The hambisela programme's effect on stress levels and quality of line of primary caregivers of children with cerebral palsy in Mamelodi: a pilot study

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Science. Johannesburg, 2016Cerebral palsy (CP) is a lifelong complex disorder that places multiple burdens on the caregivers. Caregivers of children with CP have high stress levels and poor quality of life which could have a detrimental effect on their children. Addressing the parents’ needs is an important aspect when working with children with disabilities. Sixteen participants from Mamelodi, a township in South Africa, participated in a quasi-experimental pilot study over eight consecutive weeks. The aim of the study was to determine if an educational intervention, Hambisela, could reduce caregivers’ stress levels and improve their quality of life (QoL). Contributing factors such as parent’s age and educational level, and the child’s age and level of severity of CP were correlated to the caregivers stress levels and QoL. Participants completed the Parenting Stress Index – Short Form (PSI – SF), the Paediatric Quality of Life – Family Impact Module (PedsQLTM – FIM), a demographic questionnaire and the Gross Motor Function Classification System was used to assess the child’s level of severity. No significant differences were found in the participants stress levels (p=0.7) and QoL (p=0.9) before and after completing the programme. A moderate negative correlation (r=-0.5) was found between caregiver’s education level and stress and a moderate negative correlation (r=-0.5) was found between the caregiver’s age and QoL. An educational intervention alone, such as Hambisela, is not sufficient to reduce the stress of caregiver’s of children with CP, or to improve their QoL. Stress is a complex multifactorial construct. In a developing country such as South Africa, social and environmental stressors are significant factors which play a role in these caregivers’ lives. Holistic interventions addressing all factors contributing to stress, especially social development, ought to be designed for this population.MT201

Factors associated with morbidity and mortality in children under-five years admitted with severe acute malnutrition to a regional paediatric hospital in Kwazulu-Natal

Magister Public Health - MPHBackground: Malnutrition is a complex condition profoundly impacting child mortality and morbidity, especially in sub-Saharan Africa. Severe acute malnutrition is of growing concern locally where unacceptable mortality rates persist, despite reasonable standards of clinical care. Aim: To determine factors associated with morbidity and mortality in children under-five years admitted with severe acute malnutrition to a regional paediatric hospital in KwaZulu-Natal. Methodology: This was a quantitative study. A retrospective observational study design was used. Medical records of all children with severe acute malnutrition, under the age of five years, admitted between April 2015 and December 2016 to the regional paediatric hospital in KwaZulu-Natal were included. Data was obtained from medical records and admission books. A trained research assistant was used to extract and record data with a piloted data extraction tool. Data was entered and cleaned using Microsoft Excel and analysed using SPSS (v 20) and STATA (v 14). Descriptive summary statistics were used to describe the characteristics of the study population and bivariate analysis using t-tests and Chi-square tests to determine significance. Kaplan Meier and Multivariate Cox regression was used to assess the association of variables with morbidity and mortality. Results: Of the 276 eligible case records included in the study, 54% were male and 90% of all cases were younger than 2 years. Even though associations did not reach significance, teenage pregnancy and unemployment was high amongst the caregivers of the study population. Most of the malnourished children admitted (74%) presented with multiple comorbidities. Diarrhoea (43%), HIV- infection (30%) and respiratory tract infections (30%) were the top three comorbidities found, followed by tuberculosis (27%). The overall mortality rate was 8.7%. Survival probability was significantly reduced in children with pneumonia and those who presented with hypoglycaemia, dehydration, dermatosis, severe pallor, altered consciousness or shock on admission (p < 0.05). There was a significantly increased risk of death in males (HR = 0.174, 95%CI = 0.05 - 0.665), and in those who presented with dehydration (HR = 4.1, 95%CI = 1.25 - 13.59), evidence of lethargy or coma (HR = 4.2, 95%CI = 1.04 - 17.12) or multiple clinical signs (HR = 4.4, 95% CI =2.56 - 7.59) on admission (p < 0.05). The comorbidities HIV-infection (HR = 9.9, 95%CI = 1.39 - 70.68) and pneumonia (HR = 3.4, 95%CI = 1.56 - 7.43) showed a significantly increased mortality risk (p < 0.05). Conclusion: This study supports the body of evidence that despite reasonable standards of hospital care, it is difficult to obtain the target for severe acute malnutrition mortality (< 5%), likely due to the presence of contextually specific factors. Local interventions at hospital, primary health care and community level is needed, as well as further research to facilitate comprehensive policy-making

Feasibility and applications of non-invasive laser photogrammetry on free-ranging coastal dolphins

Morphometric data plays a pivotal role in understanding key life history traits to elucidate biological, ecological and evolutionary processes. Obtaining morphometric data from free-ranging cetaceans is difficult, as traditional methods rely on either post-mortem or highly invasive techniques. The present study evaluated the feasibility of remote laser photogrammetry as a non-invasive technique to obtain morphometric data on free-ranging coastal dolphins. First, simulation models and post-mortem specimens were used to investigate potential sources of measurement error and quantify their influence on the accuracy and precision of the morphometric data. These sources include horizontal angle, distance, and body curvature. Second, to demonstrate the potential applications of this technique, laser photogrammetry measurements were obtained during boat-based photo identification surveys on Indo-Pacific bottlenose dolphins (Tursiops aduncus) from Western Australia (Bunbury, Shark Bay and Mandurah). Laser-derived, blowhole-to-dorsal fin (BH-DF) measurements were obtained from individuals of known ages in Bunbury (N=103) and Shark Bay (N=76), in addition to individuals in Mandurah (N=28). Our laser-derived measurement data facilitated the development of population growth curves in conjunction with longitudinal demographic data from Bunbury (~10 years) and Shark Bay (~33 years). These growth curves characterise not only the relationship between age and length, but also the significant morphological differences between these geographically-isolated populations. This study demonstrates the value of remote laser photogrammetry as an effective tool to investigate individual and population-based growth and life-history parameters. This non-invasive technique will provide unique opportunities to better understand the ecological, demographic and life-history characteristics of a population and so better inform conservation management strategies for free-ranging cetacean populations

Developing minimum clinical standards for physiotherapy in South African ICUs: A qualitative study

Rationale, aims, and objectives: Physiotherapists are integral members of the intensive care unit (ICU) team. Clinicians working in ICU are dependent on their own experience when making decisions regarding individual patient management thus resulting in variation in clinical practice. No formalized clinical practice guidelines or standards exist for the educational profile or scope of practice requirements for ICU physiotherapy. This study explored perceptions of physiotherapists on minimum clinical standards that ICU physiotherapists should adhere to for delivering safe, effective physiotherapy services to critically ill patients. Method: Experienced physiotherapists offering a service to South African ICUs were purposively sampled. Three focus group sessions were held in different parts of the country to ensure national participation. Each was audio recorded. The stimulus question posed was “What is the minimum standard of clinical practice needed by physiotherapists to ensure safe and independent practice in South African ICUs?” Three categories were explored, namely, knowledge, skill, and attributes. Themes and subthemes were developed using the codes identified. An inductive approach to data analysis was used to perform conventional content analysis. Results: Twenty-five physiotherapists participated in 1 of 3 focus group sessions. Mean years of ICU experience was 10.8 years (±7.0; range, 3-33). Three themes emerged from the data namely, integrated medical knowledge, multidisciplinary teamwork, and physiotherapy practice. Integrated medical knowledge related to anatomy and physiology, conditions that patients present with in ICU, the ICU environment, pathology and pathophysiology, and pharmacology. Multidisciplinary teamwork encompassed elements related to communication, continuous professional development, cultural sensitivity, documentation, ethics, professionalism, safety in ICU, and technology. Components related to physiotherapy practice included clinical reasoning, handling skills, interventions, and patient care. Conclusions: The information obtained will be used to inform the development of a list of standards to be presented to the wider national physiotherapy and ICU communities for further consensus-building activities

An analysis of ESL teacher educators' current assessment practices

Assessment should provide a catalyst for student learning and for reflective teaching practices. Fundamental to the development of appropriate assessment must be a direct link between what is being "taught" and what is being "learned". Assessment is not an end in itself but a vehicle for educational improvement, and should be a fundamental and integral part of any curriculum based on student learning outcomes. The purpose of this paper is to analyse and identify any shortcomings in the current assessment practices of English Second Language teacher educators at a tertiary institution, and to provide recommendations for improving teacher educators', at tertiary institutions, assessment practices. The results indicated a mechanistic additive assessment approach, and a misalignment between teaching, learning and assessment. Key Words: ESL; assessment; learning outcomes Journal for Language Teaching Vol.38(1) 2004: 26-4

An analysis of the extent to which English Second Language teacher educators are implementing learner-centred teaching and learning: a case study

The primary learning environment for undergraduate students, the fairly passive lecture-discussion format where teacher educators talk and most students listen, is contrary to almost every principle of an optimal student learning setting. The current view in higher education is that teacher educators need to focus on student learning rather than on teaching. One of the challenges in moving a university, and in this case specifically a Faculty of Education Sciences, toward learner-centredness is to help teacher educators understand what learnercentredness means and to help them overcome implementation barriers. The purpose in this article was to a) determine the nature and scope of English Second Language (ESL) teacher educators' tasks at a tertiary institution, b) determine the extent to which ESL teacher educators are implementing a learner-centred approach to teaching and learning, c) identify the factors, if any, that impede the transition to a learner-centred approach to teaching and learning, and d) provide recommendations to facilitate the implementation of a learner-centred approach to teaching and learning within a faculty of education sciences. South African Journal of Education Vol.24(4) 2004: 295-30

From the editors

Our settlements are under constant threat, struggling to keep up with a changing world, a world with everchanging demands, both from our citizens and our ideals of what a successful settlement should be. Specifically, geo-political forces and factors including migration, war and civil unrest, pandemics and the throes of climate change have come to affect human settlements in multiple ways. Professor Greg Clark (Future Cities and New Industries, HSBC), explains, “In the recent past, we thought a successful city was a city with a major cluster of office jobs in the centre, suburban housing on the fringes, and an attractive set of amenities, facilities, services and public space” (Goodman, 2023). However, the priorities of citizens and town and regional planners are changing, we are setting a new standard for our settlements, expecting more from it, for this living organism to deliver more, be more..

National planning in South Africa: A temporal perspective

This article aims to provide a temporal and critical perspective on national spatial&nbsp;planning since the 1970s until the most recent directive in 2012. From the first spatial&nbsp;policy initiative, the National Physical Development Plan (1975), radical changes have&nbsp;occurred in the various approaches to national planning. The most recent spatial&nbsp;planning directive in South Africa is the National Development Plan (2012), which&nbsp;has a diversified approach with political, social and economic goals. In the past four&nbsp;decades, national planning policy and directives have moved through balanced and&nbsp;unbalanced regional growth approaches. The top-down approach of the 1970s with&nbsp;rigid area-specific directives transformed into a bottom-up more adaptable, socially&nbsp;oriented and interpretation-based approach in recent years. In the process, South&nbsp;Africa’s spatial policy has evolved from a policy dominated by political objectives in the&nbsp;1960s to a multi-sectoral policy which purports to be based only on economic principles&nbsp;of a multi-sectoral free-market system; from one of strong government intervention to&nbsp;one of minor intervention. The general perception of this article is that only some of these&nbsp;policies are substantially attributed to effective socio-economic development due to&nbsp;the lack of spatially focused initiatives

Childrens' choral repetoire : hearing the voice of South African composers

This article offers a South African perspective on the role of composers as an important link in the process of conductors selecting repertoire for children’s choirs. The following research question is explored: “What is the role of South African composers with regard to the challenges that conductors experience in their quest of choosing repertoire for children’s choirs?” In this qualitative study, various factors that influence the origin and nature of new compositions are examined. Methods of data collection include literature reviews, interviews and questionnaires. South African composers as well as local and international conductors of children’s choirs were involved as respondents. Firstly, the composers were asked to reflect on personal aspects that play a role in their interest in composing choral music and that affect the nature of their compositions and, secondly, on their general opinion regarding the choice of repertoire. The conductors, in turn, reported on various role players that influence their choice of repertoire, and commented on the extent to which they include South African compositions as repertoire. The author concludes that communication between composers and conductors is one of the key issues in the creative process of finding and expanding existing suitable South African repertoire for children’s choirs.Die artikel bied ’n Suid-Afrikaanse perspektief oor die rol van komponiste as ’n belangrike skakel in die proses waarvolgens dirigente repertorium vir kinderkore kies. Die volgende navorsingsvraag word ondersoek: “Wat is die rol van Suid-Afrikaanse komponiste met betrekking tot die uitdagings waarvoor dirigente in die keuse van repertorium vir kinderkore te staan kom?” Verskeie faktore wat die oorsprong en aard van nuwe komposisies beïnvloed, word in hierdie kwalitatiewe studie ondersoek. Metodes van data-insameling wat gebruik is, sluit literatuurstudie, onderhoude en vraelyste in. Suid-Afrikaanse komponiste sowel as plaaslike en internasionale dirigente van kinderkore is as respondente betrek. Eerstens is komponiste versoek om insette te lewer oor persoonlike faktore wat ’n rol in hul belangstelling in die komponeer van koormusiek en in die aard van hul komposisies speel en, tweedens, oor hul algemene opinie rakende die keuse van repertorium. Dirigente bied op hul beurt sienings aan oor die verskeie rolspelers wat hul keuse van repertorium beïnvloed, asook die mate waarin hulle Suid-Afrikaanse komposisies as repertorium in hul konsertprogramme insluit. Die outeur kom tot die gevolgtrekking dat kommunikasie en interaksie tussen komponiste en dirigente ’n sleutelfaktor is in die kreatiewe proses van die keuse en uitbreiding van bestaande Suid-Afrikaanse repertorium vir kinderkore.On scanned article is no author - the author's name in the article of the journal Musicus (v. 39 no. 1, 2011) is Riekie van AswegenAuthor wrote her theses as Hendrika Johanna van Aswegen - as author of textbooks and conductor of a choir she is known as Riekie van Aswegenhttp://www.journals.co.za/ej/ejour_musicus.htmlgm201

The effect of penetrating trunk trauma and mechanical ventilation on the recovery of adult survivors after hospital discharge

ABSTRACT South Africa has a high incidence of violence and death due to unnatural causes. Gunshot and/or multiple stab wounds to the trunk are consequently injuries commonly seen in South African hospitals. Penetrating injuries often necessitate explorative surgical intervention to identify and treat injuries to the internal organs. Patients are managed in the intensive care unit and frequently return to theatre for abdominal lavage prior to eventual wound closure. Critical illness with prolonged mechanical ventilation and immobilization results in some degree of muscle dysfunction. Survivors of critical illness suffer from poor functional capabilities and decreased quality of life. No formal rehabilitation programmes exist in South Africa for these patients following discharge. Purpose: To determine if patients that survived penetrating trunk trauma recover adequately spontaneously following critical illness over the first six months following discharge from the hospital. Methods: A prospective, observational study was conducted. Patients with penetrating trunk trauma were recruited from four intensive care units in Johannesburg. Patients who received mechanical ventilation < 5 days were placed in Group 1 and those who received mechanical ventilation 5 days were placed in Group 2. Lung function tests, dynamometry, quality of life, six-minute walk distance and oxygen uptake tests were performed over six months following discharge from the hospital. The obtained results for dynamometry, exercise capacity and quality of life were compared between groups and to that measured for a healthy (age and sex-matched) control group. Results and Discussion: No pulmonary function abnormalities were detected for subjects in Groups 1 or 2. Distance walked during 6MWD test was significantly reduced for subjects in Group 2 compared to the control group [one-month (p = 0.00), three-months (p = 0.00)]. Morbidity correlated significantly with distance walked by subjects in Group 2 during 6MWD test [three-months (p = 0.03), six-months (p = 0.02)]. No statistically significant differences were found between subjects during the VO2peak test although subjects in Group 1 performed better clinically than those in Group 2. At one-month there was a significant reduction in upper and lower limb strength for subjects in Group 2 compared to those in Group 1 and the controls (p = 0.00 – 0.04). Similar results were detected at the three- and six-month assessments. ICU and hospital length of stay did demonstrate a significant relationship with muscle strength at one and three months following discharge for subjects in Group 2. Severity of illness and morbidity in ICU did not have a significant relation to muscle strength for subjects in Groups 1 or 2 at any of the assessments. Subjects in Group 1 had a significant reduction in right deltoid and triceps strength compared to the controls at one-month (p = 0.00 respectively) only. No significant differences in upper and lower limb muscle strength were detected between the control group and subjects in Group 1 three and six months after discharge. Subjects in both groups had similar limitations in physical and mental aspects of quality of life one-month after discharge. Subjects in Group 1 reported a quality of life comparable to the control group by three-months. Subjects in Group 2 had significant limitations in the physical components of quality of life at three- and six-months compared to those in Group 1 and the controls [p = 0.00 – 0.02]. Conclusion: Subjects in Group 1 recovered adequately on their own within three months after discharge from hospital with regard to muscle strength, exercise capacity and all aspects of quality of life. Subjects in Group 2 presented with significant limitations in exercise capacity, muscle strength and the physical aspects of quality of life even at six months after discharge. Impaired function was related to the duration of critical illness and immobility. A physiotherapist-led rehabilitation programme may be indicated for survivors of penetrating trunk trauma that received prolonged mechanical ventilation to address cardiovascular endurance and peripheral muscle strength retraining between one and three months after discharge to address the physical disabilities observed in these subjects