological economics framework for assessing environmental flows: the case of inter-basin water transfers in Lesotho Glob. Planet. Change 47 193-200 Pallas P 1980 Water resources of the Socialist People's Libyan Arab Jamahariya The Geology of Libya vol 2, ed M J Salem and M T Busrewil (London: Academic) pp 539-94 Pallas P and Salem O 2001 Water resources utilisation and management of the Socialist People's Arab Jamahiriya Regional Aquifer Systems in Arid Zones—Managing Non-Renewable Resources (IHP-V Technical Documents in Hydrology) (Paris: UNESCO) pp 147-72 Scanlon B R and Cook P G 2002 Preface: theme issue on groundwater recharge Hydrogeol. J. 10 3-4 and following papers Scanlon B R, Keese K E, Flint A L, Flint L E, Gaye C B, Edmunds W M and Simmers I 2006 Global synthesis of groundwater recharge in semi-arid and arid regions Hydrol. Process. 20 3335-70 Zammouri M, Siegfried T, El-Fahem T, Kriâa S and Kinzelbach W 2007 Salinization of groundwater in the Nefzawaoases region, Tunisia: results of a regional-scale hydrogeologic approach Hydrogeol. J. 15 1357-75