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

Background Since 1990, the lives of 48 million children under the age of 5 have been saved because of increased investments in reducing child mortality. However, despite these unprecedented gains, more than 200 million children 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), HIV and nutrition interventions. Methods We are conducting a cluster randomised controlled trial in Mokhotlong district, Lesotho, to evaluate a newly developed community-based intervention programme 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 one month later), followed by a locally hosted community health outreach day event. Group-based sessions focus on using early dialogic booksharing 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, immediately after completion of the intervention, and 12 months post intervention. Discussion 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

Views of health service providers on the need for support services for HIV-positive mothers in the rural areas of Lesotho : an ecological perspective

Thesis (M Social Work)--Stellenbosch University, 2015.ENGLISH ABSTRACT: HIV/AIDS is one of the worst pandemics affecting the world today. It cuts across all boundaries and many people are infected as well as affected. The virus has reached all the corners of the globe, but the most hit by it is Africa, especially southern Africa, which carries more than half of the population infected and affected by HIV/AIDS. The top five countries whose populationsare infected with HIV are in southern Africa. Lesotho is amongst the top three on this list and also has problems of poverty and a high unemployment rate. Women and children, who are the target groups that are most affected by poverty, are also those living in rural areas. Thus, being an HIV-positive mother living in the rural areas of Lesotho means one has to deal with poverty, the inaccessibility of services and the psychological impacts of HIV. The aim of the study was to gain a better understanding of the views of health service providers on the need and accessibility of support services for HIV-positive mothers in the rural areas of Lesotho from an ecological perspective. To achieve this aim, the objectives were: to offer an overview of the phenomenon of HIV and describe the psychosocial needs and sociocultural circumstance of HIV-positive mothers in the rural areas of Lesotho, and to discuss the HIV-positive mothers’ need for support services from an ecological perspective. Both quantitative and qualitative research approaches were used. The research utilised exploratory and descriptive design. Purposive sampling was used to select the 30 participants who took part in the study. Data was gathered by means of semi-structured questionnaires that were administered during individual interviews. The questionnaires were formulated on the basis of information retrieved during the literature review. The findings of the study reveal that HIV-positive mothers living in the rural areas of Lesotho have economic, social and cultural circumstance as factors hindering their treatment and prevention of HIV/AIDS. They are also faced with the psychological impacts of HIV, and the findings revealed that disclosure was the key to addressing their problems. The findings also show that most mothers receivedemotional, instrumental, informational and appraisal support from their families at the micro-level of the ecological perspective. The other levels – meso, exo and macro – provided only limited support for the mothers. The recommendations are that these mothers need social support at all levels of the ecological perspective to meet their needsAFRIKAANSE OPSOMMING: MIV/vigs is een van die ergste pandemies in die moderne wêreld. Dit ken geen grense nie, en vele mense ly hetsy daaraan of daaronder. Die virus het reeds alle uithoeke van die aarde bereik. Tog gaan Afrika, veral Suider-Afrika, die swaarste daaronder gebuk, en word meer as die helfte van die totale populasie wat aan of onder MIV/vigs ly hier aangetref. Die vyf lande met die hoogste MIV-infeksiesyfers ter wêreld is almal in die streek geleë. Lesotho is een van die drie lande boaan hierdie lys, en het terselfdertyd te kampe met die probleme van armoede en ’n hoë werkloosheidsyfer. Vroue en kinders, synde die groepe wat die ergste deur armoede geraak word, woon ook meestal in landelike gebiede. ’n MIV-positiewe moeder in die landelike gebiede van Lesotho moet dus armoede, ontoeganklike dienste sowel as die sielkundige uitwerking van MIV trotseer. Die doel van hierdie studie was om vanuit die ekologiese perspektief ’n beter begrip te vorm van gesondheidsdiensverskaffers se sienings oor die behoefte aan en toeganklikheid van steundienste vir MIV-positiewe moeders in die landelike gebiede van Lesotho. Om hierdie doel te bereik, was die oogmerke om ’n oorsig van die MIV-verskynsel te bied, die psigososiale behoeftes en sosiokulturele omstandighede van MIV-positiewe moeders in die landelike gebiede van Lesotho te beskryf, en die moeders se behoefte aan steundienste vanuit die ekologiese perspektief te bespreek. ’n Kwantitatiewe sowel as ’n kwalitatiewe navorsingsmetode is gevolg, en die navorser het van ’n verkennende en beskrywende ontwerp gebruik gemaak. Doelgerigte steekproefneming is gebruik om die 30 studiedeelnemers te kies. Data is met behulp van semigestruktureerde vraelyste gedurende individuele onderhoude ingesamel. Die vraelyste is opgestel op grond van inligting wat in die literatuuroorsig bekom is. Die studie bevind dat ekonomiese, maatskaplike en kulturele omstandighede MIV/vigs-behandeling en -voorkoming vir MIV-positiewe vroue in die landelike gebiede van Lesotho belemmer. Daarbenewens moet hulle die sielkundige uitwerking van MIV die hoof bied, en die studie dui op openbaarmaking as die sleutel om hul probleme te hanteer. Die bevindinge toon ook dat die meeste moeders emosionele, fisiese, inligting- en bevestigende steun van hul families op die mikrovlak van die ekologiese perspektief ontvang. Die ander vlakke – meso, ekso en makro – bied slegs beperkte steun. Die studie kom tot die gevolgtrekking dat hierdie moeders op alle vlakke van die ekologiese perspektief maatskaplike steun moet ontvang om in hul behoeftes te voorsien.Maste

Exploring the views of health care service providers on life stressors and basic needs of HIV-positive mothers in rural areas of Lesotho

CITATION: Shoeshoe, M. & Sulina, G. 2017. Exploring the views of health care service providers on life stressors and basic needs of HIV-positive mothers in rural areas of Lesotho. Social Work/Maatskaplike Werk, 53(1):45-56, doi:10.15270/53-1-545.The original publication is available at http://socialwork.journals.ac.zaThe human immunodeficiency virus (HIV) ranks as one of the deadliest viruses in the world. The second highest incidence of the virus has been recorded in Lesotho, where women and children are the most infected and affected. This article explores and describes views of health-care service providers on the life stressors experienced by HIV-positive mothers living in the rural areas of Lesotho and how their basic needs are met. Recommendations are made on how health-care service providers and the government can address the life stressors and basic needs of these mothershttp://socialwork.journals.ac.za/pub/article/view/545Publisher's versio