Ambiguous diagnosis, futile treatments and temporary recovery: Meanings of medical treatment among HIV/AIDS family caregivers providing care without ARVs

The capacity of countries with high HIV and AIDS prevalence to provide antiretroviral treatment and care for all people who need support remains a public health challenge. In Lesotho, there are improvements in this area but the high proportion of people who need ART yet they do not receive treatment suggests that many HIV-infected people continue to depend on medicines that treat opportunistic infections. The objective of the article is to explore caregivers’ experiences with diagnostic procedures and outcomes, prescriptions and treatment outcomes when ARVs were unavailable. A phenomenological design using in-depth face-to-face interviews was used to obtain the experiences of 21 family caregivers about caregiving, including access to and use of medical treatments. Caregivers’ experiences indicate that most of the consulted health professionals provided vague and inconsistent diagnoses while the medication they prescribed failed to treat most of the symptoms. Unavailability of medicines that control pain and symptoms effectively continues to be a prominent feature of HIV and AIDS home-based caregiving in Lesotho. It is recommended that health professionals should facilitate disclosure of HIV diagnosis to family caregivers to assist them to understand unstable treatment outcomes; and policy makers should strengthen home-based care by developing policies that integrate palliative care into HIV and AIDS care

Confidentiality or continuity? Family caregivers\' experiences with care for HIV/AIDS patients in homebased care in Lesotho

In the context of poor access to antiretroviral therapies in sub-Saharan Africa, the minimum treatment package intended to treat opportunistic infections common with HIV infection is inadequate but appealing, since it presumes universal coverage of medical care for patients living with HIV and AIDS. The overall objective of this study was to analyse the challenges which family caregivers encountered in home-based care when they tried to access medical treatment for home-based AIDS patients in the context of confidentiality and limited medical care. A qualitative study using in-depth interviews with a sample of 21 family caregivers –16 females and 5 males aged between 23 and 85 years was conducted with the assistance of health personnel in two hospitals in Lesotho. Using the concept of continuity of care, this article discusses the experiences of family caregivers about home care, including their experiences of adherence to confidentiality by health care professionals and non-disclosure of AIDS as the context of illness, the circumstances under which the caregivers initiated caregiving and sought medical care, and how these factors could be stressors in caregiving. There was continuity of care where the caregivers obtained hospital support. However, when confidentiality was adhered to the caregivers were frustrated by lack of information, disrupted treatment, exclusion of their perspectives in medical care, failure to secure hospitalisation, ambiguous goals and non-responsiveness, so that continuity of care was jeopardised. Thus it can be concluded that professional-assisted disclosure benefited the patients because it facilitated continuity of care through the caregivers. Dans un contexte africain sous-Saharien où l'accès aux thérapies antirétrovirales est très limité, le paquet minimum de traitement destiné au traitement des infections opportunistes liées à la séropositivité est inadéquat mais attirant puisqu'il suppose une couverture universelle de soins médicaux pour des malades vivant avec le VIH/SIDA. L'objectif global de cette communication est d'analyser les défis auxquels les soignants familiaux font face en soins à domicile lorsqu'ils essayent d'avoir accès au traitement médical pour les malades du SIDA dans un contexte de confidentialité et des soins médicaux limités. Une étude qualitative employant des entretiens détaillés auprès d'un échantillon de 21 soignants familiaux (16 femmes et 5 hommes âgés de 23 à 85 ans) a été menée grâce à l'aide du personnel de santé dans deux hôpitaux au Lesotho. En utilisant le concept de continuité de soins, cette communication met en relief des expériences des soignants sur les soins à domicile. Cette communication examine des expériences des soignants familiaux sur les éléments suivants : l'adhésion par les professionnels de santé et de soins à la confidentialité et à la non-divulgation de séropositivité comme étant le contexte de maladie, les circonstances sous lesquelles les soignants ont initié les soins, les soins médicaux suscités, surtout le diagnostic et le traitement, ainsi que l'hospitalisation et la manière dans laquelle ces facteurs pourraient être à l'origine du stresse chez les soignants. On a constaté que la continuité des soins dans le cas où les soignants recevaient du soutien hospitalier – l'information, un traitement gratuit des multiples symptômes et l'hospitalisation de manière prévue et consistante. Cependant, lorsqu'il y avait adhésion à la confidentialité, les soignants étaient frustrés par le manque d'information, un traitement perturbé, l'exclusion de leurs opinions vis-à-vis les soins médicaux, ne pas pouvoir assurer l'hospitalisation des malades et les objectifs ambigües, la non-réceptivité et la continuité a été compromise. En conclusion, on constate que en divulguant sa séropositivité avec l'aide professionnelle a énormément aidé les malades car cela a facilité la continuité de soins assurés par les soignants. Keywords: Lesotho, HIV/AIDS, confidentiality, caregiving, continuity of care, ethic of care. SAHARA J Vol. 5 (1) 2008: pp. 36-4

The role of traditional birth attendants in the provision of maternal health in Lesotho

A descriptive quantitative study was undertaken in the Leribe and Butha-buthe northern districts of Lesotho. Thirty-six trained, twenty-four untrained TBAs and nine nurses involved in training TBAs were recruited. In line with research by Clarke and Lephoto (1989:3) the TBAs were elderly females who had children of their own. In contrast with the MOH (1993: 10) where TBAs were found to be illiterate, most (93%) of the TBAs in this study had at least a primary education. The art of primary midwifery was learned through assisting with a delivery and being taught by mothers or mothers-in-law. The public health nurses conduct formal training ofTBAs in Lesotho over a period of two weeks, where subjects like ante-natal care, delivery of the baby and post- natal care are addressed. The majority (78.8%) provide antenatal care at their homes or the home of the mother. This includes palpation, history taking, and abdominal massage and health education. An important role is identifying women at risk. During labour the progress of labour is monitored and care is given to the mother and baby post-natally. Trained TBAs could identify women at risk more readily than untrained TBAs. Cases referred most frequently were prolonged labour and retained placenta. Trained TBAs practiced hygiene more often and gave less herbs than untrained TBAs. The health care system is providing support to the TBAs through training and supervision, but was found to be inadequate. Community leaders are involved in the selection of TBAs for training. Regular meetings are held with the TB As to discuss problems. Communication is one of the problems the TB As have to face, because of the long distances from health care centres. A lack of infrastructure and supplies is also of concern. It can be concluded that TBAs play an important role in maternal health care in Lesotho and are supported to a lesser degree by the health care system, which causes problems for the TBAs in their practices. It is recommended that the ministry of health becomes more aware of the need for training TBAs and that a programme for training should be more appropriate, taking cultural practices into account.Advanced Nursing ScienceD.Lit. et Phil

An investigation into the transfer of training in the Central Bank of Lesotho.

Thesis (M.Bus.Ad.)-University of KwaZulu-Natal, Pietermaritzburg, 2004.The purpose of the study is to investigate the transfer of training in the Central Bank of Lesotho. To guide this study, the following questions were formulated and answered: .:. How do managers assess transfer of training in the Central Bank of Lesotho? .:. What is the extent of transfer of training in the bank? .:. What are the reasons behind lack of transfer of training, if it exists in the bank? .:. What can be done to promote transfer of training in the bank? The research method that was used in this study was the survey method, which aims at gathering data about large numbers of people. Questionnaires were used to elicit answers to these questions and were given to the management of the Central Bank of Lesotho, as well as to the employees who have undergone training. This company was chosen because the researcher has worked there for seven years and understands how it operates. The study found that behavioural performance appraisal is used by Central Bank of Lesotho management to assess transfer of training and that a high percentage of training is transferred immediately after training, when trainees are still excited about what they have learned. It was concluded that there are barriers to transfer of training such as lack of management and co-worker support, lack of resources after training, lack of motivation and many others. On the basis of these findings and conclusions, it was recommended that Performance Appraisal should not only be carried out by managers, but colleagues also have to assess an individual. Follow-up training and management support were encouraged, to motivate trainees to apply what they have learned

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

<p>Abstract</p> <p>Background</p> <p>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.</p> <p>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.</p> <p>Methods</p> <p>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.</p> <p>Results</p> <p>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.</p> <p>Conclusions</p> <p>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.</p

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

<p>Abstract</p> <p>Background</p> <p>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.</p> <p>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.</p> <p>Methods</p> <p>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.</p> <p>Results</p> <p>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.</p> <p>Conclusions</p> <p>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.</p

School climate, an enabling factor in an effective peer education environment: Lessons from schools in South Africa

Globally, peer education and school climate are important topics for educators. Peer education has been shown to improve young people’s decision-making and knowledge about healthy and prosocial behaviour, while a positive school climate contributes to positive learning outcomes in general. In this article we explore the role of school climate in enabling the success of peer education outcomes. We do so by considering 8 geographically and socially distinct schools in the Western Cape province of South Africa where the peer education programme, Listen Up, was implemented, and for which measures of peer education quality exist. We then report a qualitative assessment of each school’s climate characteristics (student-interpersonal relations, student-teacher relations, order and discipline, school leadership, and achievement motivation), conducted through a rapid ethnography drawing on work by Bronfenbrenner (1977) and Haynes, Emmons and Ben-Avie (1997). Finally, we conclude that school climate can enhance learning and positive peer education outcomes. Keywords: learning environments; peer education; rapid ethnography; school climate; Western Cap

A case-control study of the impact of improved sanitation on diarrhoea morbidity in Lesotho.

A health impact evaluation of the Rural Sanitation Pilot Project in Mohale's Hoek district, Lesotho, was conducted from October 1987 to September 1988. A clinic-based case-control design was used to investigate the impact of improved sanitation on diarrhoea morbidity in young children. The results indicate that under-5-year-olds from households with a latrine may experience 24% fewer episodes of diarrhoea than such children from households without a latrine (odds ratio = 0.76; 95% confidence interval, 0.58-1.01). The impact of latrines on diarrhoea was greater in those households that used more water, practised better personal hygiene, and where the mothers had a higher level of education or worked outside the home. In common with studies conducted in Malawi, Philippines, and Sri Lanka, little evidence was found that the relationship between latrine ownership and diarrhoea was confounded by socioeconomic status or environmental variables. For a sample of cases and controls, data on exposure status (presence or absence of a latrine) that were collected by interview at the clinics agreed closely with those obtained by observation during a home visit

Availability and accessibility of public health services for adolescents and young people in South Africa

Against the background of increasing international calls for the development and implementation of age-appropriate programmes that address both quality and access issues to improve adolescent and youth health, this paper explores the extent to which public health facilities are available and accessible to adolescents and youth in South Africa. The impetus for the study was the current evidence that there was generally poor utilisation of services offered at public health facilities by young people in the country. The overall findings are that despite the country's comprehensive legal and policy framework and commitment to improve the health of young people, there continues to be some structural and systemic factors that hamper effective provision and programming of adolescent and youth friendly services. The paper concludes with recommendations for policy and practice.http:// elsevier.com/locate/childyouth2018-03-30hb2017Sociolog