Towards Education for 21st Century Democratic Citizenry — Philosophical Enquiry Advancing Cosmopolitan Engagement (P.E.A.C.E.) Curriculum: An Intentional Critique

Doing philosophy for/with children and exposing students to multiple perspectives, exemplified within the Austrian Centre of Philosophy with Children’s implementation project of the Philosophical Enquiry Advancing Cosmopolitan Engagement (PEACE) curriculum in schooling, may offer a valuable written, taught, and tested curriculum for democratic citizenry. This paper provides an analysis that seeks to present, describe, critique, and make recommendations on the PEACE curriculum. The paper asks the question: In what ways does the Philosophical Enquiry Advancing Cosmopolitan Engagement as a 21st century curriculum address education for democratic citizenry? In this evaluation the ways in which issues of culture and identity, human rights and democracy are perceived and addressed, along with issues of critical thinking and reasoning in verbal and nonverbal language are attended. Concepts of collaboration, cooperation, teacher support and development are also critiqued. This critique is based on a ten-day Austrian Center of Philosophy with Children conference and training course on the PEACE curriculum, and consists of open-ended interviews, personal observations, and published reports on pre- and post-test results of the PEACE curriculum. Exploring the integration of the Austrian Center of Philosophy with Children PEACE curriculum and the Philosophy for/with Children methodology, this paper utilizes Hansen’s (1995) five principles for guiding curriculum development practice as a framework for analysis. It is hoped that findings and recommendations from this study may stir further exploration and contribute to the work of Philosophy for/with Children in democratic education for 21st century citizenry worldwide. Keywords: Democratic education, Philosophy for/with Children, Philosophical Enquiry Advancing Cosmopolitan Engagement (P.E.A.C.E.) Curriculum, Curriculum development, 21st Century citizenry, critical thinki

Paediatric HIV disclosure in South Africa - caregivers' perspectives on discussing HIV with infected children

Most paediatric HIV infections in South Africa are transmitted perinatally. Lack of widely available HIV treatment means that most children do not survive to an age at which disclosure becomes a relevant concern. However, with the expansion of HIV treatment programmes the proportion of HIV-infected children surviving to an advanced age is likely to increase substantially during the next 5 - 10 years. A similar phenomenon was observed in Europe and North America with the advent of antiretroviral therapy (ART) in the mid-1990s, and in resource-rich settings approximately half of perinatally infected children are expected to survive beyond 13 years of age.

The utility of high-flow nasal oxygen for severe COVID-19 pneumonia in a resource-constrained setting: A multi-centre prospective observational study.

BACKGROUND: The utility of heated and humidified high-flow nasal oxygen (HFNO) for severe COVID-19-related hypoxaemic respiratory failure (HRF), particularly in settings with limited access to intensive care unit (ICU) resources, remains unclear, and predictors of outcome have been poorly studied. METHODS: We included consecutive patients with COVID-19-related HRF treated with HFNO at two tertiary hospitals in Cape Town, South Africa. The primary outcome was the proportion of patients who were successfully weaned from HFNO, whilst failure comprised intubation or death on HFNO. FINDINGS: The median (IQR) arterial oxygen partial pressure to fraction inspired oxygen ratio (PaO2/FiO2) was 68 (54-92) in 293 enroled patients. Of these, 137/293 (47%) of patients [PaO2/FiO2 76 (63-93)] were successfully weaned from HFNO. The median duration of HFNO was 6 (3-9) in those successfully treated versus 2 (1-5) days in those who failed (p<0.001). A higher ratio of oxygen saturation/FiO2 to respiratory rate within 6 h (ROX-6 score) after HFNO commencement was associated with HFNO success (ROX-6; AHR 0.43, 0.31-0.60), as was use of steroids (AHR 0.35, 95%CI 0.19-0.64). A ROX-6 score of ≥3.7 was 80% predictive of successful weaning whilst ROX-6 ≤ 2.2 was 74% predictive of failure. In total, 139 patents (52%) survived to hospital discharge, whilst mortality amongst HFNO failures with outcomes was 129/140 (92%). INTERPRETATION: In a resource-constrained setting, HFNO for severe COVID-19 HRF is feasible and more almost half of those who receive it can be successfully weaned without the need for mechanical ventilation

Risk factors for Coronavirus disease 2019 (Covid-19) death in a population cohort study from the Western Cape province, South Africa

Risk factors for coronavirus disease 2019 (COVID-19) death in sub-Saharan Africa and the effects of human immunodeficiency virus (HIV) and tuberculosis on COVID-19 outcomes are unknown. We conducted a population cohort study using linked data from adults attending public-sector health facilities in the Western Cape, South Africa. We used Cox proportional hazards models, adjusted for age, sex, location, and comorbidities, to examine the associations between HIV, tuberculosis, and COVID-19 death from 1 March to 9 June 2020 among (1) public-sector “active patients” (≥1 visit in the 3 years before March 2020); (2) laboratory-diagnosed COVID-19 cases; and (3) hospitalized COVID-19 cases. We calculated the standardized mortality ratio (SMR) for COVID-19, comparing adults living with and without HIV using modeled population estimates.Among 3 460 932 patients (16% living with HIV), 22 308 were diagnosed with COVID-19, of whom 625 died. COVID19 death was associated with male sex, increasing age, diabetes, hypertension, and chronic kidney disease. HIV was associated with COVID-19 mortality (adjusted hazard ratio [aHR], 2.14; 95% confidence interval [CI], 1.70–2.70), with similar risks across strata of viral loads and immunosuppression. Current and previous diagnoses of tuberculosis were associated with COVID-19 death (aHR, 2.70 [95% CI, 1.81–4.04] and 1.51 [95% CI, 1.18–1.93], respectively). The SMR for COVID-19 death associated with HIV was 2.39 (95% CI, 1.96–2.86); population attributable fraction 8.5% (95% CI, 6.1–11.1)

Operational manager’s knowledge and attitudes toward data and universal health coverage indicators in primary health clinics in Ugu, South Africa

Universal health coverage (UHC) aims to ensure people have access to the health services they need. Sixteen tracer indicators were developed for implementation by countries to measure UHC in the health system. South Africa uses 15 of the proposed 16 indicators. Operational managers in the public health care sector collect data and report on these indicators at a primary health clinic level. This qualitative study explored the knowledge and attitudes of managers toward data and UHC service indicators in a sub-district in Ugu, KwaZulu-Natal, South Africa. Operational managers saw data collection as information gathering, measuring performance and driving action. They understood UHC indicators as ‘health for all’ linking them to National Department of Health Strategic plans and saw the value of indicators for health promotion. They found the lack of training, inadequate numeracy skills, requests for data from multiple spheres of government and the indicator targets that they had to reach as challenging and untenable. While operational managers made the link between data, measuring performance and action, the limited training, skills gaps and pressures from higher levels of government may impede their ability to use data for local level planning and decision making

The utility of high-flow nasal cannula oxygen therapy in the management of respiratory failure secondary to COVID-19 pneumonia

CITATION: Lalla, U. et al. 2020. The utility of high-flow nasal cannula oxygen therapy in the management of respiratory failure secondary to COVID-19 pneumonia. South African Medical Journal, 110(6):3, doi:10.7196/SAMJ.2020.v110i6.14882.The original publication is available at http://www.samj.org.zaCOVID-19 is a potentially fatal infection caused by SARS-CoV-2.[1] As of 4 May 2020, more than 6 000 cases had been confirmed in South Africa (SA) with numbers rising steadily, a situation that will place a major strain on the country’s health resources, including its ability to provide intensive care and ventilatory support to patients with severe disease.http://www.samj.org.za/index.php/samj/article/view/12941Publisher's versio

First detection of human dirofilariasis in South Africa

Humans are occasionally inadvertently infected with dirofilariae, the zoonotic nematodes. We report two cases of human dirofilariasis in South Africa, an area apparently non-endemic for this infection. Dirofilariasis is frequently misdiagnosed, so increased awareness of this entity in areas that are non-endemic is essential for prevention of inappropriate investigations and invasive therapy