Structural orientation and social agency in South Africa: state, race, higher education and transformation

We have taken as our brief and context the latest upsurge in incidents of a racist nature in certain higher education institutions in South Africa. What we contribute to thinking on the subject is Goldberg’s (2002) theoretical framework in which he focuses on the emergence, formation, existence and transformation of racial formations as constitutive of social life. In the South African context we apply this framework and its understanding of racial traditions to higher education in order to reveal the shifts across the social formations of segregation, apartheid and constitutional democracy. Our central argument is that Goldberg’s concept of racial naturalist and racial historicist traditions of social agency when applied to higher education institutions disclose legacies of a differentiated racial regime. In this regard, we take up the trajectory of racialisation as in its segregationist and apartheid modalities of state formation; its deracialisation in our post-apartheid modality of social engagement towards the non-racial project of constitutional democracy as a movement beyond the shadow of racist thinking both implicit and explicit. The thrust of our engagement is that in order to make sense of racial formations and their modalities of structural orientation and social agency we need to think of racism within the complex of a state-race-class nexus. In sum then, the argument that we make vis-à-vis the differentiated racialised orders is that we need to embed ourselves within our national, South African, and continental, African, contexts in order to challenge the racial traditions that continue to bedevil efforts towards consolidating our constitutional democracy and its concomitant epistemic project.Keywords: developmental state, racial formations, higher education institutions, democracy, South Africa

State-in-Society: the Mutual Constitutiveness of the Developmental State and Higher Education in South Africa

Seeking to go beyond the pessimism and reification of contemporary analyses of the state in Africa, this article applies Migdal’s State in Society (2001) approach to the field of higher education transformation in South Africa. It argues that the state is best understood through its actual practices, particularly at those points where it reaches into society through policy implementation and, conversely, where society through its institutions in turn reaches into the state. In the course of these engagements, social boundaries are constituted through alliances, accommodations and resistances and have a mutually transformative effect on both state and society. The article shows how, with regard to both the image and the practices of the state, the relationship between the developmental state and higher education in South Africa reveals a range of tensions around issues such as accountability, autonomy, transformation and globalisation; and it concludes that Migdal’s approach offers a fruitful theoretical corrective to state-centric and socio-centric views of the state-society relationship.Key Words: Developmental state, South Africa, globalisation, higher educatio

Reflections on the passing of Prof Bongani Mayosi: Universities and the burden of history

Our heartfelt condolences to the family of Prof Bongani Mayosi. We begin by acknowledging that the condition of depression stalks societies, it silently chips away at the soul and identity of an individual. And, when tragedy strikes in the form of suicide, we desperately formulate questions in the hope that there will be clear answers. We have been witness to this confounding emotional process in our family. Notwithstanding, we continue to keep hope alive that advances in the social and natural sciences will walk us through the dense thicket of the vortex of our emotions. After all, it is the latter that is brought to bear on the everyday practices of our professional lives. Given that the psychological profile of an individual is layered onto the professional-workplace and since, Prof Mayosi’s tragedy is within the context of the university environment, we wish to reflect on the environment in which as academics we find ourselves in the current context.DHE

Commodification of transformation discourses and post-apartheid institutional identities at three South African universities

Using mission statements from the UCT, UWC and Stellenbosch University (South Africa), we explore how the three universities have rematerialised prior discourses to rebrand their identities as dictated by contemporary national and global aspirations. We reveal how the universities have recontextualised the experiences and discourses of liberation struggle and the new government's post-apartheid social transformation discourses to construct distinctive identities that are locally relevant and globally aspiring. This has led to the semiotic refiguring of universities from spatial edifices of racially based unequal education, to equal opportunity institutions of higher learning, and to the blurring of historical boundaries between these universities. We conclude that the universities have reconstructed distinct and recognisable identities which speak to a segregated past, but with a post-apartheid voice of equity and redress.IS

New Approaches to Preventing, Diagnosing, and Treating Neonatal Sepsis

Karen Edmond and Anita Zaidi highlight new approaches that could reduce the burden of neonatal sepsis worldwide

Accuracy of clinical pallor in the diagnosis of anaemia in children: a meta-analysis

BACKGROUND: Anaemia is highly prevalent in children of developing countries. It is associated with impaired physical growth and mental development. Palmar pallor is recommended at primary level for diagnosing it, on the basis of few studies. The objective of the study was to systematically assess the accuracy of clinical signs in the diagnosis of anaemia in children. METHODS: A systematic review on the accuracy of clinical signs of anaemia in children. We performed an Internet search in various databases and an additional reference tracking. Studies had to be on performance of clinical signs in the diagnosis of anaemia, using haemoglobin as the gold standard. We calculated pooled diagnostic likelihood ratios (LR's) and odds ratios (DOR's) for each clinical sign at different haemoglobin thresholds. RESULTS: Eleven articles met the inclusion criteria. Most studies were performed in Africa, in children underfive. Chi-square test for proportions and Cochran Q for DOR's and for LR's showed heterogeneity. Type of observer and haemoglobin technique influenced the results. Pooling was done using the random effects model. Pooled DOR at haemoglobin <11 g/dL was 4.3 (95% CI 2.6–7.2) for palmar pallor, 3.7 (2.3–5.9) for conjunctival pallor, and 3.4 (1.8–6.3) for nailbed pallor. DOR's and LR's were slightly better for nailbed pallor at all other haemoglobin thresholds. The accuracy did not vary substantially after excluding outliers. CONCLUSION: This meta-analysis did not document a highly accurate clinical sign of anaemia. In view of poor performance of clinical signs, universal iron supplementation may be an adequate control strategy in high prevalence areas. Further well-designed studies are needed in settings other than Africa. They should assess inter-observer variation, performance of combined clinical signs, phenotypic differences, and different degrees of anaemia

Dried blood spots as a source of anti-malarial antibodies for epidemiological studies

BACKGROUND: Blood spots collected onto filter paper are an established and convenient source of antibodies for serological diagnosis and epidemiological surveys. Although recommendations for the storage and analysis of small molecule analytes in blood spots exist, there are no published systematic studies of the stability of antibodies under different storage conditions. METHODS: Blood spots, on filter paper or glass fibre mats and containing malaria-endemic plasma, were desiccated and stored at various temperatures for different times. Eluates of these spots were assayed for antibodies against two Plasmodium falciparum antigens, MSP-119 and MSP2, and calculated titres used to fit an exponential (first order kinetic) decay model. The first order rate constants (k) for each spot storage temperature were used to fit an Arrhenius equation, in order to estimate the thermal and temporal stability of antibodies in dried blood spots. The utility of blood spots for serological assays was confirmed by comparing antibodies eluted from blood spots with the equivalent plasma values in a series of samples from North Eastern Tanzania and by using blood spot-derived antibodies to estimate malaria transmission intensity in this site and for two localities in Uganda. RESULTS: Antibodies in spots on filter paper and glass fibre paper had similar stabilities but blood was more easily absorbed onto filter papers than glass fibre, spots were more regular and spot size was more closely correlated with blood volume for filter paper spots. Desiccated spots could be stored at or below 4 degrees C for extended periods, but were stable for only very limited periods at ambient temperature. When desiccated, recoveries of antibodies that are predominantly of IgG1 or IgG3 subclasses were similar. Recoveries of antibodies from paired samples of serum and of blood spots from Tanzania which had been suitably stored showed similar recoveries of antibodies, but spots which had been stored for extended periods at ambient humidity and temperature showed severe loss of recoveries. Estimates of malaria transmission intensity obtained from serum and from blood spots were similar, and values obtained using blood spots agreed well with entomologically determined values. CONCLUSION: This study has demonstrated the suitability of filter paper blood spots paper for collection of serum antibodies, and provided clear guidelines for the treatment and storage of filter papers which emphasize the importance of desiccation and minimisation of time spent at ambient temperatures. A recommended protocol for collecting, storing and assaying blood spots is provided

Evidence for perinatal and child health care guidelines in crisis settings: can Cochrane help?

<p>Abstract</p> <p>Background</p> <p>It is important that healthcare provided in crisis settings is based on the best available research evidence. We reviewed guidelines for child and perinatal health care in crisis situations to determine whether they were based on research evidence, whether Cochrane systematic reviews were available in the clinical areas addressed by these guidelines and whether summaries of these reviews were provided in Evidence Aid.</p> <p>Methods</p> <p>Broad internet searches were undertaken to identify relevant guidelines. Guidelines were appraised using AGREE and the clinical areas that were relevant to perinatal or child health were extracted. We searched The Cochrane Database of Systematic Reviews to identify potentially relevant reviews. For each review we determined how many trials were included, and how many were conducted in resource-limited settings.</p> <p>Results</p> <p>Six guidelines met selection criteria. None of the included guidelines were clearly based on research evidence. 198 Cochrane reviews were potentially relevant to the guidelines. These reviews predominantly addressed nutrient supplementation, breastfeeding, malaria, maternal hypertension, premature labour and prevention of HIV transmission. Most reviews included studies from developing settings. However for large portions of the guidelines, particularly health services delivery, there were no relevant reviews. Only 18 (9.1%) reviews have summaries in Evidence Aid.</p> <p>Conclusions</p> <p>We did not identify any evidence-based guidelines for perinatal and child health care in disaster settings. We found many Cochrane reviews that could contribute to the evidence-base supporting future guidelines. However there are important issues to be addressed in terms of the relevance of the available reviews and increasing the number of reviews addressing health care delivery.</p

Treatment of Infections in Young Infants in Low- and Middle-Income Countries:A Systematic Review and Meta-analysis of Frontline Health Worker Diagnosis and Antibiotic Access

BACKGROUND: Inadequate illness recognition and access to antibiotics contribute to high case fatality from infections in young infants (<2 months) in low- and middle-income countries (LMICs). We aimed to address three questions regarding access to treatment for young infant infections in LMICs: (1) Can frontline health workers accurately diagnose possible bacterial infection (pBI)?; (2) How available and affordable are antibiotics?; (3) How often are antibiotics procured without a prescription? METHODS AND FINDINGS: We searched PubMed, Embase, WHO/Health Action International (HAI), databases, service provision assessments (SPAs), Demographic and Health Surveys, Multiple Indicator Cluster Surveys, and grey literature with no date restriction until May 2014. Data were identified from 37 published studies, 46 HAI national surveys, and eight SPAs. For study question 1, meta-analysis showed that clinical sign-based algorithms predicted bacterial infection in young infants with high sensitivity (87%, 95% CI 82%-91%) and lower specificity (62%, 95% CI 48%-75%) (six studies, n = 14,254). Frontline health workers diagnosed pBI in young infants with an average sensitivity of 82% (95% CI 76%-88%) and specificity of 69% (95% CI 54%-83%) (eight studies, n = 11,857) compared to physicians. For question 2, first-line injectable agents (ampicillin, gentamicin, and penicillin) had low variable availability in first-level health facilities in Africa and South Asia. Oral amoxicillin and cotrimoxazole were widely available at low cost in most regions. For question 3, no studies on young infants were identified, however 25% of pediatric antibiotic purchases in LMICs were obtained without a prescription (11 studies, 95% CI 18%-34%), with lower rates among infants <1 year. Study limitations included potential selection bias and lack of neonatal-specific data. CONCLUSIONS: Trained frontline health workers may screen for pBI in young infants with relatively high sensitivity and lower specificity. Availability of first-line injectable antibiotics appears low in many health facilities in Africa and Asia. Improved data and advocacy are needed to increase the availability and appropriate utilization of antibiotics for young infant infections in LMICs. REVIEW REGISTRATION: PROSPERO International prospective register of systematic reviews (CRD42013004586). Please see later in the article for the Editors' Summary