Cohort profile: the open, prospective Community-Based chronic Care Lesotho (ComBaCaL) cohort – design, baseline chronic disease risk factors and hypertension and diabetes care cascades

Felix Gerber; Giuliana Sanchez-Samaniego; Thesar Tahirsylaj; Thabo Ishmael Lejone; Tristan Lee; Fabian Raeber; Mamakhala Chitja; Malebona Mathulise; Thuso Kabi; Mosoetsi Mokaeane; Malehloa Maphenchane; Manthabiseng Molulela; Mota Mota; Sesale Masike; Matumaole Bane; Retselisitsoe Makabateng; Makhebe Khomolishoele; Mamoronts'ane Sematle; Ravi Gupta; Irene Ayakaka; Lebohang Sao; Mosa Tlahali; Sejojo Phaaroe; Malitaba Litaba; Madavida Mphunyane; Dave Brian Basler; Kevin Kindler; Pauline Grimm; Eleonora Seelig; Thilo Burkard; Matthias Briel; Frédérique Chammartin; Alain Amstutz; Niklaus Daniel Labhardt

doi:10.1136/bmjopen-2024-093852

Cohort profile: the open, prospective Community-Based chronic Care Lesotho (ComBaCaL) cohort – design, baseline chronic disease risk factors and hypertension and diabetes care cascades

Felix Gerber^*, Giuliana Sanchez-Samaniego, Thesar Tahirsylaj, Thabo Ishmael Lejone, Tristan Lee, Fabian Raeber, Mamakhala Chitja, Malebona Mathulise, Thuso Kabi, Mosoetsi Mokaeane, Malehloa Maphenchane, Manthabiseng Molulela, Mota Mota, Sesale Masike, Matumaole Bane, Retselisitsoe Makabateng, Makhebe Khomolishoele, Mamoronts'ane Sematle, Ravi Gupta, Irene AyakakaLebohang Sao, Mosa Tlahali, Sejojo Phaaroe, Malitaba Litaba, Madavida Mphunyane, Dave Brian Basler, Kevin Kindler, Pauline Grimm, Eleonora Seelig, Thilo Burkard, Matthias Briel, Frédérique Chammartin, Alain Amstutz, Niklaus Daniel Labhardt

^*Corresponding author for this work

Bristol Medical School (PHS)

Research output: Contribution to journal › Article (Academic Journal) › peer-review

3 Citations (Scopus)

Abstract

Purpose:

The open, prospective Community-Based chronic Care Lesotho (ComBaCaL) cohort is the first study to comprehensively investigate socioeconomic indicators, common chronic diseases and their risk factors in a remote rural setting in Lesotho. It serves as a platform for implementing nested trials using the Trials within Cohorts (TwiCs) design to assess community-based chronic care interventions. In this study, we present the cohort’s sociodemographic and chronic disease risk factor profile, including self-reported HIV prevalence and hypertension and diabetes care cascades.

Participants:

Since February 2023, community health worker (CHWs) supported by a clinical decision support and data collection application have enrolled inhabitants from 103 randomly selected rural villages in Butha-Buthe and Mokhotlong districts in Northeast Lesotho. As of 31 May 2024, the cohort includes 5008 households with 14 735 participants (55% female, median age 19 years). The cohort’s socioeconomic status is low with an International Wealth Index of 26, a monthly household income of US$42.4 and low levels of formal education. Among the 7917 adult participants, 42.5% are overweight or obese, with higher rates among women, and 33.1% smoke tobacco, with higher rates among men. Self-reported HIV prevalence is 15.1% with a 98.4% treatment rate. Hypertension prevalence is 17% with a 56% control rate and diabetes prevalence is 4% with a 39% control rate.

Findings to date:

The cohort’s low socioeconomic status is linked to multiple health risks including insufficient access to clean energy, essential healthcare services, adequate sanitary facilities and secure food supply. Besides the expected high HIV prevalence, we found significant hypertension, diabetes and cardiovascular risk factor prevalences. While treatment and control rates for diabetes and hypertension are higher than in similar settings, they remain below global targets.

Future plans:

Ongoing cluster-randomised TwiCs, which will be completed in 2025, are assessing the effectiveness of community-based, CHW-led care interventions for diabetes and hypertension. CHWs will continue to closely monitor the cohort and integrate additional measurements such as HIV testing. This will provide further insights into the dynamics and interactions of chronic diseases and inform the development of future nested trials on innovative community-based prevention and care interventions.

Trial registration number:

NCT05596773.

Original language	English
Article number	e093852
Number of pages	19
Journal	BMJ Open
Volume	15
Issue number	7
DOIs	https://doi.org/10.1136/bmjopen-2024-093852
Publication status	Published - 25 Jul 2025

Bibliographical note

Publisher Copyright:
© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY. Published by BMJ Group.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Adult
Female
Humans
Male
Middle Aged
Young Adult
Chronic Disease/epidemiology
Community Health Services
Diabetes Mellitus/epidemiology
HIV Infections/epidemiology
Hypertension/epidemiology
Lesotho/epidemiology
Prevalence
Prospective Studies
Risk Factors
Rural Population
Socioeconomic Factors
Observational Studies as Topic
Multicenter Studies as Topic

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10.1136/bmjopen-2024-093852Licence: CC BY

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Cite this

Gerber, F., Sanchez-Samaniego, G., Tahirsylaj, T., Lejone, T. I., Lee, T., Raeber, F., Chitja, M., Mathulise, M., Kabi, T., Mokaeane, M., Maphenchane, M., Molulela, M., Mota, M., Masike, S., Bane, M., Makabateng, R., Khomolishoele, M., Sematle, M., Gupta, R., ... Labhardt, N. D. (2025). Cohort profile: the open, prospective Community-Based chronic Care Lesotho (ComBaCaL) cohort – design, baseline chronic disease risk factors and hypertension and diabetes care cascades. BMJ Open, 15(7), Article e093852. https://doi.org/10.1136/bmjopen-2024-093852

@article{2c2e5c1fe21f444b91f7bf9cededaa29,

title = "Cohort profile: the open, prospective Community-Based chronic Care Lesotho (ComBaCaL) cohort – design, baseline chronic disease risk factors and hypertension and diabetes care cascades",

abstract = "Purpose:The open, prospective Community-Based chronic Care Lesotho (ComBaCaL) cohort is the first study to comprehensively investigate socioeconomic indicators, common chronic diseases and their risk factors in a remote rural setting in Lesotho. It serves as a platform for implementing nested trials using the Trials within Cohorts (TwiCs) design to assess community-based chronic care interventions. In this study, we present the cohort{\textquoteright}s sociodemographic and chronic disease risk factor profile, including self-reported HIV prevalence and hypertension and diabetes care cascades. Participants:Since February 2023, community health worker (CHWs) supported by a clinical decision support and data collection application have enrolled inhabitants from 103 randomly selected rural villages in Butha-Buthe and Mokhotlong districts in Northeast Lesotho. As of 31 May 2024, the cohort includes 5008 households with 14 735 participants (55\% female, median age 19 years). The cohort{\textquoteright}s socioeconomic status is low with an International Wealth Index of 26, a monthly household income of US\$42.4 and low levels of formal education. Among the 7917 adult participants, 42.5\% are overweight or obese, with higher rates among women, and 33.1\% smoke tobacco, with higher rates among men. Self-reported HIV prevalence is 15.1\% with a 98.4\% treatment rate. Hypertension prevalence is 17\% with a 56\% control rate and diabetes prevalence is 4\% with a 39\% control rate. Findings to date:The cohort{\textquoteright}s low socioeconomic status is linked to multiple health risks including insufficient access to clean energy, essential healthcare services, adequate sanitary facilities and secure food supply. Besides the expected high HIV prevalence, we found significant hypertension, diabetes and cardiovascular risk factor prevalences. While treatment and control rates for diabetes and hypertension are higher than in similar settings, they remain below global targets. Future plans:Ongoing cluster-randomised TwiCs, which will be completed in 2025, are assessing the effectiveness of community-based, CHW-led care interventions for diabetes and hypertension. CHWs will continue to closely monitor the cohort and integrate additional measurements such as HIV testing. This will provide further insights into the dynamics and interactions of chronic diseases and inform the development of future nested trials on innovative community-based prevention and care interventions. Trial registration number:NCT05596773.",

keywords = "Adult, Female, Humans, Male, Middle Aged, Young Adult, Chronic Disease/epidemiology, Community Health Services, Diabetes Mellitus/epidemiology, HIV Infections/epidemiology, Hypertension/epidemiology, Lesotho/epidemiology, Prevalence, Prospective Studies, Risk Factors, Rural Population, Socioeconomic Factors, Observational Studies as Topic, Multicenter Studies as Topic",

author = "Felix Gerber and Giuliana Sanchez-Samaniego and Thesar Tahirsylaj and Lejone, \{Thabo Ishmael\} and Tristan Lee and Fabian Raeber and Mamakhala Chitja and Malebona Mathulise and Thuso Kabi and Mosoetsi Mokaeane and Malehloa Maphenchane and Manthabiseng Molulela and Mota Mota and Sesale Masike and Matumaole Bane and Retselisitsoe Makabateng and Makhebe Khomolishoele and Mamoronts'ane Sematle and Ravi Gupta and Irene Ayakaka and Lebohang Sao and Mosa Tlahali and Sejojo Phaaroe and Malitaba Litaba and Madavida Mphunyane and Basler, \{Dave Brian\} and Kevin Kindler and Pauline Grimm and Eleonora Seelig and Thilo Burkard and Matthias Briel and Fr{\'e}d{\'e}rique Chammartin and Alain Amstutz and Labhardt, \{Niklaus Daniel\}",

note = "Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY. Published by BMJ Group.",

year = "2025",

month = jul,

day = "25",

doi = "10.1136/bmjopen-2024-093852",

language = "English",

volume = "15",

journal = "BMJ Open",

issn = "2044-6055",

publisher = "BMJ Publishing Group",

number = "7",

}

Gerber, F, Sanchez-Samaniego, G, Tahirsylaj, T, Lejone, TI, Lee, T, Raeber, F, Chitja, M, Mathulise, M, Kabi, T, Mokaeane, M, Maphenchane, M, Molulela, M, Mota, M, Masike, S, Bane, M, Makabateng, R, Khomolishoele, M, Sematle, M, Gupta, R, Ayakaka, I, Sao, L, Tlahali, M, Phaaroe, S, Litaba, M, Mphunyane, M, Basler, DB, Kindler, K, Grimm, P, Seelig, E, Burkard, T, Briel, M, Chammartin, F, Amstutz, A & Labhardt, ND 2025, 'Cohort profile: the open, prospective Community-Based chronic Care Lesotho (ComBaCaL) cohort – design, baseline chronic disease risk factors and hypertension and diabetes care cascades', BMJ Open, vol. 15, no. 7, e093852. https://doi.org/10.1136/bmjopen-2024-093852

Cohort profile: the open, prospective Community-Based chronic Care Lesotho (ComBaCaL) cohort – design, baseline chronic disease risk factors and hypertension and diabetes care cascades. / Gerber, Felix; Sanchez-Samaniego, Giuliana; Tahirsylaj, Thesar et al.
In: BMJ Open, Vol. 15, No. 7, e093852, 25.07.2025.

Research output: Contribution to journal › Article (Academic Journal) › peer-review

TY - JOUR

T1 - Cohort profile

T2 - the open, prospective Community-Based chronic Care Lesotho (ComBaCaL) cohort – design, baseline chronic disease risk factors and hypertension and diabetes care cascades

AU - Gerber, Felix

AU - Sanchez-Samaniego, Giuliana

AU - Tahirsylaj, Thesar

AU - Lejone, Thabo Ishmael

AU - Lee, Tristan

AU - Raeber, Fabian

AU - Chitja, Mamakhala

AU - Mathulise, Malebona

AU - Kabi, Thuso

AU - Mokaeane, Mosoetsi

AU - Maphenchane, Malehloa

AU - Molulela, Manthabiseng

AU - Mota, Mota

AU - Masike, Sesale

AU - Bane, Matumaole

AU - Makabateng, Retselisitsoe

AU - Khomolishoele, Makhebe

AU - Sematle, Mamoronts'ane

AU - Gupta, Ravi

AU - Ayakaka, Irene

AU - Sao, Lebohang

AU - Tlahali, Mosa

AU - Phaaroe, Sejojo

AU - Litaba, Malitaba

AU - Mphunyane, Madavida

AU - Basler, Dave Brian

AU - Kindler, Kevin

AU - Grimm, Pauline

AU - Seelig, Eleonora

AU - Burkard, Thilo

AU - Briel, Matthias

AU - Chammartin, Frédérique

AU - Amstutz, Alain

AU - Labhardt, Niklaus Daniel

PY - 2025/7/25

Y1 - 2025/7/25

N2 - Purpose:The open, prospective Community-Based chronic Care Lesotho (ComBaCaL) cohort is the first study to comprehensively investigate socioeconomic indicators, common chronic diseases and their risk factors in a remote rural setting in Lesotho. It serves as a platform for implementing nested trials using the Trials within Cohorts (TwiCs) design to assess community-based chronic care interventions. In this study, we present the cohort’s sociodemographic and chronic disease risk factor profile, including self-reported HIV prevalence and hypertension and diabetes care cascades. Participants:Since February 2023, community health worker (CHWs) supported by a clinical decision support and data collection application have enrolled inhabitants from 103 randomly selected rural villages in Butha-Buthe and Mokhotlong districts in Northeast Lesotho. As of 31 May 2024, the cohort includes 5008 households with 14 735 participants (55% female, median age 19 years). The cohort’s socioeconomic status is low with an International Wealth Index of 26, a monthly household income of US$42.4 and low levels of formal education. Among the 7917 adult participants, 42.5% are overweight or obese, with higher rates among women, and 33.1% smoke tobacco, with higher rates among men. Self-reported HIV prevalence is 15.1% with a 98.4% treatment rate. Hypertension prevalence is 17% with a 56% control rate and diabetes prevalence is 4% with a 39% control rate. Findings to date:The cohort’s low socioeconomic status is linked to multiple health risks including insufficient access to clean energy, essential healthcare services, adequate sanitary facilities and secure food supply. Besides the expected high HIV prevalence, we found significant hypertension, diabetes and cardiovascular risk factor prevalences. While treatment and control rates for diabetes and hypertension are higher than in similar settings, they remain below global targets. Future plans:Ongoing cluster-randomised TwiCs, which will be completed in 2025, are assessing the effectiveness of community-based, CHW-led care interventions for diabetes and hypertension. CHWs will continue to closely monitor the cohort and integrate additional measurements such as HIV testing. This will provide further insights into the dynamics and interactions of chronic diseases and inform the development of future nested trials on innovative community-based prevention and care interventions. Trial registration number:NCT05596773.

AB - Purpose:The open, prospective Community-Based chronic Care Lesotho (ComBaCaL) cohort is the first study to comprehensively investigate socioeconomic indicators, common chronic diseases and their risk factors in a remote rural setting in Lesotho. It serves as a platform for implementing nested trials using the Trials within Cohorts (TwiCs) design to assess community-based chronic care interventions. In this study, we present the cohort’s sociodemographic and chronic disease risk factor profile, including self-reported HIV prevalence and hypertension and diabetes care cascades. Participants:Since February 2023, community health worker (CHWs) supported by a clinical decision support and data collection application have enrolled inhabitants from 103 randomly selected rural villages in Butha-Buthe and Mokhotlong districts in Northeast Lesotho. As of 31 May 2024, the cohort includes 5008 households with 14 735 participants (55% female, median age 19 years). The cohort’s socioeconomic status is low with an International Wealth Index of 26, a monthly household income of US$42.4 and low levels of formal education. Among the 7917 adult participants, 42.5% are overweight or obese, with higher rates among women, and 33.1% smoke tobacco, with higher rates among men. Self-reported HIV prevalence is 15.1% with a 98.4% treatment rate. Hypertension prevalence is 17% with a 56% control rate and diabetes prevalence is 4% with a 39% control rate. Findings to date:The cohort’s low socioeconomic status is linked to multiple health risks including insufficient access to clean energy, essential healthcare services, adequate sanitary facilities and secure food supply. Besides the expected high HIV prevalence, we found significant hypertension, diabetes and cardiovascular risk factor prevalences. While treatment and control rates for diabetes and hypertension are higher than in similar settings, they remain below global targets. Future plans:Ongoing cluster-randomised TwiCs, which will be completed in 2025, are assessing the effectiveness of community-based, CHW-led care interventions for diabetes and hypertension. CHWs will continue to closely monitor the cohort and integrate additional measurements such as HIV testing. This will provide further insights into the dynamics and interactions of chronic diseases and inform the development of future nested trials on innovative community-based prevention and care interventions. Trial registration number:NCT05596773.

KW - Adult

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Young Adult

KW - Chronic Disease/epidemiology

KW - Community Health Services

KW - Diabetes Mellitus/epidemiology

KW - HIV Infections/epidemiology

KW - Hypertension/epidemiology

KW - Lesotho/epidemiology

KW - Prevalence

KW - Prospective Studies

KW - Risk Factors

KW - Rural Population

KW - Socioeconomic Factors

KW - Observational Studies as Topic

KW - Multicenter Studies as Topic

U2 - 10.1136/bmjopen-2024-093852

DO - 10.1136/bmjopen-2024-093852

M3 - Article (Academic Journal)

C2 - 40713039

SN - 2044-6055

VL - 15

JO - BMJ Open

JF - BMJ Open

IS - 7

M1 - e093852

ER -

Cohort profile: the open, prospective Community-Based chronic Care Lesotho (ComBaCaL) cohort – design, baseline chronic disease risk factors and hypertension and diabetes care cascades

Abstract

Bibliographical note

UN SDGs

Keywords

Access to Document

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