Common Diseases in LesothoThe Kingdom of Lesotho is a small country of 2 million people. Lesotho is completely surrounded by South Africa and is also very dependent on South Africa for jobs, resources and healthcare.

The average life expectancy in Lesotho is 50 years for men and 48 years for women. This low life expectancy is the result of the high prevalence of HIV/AIDS. The number one cause of death in Lesotho, HIV/AIDS has a mortality rate of 38.2 percent. The mortality rate for HIV/AIDS peaks in the 40-49 age group and nearly a quarter of the population between ages 15-49 are infected with HIV.


HIV/AIDS is the most common communicable disease in Lesotho. Perhaps the reason that communicable diseases are so pervasive in Lesotho is because behavioral risk factors are ubiquitous. Behavioral risk factors include unsafe sex, poor diet, tobacco smoke and drug and alcohol use. For deaths attributed to behavioral risk factors, unsafe sex is by far the most common, and attributes to 45.8 percent of deaths.

Unsurprisingly, unsafe sex is also the number one mode of transmission for HIV/AIDS. Other modes of transmission include pregnancy, breastfeeding and needle-sharing.

HIV transmission is clearly a problem in Lesotho but is not impossible to solve. The government of Lesotho and other organizations have implemented projects that strive to address the root causes of HIV transmission and provide treatment to as many sick people as possible.

In April 2016, the government of Lesotho provided universal treatment for persons with HIV. Lesotho has also committed to achieving the UNAIDS goal of 90-90-90 by 2020. With the 90-90-90 goal, 90 percent of all people with HIV will know their HIV status, 90 percent of people diagnosed with HIV will receive consistent treatment and 90 percent of people receiving treatment for their HIV will receive viral load suppression.

Center for Disease Control and Prevention

The Centers for Disease Control and Prevention (CDC) Lesotho has collaborated with the Ministry of Health since 2007. The President’s Emergency Plan for AIDS Relief (PEPFAR) has been instrumental in allowing CDC Lesotho to assist the Ministry of Health in implementing a national HIV program. Through PEPFAR, CDC Lesotho has also provided all community-based testing for HIV.

Help Lesotho

Other projects and organizations aim to tackle the root causes of unsafe sex in Lesotho. Help Lesotho is an advocacy organization that, among many goals, promotes the prevention of HIV transmission. Help Lesotho specifies that an individual’s behavior is the only risk factor for contracting HIV.

Thus, Help Lesotho’s number one recommendation for avoiding HIV is wearing condoms. Their second two recommendations are taking prescribed treatment to prevent transmission and getting informed about HIV transmission.

The World Bank

A World Bank-funded team in Lesotho has promoted safe sex with lottery tickets. The researchers tested for two STIs in two groups of volunteers in Lesotho. Participants would return every four months for testing. Volunteers in the first group received a stipend for returning. Volunteers in the second group received a lottery ticket.

If the volunteers did not test positive for HIV, they would be entered into the lottery for a prize of $50, a large sum in Lesotho. The study found that after two years, the incidence of HIV infections decreased by 21.4 percent in the lottery-ticket group versus the stipend-group.

International Condom Day

On International Condom Day, February 2, 2017, three organizations teamed up to promote condom use in Lesotho. The United Nations Population Fund, Lesotho Planned Parenthood Association and Mothers to Mothers Organization held a condom use promotion in the village of Ha Ntema, Maboloka in the district of Mafeteng.

The goal of this day in Lesotho was to emphasize the importance of keeping condoms in the home. Previously, condoms were kept at the Councilor’s and Chief’s place and local shops, which made young people embarrassed to get them and ultimately discouraged condom use.

HIV is by far the most of common diseases in Lesotho, with a significantly higher mortality rate than other common diseases in Lesotho.

Despite this statistic, there is still hope. Efforts from the government of Lesotho and other organizations prove that addressing root causes and providing information and resources goes a long way in reducing the prevalence, incidence and mortality rate of HIV in Lesotho.

Christiana Lano

Photo: Flickr

Water and Sanitation in LesothoLesotho is a small landlocked country surrounded by South Africa, located within the Orange River Basin. Water resources in Lesotho are abundant, but scarcity in supply is due to climate change and the Lesotho Highlands Water Project (LHWP).

Water resources in Lesotho include high levels of rainfall that collect and drain off into the major river systems of the Senqu (Orange), Mohokare (Caledon) and Makhaleng. Because these resources exceed the Basotho population’s current levels of use, the country exports water to South Africa and other neighboring countries.

Water is Lesotho’s main income generator, earning millions of dollars for the country each year though the LHWP. Despite Lesotho’s economic dependence on the richness of its water resources, the country faces some water-related challenges.

Nearly 25 percent of the population lacks access to safe drinking water. In 2016, 17 percent of households in Lesotho reported using unprotected water sources. Climate change and variable rain patterns lead to periods of chronic drought in Lesotho, resulting in water shortages and Basotho people needing to walk hours to collect water.

Even worse is the provision of sanitation in Lesotho, with 75 percent of people lacking access to adequate sanitation services. Without sanitation facilities, or access to working toilets or latrines, people’s only option is open defecation. Open defecation and the absence of washing facilities get associated with poor hygiene and an increased risk for diarrheal diseases.

Children under the age of five are the most vulnerable group.  Each year, 500 children under the age of five die from diarrheal diseases caused by unsafe and inadequate water and sanitation in Lesotho.

The inability to access to safe drinking water and sanitation in Lesotho has impinged upon human development and poverty reduction. The Metolong Dam Project plans to increase water accessibility in Lesotho by 2020. Until then, the Basotho population has to deal with the chronic drought conditions and the far-reaching negative consequences resource shortages have for national health and development.

Gabrielle Doran

Photo: Flickr

Geographically surrounded by the entire nation of South Africa, education in Lesotho, a mountainous country, has maintained an incredible track record. Boasting one of the highest adult literacy rates in all of Africa, Lesotho prides itself on its educational policies and opportunities.

Following the passage of the Education Act in 2010, education in Lesotho experienced tremendous success: by providing free, universal and compulsory education for students, the nation increased the rate of enrollment to 82 percent. In fact, of all the school-aged girls in the nation, 84 percent are enrolled in school.

Similar to many parts of the United States, Lesotho mandates a formal education structure that places students in primary school starting at the age of six. From there, students remain in primary school for seven years (from grades one through seven), enter lower secondary school from grades eight through 10, and complete their education with upper secondary school in grades 11 and 12.

Although the nation has made significant progress, organizations such as the Global Partnership for Education have been working to improve education in Lesotho. As of 2015, they helped reduce the student-to-teacher ratio in primary schools to 45:1 and purchased 1.1 million textbooks throughout the country. They also helped build, reform and furnish 143 classrooms.

In fact, with the World Bank Group’s approval of $25 million for education in Lesotho, leaders project that another 84,500 students will benefit. Lasting until 2021, the project will support teachers, improve student learning and retention and bolster institutional capacity. The project will also aim to reduce dropout rates in 300 of the lowest-performing schools, many of which are inaccessible and are located in poverty-stricken rural areas.

Higher education is also a priority in Lesotho. Through thirteen private and public institutions, including the National University of Lesotho, Lerotholi Polytechnic, Lesotho College of Education and the Limkokwing University of Creative Technology, Lesotho serves the needs of its students interested in pursuing higher education.

In Lesotho, women’s literacy rates remain incredibly high. Recent statistics suggest that, despite a high number of out-of-school girls, 95 percent of all Lesotho women are literate. This suggests that some success is emerging as a result of the educational policies put forward in Lesotho.

Although there remains room for improvement, as no system can ever truly be perfect, Lesotho has made incredible strides as a nation in prioritizing and developing their educational system. Through international support and continued relief efforts, the nation will inevitably reach their goal of providing education for all in the near future.

Emily Chazen

Photo: Flickr

In response to apartheid in South Africa, refugees emerged in Lesotho in the 1960s. These refugees—the majority of whom were South African and children or teenagers—play a crucial role in defining Lesotho’s vibrant society. Here are 10 facts about refugees in Lesotho.

10 Facts About Refugees in Lesotho

  1. Home to fewer than 10,000 refugees, Lesotho began implementing projects to help grant loans and business training to refugees in 1983. Of the 17 businesses which ultimately emerged, only one was run by a woman.
  2. Lesotho has been incredibly welcoming to refugees, ensuring their integration into local Basotho communities and serving as a global paradigm of refugee inclusivity and acceptance.
  3. In 2005, in an attempt to solidify its commitment to refugee protection, Limakatso Ntlhoki of Lesotho held a four-day workshop intended to help people develop the skills for working with refugees and guaranteeing their protection.
  4. Lesotho has been deemed a “South African Development Community” (SADC) alongside fifteen other countries such as Botswana, Mozambique, Malawi and Zimbabwe. Recent statistics indicate that SADC countries are home to approximately 68 percent of international migrants living in South Africa.
  5. In June 2017, the Vodafone Foundation put forward a system for young refugees living in nations, including Lesotho, to gain free and unlimited access to online education using tablets.
  6. During apartheid, Lesotho’s rural regions served as a safe haven for a number of political refugees escaping the wrath of a government who rejected their ideas. However, when the country was threatened by South Africa, they helped a significant number of refugees flee and obtain safety.
  7. The 1983 Lesotho Refugee Act guarantees that the country will provide refugees with the rights laid out by the United Nations Convention and the 1967 Protocol relating to the Status of Refugees. They also incorporated the criterion outlined by the OAU Convention Governing the Specific Aspects of Refugee Problems in Africa, which rendered their definition amongst the most inclusive in terms of explicating the legal status of refugees in the world.
  8. The former Prime Minister of Lesotho, Chief Leabua Jonathan, attested to the United Nations General Assembly that Lesotho maintained full respect for human dignity, would not use violence towards refugees, and recognized their moral responsibility to help solve their problems through support and openness.
  9. In response to Lesotho’s refugee policies, nations such as India and Thailand praised the nation for its willingness to welcome individuals despite South African threats.
  10. In 2002, the United Nations Refugee Agency (UNHCR) returned 48 brick homes originally used to house refugees in Lesotho to the country’s government, thereby indicating the true end of apartheid and highlighting the ways in which the nation could be entrusted to maintain respectful living conditions for refugees without external intervention.

These 10 facts about refugees in Lesotho illuminate how the country has, since the 1960s, experienced tremendous success in its relationship with refugees. Ultimately, this undeniable altruism indicates that Lesotho ought to be lauded as an example of how to positively incorporate refugees into societies throughout the world.

Emily Chazen

Photo: Flickr

Top Diseases in Lesotho
Lesotho is a small landlocked country in Southern Africa. The country, with a population of 2.1 million, suffers from high rates of poverty with more than 50% of the population living below the income poverty line of $1.25 a day. The majority (72%) of the population lives in rural areas far away from services, like healthcare.

Many people in Lesotho thus face barriers to accessing healthcare because of the cost of traveling to distant healthcare facilities. A shortage of skilled health workers only adds to this problem.

Lesotho has one of the highest mortality rates in Southern Africa and an average life expectancy of only 49 years. These are the top diseases in Lesotho:

  • HIV/AIDS and tuberculosis: Lesotho has the third-highest HIV infection rate in the world, with almost 23% of adults aged 15-49 affected and more than 9,000 AIDS-related deaths in 2014. Of the people infected with HIV, 80% are also infected with tuberculosis.
  • Lower respiratory infections: Lower respiratory infections like pneumonia affect many people in Lesotho. Lower respiratory infections result in an annual mortality rate of 120 deaths per 100,000 people. One of the main causes of these infections is household air pollution from solid fuels used for cooking and heat.
  • Diarrheal Diseases: Lack of access to clean water and adequate sanitation contributes to high rates of diarrheal diseases. While diarrheal diseases do not necessarily cause many deaths, they contribute greatly to the overall disease burden in the country.
  • Non-communicable diseases: Like many other countries in Africa, Lesotho has seen a spike in cases of non-communicable diseases in recent years. This rise is due to various lifestyle risk factors like smoking, alcohol consumption, high blood pressure and obesity. The most common non-communicable diseases are cardiovascular diseases, diabetes and cancer. In 2014, non-communicable diseases accounted for 27 % of total deaths.

While most of the top diseases in Lesotho are infectious diseases, lifestyle diseases are increasingly contributing to the overall disease burden of the country.

Helena Jacobs

Photo: Flickr

Mobile Technology Transforms HIV Care in Lesotho
In the small, mountainous African country of Lesotho, one in four people are HIV-positive, but the rugged terrain and negative stigma surrounding the disease prevent many from seeking care or even being diagnosed. However, with the introduction of a new cellphone app and mobile health clinics, the HIV healthcare in Lesotho will change drastically.

With mountains separating the various regions of the country and minimal infrastructure, many people in Lesotho cannot access basic healthcare services. It is for this reason that many people who are HIV-positive go undiagnosed and unknowingly spread the disease to their partners or children. This year, only 60 percent of those with HIV in Lesotho received treatment.

More than half of the country’s two million people live below the poverty line. Moreover, insufficient HIV care in Lesotho has led the country to the second-highest prevalence rate of HIV/AIDS in the world.

Mobile clinics run by the Vodafone Foundation, Baylor International AIDS Initiative and Riders for Health, will ensure that all people in Lesotho can get treatment closer to home. The clinics offer on-site HIV testing.

Those who test positive for HIV are registered with Vodafone’s M-Pesa mobile money transfer service, where they receive funds to pay for transport to a treatment center. They are also registered with another mobile app which serves as a central database where healthcare professionals can plan and record their treatment in real time.

There were 36.7 million people living with HIV or AIDS worldwide in 2015. In the same year, 1.1 million people died from the disease.

Infants are especially vulnerable to HIV, and the disease can quickly develop into AIDS if not identified and treated. Around the world, only half of infants with HIV are tested by the recommended age of two months.

The app and mobile clinics have been applauded by the Government of Lesotho, which will fully fund both programs from mid-2017.

Cassie Lipp

Photo: Flickr

Poverty in Lesotho
Gaining independence from the U.K. in 1966, Lesotho has aspired to develop economically, socially and environmentally. Like many African nations, however, Lesotho has also faced a difficult struggle with poverty alleviation. In fact, according to the World Bank, approximately 57 percent of the population still lives in extreme poverty,  which provides an incentive to understand the factors at play. As such, here are five major aspects of persisting poverty in Lesotho today:

  1. Geography. Lesotho is a mountainous enclave of South Africa meaning that not only is the nation landlocked from trading ports, but it faces a difficult terrain as well. The country is also currently in the midst of a multiyear drought which has ravaged the productivity of agricultural sectors. Together, this implies poor infrastructure, rising food prices and an environment vulnerable to consequences of overgrazing and soil erosion — all of which contribute to enduring poverty in Lesotho. Related to its geography, approximately two-thirds of the workforce remains employed in agricultural sectors, which presents an additional challenge to development.
  2. High unemployment rates. The fact that so many laborers work in agriculture, other employment opportunities are extremely limited in Lesotho. The garment and mining industries support the highest percentages of the workforce, but profits are currently in decline for both sectors. Hence, unemployment rates are reported to be around one-third of the population with a particularly high concentration among young Basotho. The resulting disparity of prolonged unemployment also contributes to high levels of income inequality. Without adequate social transfer programs, it follows that the unemployed are inevitably trapped in extraordinarily high levels of poverty.
  3. Health concerns. The HIV and AIDS pandemics took root in Lesotho just the same as other states in Southern Africa. According to the U.N., in the 15 year period between 1990 and 2005, life expectancy in Lesotho plummeted by more than 15 years. Mortality rates for infants, children and mothers followed a similar trajectory. While the country is on the rebound today, figures have not yet restored to 1980 levels. Additionally, concerns are further exacerbated by a lack of quality healthcare facilities. Without a healthy population, the economy of Lesotho will be stunted by continuing poverty.
  4. Lesotho’s international partnership. To begin, make no mistake that Lesotho does reap major benefits from its location within South Africa. South African forces have provided stability during times of unrest, and South Africa has led international coalitions to assist Lesotho with development strategies.  Lesotho even taxed South Africa for water usage following the completion of the Metelong Dam project. However, it is equally concerning how heavy reliance on South Africa hinders Lesotho’s own growth. For example, approximately 90 percent of the goods consumed in Lesotho are imported from its neighbor. Many families in Lesotho also survive on incomes from migrants who left the country looking for work. Economically, the lack of resources in Lesotho has contributed to an international dependency making it more susceptible to crises such as the recent Eskom power interruptions or the rising levels of debt.
  5. Infrastructure. Existing transportation networks in Lesotho may be adequate, but they are severely lacking in size. According to the CIA World Factbook, the entire country only has three paved airports and about 660 miles of paved roadways. Access to utilities was similarly absent with only 17 percent of the population receiving electricity, and only 16 percent able to access the internet and the water supply outside the capital city of Maseru. Notably, rural areas, where the majority of the population resides, are disproportionately lacking these services. All of these factors contribute to the multi-dimensional nature of poverty in Lesotho.

Lesotho’s outlook is not entirely disconcerting. Women in Lesotho boast one of the highest literacy rates in all of Africa, reflecting Lesotho’s commitment to both education and gender equality. In fact, the percentage of GDP spent on education is the largest of any country in the world. Likewise, women in Lesotho report higher human development levels than their male counterparts in all areas except overall income. While there are admittedly several factors to consider for overcoming poverty in Lesotho, it is likely that solutions will continue to build on the nation’s current strengths.

Zack Machuga

Photo: Flickr

Surrounded on all sides by its neighbor South Africa, the little country of Lesotho is the largest enclave in the world; larger than its only rivals Monaco, San Marino and Vatican City.

Essentially a landlocked island amidst African highlands, Lesotho also features the lowest point of any country in the world, measured at 1400 meters or 4,953 feet. However, it has another, less fortunate distinction; it places third on the list of countries with the highest HIV/AIDS prevalence.

In total, nearly one-quarter of the population lives with HIV, which accounts for 360,000 people. Close to 26,000 new HIV infections and 14,000 AIDS deaths were recorded in 2011. Of these infections, 40,000 are in children while around 60 percent of adults with HIV are women. On top of these harrowing figures, 42 percent who need treatment cannot access it.

Lesotho’s first reported incidence of HIV occurred in 1986 and accelerated rapidly into a national epidemic. While the government made attempts to monitor and treat the illness, the proved insufficient due to poor finances and infrastructure. Just six years later, in 1992, 3.2 percent of pregnant women between the ages of 20 and 24 had HIV. By 1996, the figures had exploded; in just four years, a quarter of the same demographic was living with HIV.

The sheer extent of this illness has had a detrimental impact on the development of Lesotho. The most productive age group in the country is also the most infected. This has compromised their ability to work and sustain themselves and their families.

For the Basotho people, family is vital. For centuries, extended relatives have supported one another through any hardship. However, AIDS/HIV has eroded this support system by orphaning 220,000 children. This has left children as the head of families in which the working generations are debilitated or have died.

One can notice the extent of the AIDS epidemic by looking at the data. It has significantly shortened the life span of the average Basotho to just 48.3 years from nearly 60 years in 1990.

Moreover, the two main statistics most indicative of development, GDP and the Under Five Mortality Rate have worsened. Since 1990, the Under Five Mortality rate has risen from 85 in 1000 to 100 in 1000. While from 1970 to 1990 the average annual growth rate of Lesotho stood at 3 percent, it fallen to 2.6 from 1990 to 2012.

With such a widespread influence throughout Lesotho, the nation’s government, along with international aid groups has made efforts to tackle the AIDS crisis. The first step was to provide universal testing for the entire country. Beginning in 2004, the program called “Know Your Status” involved training thousands of health care workers to perform swift HIV testing. However, the government has only trained one-quarter of the required workers, failing to meet its objective of universal coverage.

Besides testing, the government has implemented a variety of campaigns to confront the epidemic, but with mixed results. It introduced HIV/AIDS awareness to the curriculums of both primary and secondary schools. A ‘road show’ was also planned to inform communities about AIDS/HIV while providing both entertainment and HIV testing. Despite the efforts, only 29 percent of 15 to 24-year-old males and 29 percent of females from the same demographic had an understanding of HIV prevention.

Unlike awareness efforts, the distribution of cheap condoms has also served as an effective mainstay of HIV intervention in Lesotho. In 2001 affordable condoms began selling throughout communities. The sales spiked, with the number of distributors tripling and the number of condoms bought doubling.

In order to help those already infected with AIDS, the government has worked to provide better access to antiretroviral treatments. Since 2004 the government of Lesotho has sought to make antiretroviral treatment free to those in need. With only 89 trained medical professionals in the whole country, the program lagged behind at first. But since expansion in 2008 coverage has expanded to around 86,000 people, or close to 60 percent of those needing treatment. Still, only a quarter of children in need receive antiretroviral treatment.

While Lesotho has become closer to controlling its AIDS epidemic it has come at the cost of the nation’s development. Despite its aspirations, the country’s inadequate infrastructure, health care and budget have hindered its efforts. With more foreign assistance, Lesotho has the capacity to get back on its feet.

– Andrew Logan

Photo: NY Times

Like many countries in Africa, Lesotho faces a multifaceted humanitarian crisis in which issues are intertwined and often exacerbated by each other’s presence. The Lesotho government estimates that around 725,000 people, or about a third of the population, are in need of some form of humanitarian aid. Lesotho has the third highest prevalence of HIV/AIDS with almost a full quarter of adults ages 15-49 infected with the virus.

Furthermore, the United Nations estimates that almost 9,000 children under the age of 5 are severely malnourished in Lesotho. In 2009, a study conducted by the World Food Program (WFP) estimated that 39 percent of children under 5 years old exhibited signs of stunted growth resulting from malnutrition. UN research shows that school attendance for young boys and girls has been decreasing in recent years as well. This is likely due to families reliance on children to assist with increasing agricultural responsibilities.

Unpredictable weather conditions such as floods and droughts have burdened the production and availability of food in addition to other necessary resources. These factors have also contributed to increases in soil erosion and infertile lands. Minimal access to secure, high yielding seeds has also been an obstacle. These fluctuations of climate, coupled with the constant demand for staples such as maize, oil and sugar have caused prices to increase. All of these factors have contributed to malnutrition in Lesotho.

In an effort to combat the drastic price increases, UNICEF, WFP and the Lesotho government are working to implement relief measures. Efforts to adapt to irregular climate conditions are also in place. The Food & Agriculture Organization of the UN has created the Emergency & Resilience Program along with the Lesotho government to implement long term procedures such as subsistence farming and agro-conservation tactics. So far, the program has aided almost 20,000 farmers in Lesotho.

In 2007, UNICEF helped create the Lesotho Child Grants Program that affords impoverished families 40 U.S. dollars each quarter to purchase basic necessities. The program helps over 10,000 families and is being expanded to provide assistance to over 15,000. In addition, the dollar amount allocated to each family will be increased by 94 U.S. dollars.

Puseletso Tsiu is a recipient of the child grant who has greatly benefited from the program’s assistance. Tsiu’s two daughters died of AIDS and she has assumed responsibility for their childrens’ care. As a result of the extra support, she has been able to buy pairs of shoes for her orphaned grandchildren to wear to school. A commonplace purchase in the first world, such as the purchase of shoes, is viewed as a crucial investment in countries like Lesotho.

The National School Feeding Policy, sponsored by the WFP, provides two meals per day for students who can meet attendance requirements. For many families, the program provides an added educational and economic incentive to send young children to school. Families like Tsiu’s rely heavily upon the meals provided in schools so they can save money by not feeding them at home. In total, this program provides meals for over 400,000 students in Lesotho.

In the case of Lesotho, it has been demonstrated that international unity between organizations and governments can make a positive difference. “Kopano ke matla” is an old saying in Lesotho that roughly translates to “unity is power.” When faced with such adverse conditions, the meaning and power of this phrase must not be underestimated.

– The Borgen Project

Photo: World Food Programme