Lesotho

Aim. This paper is a report on the development of a conceptual model delineating contexts and processes of HIV/AIDS stigma as reported by persons living with HIV/AIDS and nurses from African countries. It is part of a larger study to increase understanding of HIV/AIDS ...

Home-based HIV testing is a frequently used strategy to increase awareness of HIV status in sub-Saharan Africa. However, with referral to health facilities, less than half of those who test HIV positive link to care and initiate antiretroviral therapy (ART). To determine whether offering same-day home-based ART to patients with HIV improves linkage to care and viral suppression in a rural, high-prevalence setting in sub-Saharan Africa. Open-label, 2-group, randomized clinical trial (February 22, 2016-September 17, 2017), involving 6 health care facilities in northern Lesotho. During home-based HIV testing in 6655 households from 60 rural villages and 17 urban areas, 278 individuals aged 18 years or older who tested HIV positive and were ART naive from 268 households consented and enrolled. Individuals from the same household were randomized into the same group. Participants were randomly assigned to be offered same-day home-based ART initiation (n = 138) and subsequent follow-up int...

People living with HIV (PLWH) and their families are subjected to prejudice, discrimination, and hostility related to the stigmatization of AIDS. This report examines how PLWH cope with HIV-related stigma in the five southern African countries of Lesotho, Malawi, South Africa, Swaziland, and Tanzania. A descriptive qualitative research design was used to explore the experience of HIV-related stigma of PLWH and nurses in 2004. A total of 43 focus groups were conducted with 251 participants (114 nurses, 111 PLWH, and 26 volunteers). In describing incidents of stigma, respondents reported strategies used or observed to cope with those incidents. Nurse reports of coping strategies that they used as well as observed in HIV-infected patients were coded. Coping strategies used by PLWH in dealing with HIV-related stigma were coded. A total of 17 different self-care strategies were identified: restructuring, seeing oneself as OK, letting go, turning to God, hoping, changing behavior, keeping oneself active, using humor, joining a support or social group, disclosing one's HIV status, speaking to others with same problem, getting counseling, helping others to cope with the illness, educating others, learning from others, acquiring knowledge and understanding about the disease, and getting help from others. Coping appears to be self-taught and only modestly helpful in managing perceived stigma.

Natural resource extraction projects such as dams and mines entail alteration to or destruction of natural and cultural landscapes. Heritage mitigation efforts often propose compensating for or salvaging material heritage, largely because this can be inventoried and evaluated alongside economic and environmental resources. Intangible Cultural Heritage (ICH) is often overlooked, despite the fact that tangibles, intangibles, and economic resources together constitute the impacted landscape. Writing from the perspective of western Lesotho's Metolong Dam, we view landscape as an embodiment of intangible heritage to explore what 'landscape loss' consequent on dam-building entails. We contend that this process involves dissociating intangibles from their material correlates, and transforming landscape experiences by dissolving and re-constituting boundaries and 'resources' in line with developer perspectives. We suggest that considering interdisciplinary approaches to landscape theorisation and ICH achieves a more nuanced view of how landscape loss and ICH interrelate, and thus improves mitigatory practice.

The relationship between energy availability and species richness (the species-energy relationship) is one of the best documented macroecological phenomena. However, the structure of species distribution along the gradient, the proximate driver of the relationship, is poorly known. Here, using data on the distribution of birds in southern Africa, for which species richness increases linearly with energy availability, we provide an explicit determination of this structure. We show that most species exhibit increasing occupancy towards more productive regions (occurring in more grid cells within a productivity class). However, average reporting rates per species within occupied grid cells, a correlate of local density, do not show a similar increase. The mean range of used energy levels and the mean geographical range size of species in southern Africa decreases along the energy gradient, as most species are present at high productivity levels but only some can extend their ranges towards lower levels. Species turnover among grid cells consequently decreases towards high energy levels. In summary, these patterns support the hypothesis that higher productivity leads to more species by increasing the probability of occurrence of resources that enable the persistence of viable populations, without necessarily affecting local population densities.

Understanding the historical dynamics of wildlife distribution and abundance is essential to developing appropriate conservation measures. Here we investigate the occurrence and status of medium-to large-sized fauna (excluding avifauna) for the mountain Kingdom of Lesotho and immediate adjoining regions of South Africa, from the late Pleistocene to the present-day. We provide historical timelines and records of reported medium to large faunal taxa based on: data from eight published archaeological excavations, analyses of several hundred unpublished 19th and 20th century historical documents (including missionary letters, diaries, colonial reports and newspapers), and 58 recent oral history interviews. Vegetation and climate changes through the Holocene are also noted, based on archaeo-botanical records. Through these sources, we record 61 medium to large faunal species for Lesotho and surrounding regions over the past~21 ka, of which only 22 are present today. Some species not previously known to the region are documented (e.g. Temminck's pangolin). Most species were present during the early 19th century, but many regional species extinctions and a major faunal population decline occurred between 1845 and 1850, owing mainly to settler hunting campaigns. Subsequent extinctions have taken place over a wider temporal interval, due to factors including overhunting, human-wildlife conflicts and habitat loss. It seems that some taxa were forced into unsuitable mountain refugia where species eventually succumbed to genetic erosion and/or harsh climatic conditions. Our results increase current understanding of regional faunal and environmental changes, such as the timing of species occurrences and extinction events and processes in Lesotho. Such work adds valuable knowledge to understanding the environmental heritage of the region. Information can be disseminated into wildlife records, national environmental reports, the WWF, the national school environmental educational curriculum and to National Parks and Heritage Sites.

Melanorosaurus is a genus of basal sauropodomorph that currently includes two species from Southern Africa. In this paper, we redescribe the holotype femur of Melanorosaurus thabanensis from the Elliot Formation of Lesotho, as well as associated remains. The stratigraphic position of this taxon is reviewed, and it is clear that it comes from the Lower Elliot Formation being, therefore, Late Triassic in age, and not Early Jurassic as originally described. The knowledge of the anatomy of the basal sauropodomorph of Thabana Morena is enhanced by the description of six new skeletal elements from the type locality. The femur and the ilium from Thabana Morena are diagnostic and characterized by unusual proportions. The first phylogenetic analysis including both this specimen and Melanorosaurus is conducted. This analysis leads to the conclusion that the femur described in the original publication of Melanorosaurus thabanensis can no longer be referred to Melanorosaurus. For these reasons, we hereby create Meroktenos gen. nov. to encompass Meroktenos thabanensis comb. nov.

Background  Evidence is increasing of high HIV risks among southern African men who have sex with men (MSM). This represents the first study of HIV risks and human rights contexts among MSM in Lesotho. Methods  Two hundred and fifty-two men who reported ever having anal sex with another man were accrued with snowball sampling and were administered a structured quantitative instrument in

Background: Cervix cancer, preventable, continues to be the third most common cancer in women worldwide, especially in lowest income countries. Prophylactic HPV vaccination should help to reduce the morbidity and mortality associated with cervical cancer. The purpose of the study was to describe the results of and key concerns in eight HPV vaccination programs conducted in seven lowest income countries through the Gardasil Access Program (GAP).

Soil organic carbon constitutes an important indicator of soil fertility. The purpose of this study was to predict soil organic carbon content in the mountainous terrain of eastern Lesotho, southern Africa, which is an area of high endemic biodiversity as well as an area extensively used for small-scale agriculture. An integrated field and laboratory approach was undertaken, through measurements of reflectance spectra of soil using an Analytical Spectral Device (ASD) FieldSpec ® 4 optical sensor. Soil spectra were collected on the land surface under field conditions and then on soil in the laboratory, in order to assess the accuracy of field spectroscopy-based models. The predictive performance of two different statistical models (random forest and partial least square regression) was compared. Results show that random forest regression can most accurately predict the soil organic carbon contents on an independent dataset using the field spectroscopy data. In contrast, the partial least square regression model overfits the calibration dataset. Important wavelengths to predict soil organic contents were localised around the visible range (400-700 nm). is study shows that soil organic carbon can be most accurately estimated using derivative field spectroscopy measurements and random forest regression.

Blockstreams are found in many mountain ranges worldwide and can be considered as an expression of the interplay between upslope sediment supply and transport-limited capacity of slope sediment systems. In mountain settings, blockstreams have been most commonly described as periglacial landforms, whose development and internal morphology reflect active layer processes, and where the landforms are not active under present climatic conditions. In the Maloti–Drakensberg mountain range of eastern Lesotho, southern Africa, several blockstreams have been identified but their age, evolution and relationships to climatic conditions are largely not known. This study maps and analyses the properties of one large blockstream in the Maloti–Drakensberg using field measurement techniques including Schmidt hammer relative exposure age dating of blockstream boulders. Results show that the blockstream is a relict feature but debris may have been derived from several sources including from periglacial slope activity. The presence of arcuate flow lobes within the main body of the studied blockstream attests to phases of slope-driven boulder movement possibly controlled by active-layer processes and cryoturbation, or by slip at the base of the sediment body driven by seasonal water availability. Relative age data from Schmidt hammer analysis suggest that different parts of the blockstream may have different ages and/or sources. By comparison with blockstreams elsewhere in the Maloti–Drakensberg, it is likely that it is of late Quaternary and probably of local last glacial maximum age, but younger Holocene phases of activity cannot be excluded.

Adults in a village in Lesotho, Africa, were interviewed to determine the community prevalence of major depression, panic disorder, and generalised anxiety disorder. The prevalence data were compared with data from a large epidemiological study in the United States utilising the same researchinstrument. There was a significantly higher prevalenceof all three diagnoses in Lesotho as compared with the United States. As in the United States, women were at an increased risk for these disorders, although statistical significance was not demonstrated for depression. The majority of people (77%) who had experienced panic attacks said they had sought help for their symptoms, with the majority attending Western-trained doctors. The relationship between explanatory models and help-seeking behaviour was explored in people who had had panic attacks. Less than 40% of those with generalised anxiety disorder said they sought help.

Slope and lowland sediment systems throughout southern Africa are dominated by the presence of colluvium with interbedded palaeosols and hardground duricrusts. These sediments correspond to phases of land surface instability and stability, respectively, during the late Quaternary. This study examines the stratigraphy and environmental interpretation of slope sediment records from specific sites in southern Africa for the period of marine isotope stages (MIS) 6 to 1 (~191 ka to present), informed by theoretical ideas of the dynamics of slope systems including sediment supply and accommodation space. Based on this analysis, phases of land surface instability and stability for the period MIS 6 to 1 are identified. The spatial and temporal patterns of land surface conditions are not a simple reflection of climate forcing, but rather reflect the workings of slope systems in response to climate in addition to the role of geologic, edaphic and ecological factors that operate within catchment-scale sediment systems. Considering these systems dynamics can yield a better understanding of the usefulness and limitations of slope sediment stratigraphies.

Background: The success of HIV programs relies on widely accessible HIV testing and counseling (HTC) services at health facilities as well as in the community. Home-based HTC (HB-HTC) is a popular community-based approach to reach persons who do not test at health facilities. Data comparing HB-HTC to other community-based HTC approaches are very limited. This trial compares HB-HTC to mobile clinic HTC (MC-HTC).

Present-day drainage patterns in mountain regions are strongly affected by antecedent tectonic and geologic factors. In the mountains of eastern Lesotho, southern Africa, bedrock comprises flat-lying Jurassic basalts which have given rise to a relatively uniform initial land surface. Here, we present key morphometric measurements of river drainage patterns from this region, from six 4th order river basins, including principal river sinuosity, river long profiles and valley cross profiles, in order to evaluate geological controls on drainage evolution and the potential ages of river elements. Results show that there are highly variable spatial patterns of river morphometric properties, even between adjacent basins, despite identical geologies and altitudes across the region. However, northerly catchments show knickpoints, variable long profiles and have steep sided and V-shaped valley cross profiles. Southerly catchments have much smoother long profiles, no knickpoints, and concavo-convex valley cross profiles. There are also differences in river sinuosity values, both for the catchments as a whole and for reaches of different lengths within the catchments. These spatially varying river morphometric and drainage properties most likely are the long-preserved outcomes of epeirogenic forcing on the land surface (including tectonic uplift, mantle relaxation and rebound during the Cenozoic), and subtle long-term variations in climate from north to south across the region, including in precipitation and weathering.

Background-Data on outcomes of antiretroviral treatment (ART) programs in rural sub-Saharan African are scarce. We describe early losses and long-term outcomes in six rural programs in Southern Africa with limited access to viral load monitoring and second-line ART.

Subaerial physical, chemical and biological weathering processes are significant contributors to mountain landscape development worldwide, and over long time scales. This paper reports on pseudokarst features formed by different subaerial weathering processes on a high-elevation basalt plateau surface in the Maloti–Drakensberg mountains of eastern Lesotho, southern Africa. Different mesoscale landforms identified on this plateau surface include enclosed depressions (containing seasonal pools) that are morphologically similar to karstic solutional features. Such basalt pseudokarst landforms have not been previously described. This study uses field data on depression morphometry, sediments, water chemistry and rock surface hardness to explore the varied subaerial weathering and erosion processes contributing to pseudokarst depression development. Results show that physical, chemical and biological weathering and erosion processes in combination can impact on the basalt land surface in widening and deepening these depressions. An evolutionary model for pseudokarst depression development proposes that different weathering processes in combination within the ‘critical zone’ cause changes in depression morphology, and that there are significant feedbacks between bedrock, weathering, and the development of distinctive micromorphological forms. It is likely that similar pseudokarst landforms from other locations with non-carbonate substrates have been under-reported in the literature.

POSTER:

Ornithischian dinosaurs were important and often dominant members of Cretaceous ecosystems around the world. However, the early evolution of this interesting and diverse clade during the Late Triassic–Early Jurassic remains poorly understood. Lesothosaurus diagnosti-cus from the Upper Elliot Formation of South Africa and Lesotho (?Hettangian-Sinemurian) is an important early representative of Orni-thischia and has been recovered in several positions on the ornithischian tree in previous studies (Butler, 2005; Butler et al., 2008). It has been suggested that L. diagnosticus represents the earliest known member of Thyreophora, the earliest known member of Neornithis-chia or an even more basal ornithischian lineage, which diverged before these major groups appeared. A second non-heterodontosaurian ornithischian taxon from the Upper Elliot Formation, Stormbergia dangershoeki, has also been recovered as the earliest known neornithischian in similar studies, although the validity of this taxon has been challenged (Knoll et al., 2010). Given their early appearance and 'primitive' body plans the taxonomy and systematics of L. diagnosticus and S. dangershoeki are critical for interpreting the early evolution of this group. A redescription of the post-cranial material of L. diagnosticus and a re-evaluation of other 'fabrosaur' material (including the hypodigm of S. dangershoeki) was carried out in order to better resolve relationships at the base of Ornithischia.

Presented at SVP 2014.


By Dr Matthew Grant Baron

The enclave state of Lesotho served as a labor reserve for South Africa's mining industries for more than a century before the the migrant labor economy declined dramatically in the 1990s. The Lesotho government has since hung its hopes on becoming another kind of reserve for South Africa: a water reservoir. A treaty between the two countries initiated the Lesotho Highlands Water Project, a multibillion‐dollar effort to dam and divert water from the mountains of Lesotho to the arid industrial areas south of Johannesburg. Just as the infrastructure of South African apartheid‐era labor reserves required “upstream” engineering, whether material, social, or symbolic, so too does its water reservoir. One example of symbolic engineering, described here, includes the construction of Lesotho as a place defined by water abundance. Elites in Lesotho have sought to deploy water as a symbol of national identity, sovereignty, and economic prosperity, integrating rivers, dam reservoirs, and hydroelectric infrastructure into its national iconography. But while it is true that water is abundant in rivers that flow out of the highlands, the country is plagued by regular droughts and spotty water access. Everyday notions of water in Lesotho emphasize these contingent, capricious, and even destructive qualities. Scrutinizing contradictions between the representation of water and local realities, I show that the production of water commodities entails more than water's disarticulation from its meaningful cultural contexts, as depicted in literature on water commodification elsewhere. Water commodification in Lesotho—and therefore Lesotho's status as a water reservoir for South African industry—is dependent on water engineers' ability first to link water to those local contexts. That is, engineers generate a type of water that is locally emplaced but unfamiliar to local people. In conclusion, I show how everyday notions of water in Lesotho call into question anthropological depictions of the “harmonious” water threatened by commodification.

Background: Few studies have examined outcomes for children treated for multidrug-resistant tuberculosis (MDR-TB), including those receiving concomitant treatment for MDR-TB and HIV co-infection. In Lesotho, where the adult HIV seroprevalence is estimated to be 24%, we sought to measure outcomes and adverse events in a cohort of children treated for MDR-TB using a community-based treatment delivery model. Methods: We reviewed retrospectively the clinical charts of children #15 years of age treated for culture-confirmed or suspected MDR-TB between July 2007 and January 2011. Results: Nineteen children, ages two to 15, received treatment. At baseline, 74% of patients were co-infected with HIV, 63% were malnourished, 84% had severe radiographic findings, and 21% had extrapulmonary disease. Five (26%) children had culture-confirmed MDR-TB, ten (53%) did not have culture results available, and four (21%) subsequently had results indicating drug-susceptible TB. All children with HIV co-infection who were not already on antiretroviral therapy (ART) were initiated on ART a median of two weeks after the start of the MDR-TB regimen. Among the 17 patients with final outcomes, 15 (88%) patients were cured or completed treatment, two (12%) patients died, and none defaulted or were lost to followup. The majority of patients (95%) experienced adverse events; only two required permanent discontinuation of the offending agent, and only one required suspension of MDR-TB treatment for more than one week. Conclusions: Pediatric MDR-TB and MDR-TB/HIV co-infection can be successfully treated using a combination of social support, close monitoring by community health workers and clinicians, and inpatient care when needed. In this cohort, adverse events were well tolerated and treatment outcomes were comparable to those reported in children with drugsusceptible TB and no HIV infection.

Here, we aim to establish possible morphogenetic associations between periglacial phenomena (sorted circles and turf-/stone-banked lobes) by examining (a) rock surface weathering rinds by thin section microscopy and SEM-EDX analysis, and (b) alpine shrub growth patterns of Helichrysum trilineatum supported by AMS 14C age determination. The study area is the Mafadi–Njesuthi summit zone, one of the highest alpine regions of southern Africa. Rock weathering results indicate that clasts in large sorted circle centres experience high chemical weathering rates on both exposed (upper) and non-exposed (lower) surfaces, whereas clasts in lobes and very large apparently ‘relict’ sorted circles have been inactive for a prolonged period of time, based on strongly contrasting weathering rates on both exposed and nonexposed clast surfaces. Large sorted circles originating from a previous (possibly Last Glacial Maximum or late-glacial) colder period are still marginally or episodically active, thus restricting plant succession on these landforms. Even where very large sorted circles and turf-/stonebanked lobes are inactive, their legacy continues, as expressed in today’s surface morphology, and still influence ground abiotic conditions through the generation of microrelief and microclimate which in turn have impacts on ecosystem patterns including the distribution of H. trilineatum. Such shrub growth patterns are influenced by microscale site morphology, associated abiotic controls, and ongoing seasonal cryogenic activity. Both active and inactive periglacial landforms on highest summits of the Drakensberg represent microscale environments with distinct fine-scale abiotic and geomorphic settings, which in turn are manifested through differences in plant ecology and rock surface weathering, respectively.

French language as a subject was formally re-injected in the mainstream schools as a pilot project in 2009 in Lesotho. This language, which was initially introduced in schools in 1868 and whose popularity decreased following the missionaries' departure from Lesotho, is viewed by the Ministry of Education and Training as an instrumental tool in promoting individual, national and socioeconomic development. French, vis-à-vis English and Sesotho, is at the basis of the concept of multilingualism in a country that is officially recognised as being bilingual. It is against this backdrop that this article sought to explore learners' attitudes towards multilingualism through the reintroduction of French as a subject. Purposive sampling was used to select 9 secondary school participants where French was taught. Data were generated using focus group interviews and open-ended questionnaires. The findings demonstrate that most participants display positive affective attitudes towards multilingualism, viewing it as a step towards attainment of an idealised self, as creating job opportunities and as promoting globalisation. Seemingly, habitual attitudes influence social and/or factual attitudes. The paper is nuanced by the neoliberalism theory to demonstrate that the students' understanding of the utility of languages is largely informed by the logic of the market and business, reducing education to a clinical activity. This article thus recommends the inclusion of three propositions of affective attitudes in the language policy in order to contribute to the development of a holistic individual who would work towards the attainment of an idealised self through qualification, socialisation and subjectification, thereby preserving the concept of multilingualism.

Economic anthropologists often look to goods that resist commodification to understand how culture determines what can be exchanged and on what terms. Livestock in Africa have served as prominent examples of such “recalcitrant commodities.” In this article, I argue that goods that do not resist commodification—what I call “clean‐break commodities”—also illuminate the culture of the economy. Drawing on fifteen months of fieldwork in Lesotho, I contrast the reticence to sell cattle in African societies, long the focus of anthropologists as well as experts in conservation and development, with the prodigious sale of sheep and goats (i.e., ovicaprids). Narrow focus on charismatic cattle cultures obscures both the historically shifting commodification of ovicaprids and the economic dreamworlds in which they become enrolled. Ovicaprid cultures morphed over time as rural Basotho navigated their country's structural transitions in the regional political economy—from recently colonized ethnostate to labor reserve for South African mining industries and to defunct labor reserve. Just as the resistance of cattle to commodification described by James Ferguson as the “bovine mystique” opened a window into social life in the labor reserve, the facile commodification of ovicaprids that I call the “ovicaprine mystique” does the same throughout Lesotho's history. [bovine mystique, livestock, commodification, postindustry, sub‐Saharan Africa]

Given the well documented undesired impacts of HIV/AIDS globally, there is a need to create a statistical inventory of research output on HIV/AIDS. This need is particularly important for a country such as Lesotho, whose HIV/AIDS prevalence is one of the highest globally. Research on HIV/AIDS in sub-Saharan Africa continues to trail behind that of other regions, especially those of the developed countries. Lesotho, a sub-Saharan country, is a developing country with lower research output in this area when longitudinally compared to other countries. This study reviewed the volume and scope of the general research output on HIV/AIDS in Lesotho and assessed the coverage of the national research agenda on HIV/AIDS, making recourse to statistical principles. A bibliometric review of studies on HIV/AIDS retrieved from the SCOPUS and PubMed databases, published within the 30-year period between 1985 and 2016, was conducted. The focus of each of the studies was analysed and the studies were...

Malva parviflora leaves and roots were collected from five sites within the Qacha's Nek District in Lesotho. These plants had two distinct growth forms -upright and prostrate. Hexane, methanol and water extracts were made from the plant material and tested for antibacterial and anti-inflammatory activity using the disc diffusion and cyclooxygenase-1 (Cox-1) bioassays, respectively. Hexane, methanol and water extracts made from Malva parviflora with a prostrate growth form inhibited the growth of Gram-positive and Gram-negative bacteria, while extracts made from plants with an upright growth form inhibited the growth of Gram-positive bacteria only. Cox-1 anti-inflammatory activity of hexane, methanol and water extracts did not show any variation between the two growth forms. The hexane extracts of both the leaves and roots were the most inhibitory. The water extracts had the least inhibitory activity. Bioassay-guided fractionation of the root dichloromethane extract showed that Cox-1 anti-inflammatory activity was caused by at least two compounds that acted synergistically to produce the biological effect.

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.

Background: The latest World Health Organization guidelines recommend replacing stavudine with tenofovir or zidovudine in firstline antiretroviral therapy in resource-limited settings. We report on outcomes and toxicities among patients on these different regimens in a routine treatment cohort in Lesotho.

Single-to multiple-year drought episodes posed significant challenges for agrarian communities across southern Africa during the nineteenth century and hence are widely recorded in a variety of historical documents. However, the ways in which droughts are articulated, and the focus of individual accounts, vary considerably between different authors and historical source types. This study draws on a range of documentary source types-specifically newspapers, letters, reports and diaries-to explore the varied narratives associated with three protracted droughts (those of 1861-1863, 1876-1879 and 1895-1897) that affected large areas of the subcontinent. The analysis spans four case study areas-present day KwaZulu-Natal (South Africa), Lesotho, Malawi and the southern Kalahari (Botswana and South Africa)-which were investigated as part of different interdisciplinary projects. We explore issues common to all case study areas, including (i) how specific drought events are framed and (ii) what is and is not reported about individual droughts across different source types. We conclude that different source types in the subcontinent may be more or less appropriate for addressing the specific objectives of historical climatology, particularly in relation to historical drought. Sources such as newspapers and weather diaries are rich in qualitative and quantitative observations suitable for the reconstruction of temporal and spatial patterns of weather and climate, as well as climate-related natural disasters. In contrast, letters, reports and personal journals, especially those written by missionaries, provide additional qualitative narratives through which to investigate the vulnerability of past societies and economies to climate variations, and to explore past discourses and social representations of climate. While studies of this kind have been published for European and American source types, this is the first systematic exploration of documentary sources for the historical climatology of Africa. It should therefore provide a guide for climate history studies elsewhere in the continent, or other regions where written records are absent prior to the arrival of European colonists.

The article describes the caregiving responsibility to provide food for chronically ill family members and the meanings attached to food and eating when ill created stress for family caregivers. The results come from a qualitative phenomenological study using in-depth interviews with 21 family caregivers of chronically ill HIV and AIDS patients in one district in Lesotho. Analysis of the interview data showed that the caregivers attached profound meanings to food and feeding care recipients. Their perceptions about food as part of family life and caring, the role of food and eating in curbing disease progression, the link between food and medical efficacy and the link between food and life led to ritualised behaviour around food, and moments of optimism and anguish in caregiving. Patients' behaviour in relation to food was in most instances inconsistent with the caregivers' goals, thus leading this aspect of caregiving to induce stress. Services intended to support home-based caregivers and patients could contribute to the reduction of stress associated with food through suitably tailored food assistance and professional support to caregivers to enhance their competences and understanding of the dynamics of food intake as AIDS progressed.

Increasingly national statistical agencies are being called upon to provide high quality data on a regular basis, to be used by governments for evidence-based policy development. Poverty Reduction Strategy Papers (PRSPs) give impetus to this, and bring a prerequisite for comprehensive “poverty diagnosis”. Often the data that are required are not available, or are incomplete while the concepts that are to be used may be ambiguous or require adaptation to local conditions. The poverty analysis of Lesotho in this article represents a contribution towards the emerging culture of evidence-based policy-making in developing countries in that it explores changes in key poverty-related social indicators. Techniques for dealing with poor data are discussed and an approach to developing a poverty threshold adapted to the local conditions of Lesotho is described.

Introduction: Current guidelines contraindicate TDF use when creatinine clearance (CrCl) falls below 50 ml/min. We report prevalence of abnormal renal function at baseline and factors associated with abnormal renal function from a community cohort in Lesotho. Methods: We calculated changes in CrCl from baseline for patients initiated on TDF at 6 and 12 months and the proportion of patients initiated on TDF who developed renal impairment. Screening algorithms were developed using risk factors determined by multivariate analysis. Results: Among 933 adults for whom baseline creatinine was available, 176 (18.9%) presented with a baseline CrCl ,50 ml/ min. Renal function improved during follow-up. 19 patients who developed renal toxicity during follow up remained on TDF; renal function improved (CrCl$50 ml/min) in all but 3 of these patients. Among 15 patients with a baseline CrCl ,50 ml/min were started in error, none developed severe renal impairment. Conclusion: In this setting TDF-associated renal toxicity is rare and mainly transient. Further studies to assess TDF safety at lower CrCl thresholds are warranted.

Economic empowerment brings with it a wide range of consequences, both positive and negative. The objective of this paper was to examine the relationship between economic empowerment and the sexual behaviour and practices of migrant workers within the context of HIV and AIDS in the Lesotho textile industry. Data for this paper were extracted from the findings of a larger study which had been conducted concerning HIV and AIDS in the textile industry in Lesotho. Using in-depth interviews, data were collected from 40 participants who were purposively selected from five factories which had been chosen randomly. Empowerment theory was used as a lens to provide meanings for the experiences of the participants. The findings show that the participants were empowered only in certain respects in terms of Kabeer's empowerment model of 'power to' and 'power within', on one hand, and in terms of Malhotra's comprehensive empowerment framework at the household level, on the other, as being employed in the industry enabled them to participate in the economy. Employment in the sector provided the participants with the means to be able to acquire basic needs and the ability to participate in household decision-making: for the female participants, the ability to make independent sexual decisions was also enhanced. These improvements were greeted enthusiastically, particularly by the female participants, given their previously disadvantaged status as a result of coming from rural patriarchal villages with gender-defined hegemonic notions of respectability. The findings also indicate that environmental factors and others, such as meagre salaries, encouraged some of the female workers to engage in transactional sex, while some of the male participants tended to increase their sexual relationships as a result of acquiring employment and income from the industry. It is the contention of the authors of this study that true empowerment requires both vital resources and individual and collective participation, particularly for the women, who are more vulnerable than men. Finally, we conclude that the opportunities provided by economic empowerment have given the participants a new social meaning for their situation and an awareness about their place in power relations.

One of the biggest challenges in scaling up health interventions in sub-Saharan Africa for government recipients is to effectively manage the rapid influx of aid from different donors, each with its own requirements and conditions. However, there is little empirical evidence on how governments absorb knowledge from new donors in order to satisfy their requirements.