Childhood tuberculosis notifications increase in Lesotho following enhanced training of healthcare workers across the country.
The Union’s Sub-Saharan Africa Region Child and Adolescent TB Centre of Excellence (COE) in collaboration with U.S. Centers for Disease Control and Prevention (CDC) conducted a pilot of a new curriculum on the management of child and adolescent tuberculosis (TB) for healthcare workers in August 2024 in Lesotho.
More than 45 healthcare professionals from Lesotho and COE member countries (Cameroon, Eswatini, Ethiopia, Kenya, Mozambique, Rwanda, Tanzania, Uganda, Zambia and Zimbabwe) attended the training. The training materials were delivered through a variety of adult learning methods, including lectures, discussions, case studies and role plays. TeachBack, an effective approach to enhance participants’ facilitation skills, was also introduced during the training. Using this method, master trainers demonstrated training skills and styles of delivery to participants, who were then assigned sessions or activities to facilitate to the other participates. Master trainers and participants provided constructive feedback to strengthen delivery followed by discussion to reflect on the style and substance of the training materials for the purpose of the pilot.
Following the training of trainers, the national TB programme in Lesotho organised follow-up cascade training sessions that took place from September to November 2024. In total, 240 healthcare professionals from five of Lesotho’s ten districts were trained, including child TB focal points, training officers, paediatricians, TB coordinators, health information specialists, laboratory technicians and radiologists.
Since the training was conducted, Lesotho observed an increase in the proportion of children (below 15 years of age) diagnosed with TB. Children accounted for 3%-6% of all TB diagnoses before the trainings (March-August 2024) which increased to 7%-11% from October 2024 to April 2025 as shown in the figure below. Global estimates suggest that in 2023, approximately 9% of all TB cases in Lesotho were among children under 15 years of age.
One of the participants in the pilot training, Dr Moliehi Lephosa said: “The training has greatly strengthened my understanding and ability to diagnose and manage TB in children and adolescents. It has also enhanced my confidence in educating other healthcare workers about TB care and prevention.”
During the sub-national sessions employing the TeachBack approach, facilitators reported that some healthcare professionals initially struggled with the shift from being passive participants to active facilitators. Hesitation arose from the process of giving and receiving feedback, with some participants fearing feedback would not be constructive. Over time, however, the emphasis on encouragement and constructive communication helped the healthcare professionals embrace the approach, fostering a more open and collaborative environment for learning and growth.
The Childhood TB and Training Coordination Officer in the NTP, Ms Mpho Matheketheke Khesa said: “The training has had a significant impact. Many of our healthcare professionals are now more confident and better at diagnosing TB in children and adolescents. Strategies are being developed to further encourage healthcare professionals to take on leadership roles as trainers and embrace the TeachBack approach. The importance of continuous monitoring of child and adolescent TB notifications and other routinely available data will ensure that the impact of these efforts is measured and sustained.”
This initiative marks a significant step in the fight against childhood TB in Lesotho, fostering a well-equipped and confident healthcare workforce dedicated to improving outcomes for the nation's youngest patients.
The senior advisor at The Union, Dr Riitta Dlodlo, said: “We at the Centre of Excellence and The Union are delighted with how well the training at the national and district levels went and we would love to see it rolled out in entire Lesotho and other countries.”
The Union has made these training materials and the free-of-charge course available on Union Courses Online.