Rethinking the sources of disaffection among secondary school students

This work is a study aimed at investigating whether there is disaffection among black adolescent secondary school students in six secondary schools in the Phuthaditjhaba area of the eastern Free State Province of South Africa. Disaffection is viewed as the feeling of displeasure students have towards schooling and its activities arising from negative perceptions of and experiences in school. To investigate this issue, a survey was conducted among two carefully selected samples of students and teachers. In this survey, information was sought on demographic features of the representative student and teacher group. The questionnaire directed to the students contained an adapted form of Mau's Student Alienation Inventory to assess the extent to which students felt powerless, perceived meaninglessness and experienced normlessness, as well as the degree to which they were socially disconnected from others at school. The results obtained were numerous and varied but confirmed that some students were prone to disaffection as a result of both personal factors and school factors. In particular, the study underscored that some demographical factors--namely, students' ages, class size, family background, etc. could render them prone to disaffectio

The potential of agroecology to build climate-resilient livelihoods and food systems

Climate change has severe negative impacts on livelihoods and food systems worldwide. Our future climate according to latest scenarios seriously undermine current efforts to improve the state of food security and nutrition, especially in sub-Sahara Africa. To address this to its full extent, there is an urgent need for transformational change of our food systems towards more sustainability and resilience. Agroecology could play a vital role here. As a response to FAO’s governing bodies’ call for increased evidence-based work on agroecology, this study aims to elaborate on existing links between agroecology and climate change. It provides evidence on the technical and policy potential of agroecology to build resilient food systems. Inspired by the idea that transformation will only happen through a coordinated approach among all levels, this study was jointly developed by a broad set of actors from UN agencies (FAO), research institutes (FIBL, Bioversity, ISRA) and CSOs (Biovision, Enda Pronat, ICE) and thus combines evidence from a broad range of backgrounds and perspectives. The overall research question of this study was: How can agroecology foster climate change adaptation, mitigation and resilience through practices and policies? To provide a robust and evidence based answer to this we analysed three different dimensions: 1. International policy arena, in particular in the United Nations Framework Convention on Climate Change and the Koronivia Joint Work on Agriculture; 2. Peer-reviewed scientific studies on agroecology applying a meta-analysis; and 3. Two case studies in Kenya and Senegal that assess both, the policy potential of agroecology in respective national settings and the technical potential of agroecology to foster climate resilience on farm-level. The main findings of the study are: - Robust scientific evidence demonstrates that agroecology increases climate resilience. Success factors for this are that agroecology builds on: a) ecological principles, in particular on biodiversity, overall diversity and healthy soils (meta-analysis and case studies results); b) social aspects, in particular on the co-creation and sharing of knowledge and fostering traditions (case study results). - More than ten percent of the nationally determined contributions (NDCs) by UNFCCC member states mention agroecology and consider it a valid approach to address climate change. The climate potential of agroecology is furthermore backed by the IPCC Special Report on Climate Change and Land and the 2019 HLPE report of the Committee on World Food Security (CFS) (int. policy analysis result). - The interdisciplinary and systemic nature of agroecology is key for its true transformational power. However these characteristics are also the main challenges for both, conducting comprehensive research and policy revisions: typically research concepts and policy processes focus on the productive dimension with selective sectorial views (meta-analysis and policy analysis results). The key recommendations from this study are: - Given the sound knowledge base, fostering agroecology to build resilience should be recognized as a viable climate change adaptation strategy. - Barriers to the scaling-up of agroecology need to be addressed: amongst others, improved access to knowledge and understanding of systemic approaches should be fostered across sectors, stakeholders and scales. - Further comparative research on the multidimensional effects of agroecology is needed. - Agroecology’s transformative resilience-building potential depends on its holistic and systemic nature which goes beyond a set of practices and includes: a social movement for producers’ empowerment and a multidisciplinary scientific paradigm

Advanced Human Immunodeficiency Virus Disease in Botswana Following Successful Antiretroviral Therapy Rollout: Incidence of and Temporal Trends in Cryptococcal Meningitis.

Background: Botswana has a well-developed antiretroviral therapy (ART) program that serves as a regional model. With wide ART availability, the burden of advanced human immunodeficiency virus (HIV) and associated opportunistic infections would be expected to decline. We performed a nationwide surveillance study to determine the national incidence of cryptococcal meningitis (CM), and describe characteristics of cases during 2000-2014 and temporal trends at 2 national referral hospitals. Methods: Cerebrospinal fluid data from all 37 laboratories performing meningitis diagnostics in Botswana were collected from the period 2000-2014 to identify cases of CM. Basic demographic and laboratory data were recorded. Complete national data from 2013-2014 were used to calculate national incidence using UNAIDS population estimates. Temporal trends in cases were derived from national referral centers in the period 2004-2014. Results: A total of 5296 episodes of CM were observed in 4702 individuals; 60.6% were male, and median age was 36 years. Overall 2013-2014 incidence was 17.8 (95% confidence interval [CI], 16.6-19.2) cases per 100000 person-years. In the HIV-infected population, incidence was 96.8 (95% CI, 90.0-104.0) cases per 100000 person-years; male predominance was seen across CD4 strata. At national referral hospitals, cases decreased during 2007-2009 but stabilized during 2010-2014. Conclusions: Despite excellent ART coverage in Botswana, there is still a substantial burden of advanced HIV, with 2013-2014 incidence of CM comparable to pre-ART era rates in South Africa. Our findings suggest that a key population of individuals, often men, is developing advanced disease and associated opportunistic infections due to a failure to effectively engage in care, highlighting the need for differentiated care models

Cryptococcal meningitis: epidemiology, immunology, diagnosis and therapy.

HIV-associated cryptococcal meningitis is by far the most common cause of adult meningitis in many areas of the world that have high HIV seroprevalence. In most areas in Sub-Saharan Africa, the incidence of cryptococcal meningitis is not decreasing despite availability of antiretroviral therapy, because of issues of adherence and retention in HIV care. In addition, cryptococcal meningitis in HIV-seronegative individuals is a substantial problem: the risk of cryptococcal infection is increased in transplant recipients and other individuals with defects in cell-mediated immunity, and cryptococcosis is also reported in the apparently immunocompetent. Despite therapy, mortality rates in these groups are high. Over the past 5 years, advances have been made in rapid point-of-care diagnosis and early detection of cryptococcal antigen in the blood. These advances have enabled development of screening and pre-emptive treatment strategies aimed at preventing the development of clinical infection in patients with late-stage HIV infection. Progress in optimizing antifungal combinations has been aided by evaluation of the clearance rate of infection by using serial quantitative cultures of cerebrospinal fluid (CSF). Measurement and management of raised CSF pressure, a common complication, is a vital component of care. In addition, we now better understand protective immune responses in HIV-associated cases, immunogenetic predisposition to infection, and the role of immune-mediated pathology in patients with non-HIV associated infection and in the context of HIV-associated immune reconstitution reactions

Tropical Data: Approach and Methodology as Applied to Trachoma Prevalence Surveys

PURPOSE: Population-based prevalence surveys are essential for decision-making on interventions to achieve trachoma elimination as a public health problem. This paper outlines the methodologies of Tropical Data, which supports work to undertake those surveys. METHODS: Tropical Data is a consortium of partners that supports health ministries worldwide to conduct globally standardised prevalence surveys that conform to World Health Organization recommendations. Founding principles are health ministry ownership, partnership and collaboration, and quality assurance and quality control at every step of the survey process. Support covers survey planning, survey design, training, electronic data collection and fieldwork, and data management, analysis and dissemination. Methods are adapted to meet local context and needs. Customisations, operational research and integration of other diseases into routine trachoma surveys have also been supported. RESULTS: Between 29th February 2016 and 24th April 2023, 3373 trachoma surveys across 50 countries have been supported, resulting in 10,818,502 people being examined for trachoma. CONCLUSION: This health ministry-led, standardised approach, with support from the start to the end of the survey process, has helped all trachoma elimination stakeholders to know where interventions are needed, where interventions can be stopped, and when elimination as a public health problem has been achieved. Flexibility to meet specific country contexts, adaptation to changes in global guidance and adjustments in response to user feedback have facilitated innovation in evidence-based methodologies, and supported health ministries to strive for global disease control targets

The prevalence of urogenital and intestinal schistosomiasis among school age children (6-13 years) in the Okavango Delta in Botswana.

This study sought to investigate prevalence of urogenital and intestinal schistosomiasis among school age children 6-13 years in selected communities in the Okavango Delta. The termination of the Botswana national schistosomiasis control program in 1993 contributed to its neglect. An outbreak of schistosomiasis in 2017 at one of the primary schools in the northeastern part of the country resulted in 42 positive cases, indicating that the disease exists. A total of 1,611 school age children 6-13 years were randomly selected from school registers in 10 primary schools; from which 1603 urine and 1404 stool samples were collected. Macroscopic examination of urine and stool for color, odor, blood; viscosity, consistency, and the presence of worms. Urine filtration and centrifugation methods were used to increase sensitivity of detecting parasite ova. Kato-Katz and Formalin-Ether were used for the examination of stool samples. Data were analyzed using SPSS version 25. Results were expressed as odds ratio (OR) with their 95% CI and statistical significance set at p < 0.05. A total of (n = 1611) school age children 6-13 years participated in the study, mean age 9.7years (SD 2.06), females (54%) and males (46%). Results indicated an overall prevalence of SS. hematobium and S.mansoni at 8.7% and 0.64% respectively. Intensity of SS. hematobium was generally light (97.6%) and heavy intensity (2.4%). Results also revealed a knowledge deficit, about 58% of children had never heard of bilharzia even though they lived in communities where the disease was previously endemic. Learners who had a family member who previously suffered from schistosomiasis had higher knowledge than those who did not. Interestingly, these learners were likely to engage in risky behaviors compared to those with lower knowledge of the disease. An integrated approach that emphasizes health education, mass drug administration, water, sanitation, and hygiene infrastructure should be prioritized for prevention and control of schistosomiasis

AMBITION-cm : intermittent high dose AmBisome on a high dose fluconazole backbone for cryptococcal meningitis induction therapy in sub-Saharan Africa : study protocol for a randomized controlled trial

Cryptococcal meningitis (CM) is a leading cause of mortality among HIV-infected individuals in Africa. Poor outcomes from conventional antifungal therapies, unavailability of flucytosine, and difficulties administering 14 days of amphotericin B are key drivers of this mortality. Novel treatment regimes are needed. This study examines whether short-course high-dose liposomal amphotericin B (AmBisome), given with high dose fluconazole, is non-inferior (in terms of microbiological and clinical endpoints) to standard-dose 14-day courses of AmBisome plus high dose fluconazole for treatment of HIV-associated CM.; This is an adaptive open-label phase II/III randomised non-inferiority trial comparing alternative short course AmBisome regimens. Step 1 (phase II) will compare four treatment arms in 160 adult patients (≥18 years old) with a first episode of HIV-associated CM, using early fungicidal activity (EFA) as the primary outcome: 1) AmBisome 10 mg/kg day one (single dose); 2) AmBisome 10 mg/kg day one and AmBisome 5 mg/kg day three (two doses); 3) AmBisome 10 mg/kg day one, and AmBisome 5 mg/kg days three and seven (three doses); and 4) AmBisome 3 mg/kg/d for 14 days (control); all given with fluconazole 1200 mg daily for 14 days. STEP 2 (phase III) will enrol 300 participants and compare two treatment arms using all-cause mortality within 70 days as the primary outcome: 1) the shortest course AmBisome regimen found to be non-inferior in terms of EFA to the 14-day control arm in STEP 1, and 2) AmBisome 3 mg/kg/d for 14 days (control), both given with fluconazole 1200 mg daily for 14 days. STEP 2 analysis will include all patients from STEP 1 and STEP 2 taking the STEP 2 regimens. All patients will be followed for ten weeks, and mortality and safety data recorded. All patients will receive consolidation therapy with fluconazole 400-800 mg daily and ART in accordance with local guidelines. The primary analysis (for both STEP 1 and STEP 2) will be intention-to-treat

Analyzing the obstacles: what is structural and what is personal?: initial findings from a longitudinal study on student success in South African universities

Panel discussion held at the World Social Science Forum, Durban International Convention Centre, South Africa, 14 Septembe