Towards improved knowledge and optimization of health care for non-communicable diseases in Lesotho

Abstract

Lesotho is undergoing notable changes in its population and epidemiology, mirroring patterns observed in the sub-Saharan region. These changes are characterised by an increasing and aging population, as well as a growing prevalence of non-communicable diseases. At the start of my PhD thesis, updated data on frequency and distribution of cardiovascular risk factors and mental health problems in the Lesotho’s adult population was lacking. The studies included in this thesis aimed to cover this gap by providing up-to-date measures of prevalence and characterizing the quality of care for a selection of cardiovascular risks and mental health problems the country. Furthermore, I reviewed existing evidence to inform the design of a community-based hypertension care intervention that will be tested in hard-to-reach areas of the country. These studies shed light on the high prevalence rates of tobacco use, elevated blood pressure, overweight, and diabetes among adults in Lesotho. Trauma and excessive alcohol use emerged as prevalent mental health problems, with a considerable proportion of individuals not seeking help for their symptoms. Additionally, notable disparities in terms of age, socioeconomic status, and the treatment gap for the above conditions were identified. The availability of a diverse health workforce providing health services in the country indicates the potential to test and scale task-shifted and task-shared interventions to mitigate the impact of such health risks in the adult population. In this regard, feasibility of community-based approaches for hypertension care in sub-Saharan Africa was confirmed in a scoping review, although, the quality of the evidence was poor. This thesis provides valuable insights into the health landscape of Lesotho and underscores the need for comprehensive interventions to address cardiovascular risks and mental health problems in most-at-risk groups.