Hospitals In Lesotho Research Articles

Resistance-informed versus empirical management of viraemia in children and adolescents with HIV in Lesotho and Tanzania (GIVE MOVE trial): a multisite, open-label randomised controlled trial

Children and adolescents with HIV taking antiretroviral therapy (ART) have high rates of viraemia. We assessed if genotypic resistance testing (GRT) to inform onward treatment improved treatment outcomes in Lesotho and Tanzania, two countries with little access to GRT. The Genotype-Informed Versus Empirical Management of Viremia (GIVE MOVE) open-label, parallel-group randomised controlled trial enrolled children and adolescents with HIV between the ages of 6 months and 19 years, taking ART, and with a viral load at least 400 copies per mL. Participants were recruited from ten clinical centres and hospitals in Lesotho and Tanzania. Participants were electronically randomly allocated 1:1 to receive either GRT with expert recommendation (GRT group) or repeat viral-load testing and empirical onward treatment (usual care group). Participants and study staff were not masked, but the endpoint committee and laboratory staff conducting viral-load testing were. Participants in both groups received at least three sessions of enhanced adherence counselling, and in the GRT group, blood for GRT assessed via Sanger sequencing was drawn at enrolment. The composite primary endpoint was death, hospitalisation, a new WHO HIV clinical stage 4 event, or not having documented viral suppression of less than 50 copies per mL at 36 weeks in the modified intention-to-treat population, which excluded participants who were retrospectively found to be ineligible after randomisation. Serious adverse events were analysed in the modified intention-to-treat population. The trial was registered with ClinicalTrials.gov (NCT04233242) and the trial status is completed. Between March 3, 2020, and July 5, 2022, 286 participants were enrolled and 284 were included in the modified intention-to-treat analysis (144 in the GRT group and 140 in the usual care group). Of these participants, 158 (56%) were female and 126 (44%) were male. Five (3%) in the GRT group and four (3%) in the usual care group did not complete follow-up but were included in the primary analysis. The median age across both groups was 14 years (IQR 9-16). The composite primary endpoint occurred in 67 (47%) participants in the GRT group and 73 (52%) in the usual care group (adjusted odds ratio 0·79 [95% CI 0·49 to 1·27]; adjusted risk difference -0·06 [95% CI -0·17 to 0·06]; p=0·34); all participants reaching the composite primary endpoint had no documented viral suppression at 36 weeks. No deaths were recorded, and only one clinical stage 4 event requiring hospitalisation occurred (in the usual care group); this was the only serious adverse event recorded in the study. GRT-informed management did not significantly improve treatment outcomes for children and adolescents with viraemia while taking ART. Fondation Botnar, Swiss National Science Foundation, and Gottfried and Julia Bangerter-Rhyner Foundation. For the Sesotho and Swahili translations of the abstract see Supplementary Materials section.

Factors Associated with Unplanned Pregnancy Among Youth at a Selected Hospital in Lesotho

Unplanned pregnancy amongst youth is a fundamental health problem that affects both developing and developed countries globally. There are various factors associated with unplanned pregnancy amongst youth and these factors have differing propagators. Unplanned pregnancies account for over half of total pregnancies in Lesotho; youth pregnancies contribute vast percentage overall. This study aimed to assess which factors associated are with unplanned pregnancy among youths who sought antenatal and postnatal care services at a selected government hospital in Lesotho. A descriptive cross-sectional design was used, and data was collected from a sample of 100 participants using a structured questionnaire. The results revealed that unplanned pregnancy among youths was associated with age, unemployment, lack of contraceptive use, sexual abuse, living in rural areas and lack of unplanned pregnancy prevention campaigns. The findings of this study support socio-ecological model which postulates that variety of factors influence health outcomes. We conclude that more needs to be done to improve access to formal education, availability and accessibility of unplanned pregnancy prevention campaigns and sexual and reproductive services. Reduction in unplanned pregnancy has several benefits not only to sexual and reproductive health but to life holistically. Sexual and reproductive health benefits include reduced maternal and neonatal morbidity and mortality and reduced abortions.

Nurses' practice of metabolic monitoring for patients on antipsychotics in Lesotho.

Severe mental illness is associated with higher physical health morbidities and reduced life expectancy, with an estimated 14.3% of global deaths attributed to mental disorders. Antipsychotic medications (APs) used in treatment contribute to physical health issues, including metabolic and cardiovascular effects. The aim of this study was to assess nurses' practices regarding metabolic monitoring for patients prescribed antipsychotic medications at Mohlomi Hospital in Lesotho. The study was conducted at Mohlomi Hospital, the primary psychiatric facility in Lesotho. Using a cross-sectional design, 44 nurses from Mohlomi Hospital participated in the study. A structured questionnaire assessed nurses' metabolic monitoring practices. Most of the respondents were female (n = 30, 75%), and minority were male (n = 10, 25%). The academic qualifications of respondents were distributed as follows: 40% (16) held a nursing assistant certificate and 22.5% (9) held an advanced nursing diploma, among others. The average age of all respondents was 39.05 (s.d. 8.9), with an average of 8 years of experience in psychiatry (s.d. 7.6). The overall rate of nurses' practices of metabolic monitoring for patients taking antipsychotic medications showed variability, with a mean score of 2.83 (s.d. 0.524). However, only 20% performed ECG tests, 22.5% measured blood pressure, 27.5% tested for glucose abnormalities and 17.5% conducted lipid profile testing. Results revealed a significant gap in the practice of metabolic monitoring among nurses with various aspects of metabolic monitoring, not being adequately monitored. The study's findings shall inform policy and guidelines for monitoring patients on antipsychotic medications while guiding future research.

Identifying avoidable causes of perinatal deaths in a district hospital in Lesotho.

Certain determinants can be associated with avoidable perinatal deaths, and audits are needed to establish what these determinants are, and what can be done to prevent such deaths. The study aimed at identifying and describing determinants associated with avoidable perinatal deaths at a district hospital in Lesotho and strategies to curb their occurrence. A retrospective descriptive study was conducted using 142 anonymised obstetric records from January 2018 to December 2020. A data collection tool was adopted from the Perinatal Problem Identification Programme. In this tool, avoidable determinants are referred to as 'factors' or 'problems'. A concerning number of perinatal deaths were secondary to avoidable patient factors, namely a delay in seeking medical care, inappropriate responses to antepartum haemorrhage, and inadequate responses to poor foetal movements. Medical personnel factors are also worth observing, namely incorrect use of partograph, insufficient notes to comment on avoidable factors and 'other' medical personnel problems. Ranking highest among administrative problems were the unavailability of intensive care unit beds and ventilators and inadequate resuscitation equipment. Administrative problems accounted for more perinatal deaths than the patient-related factors and medical personnel factors. There is an urgent need for periodic audits, health education for patients, staff competency and the necessary equipment to resuscitate neonates.Contribution:Avoidable determinants associated with perinatal deaths in a district hospital in Lesotho could be identified. This information provides an understanding of what can be done to limit avoidable perinatal deaths.

Psychological Experiences of Midwives Regarding Maternal Deaths at Two Selected Public Hospitals in Lesotho

Maternal deaths are a pervasive problem that frequently occurs in developing countries, driven by socio-economic issues, healthcare service-related issues, pre-existing health conditions, health professional-related issues, and socio-cultural issues. This paper describes the psychological experiences of midwives regarding maternal deaths at two selected public hospitals in Lesotho. A qualitative, phenomenological inquiry was employed to collect data from a purposively selected sample of 10 midwives through face-to-face interviews. Audiotapes were used to record the interviews, and the data were transcribed verbatim. The qualitative content analysis method was used to analyse the data. Permission to conduct the study was sought and granted by the Ministry of Health Lesotho (ID58-2022). Participants’ identities were confidential, and they were allowed to withdraw from the study without any prejudice. Psychological experiences such as trauma, shock, fear, stress, depression, loss of trust, helplessness, bad dreams, and insomnia were reported by the midwives after the occurrence of maternal deaths. They resorted to individual coping strategies such as crying, alcohol and other substance-related use, and recreational activities. Unfortunately, these strategies were not guided, hence the need for trained healthcare professionals who will take care of midwives’ psychological and emotional problems emanating from maternal deaths.

Knowledge of antipsychotic medication and their side effects among psychiatric nurses at a tertiary hospital in Lesotho

Factors that impede the physical health monitoring of patients with severe mental illness are multidimensional, and healthcare providers’ knowledge and expertise regarding antipsychotic medication and side effects remain key determinants of the frequency and quality of screening a patient shall be subjected to. This challenge transcends the monitoring of patients treated with antipsychotics, where scholars have determined a lack of knowledge about screening for adverse effects, resulting in poor clinical assessments among patients prescribed antipsychotics. This study aimed to describe nurses’ knowledge regarding antipsychotic medications and their side effects at the psychiatric hospital in Lesotho. To guide the research process, a quantitative, non-experimental, descriptive approach was employed with 40 nurses out of 44 nurses as respondents, who were selected using convenience sampling, and respondents rated their knowledge regarding the side effects of antipsychotic medication using a Likert scale on a structured research questionnaire. The data were collected using a self-administered questionnaire, analysed using SPSS (version 28), and displayed using tables, frequencies, standard deviations, and means. This study's female respondents comprised 30 (75.0%) and 10 (25.0%) males. The mean age was 39.05 (SD 8.9), with eight years of psychiatry experience. A total of 29 (72.0%) had sufficient antipsychotic knowledge (t = 36.38, df = 39, p < .000), 31 (78.3%) and had adequate knowledge of the side effects of antipsychotic drugs (t = 34.00375, df = 39, p < .000). In conclusion, this study reveals a positive trend in nursing knowledge about antipsychotic medications and associated side effects, highlighting the importance of ongoing professional development to maintain and enhance this expertise.

Knowledge, Perceptions and Practices of Adults towards Dementia at a Selected Hospital in Lesotho

Objective: This study aimed to determine knowledge, perceptions and practices towards dementia in adults seeking health services at a selected hospital in Lesotho. Method: The descriptive quantitative research design was used in conducting the study. A sample of 52 participants were selected using convenience sampling method. Data was collected using pre-tested semistructured questionnaire written in both English and Sesotho languages. Data was analyzed through the use of Microsoft Excel, presented on frequency tables, pie charts and bar charts. Results: The study results revealed that there is dearth of knowledge towards dementia (27%), majority of participants (n=26) had insufficient knowledge towards dementia. On the perception, 26.9% strongly perceived dementia as witchcraft and 34.6% of participants disregard dementia as part of the aging process. As much as majority of participants (63.5%) reported that demented people should be hospitalized, 13.5% of adults still believed that demented people should seek prophetic help. Conclusion: It can be concluded that there is need to raise awareness regarding mental health such as dementia so that affected individuals and families may be supported accordingly.

Abstract 92: Using Innovative Technology and Collaborative Efforts to Reduce Disparities and Inequities in Cancer Care and Improve the Lives of Patients in Low-Middle Income Countries in Sub-Saharan Africa: South African and Lesotho Experience of the ECHO Model

Abstract Purpose: Sub-Saharan Africa has huge disparities and inequities in cancer care. Some low resource countries have no facilities or trained oncologists and other healthcare professionals for cancer care. Patients often must travel long distances to access specialised cancer care such as radiotherapy, chemotherapy and palliative care. Patients with cancer in Lesotho who needed chemotherapy had to be flown to India; those who needed radiotherapy were referred to South Africa. Majority of the cancers diagnosed in the Northern cape province and Lesotho are in late stages and need treatment with chemotherapy and radiotherapy as part of the multimodality therapy. Methods: The Northern Cape Cancer Centre of Excellence and Research (NCCanCER) at Kimberley Hospital in South Africa collaborated with the Senkatana Hospital in Lesotho. Oncologists, specialist oncology nurses and IT personnel were trained at Project ECHO Institute in Albuquerque, NM to use the ECHO model for training, transfer of skills and mentorship. NCCanCER assisted Lesotho to set up a chemotherapy facility at Senkatana Hospital. An initial visit to the Kimberley Hospital Oncology Department for benchmarking was done by oncology staff from Lesotho. NCCanCER oncology staff went to Lesotho to provide on-site training in chemotherapy administration. Weekly virtual ECHO clinics were run from the Hub at Kimberley with spoke sites in Lesotho, Upington, Springbok and Kuruman. At the ECHO clinics, management of patients are discussed using evidence-based management protocols for continued training, transfer of skills, support and mentorship. Results: Doctors, nurses, pharmacists, social workers, clinical psychologists and community healthcare workers have been trained to provide cancer care and palliative care services in the underprivileged and underserved areas of the Northern cape and Lesotho. The first chemotherapy facility was opened in Lesotho in July 2022 and patients in Lesotho are no longer flown to India for chemotherapy. Patients in remote areas of the Northern cape province of South Africa can now receive chemotherapy and palliative care closer to their homes. There is continuous training, transfer of skills, expertise and mentorship of oncology staff. Conclusion: The ECHO model is useful in democratizing knowledge, transfer skills and expertise to improve care to patients in low resource countries. Citation Format: Daniel Osei-Fofie, Kabelo Mputsoe Cekwane, Mobashshar Hassan, Sophie Victoria Masuabi, Pearl Ntsekhe. Using Innovative Technology and Collaborative Efforts to Reduce Disparities and Inequities in Cancer Care and Improve the Lives of Patients in Low-Middle Income Countries in Sub-Saharan Africa: South African and Lesotho Experience of the ECHO Model [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 92.

Head-to-head comparison of nasal and nasopharyngeal sampling using SARS-CoV-2 rapid antigen testing in Lesotho.

To assess the real-world diagnostic performance of nasal and nasopharyngeal swabs for SD Biosensor STANDARD Q COVID-19 Antigen Rapid Diagnostic Test (Ag-RDT). Individuals ≥5 years with COVID-19 compatible symptoms or history of exposure to SARS-CoV-2 presenting at hospitals in Lesotho received two nasopharyngeal and one nasal swab. Ag-RDT from nasal and nasopharyngeal swabs were performed as point-of-care on site, the second nasopharyngeal swab used for polymerase chain reaction (PCR) as the reference standard. Out of 2198 participants enrolled, 2131 had a valid PCR result (61% female, median age 41 years, 8% children), 84.5% were symptomatic. Overall PCR positivity rate was 5.8%. The sensitivity for nasopharyngeal, nasal, and combined nasal and nasopharyngeal Ag-RDT result was 70.2% (95%CI: 61.3-78.0), 67.3% (57.3-76.3) and 74.4% (65.5-82.0), respectively. The respective specificity was 97.9% (97.1-98.4), 97.9% (97.2-98.5) and 97.5% (96.7-98.2). For both sampling modalities, sensitivity was higher in participants with symptom duration ≤ 3days versus ≤ 7days. Agreement between nasal and nasopharyngeal Ag-RDT was 99.4%. The STANDARD Q Ag-RDT showed high specificity. Sensitivity was, however, below the WHO recommended minimum requirement of ≥ 80%. The high agreement between nasal and nasopharyngeal sampling suggests that for Ag-RDT nasal sampling is a good alternative to nasopharyngeal sampling.

The role of corporate governance in management of physical public infrastructures in some selected Sub-Saharan African countries

This study used the case study research design to achieve its objective. Secondary data were collected from five public infrastructures in five African countries made up of Cameroon, Lesotho, Zimbabwe, Zambia, and Mozambique. The analysis focused on the failures and successes in planning, development, and operation of public infrastructure according to the tenets of corporate governance theories chosen. The findings revealed that the failures in public infrastructure management as observed in three of the five cases studied, namely, the Olembe Stadium in Cameroon, the Matabeleland Zambezi Water Project in Zimbabwe, and the Queen Mamohato Memorial Hospital in Lesotho, originated mostly from the planning and development stages. On the other hand, the success recorded in two cases, which are Mozambique’s Maputo Development Corridor and Zambia’s Chirundu One-Stop Border Post, are attributable to the fact that they are governed by clear coordination in all stages of the public infrastructure management process with the clear involvement of all the stakeholders.

Competency and clinical mentoring: Perceptions of newly graduated and experienced professional nurses in Lesotho

Clinical mentoring has been the norm to coach new nursing professionals to achieve professional competency. Structured mentoring programmes are effective. However, there is a need for research to understand newly graduated professional nurses’ initial workplace transition. PurposeTo explore and describe the perceptions of newly graduated professional nurses and experienced professional nurses regarding clinical mentorship and competency. Design and methodA qualitative descriptive research design was used. The research population included newly graduated professional nurses and experienced professional nurses working together in two regional hospitals in Lesotho, where most government health projects are piloted. Purposive sampling and semi-structured interviews were used for both groups. Data was analysed through content analysis by categorising data and formulating themes. FindingsTwo categories emerged. Firstly, the perceptions of newly graduated professional nurses describe their experience as newly graduated professional nurses, with four themes, namely a delay in getting employed post-graduating, the need for orientation, taking on a high level of responsibility and the fact that competency levels are influenced by various factors. Secondly, findings from both newly graduated and experienced participants could be divided into three themes with sub-themes, namely: standardisation of nursing competency; safe and cost-effective nursing care; and emphasis on persona and self-efficacy. ConclusionThere is a considerable gap in supporting newly graduated nurses to gain confidence. It is recommended to nurse leaders to plan, restructure, and implement structured clinical mentorship.

National hospital readiness for COVID-19 in Lesotho: evidence for oxygen ecosystem strengthening.

Sub-Saharan African country, Lesotho, during the SARS-CoV-2 COVID-19 pandemic. To evaluate COVID-19 hospital capacity in Lesotho. We conducted a pragmatic assessment of all public hospitals in Lesotho using a WHO COVID-19 hospital assessment tool during July 2020 (baseline), with targeted follow-up in December 2020. We adapted the WHO tool into a questionnaire with a focus on hospital services and included oxygen ecosystem elements (pulse oximeters, oxygen, and advanced respiratory care). We converted qualitative questionnaire answers into quantitative ordinal variables and used standard statistics for analysis. At baseline, we found all 12 questionnaire domains demonstrate both hospital preparedness and weakness in infection prevention and control. Key baseline gaps were lack of a dedicated team, and insufficient personal protective equipment and space for donning and doffing. Substantial limitations were noted in hypoxemia diagnosis and treatment; information management and care coordination pathways were also suboptimal. Targeted follow-up after 5 months revealed improvement in the availability of pulse oximetry, oxygen capacity, and heated high-flow nasal cannula devices. Our baseline findings may reflect uneven early pandemic care quality; targeted follow-up suggests strengthening of the oxygen ecosystem.

Nurses’ Perceptions regarding Types of Aggressive Behaviour displayed by Patients in a Selected Psychiatric Hospital in Lesotho

Aggressive behaviour of inpatients in mental health facilities occurs globally and is a serious nursing problem. Consequently, there is insufficient research studies conducted among nurses regarding the types of aggressive behaviour displayed by patients in psychiatric institutions. The purpose of this study was to determine nurses’ perceptions regarding the types of aggressive behaviour displayed by patients in a selected psychiatric hospital in Lesotho. A quantitative descriptive survey was used to collect data from 119 nurses who were selected by quota sampling. The data were collected by means of a self-administered questionnaire, analysed by using SPSS (version 25), and displayed by using tables, frequencies, standard deviations, means and Pearson’s chi-square test. The findings reported that the types of aggressive behaviour included verbal aggression (86%, n = 103), physical aggression against objects (79%, n = 94), physical aggression against self (65.5%, n = 78), and physical aggression against other people (81.5%, n = 97). This study concludes that the perceptions of the nurses were positively inclined towards violent behaviour displayed by patients. The study recommends that nurses be equipped with comprehensive psychiatric skills and information to enable them to manage and cope with patients’ aggression.

Factors Contributing to the Late Commencement of Antenatal Care at a Rural District Hospital in Lesotho

Antenatal care (ANC) is a key approach aimed at improving maternal and infant health. Numerous factors are associated with late commencement of antenatal care. Sub-Saharan Africa countries are exception to the problem of late commencement of antenatal care. The qualitative, explorative, descriptive and contextual approach was followed. The pregnant women meeting the inclusion criteria, were above 16 weeks and attended antenatal care at the time of the study. Different authorities granted permission to conduct face-to-face, unstructured in-depth interviews. Tesch approach enabled the qualitative researchers to immerse themselves through systematic organization and synthesis of data to create manageable units. an independent co-coder also analyzed data independently. Afterwards, they met and agreed on specific themes and sub-categories. The following five themes emerged; personal and family factors, cultural beliefs and practices, health systems and poor infrastructure. Measures aimed at improving accessibility to the health centers include; road infrastructure, telecommunication and more client centered services. Improvement of early commencement of antenatal services becomes an ideal approach influencing excellent maternal and neonatal outcomes. Therefore, government initiatives aimed at empowering communities on the benefits of commencing antenatal care on time is necessary.

The coArtHA trial\u2014identifying the most effective treatment strategies to control arterial hypertension in sub-Saharan Africa: study protocol for a randomized controlled trial

BackgroundArterial hypertension is the most prevalent risk factor for cardiovascular disease in sub-Saharan Africa. Only a few and mostly small randomized trials have studied antihypertensive treatments in people of African descent living in sub-Saharan Africa.MethodsIn this open-label, three-arm, parallel randomized controlled trial conducted at two rural hospitals in Lesotho and Tanzania, we compare the efficacy and cost-effectiveness of three antihypertensive treatment strategies among participants aged ≥ 18 years. The study includes patients with untreated uncomplicated arterial hypertension diagnosed by a standardized office blood pressure ≥ 140/90 mmHg. The trial encompasses a superiority comparison between a triple low-dose antihypertensive drug combination versus the current standard of care (monotherapy followed by dual treatment), as well as a non-inferiority comparison for a dual drug combination versus standard of care with optional dose titration after 4 and 8 weeks for participants not reaching the target blood pressure. The sample size is 1268 participants with parallel allocation and a randomization ratio of 2:1:2 for the dual, triple and control arms, respectively. The primary endpoint is the proportion of participants reaching a target blood pressure at 12 weeks of ≤ 130/80 mmHg and ≤ 140/90 mmHg among those aged < 65 years and ≥ 65 years, respectively. Clinical manifestations of end-organ damage and cost-effectiveness at 6 months are secondary endpoints.DiscussionThis trial will help to identify the most effective and cost-effective treatment strategies for uncomplicated arterial hypertension among people of African descent living in rural sub-Saharan Africa and inform future clinical guidelines on antihypertensive management in the region.Trial registrationClinicaltrials.govNCT04129840. Registered on 17 October 2019 (https://www.clinicaltrials.gov/).

Removal of user fees and system strengthening improves access to maternity care, reducing neonatal mortality in a district hospital in Lesotho.

ObjectiveLesotho has one of the highest maternal mortality rates in the world. While at primary health care (PHC) level maternity care is free, at hospital level co‐payments are required from patients. We describe service utilisation and delivery outcomes before and after removal of user fees and quality of delivery care, and associated costs, at St Joseph's Hospital (SJH) in Roma, Lesotho.MethodsWe compared utilisation of delivery services, stillbirths and maternal and neonatal mortality for the periods before (1 July 2012 to 31 December 2013) and after (1 January 2014 to 30 June 2015) user fee removal through a retrospective chart review and estimated additional costs attributed to user fee removal from provider (hospital) and patient perspectives.ResultsOf 4715 deliveries 3855 were at SJH and 860 at PHC centres. Of women delivering at SJH 684 (18.5%) were ≤19 years and 894 (23.6%) were HIV positive. After user fee removal hospital deliveries increased by 49% — from 1547 to 2308 — and neonatal mortality decreased from 4.8 to 1.3 per 1000 live births (P = 0.033). Extrapolating costs to the entire country, 1 USD per capita per year would allow user fee removal at hospital level, the provision of free transport to/from and accommodation at hospital.ConclusionRemoving user fees for hospital delivery care in Lesotho is feasible and affordable, and has the potential to improve maternal and neonatal outcomes by removing financial barriers to skilled birth attendants and increasing coverage of institutional deliveries.

Perceptions of Nurses Regarding Information and Communication Technology at a Rural Hospital in Lesotho

Perceptions of Nurses Regarding Information and Communication Technology at a Rural Hospital in Lesotho

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

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.

Professional nurses’ perception of their clinical teaching role at a rural hospital in Lesotho

Background. Nursing education institutions in Lesotho face an increasing number of enrolments owing to a high demand for professional nurses to work in the community. Enrolments have doubled during the last 3 years, without an increase in teaching resources or staff. Professional nurses in the wards are expected to mentor students and teach the clinical elements of nursing while continuing with their day-to-day clinical duties. Furthermore, professional nurses in Lesotho have not been trained for this clinical teaching role. Objective. To explore the perceptions of professional nurses with regard to their clinical teaching role in the development of competent nurses. Methods. A qualitative study was undertaken at a rural hospital in Lesotho. Data were gathered by conducting semi-structured interviews with professional nurses. Interview transcripts were coded and emerging themes identified. Data saturation was reached after eight interview transcripts were analysed. Results. Four themes representing the perceptions of the professional nurses emerged in the analysis: (i) the clinical teaching role; (ii) the complexities of clinical teaching; (iii) learners have their issues; and (iv) making it work. Conclusion. Professional nurses understand and appreciate their educational role in the development of competent nurses. This clinical teaching role is performed in difficult circumstances, including administrative challenges, limited resources and staff shortages, while maintaining clinical responsibilities. Despite these challenges, the nurses have remained resilient and solution focused. Nursing education institutions should re-orientate professional nurses with regard to current trends and principles of nursing education to enhance their clinical teaching role.

Integrating social medicine into international curricula: A case study across Uganda and Haiti

paid at a higher specialist-level salary. Salaries and housing costs for physician trainees are now paid for by the Government of Lesotho. The Government of Lesotho also pays the salaries and housing costs for two physician specialist educators. Outcomes & Evaluation: The Boston University School of Medicine certifies that graduates successfully complete the program as outlined in the detailed curriculum documents approved by the CHE. To date, 2 physicians have graduated from the FMSTP and are the first Lesotho-trained specialists in the country. Going Forward: Our program has seven students who are enrolled and ready to begin training in January 2015. We are also working with the Ministry of Health to expand our program to include additional hospitals in Lesotho’s southern districts. Funding: Funding has been received from the Kellogg Foundation, PEPFAR, and the Global Fund. Abstract #: 01ETC059