The Kingdom of Lesotho is a small, landlocked and mountainous country, entirely surrounded by the Republic of South Africa. The population is young and predominantly rural. Despite a low contribution to GDP, agriculture remains an important source of livelihood for a significant part of the population. The agricultural population is engaged in rain-fed subsistence farming, largely based on a single crop, maize. The agricultural sector suffers major constraints which have entailed a preoccupying decline in cereal production. Lesotho’s economy has registered mixed growth over the last decade but recent economic performance is promising. Although declining, the incidence of poverty is still very high.
Over the last decade, the infant mortality rate has increased while the under-five mortality rate has remained stable. The maternal mortality ratio also shows a worrying upward trend. HIV/AIDS affects about a quarter of the adult population and is the main cause of death among children under-five. The very high prevalence of HIV/AIDS reverses progress made in human development and threatens the entire development of the country.
The diet is mainly based on cereals - predominantly maize, and, to a much lesser extent, wheat and sorghum. Rice is gaining importance in the diet of the urban middle-income group. The staples are complemented by starchy roots (potatoes) and fruit and vegetables. Cereals provide more than three-quarters of the dietary energy supply. The importance of maize in the diet, the decline in the production of this staple and the heavy dependency on cereal imports make the country very vulnerable to economic and climatic shocks for its food supply. The dietary energy supply meets population energy requirements, but the share of lipids in the supply is lower than recommendations and that of protein is at the lower limit. Prevalence of undernourishment has remained stagnant over the last decade (15% in 2003-2005). The decline in cereal production, low income and rising staple food prices contribute to worsening food insecurity among the population.
Breastfeeding is a common practice but only about a third of children under 6 months are exclusively breastfed. Complementary foods are often introduced too early or too late and are insufficiently diversified. These inadequate infant and young child feeding practices coupled with food insecurity of households, the HIV/AIDS pandemic and low access to health services are among the major causes of chronic malnutrition in young children. The prevalence of stunting among young children is very high (42% in 2007 among children aged 6-59 months). Since 2000, prevalence has declined but more efforts are needed to combat this silent emergency. Among young children, the prevalence of wasting is low. Meanwhile Lesotho is undergoing a nutrition transition. Among adult women, the prevalence of overweight and obesity is very high, in urban areas but also in rural areas, while undernutrition persists, especially among young women.
Thanks to the effective implementation of the universal salt iodization strategy, a significant decline in iodine deficiency disorders has been observed. At national level, the median urinary iodine concentration indicates that iodine intake is above requirements. Regular monitoring is thus recommended to prevent risks associated with excessive iodine intake. In mountain areas, where mild iodine deficiency persists, and in remote rural areas, awareness campaigns on iodized salt consumption should continue. There is a lack of recent and nationally representative data on vitamin A deficiency (VAD) among young children. Among women, recent data on night blindness show that VAD is not a public health problem. Although vitamin A supplementation coverage has been extended among young children, recent data are lacking to assess the magnitude of the deficiency and the effects of the vitamin A supplementation campaign. Anemia is a severe public health problem in the country, affecting about half of preschool children and more than a quarter of women of childbearing age. Nonetheless, iron supplementation coverage of pregnant women remains low. To combat micronutrient deficiencies, in addition to short-term measures such as supplementation, more long-term interventions should be efficiently implemented, i.e. food-based approaches.
Lesotho has to face major challenges such as the HIV/AIDS pandemic, widespread poverty and food insecurity, which have a considerable impact on child and maternal health and nutritional status. Major efforts are needed to improve the situation in a sustainable way.