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Health in Lesotho

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Traditional medicine woman travelling on foot over mountain range

Lesotho's Human development index value for 2018 was 0.518—which put the country in the low human development category—positioning it at 164 out of 189 countries and territories.[1] Health care services in Lesotho are delivered primarily by the government and the Christian Health Association of Lesotho. Access to health services is difficult for many people, especially in rural areas. The country's health system is challenged by the relentless increase of the burden of disease brought about by AIDS, and a lack of expertise and human resources. Serious emergencies are often referred to neighbouring South Africa. The largest contribution to mortality in Lesotho are communicable diseases, maternal, perinatal and nutritional conditions.[2]

The Human Rights Measurement Initiative[3] finds that Lesotho is fulfilling 72.7% of what it should be fulfilling for the right to health based on its level of income.[4] When looking at the right to health with respect to children, Lesotho achieves 80.5% of what is expected based on its current income.[4] In regards to the right to health amongst the adult population, the country achieves only 43.9% of what is expected based on the nation's level of income.[4] Lesotho falls into the "fair" category when evaluating the right to reproductive health because the nation is fulfilling 93.8% of what the nation is expected to achieve based on the resources (income) it has available.[4]

Health indicators

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Crude death rate and life expectancy

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The population pyramid of Lesotho illustrates the age and sex structure of population and may provide insights about political and social stability, as well as economic development. The population is distributed along the horizontal axis, with males shown on the left and females on the right. The male and female populations are broken down into 5-year age groups represented as horizontal bars along the vertical axis, with the youngest age groups at the bottom and the oldest at the top. The shape of the population pyramid gradually evolves over time based on fertility, mortality, and international migration trends.

In 2019, the Crude Death Rate in Lesotho (per 1,000 people) were 13.936 people.[5] The most recent (2019) life expectancy at birth in Lesotho is 47 for males and 54 for females.[6] In 2005 life expectancy was 42.5, giving an increase of 11 years over the past 13 years.[7]

Health economy

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The total expenditure on health as percentage of GDP is 10.6 (2014).[8] Out-of-pocket expenditure per capita on healthcare was $42.33 in 2014. The same year public expenditure on healthcare as percent of total healthcare expenditure 76.12%.[9]

Child and infant mortality

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Child mortality indicators such as Under-Five Mortality Rate (U5MR), Infant Mortality Rate (IMR) and Neonatal Mortality Rate (NMR) are estimates that measures child survival, but they also reflect social, economic, and environmental conditions that the people of the country have, such as their health care.[10]

Under 5 mortality rate is 86 per 1,000 live births (2019). Under-five mortality rate is the probability of dying between birth and exactly 5 years of age, expressed per 1,000 live births.[11] The infant mortality rate, in 2019 was 68.1 (per 1,000 live births).[12]

Child and Infant Mortality Rates in Lesotho compared to the World Average
Lesotho World Average Ref
Under-Five Mortality Rate (U5MR) per 1,000 live births 86.40 37.70 [13]

[14]

Infant Mortality Rate (IMR) per 1,000 live births 68.10 28.20 [15]

[16]

Neonatal Mortality Rate (NMR) per 1,000 live births 42.80 17.50 [17]

[18]

Nutrition

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Malnutrition is a major problem in Lesotho. 33.4% of children under five are moderately or severely stunted. Children born with a low birth weight (<2500 g) was in 2014 14.6%.[12]

Maternal health and family planning

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Adolescent birth rate is 92.7 births per 1,000 women ages 15–19 (2019). Contraceptive prevalence, any method is 60.2 (% of married or in-union women of reproductive age, 15–49 years). Antenatal care coverage, (at least one visit) 95.2%. Maternal mortality ratio is very high with the number 487 (deaths per 100,000 live births). SDG goal is under 70. The proportion of births attended by skilled health personnel are 77.9%.[8]

Health system

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In the most recent survey, conducted between 1997 and 2010, there were five doctors, and 62 nurses and midwives per 100,000 people.[2]

There were 117 medical facilities in Lesotho in 2019.[19]

The Queen Elizabeth II Hospital in Maseru, the main secondary care centre, was closed in 2011 and replaced by a newly built hospital, the Queen Mamohato Memorial Hospital, with 425 beds, constructed on a public–private partnership basis. This has produced considerably better health outcomes and more advanced medical technologies than were previously available. It has also attracted patients who could have been dealt with in primary care. More than 27,000 inpatients and nearly 350,000 outpatients were treated in 2015. The scheme absorbed an average of 34.8% of the total government recurrent budget for the health sector for 2012-15. All invasive cardiac care and cancer treatment is referred to public hospitals in Bloemfontein.[20]

Hospitals in Lesotho
Name Location Type facility Ownership Coordinates Ref
Maluti Adventist Hospital Berea Mission Hospital Faith-based 29°06′21″S 27°57′20″E / 29.1059°S 27.95554°E / -29.1059; 27.95554 (Maluti Adventist Hospital) [19]
Seboche Hospital Butha-Buthe Mission Hospital Faith-based 28°41′06″S 28°24′38″E / 28.6850393206467°S 28.4106506766422°E / -28.6850393206467; 28.4106506766422 (Seboche Hospital) [19][21]
Mamohau Hospital Leribe Mission Hospital Faith-based 29°06′28″S 28°29′25″E / 29.107792°S 28.490226°E / -29.107792; 28.490226 (Mamohau Hospital) [19][21]
Scott Hospital Hospital Maseru Mission Hospital Faith-based 29°37′32″S 27°30′25″E / 29.625576°S 27.506883°E / -29.625576; 27.506883 (Scott Hospital Hospital) [19][21]
St Joseph's Hospital Maseru Mission Hospital Faith-based 29°27′04″S 27°43′23″E / 29.451059°S 27.723139°E / -29.451059; 27.723139 (St Joseph’s Hospital) [19][21]
St James Hospital Mokhotlong Mission Hospital Faith-based 29°17′12″S 29°04′28″E / 29.2866026450759°S 29.0744239210947°E / -29.2866026450759; 29.0744239210947 (St James Hospital) [19][21]
Tebellong Hospital Qacha's Nek Mission Hospital Faith-based 30°07′02″S 28°41′00″E / 30.117104°S 28.683294°E / -30.117104; 28.683294 (Tebellong Hospital) [19][21]
Paray Hospital Thaba-Tseka Mission Hospital Faith-based 29°29′18″S 28°34′58″E / 29.48841°S 28.58269°E / -29.48841; 28.58269 (Paray Hospital) [19][21]
Queen Mamohato Memorial Hospital Maseru Hospital Public/Private 29°20′28″S 27°31′42″E / 29.3410696948855°S 27.5282299433817°E / -29.3410696948855; 27.5282299433817 (Queen Mamohato Memorial Hospital) [19][21]
Wilies Hospital Foso Hospital Private 29°16′18″S 27°31′39″E / 29.2716832293936°S 27.5276290996774°E / -29.2716832293936; 27.5276290996774 (Wilies Hospital) [21]
Center For Equal Health Access Lesotho Hospital Teyateyaneng Hospital Private 29°07′12″S 27°45′40″E / 29.1199953922775°S 27.7610883395368°E / -29.1199953922775; 27.7610883395368 (Center For Equal Health Access Lesotho Hospital) [21]
Makoanyane Military Hospital Maseru Hospital Military 29°20′03″S 27°32′39″E / 29.3342197242532°S 27.5441083585756°E / -29.3342197242532; 27.5441083585756 (Makoanyane Military Hospital) [22]
Mohlomi Mental Hospital Maseru Psychiatric hospital Public 29°20′37″S 27°32′02″E / 29.3436109274556°S 27.533757952656°E / -29.3436109274556; 27.533757952656 (Mohlomi Mental Hospital) [23]
Map all coordinates in "Health in Lesotho" using OpenStreetMap

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Burden of disease

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The burden of disease refers to the sum of mortality and morbidity (the prevalent diseases), often measured by the metric called "Disability Adjusted Life Years" (DALYs).[24] This metric does not only consider if people die from the diseases, but they also include the suffering it causes to the diseased.

Communicable diseases

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Lesotho's burden of disease is centered around Communicable Diseases (CDs), where HIV/AIDS is the leading cause of DALYs, followed by tuberculosis and Lower respiratory infections.[25]

Human Immunodeficiency Virus and AIDS (HIV/AIDS)

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Main article: HIV/AIDS in Lesotho

HIV/AIDS is contributing to as much as 34.76% of all DALYs in Lesotho. However, the percent of total DALYs has declined since 2005 where HIV/AIDS contributed to 46.08% of total DALYs.[25]

Lesotho is severely afflicted by AIDS and has one of the highest infection rates in the world.[26] In 2005 there were 30,000 new infections compared to 21,000 new infections in 2016.[27] In urban areas, about 50 percent of women under 40 are infected with human immunodeficiency virus.

The country regards HIV as one of its most important development issues, and the government is addressing the pandemic through its HIV/AIDS National Strategic Plan. Coverage of some key HIV/AIDS interventions has improved, including prevention of mother to child transmission and antiretroviral therapy. Prevention of mother to child transmission coverage increased from about 5 percent in 2005, to 31 percent in 2007. The roll-out of antiretroviral therapy has made good progress, with 38,586 people receiving treatment by 2008.[28]

The "Know Your Status" campaign boosted the number of people being tested for human immunodeficiency virus infection to 229,092 by the end of 2007, 12 percent of the population and three times the number tested in 2005. The program is funded by the Clinton Foundation and started in June 2006. Bill Clinton and Microsoft chairman Bill Gates visited Lesotho in July 2006 to assess its fight against AIDS.[29] As a result, the annual rate at which adults in the population who are HIV-negative become HIV-positive declined from 2.9 percent in 2005 to 2.3 percent in 2007, lowering the estimated annual number of new infections from 26,000 to 21,560. These are the first signs of a decline in the HIV epidemic.[28]

The Apparel Lesotho Alliance to Fight AIDS is an industry-wide program providing prevention and treatment, including ARVs when these are necessary, for the 46,000 mainly women workers in the Lesotho apparel industry. It was launched in May 2006. The program is helping to combat two of the key drivers of the HIV/AIDS epidemic: poverty and gender inequality. Surveys within the industry by ALAFA show that 43 percent of employees have HIV.[30]

Prince Harry of UK co-founded the charity Sentebale in Lesotho, for children with HIV/AIDS. The other co-founder is the Prince of Lesotho.

Tuberculosis (TB)

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Tuberculosis attributes to 7.1% of total DALYs in Lesotho (2019).[25] Lesotho has a very high incidence rate of tuberculosis with 665 cases per 100,000 people (2017). Treatment success rate is 77% (2016). The mortality rate is 46 per 100,000 people (2017).[31] Approximately 70% of patients with tuberculosis in Lesotho are co-infected with human immunodeficiency virus.[32]

COVID-19

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While the DALYs for COVID-19 remain unknown, Lesotho's humanitarian situation has worsened along with the increase of COVID-19 cases and deaths.[33] The country has confirmed cases of the Delta variant and confirmed new cases has exceeded the WHO threshold of resurgence >20%. As of 28 August 2021, 201,795 vaccines doses have been administered.[34] By 15 September 2021, Lesotho had a cumulative of 14,395 confirmed COVID-19 cases and 403 deaths.

Main article: COVID-19 pandemic in Lesotho

Non-communicable diseases

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Stroke

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Stroke is the leading cause of DALYs among the Non-Communicable Diseases (NCDs), but only accounts for 2.65% of total DALYs in Lesotho.[25]

Diabetes

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Diabetes is the second leading cause of DALYs among the NCDs, accounting for 2.3% of total DALYs.[25]

Injuries

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Road injuries

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Road traffic injuries accounts for a total of 3.06% DALYs.[25] These injuries may cause large economic losses to individuals and their families.[35] Economic loss happens due to cost of treatment and lost productivity for those killed or disabled by their injuries, as well as loss of income for the family members if they can't attend work or school while taking care for the injured.

Interpersonal violence

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Interpersonal violence, such as physical, sexual, or psychological (emotional) violence, deprivation and neglect, accounts for 2.7% of total DALYs.[25] Interpersonal violence can make individuals more prone to a broad range of emotional, behavioral, and physical health problems.[36]

References

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  1. ^ "Inequalities in Human Development in the 21st Century" (PDF). UNDP. Retrieved 22 September 2020.
  2. ^ a b "Health systems in Lesotho". Commonwealth Health. Retrieved 22 September 2020.
  3. ^ "Human Rights Measurement Initiative – The first global initiative to track the human rights performance of countries". humanrightsmeasurement.org. Retrieved 2022-03-24.
  4. ^ a b c d "Lesotho - HRMI Rights Tracker". rightstracker.org. Retrieved 2022-03-24.
  5. ^ "Death rate, crude (per 1,000 people) - Lesotho | Data". data.worldbank.org. Retrieved 2021-09-15.
  6. ^ "Lesotho Country Overview | World Health Organization". www.who.int. Retrieved 2021-09-15.
  7. ^ "Life expectancy at birth, Lesotho". Data Worldbank. Retrieved 22 September 2020.
  8. ^ a b "Countries: Lesotho". WHO. World Health Organisation. Retrieved 22 September 2020.
  9. ^ "Lesotho Our World in Data". Our World in Data. Retrieved 22 September 2020.
  10. ^ "Indicator Metadata Registry Details". www.who.int. Retrieved 2021-09-15.
  11. ^ "Key demographic indicators: Lesotho". Unicef. Retrieved 22 September 2020.
  12. ^ a b "NLiS Country Profile: Lesotho". WHO. Retrieved 22 September 2020.
  13. ^ "Mortality rate, under-5 (per 1,000 live births) - Lesotho | Data". data.worldbank.org. Retrieved 2021-09-15.
  14. ^ "Mortality rate, under-5 (per 1,000 live births) | Data". data.worldbank.org. Retrieved 2021-09-15.
  15. ^ "Mortality rate, infant (per 1,000 live births) - Lesotho | Data". data.worldbank.org. Retrieved 2021-09-15.
  16. ^ "Mortality rate, infant (per 1,000 live births) | Data". data.worldbank.org. Retrieved 2021-09-15.
  17. ^ "Mortality rate, neonatal (per 1,000 live births) - Lesotho | Data". data.worldbank.org. Retrieved 2021-09-15.
  18. ^ "Mortality rate, neonatal (per 1,000 live births) | Data". data.worldbank.org. Retrieved 2021-09-15.
  19. ^ a b c d e f g h i j "A spatial database of health facilities managed by the public health sector in sub-Saharan Africa". World Health Organization. February 11, 2019. Archived from the original on April 22, 2019. Retrieved May 8, 2020.
  20. ^ "Lesotho Health Network Public-Private Partnership (PPP)". World Bank. 19 February 2016. Retrieved 19 November 2018.
  21. ^ a b c d e f g h i j "List of doctors and medical facilities in Lesotho" (PDF). US Embassy, Lesotho. Retrieved January 12, 2021.
  22. ^ "Military hospital in botched delivery". The Post. Retrieved January 12, 2021.
  23. ^ "mental hospital grapples with- overcrowding". Lesotho Times. Retrieved January 12, 2021.
  24. ^ Roser, Max; Ritchie, Hannah (2016-01-25). "Burden of Disease". Our World in Data.
  25. ^ a b c d e f g "GBD Compare | IHME Viz Hub". vizhub.healthdata.org. Retrieved 2021-09-15.
  26. ^ "The World Factbook" Archived 27 July 2009 at the Wayback Machine. cia.gov.
  27. ^ "HIV and AIDS in Lesotho". AVERT. 21 July 2015. Archived from the original on 2 October 2018. Retrieved 1 October 2018.
  28. ^ a b "World bank Lesotho: Country Brief". Archived from the original on 31 March 2014. Retrieved 3 March 2012.
  29. ^ Julian Rademeyer (16 July 2006). "Lesotho praised for fight against Aids". Sunday Times of South Africa. Archived from the original on 8 March 2012. Retrieved 27 January 2011.
  30. ^ "Apparel Lesotho Alliance to Fight AIDS (ALAFA)". Archived from the original on 25 February 2011. Retrieved 4 February 2012.
  31. ^ "Lesotho Country Profile". Centers for Disease Control. 4 May 2022.
  32. ^ "CDC Division of Global HIV & TB – Country Profile – Lesotho" (PDF). CDC. Retrieved 22 September 2020.
  33. ^ "Lesotho situation reports". www.unicef.org. Retrieved 2021-09-15.
  34. ^ "Lesotho: WHO Coronavirus Disease (COVID-19) Dashboard With Vaccination Data". covid19.who.int. Retrieved 2021-09-15.
  35. ^ "Road traffic injuries". www.who.int. Retrieved 2021-09-15.
  36. ^ Mercy, James A.; Hillis, Susan D.; Butchart, Alexander; Bellis, Mark A.; Ward, Catherine L.; Fang, Xiangming; Rosenberg, Mark L. (2017), Mock, Charles N.; Nugent, Rachel; Kobusingye, Olive; Smith, Kirk R. (eds.), "Interpersonal Violence: Global Impact and Paths to Prevention", Injury Prevention and Environmental Health (3rd ed.), Washington (DC): The International Bank for Reconstruction and Development / The World Bank, doi:10.1596/978-1-4648-0522-6_ch5, ISBN 978-1-4648-0522-6, PMID 30212109, retrieved 2021-09-15
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