Adolescents In Lesotho Research Articles

Experiences and challenges of nurses in initiating antiretroviral drugs among adolescents living with HIV and AIDS in Thaba-Tseka, Lesotho

Background: Lesotho has the second-highest HIV and AIDS prevalence globally and is the country’s second leading cause of death. Despite increasing ART coverage, adolescents remain left behind and face high mortality because of delayed ART initiation. This study aimed to explore the experiences and challenges of nurses when initiating adolescents living with HIV on ART in Thaba-Tseka, Lesotho. Methods: A qualitative descriptive research design and twelve in-depth interviews were conducted among nurses from a hospital in the Thaba-Tseka district. Participants were selected purposively until data saturation was reached. Data were transcribed verbatim and analysed manually using the thematic analysis approach. The findings were presented in themes and sub-themes. Individual face-to-face interviews were conducted in English and Sesotho from May to August 2021. Results: The key findings in this study involved adolescents’ attendance at the health care facility, ART initiation process, HIV stigma influencing the uptake of ART, poor ART follow-up and socio-economic factors affecting adherence to ART. Conclusion: The themes uncovered in this study provide valuable insights into the gaps in ART initiation, and highlight the challenges encountered by nurses during this process among adolescents in Lesotho. The experiences and obstacles shared by nurses during ART initiation cover a range of issues, collectively demonstrating their engagement in HIV and ART care. These findings emphasise the critical role of policymakers and health care providers in devising customised ART initiation interventions for adolescents. Addressing these challenges will be crucial for enhancing ART uptake and adherence among adolescents living with HIV in Lesotho.

Social protection as a strategy for HIV prevention, education promotion and child marriage reduction among adolescents: a cross-sectional population-based study in Lesotho

BackgroundLesotho’s government has shown consistent efforts to implement social protection programmes. However, while recent evidence established a positive causal relationship between some of these programmes and food security there is little evidence on the extent to which these initiatives are associated with better educational and sexual and reproductive health outcomes among vulnerable adolescents in Lesotho.Methods and FindingsThe study uses cross-sectional, nationally representative data from the 2018 Lesotho Violence Against Children and Youth Survey. Our research examined the association between social protection receipt and educational and sexual and reproductive health outcomes among adolescents and young people (13–24 years) living in poverty. We employed multivariate logistic regression controlling for age, orphanhood, HIV status and sex. Social protection receipt was defined as household receipt of financial support from a governmental, non-governmental, or community-based program that provides income. Additionally, we fitted a marginal effects model by sex. Among the 3,506 adolescent females and males living in the two lowest poverty quintiles, receipt of social protection was associated with improvements in multiple adolescent outcomes: higher odds of consistent condom use (aOR 1.64, 95% CI 1.17–2.29), educational attainment (aOR 1.79, 95% CI 1.36–2.36), and school enrolment (aOR 2.19, 95% CI 1.44–3.34). Stratified analyses by sex showed that social protection receipt was also associated with reduced likelihood of child marriage among females (aOR 0.59, 95% CI 0.42–0.83) and higher odds of educational attainment and school enrolment among males (aOR 2.53, 95% CI 1.59–4.03 and aOR 3.11, 95% CI 1.56–6.19, respectively).ConclusionsOur study provides evidence that social protection programs are associated with improved educational, sexual and reproductive health and child marriage prevention outcomes among adolescents living in poverty. Implementing and expanding such social protection initiatives could prove instrumental in improving the well-being of vulnerable adolescents.ContributionsSocial protection programs have been increasing in sub-Saharan African countries, playing a pivotal role in poverty reduction, with Lesotho being no exception. Despite the optimistic outlook brought about by the implementation of the National Social Protection Strategy Lesotho I (2014-19) and II (2021–2031), the impact of these programs on some specific outcomes that concern the lives of the most vulnerable adolescents in Lesotho remains to some extent unexplored. Additionally, Lesotho grapples with high rates of HIV, adolescent pregnancy, child marriage and early school dropout, which can further contribute to poor long-term health and social outcomes among adolescents. In this study, we used data from the 2018 Lesotho Violence Against Children and Youth Survey (VACS) to examine the association between receiving social protection and multiple adolescent outcomes: educational, sexual and reproductive. The findings revealed that social protection programs, particularly the existing government-provided cash transfers, are significantly associated with multiple better outcomes among adolescents living in the poorest households in Lesotho. Such cash transfer schemes in Lesotho are associated with improved sexual and reproductive health outcomes for adolescent females, including reduced child marriage rates, and improved educational outcomes for males. These findings indicate that government-led social protection programmes are positively associated with favourable outcomes that can improve the quality of life for adolescents in resource-limited settings.

HIV viral suppression in children and adolescents 2 years after transition to dolutegravir: a multicentre cohort study.

Treatment failure is common among children and adolescents with HIV. Antiretroviral therapy (ART) containing dolutegravir has recently been rolled out across Africa, though long-term real-world data in paediatric populations are lacking. Here, we report treatment outcomes among children and adolescents in Lesotho who transitioned from nonnucleoside reverse transcriptase inhibitor (NNRTI)-based to dolutegravir-based ART through 2 years' follow-up. Data were derived from two open cohort studies in Lesotho. Children and adolescents aged less than 18 years who transitioned from NNRTI-based to dolutegravir-based ART at least 18 months before data closure were included. We report viral load results less than 12 months before, 12 (window: 6-17) months after, and 24 (window: 18-29) months after transition to dolutegravir. Associations of pretransition demographic and clinical factors with 24-month viraemia were assessed through multivariable logistic regression. Among 2126 included individuals, 1100 (51.7%) were female individuals, median age at transition to dolutegravir was 14.0 years [interquartile range (IQR) 11.5-15.8], and median time taking ART at transition was 7.6 years (IQR 4.4-10.6). Among those with a viral load result at the respective time points, viral suppression to less than 50 copies/ml was achieved by 1635 of 1973 (82.9%) less than 12 months before, 1846 of 2012 (91.8%) 12 months after, and 1725 of 1904 (90.6%) 24 months after transition to dolutegravir. Pretransition viraemia was associated with viraemia at 24 months, though more than 80% of individuals with pretransition viraemia achieved resuppression to less than 50 copies/ml at 24 months. The proportion of children and adolescents with viral suppression increased after transition to dolutegravir, though further progress is needed to reach global targets.

Protecting the human rights of pregnant and parenting adolescents in Lesotho: 'What's culture got to do with it?'

Poor health, social exclusion, and stigma are usually associated with adolescent pregnancy and parenting, resulting in girls' suspension and, in some instances, expulsion from school. While most African states, including Lesotho, have laws and policies protecting the rights of all children, including adolescents, to enroll and be retained in school, implementation is lagging behind. Using a socio-legal approach, the article explores the challenges in implementing policies and guidelines on school re-entry following pregnancy and/or parenthood, with particular reference to Lesotho. It argues that, despite the adoption of enabling laws and policies protecting sexual and reproductive health rights, and the right to education of pregnant and parenting adolescent girls, punitive and discriminatory practices continue to serve as barriers that undermine countries' human rights commitments. The barriers are attributable to the influences of family, societal, religious and cultural beliefs and practices. To address these barriers, this article proposes comprehensive, innovative, gender-transformative, targeted and rights-based interventions, and supportive policies and strategies, to facilitate continuous awareness-raising, social and attitudinal change, and social justice.

Caregivers’ Perception on Adolescents’ Access on, Use of, and Support Required to Prevent Unwanted Pregnancies in Lesotho

Background: Usage of hormonal or barrier contraception by adolescents is challenging for most adolescents. The study revealed new evidence of caregivers’ support to adolescents on access and effective contraception use to prevent unwanted pregnancies in k.w. There is a need for adolescents’ user-friendly services, supportive supervision, accommodative cultural and religious practices, and the promotion of independent decisions. Objectives: To explore and describe caregivers’ perceptions of access (1) and the use of (2) contraception for adolescents in Lesotho and to explore and describe caregivers’ perception of types of support needed for adolescents to prevent unwanted pregnancies in Lesotho (3). Methods: A qualitative explorative, descriptive, and contextual design. Purposive sampling caregivers of adolescents in a government primary health care facility with the highest outpatient number in Maseru district, Lesotho. Five focus groups with six participants each, which included (N=30) participants, were conducted using an interview schedule. Data were analysed using Creswell’s six steps of data analysis with the assistance of a co-coder. Results: Three categories emerged, namely (1) access to contraception by adolescents, (2) use of contraception by adolescents, (3) and support to prevent unwanted pregnancies with respective themes and sub-themes emerged. Conclusion: Contraception use among adolescents is challenging. Adolescents’ caregivers disclosed being unskilled to discuss sexuality due to their cultural and religious background. Basic sexuality education has been included in the school curriculum. Service providers’ attitudes and rigid health services contribute to the limited access to contraception for adolescents.

Oral Health and Psychosocial Predictors of Quality of Life and General Well-Being among Adolescents in Lesotho, Southern Africa.

Background: Adolescents’ quality of life is reported to be significantly associated with physical and social wellbeing. Although adolescents are 30% of the Southern African population, no previous studies have focused on this group in relation to oral health and quality of life. Methods: A 40-item survey and clinical oral examinations were conducted in public schools in Maseru from 10 to 25 August 2016. Simple, bivariate, and multivariate regressions were used to evaluate the associations of oral health and psychosocial factors with self-reported general health status and quality of life. Results: A total of 526 participants, aged 12–19 years old, responded to the survey and participated in the clinical examinations. The majority reported a good (good/very good/excellent) quality of life (84%) and general health (81%). Bivariate results showed that self-reported general health in this population was significantly influenced by age. The presence of toothache and sensitivity in the adolescents were significantly associated with poor (fair/poor) self-reported general health and were found to be the best predictors for self-general health and quality of life. Conclusions: The absence of dental conditions such as toothache and tooth sensitivity can lead to a better perception of general health and Quality of Life in adolescents.

Oral Health Status and Patterns of Dental Service Utilization of Adolescents in Lesotho, Southern Africa.

This study aimed to characterize the best predictors for unmet dental treatment needs and patterns of dental service utilization by adolescents in the Kingdom of Lesotho, Southern Africa. A self-reported 40-item oral health survey was administered, and clinical oral examinations were conducted in public schools in Maseru from August 10 to August 25, 2016. Associations between psychosocial factors with oral health status and dental service utilization were evaluated using simple, bivariate, and multivariate regressions. Five hundred and twenty-six survey responses and examinations were gathered. The mean age of student participants was 16.4 years of age, with a range between 12 and 19 years of age. More than two thirds (68%; n = 355) of participants were female. The majority reported their quality of life (84%) and general health to be good/excellent (81%). While 95% reported that oral health was very important, only 11% reported their personal dental health as excellent. Three percent reported having a regular family dentist, with the majority (85%) receiving dental care in a hospital or medical clinic setting; only 14% had seen a dental professional within the previous two years. The majority of participants did not have dental insurance (78%). Clinical examination revealed tooth decay on 30% of mandibular and maxillary molars; 65% had some form of gingivitis. In multivariate analysis, not having dental education and access to a regular dentist were the strongest predictors of not visiting a dentist within the last year. Our results suggest that access to oral health care is limited in Lesotho. Further patient oral health education and regular dental care may make an impact on this population.

"If it is left, it becomes easy for me to get tested": Use of oral self-tests and community health workers to maximize the potential of home-based HIV testing among adolescents in Lesotho.

IntroductionHome‐based HIV testing fails to reach high coverage among adolescents and young adults (AYA), mainly because they are often absent during the day of home‐based testing. ADORE (ADolescent ORal tEsting) is a mixed‐method nested study among AYA in rural Lesotho, measuring the effect of home‐based secondary distribution of oral HIV self‐tests (HIVST) on coverage, as well as exploring how AYA perceive this HIV self‐testing model.MethodsADORE study was nested in a cluster‐randomized trial. In intervention village‐clusters, oral HIVST were left for household members who were absent or declined testing during a testing campaign. One present household member was trained on HIVST use. Distributed HIVST were followed up by village health workers (VHW). In control clusters no self‐tests were distributed. The quantitative outcome was testing coverage among AYA (age 12 to 24) within 120 days, defined as a confirmed HIV test result or known status, using adjusted random‐effects logistic regression on the intention‐to‐treat population. Qualitatively, we conducted in‐depth interviews among both AYA who used and did not use the distributed HIVST.ResultsFrom July 2018 to December 2018, 49 and 57 villages with 1471 and 1620 consenting households and 1236 and 1445 AYA in the control and intervention arm, respectively, were enrolled. On the day of the home‐visit, a testing coverage of 37% (461/1236) and 41% (596/1445) in the control and the intervention arm, respectively, were achieved. During the 120 days follow‐up period, an additional 23 and 490 AYA in control and intervention clusters, respectively, knew their status. This resulted in a testing coverage of 484/1236 (39%) in the control versus 1086/1445 (75%) in the intervention arm (aOR 8.80 [95% CI 5.81 to 13.32]; p < 0.001). 21 interviews were performed. Personal assistance after the secondary distribution emerged as a key theme and VHWs were generally seen as a trusted cadre.ConclusionsSecondary distribution of HIVST for AYA absent or refusing to test during home‐based testing in Lesotho resulted in an absolute 36% increase in coverage. Distribution should, however, go along with clear instructions on the use of the HIVST and a possibility to easily access more personal support.

Cervical cancer screening among adolescent girls in Lesotho: Levels and Determinants.

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

Body mass index of 16-year olds in urban Maseru, Lesotho.

BackgroundOverweight and/or obesity amongst children and adolescents is a global epidemic with health consequences that track into adulthood. No data are currently available regarding overweight/obesity amongst adolescents in Lesotho.Aim and settingTo assess the prevalence of overweight and/or obesity and the associated risk factors amongst 16-year olds in urban Maseru, Lesotho.MethodA cross-sectional descriptive study was conducted on a systematic sample of 16-year olds in grade four (N = 221; 56.6% girls) from randomly-selected schools in urban Maseru. Diet histories and data on lifestyle, physical activity and knowledge, attitudes and/or perceptions and practices regarding nutrition were obtained during structured interviews and body mass index (BMI) was determined.ResultsAmongst these 16-year olds, 27.2% girls and 8.3% boys were overweight and/or obese based on World Health Organization cut-offs for BMI; 39.8% were insufficiently active or inactive; 6.4% used alcohol regularly; and 11.7% used tobacco. Whilst 28.1% reported no television watching/electronic gaming/computer usage (combined screen time) outside school, 23.6% reported ≥ 4 hours of combined screen time outside school. Most (91.4%) consumed < 3 servings of vegetables/day; 86.4% consumed < 2 servings of fruits/day; and 95.5% consumed < 2 servings of dairy/day. The majority consumed maize porridge (56.1%), bread (63.8%) and margarine/oil/fat (82.3%) daily and added sugar to their food (74.2%). Fruits, vegetables, dairy, meat, pulses and traditional foods were only consumed weekly or less often. Most bought from tuck shops (18.6% daily; 54.3% weekly). Various gaps in knowledge, perceptions and practices were identified that may benefit from educational intervention.ConclusionsThe current study identifies westernised dietary and lifestyle changes, along with overweight and/or obesity, amongst 16-year old adolescents in Lesotho.

Factors associated with risky sexual behaviour among adolescents in Lesotho.

Since 1993 HIV prevalence in Lesotho has increased 5 fold making Lesotho the third highest HIV infected country in the world. The government of Lesotho has not only declared HIV pandemic a crisis, but several efforts have been made to curb the spread of the disease that include encouraging Basotho to know their status as well as requesting government departments to use 2 percent of their budget allocations towards mitigation against the disease. The latest HIV prevalence figures from the 2004 Lesotho Demographic and Health Survey suggest that more still needs to be done in order to reverse the spread of the disease. Using the 2002 Lesotho Core Welfare Indicator Questionnaire Survey (CWIQ) data the paper examined variables associated with risky sexual behaviour among Basotho adolescents. The results of the paper suggest that HIV programmes targeting girls should be different from those targeting boys. Results further indicate that HIV programmes might have to be district specific.

A descriptive study of the reasons and consequences of pregnancy among single adolescent mothers in Lesotho

The adolescents, who engage in unprotected sex, face the risk of unplanned pregnancy and sexually transmitted diseases. It is not clear why adolescents in Lesotho engage in unprotected sex and end up with unplanned pregnancies. In addition, it is not clear what the consequences of early childbearing are on the life of the adolescent and her infant. An understanding of the reasons why a number of adolescents engage in unprotected sex and the impact of pregnancy and early childbearing on the lives of adolescent mothers and their infants will potentially assist nurses and other health workers in adolescent health promotion programmes. The purpose of this study was: 1) to determine the adolescent mother’s perceived reasons for pregnancy and 2) to determine pregnancy related joys, and problems faced by adolescent mother and her infant.

Premarital Childbearing Among Adolescents in Lesotho

The issue of premarital childbearing has been a concern of many analysts in southern Africa. This paper looks at the situation of premarital childbearing in Lesotho in comparative context with the neighbouring countries. The total fertility rate (TFR) estimated from the 1996 population census of Lesotho for all women combined was 4.1 births, a decline from a TFR of 5.5 in the mid-1970s. Only a small proportion of births in Lesotho are born out-of-wedlock. The Lesotho Safe Motherhood Initiative Survey data of 1995 found that only 3 per cent of never married Basotho women aged 15–19 had given birth; a very much lower rate than in Botswana where the rate was 21 per cent. There are a number of factors that influence the relatively low incidence of premarital, adolescent childbearing in Lesotho. It is argued that one factor is that, despite significant social change, Sesotho culture is still generally opposed to such pregnancies. Local derogatory names are given to children born out-of-wedlock, and their mothers are still referred to as 'spoilt' or 'destroyed' in order to discourage such behaviour. The strength of such stigmatisation appears to be much less, or negligible, in neighbouring countries. There is a growing tendency to separate motherhood from marriage in many societies in the region and in some cases having a child can increase the chance of marriage. In Lesotho, the culture against premarital sex is changing as well, and a substantial number of adolescent females conceive before marriage. It appears that a significant proportion resort to illegal, unsafe abortions and the government needs to be aware of these changes in the behaviour of adolescents and their needs.

Premarital Childbearing Among Adolescents in Lesotho

Premarital Childbearing Among Adolescents in Lesotho