Investing in health professions education: A national development imperative for South Africa

Background: Human resources for health are an essential component of any health system. South Africa’s National Development Plan identifies the need for a strengthened public health system and improvements in the quality of education and service delivery. While efforts to increase the number of trained health personnel are acknowledged, a lack of sustainable investment in improving the quality of health professions education in South Africa may have detrimental consequences for these national ideals. Discussion: South Africa’s economic growth has declined in recent years, placing pressure on its fiscal capacity and the ability of academic institutions to fund critical aspects relating to training needs within health professions education programmes. Increased intakes at universities have not been supported by concurrent increases in funding required to support evolving training needs. Reduced financial support for health professions education programs has implications for required resource capacity, and will potentially negatively impact the quality, as well as global competitiveness, of health professions training programmes in South Africa. Funding gaps which impact the quality of training also ultimately affect the quality of health services delivered by the health system in the long term. Conclusion: Political will in support of more sustainable funding mechanisms for ongoing investment into health professions education programs and their evolving training needs is required in order for South Africa to meet its development objectives as outlined in the National Development Plan and its National Health Insurance policy.     &nbsp

Future-proofing imperatives for remote online teaching, learning and student support in the context of pandemic change and beyond: A case for South African higher education transformation

South Africa’s Plan for Higher Education identified equity and redress as key objectives guiding institutional transformation. This encompasses granting individuals fair opportunities to enter higher education and succeed therein. The COVID-19 pandemic which abruptly disrupted the 2020 academic year highlighted several challenges which have implications for student success. Academic continuity in the form of online learning was pursued by most higher education institutions. However, the remoteness of rural communities, which typifies the home environments for many South African students, threatened to exclude such students from online learning activities. The lack of access to digital devices as well as reliable internet connectivity in many of these communities impacted students’ ability to engage in online learning as well as access campus-based support services. The imposed lockdown therefore caused heightened anxiety and feelings of isolation from academic activities amongst the South African student population. Since access to on-campus support systems was no longer possible, student wellness and ongoing academic engagement was potentially compromised. Increasingly, the mental health cost of remote learning was becoming apparent, with higher education institutions compelled to rethink how student support services are delivered. In the absence of face-to-face support services during the hard lock-down period, the emergent need was to identify new ways of reaching out to displaced students who may be experiencing both academic and personal distress under conditions of daunting technological changes and virtual forms of engagement, social isolation, socio-economic disadvantage and psycho-social stressors. While blended learning and hybrid forms of holistic student support were accelerated by the advent of the Covid-19 pandemic, the blended approach has become an indelible reality of Higher Education that is here to stay. As such, reflections on how student support services at universities in South Africa have adapted and need to continuously evolve in the face of an uncertain world, is both timely and necessary if the goal of promoting equal access and success in Higher Education – for all - is to be fully realized

The teaching, learning and assessment of health advocacy in a South African College of Health Sciences

Health advocacy is a core competency identified by Health Professions Council of South Africa to be acquired by health professional graduates. There is a lack of information on how health advocacy (HA) is taught and assessed in health science programmes. The aim of the study was to explore the teaching, learning and assessment of HA in undergraduate health science programmes at a South African university. Methods: Curriculum mapping of eight programmes and a Focus Group Discussion (FGD) with eleven key informants were conducted using a sequential mixed methods approach. Content analysis was used to analyse Curriculum Mapping data. Thematic analysis was used to analyse the FGD data. Results from both data sets were triangulated. Results: Six themes emerged: Perceived importance of HA role for health practitioners; Implicit HA content in curricula; HA as an implicit learning outcome; Teaching HA in a spiral curriculum approach; Authentic Assessment of HA, and Perceived barriers to incorporation of HA into curricula. Conclusion and Recommendations: HA is perceived as an important role for health professionals but it is not explicitly taught and assessed in undergraduate health sciences programmes. Barriers to its teaching and assessment can be addressed through capacity development of academics

Learn 2.0 technologies and the continuing professional development of secondary school mathematics teachers

Published ArticleThe paper reports on a Learn 2.0 technology that was used to support the continuing professional development of mathematics teachers at a secondary school. Design Based Research methods were used within a Multiphase Mixed Methods research framework to create professional development opportunities that were subsequently monitored by Social Network Analysis techniques. We demonstrate that Learn 2.0 technologies can indeed support the continuing professional development of teachers and improve their performance, and also that Social Network Analysis is an effective method to describe, comprehend, clarify and transparently monitor teacher engagement during online professional development activities. We identify 'participation' as a key pre-determinant to success

Profile of the geriatric patients hospitilised at Universitas hospital, South Africa

Background: The elderly population in Africa is unevenly distributed across the continent, with the highest percentage of elderly living in the Southern African region. In 1996, the elderly population of South Africa (65 years and older) was roughly 6.7%, and was calculated to be 10.4% by 2025. If the latter expectation is anywhere near realistic, it stands to reason that the Department of Health should make timely provision for the care of these future patients, as the prevailing disease patterns within a population change as that population ages. Thus, there is an urgent need for profiles of elderly patients in order for adequate training to be implemented and for beds and equipment to be ready when needed. Methods: A retrospective study was undertaken of all data available from a clinical audit done at Universitas Hospital's Geriatric Unit. All patients aged 65 years and older who were admitted by Internal Medicine's Geriatric Unit over four years were analysed in order to compile a profile of geriatric patients hospitalised at Universitas Hospital. Results: The study group consisted of 791 elderly patients. Their average age was 81 years (range: 65 to 101 years of age) and they were hospitalised for an average of 11 days, with an average use of five medications per patient. Women represented 66% of the patients and the mortality rate was 17% in the total study group. The main admitting clinical problems were hypertension, heart failure, ischemic heart disease and anaemia. Most of the patients did not smoke or use alcohol. Out of a group of 523(due to the fact that it was a retrospective study, data for this criteria were only available for 523 of the 791 patients), 235 (45%) were self-supporting and 32% were known to use living aids. The majority of the patients were single and an equal amount were living in old age homes and with their families. The main special examinations used in their treatment were chest X-rays, nuclear examinations of the liver, ECG, heart sonar and CT of the brain, and gastroscopies. Almost all of the patients had undergone full blood count analysis and U+E determinations, and in more than 50% of cases, creatine, albumin and glucose measurements were taken. Conclusion: For successful geriatric care at Universitas Hospital there will be a need for at least 11 days hospitalisation, and a unit with good training in internal medicine, psychiatry, urology, orthopaedy and oncology. The main supporting services will be physiotherapy, occupational therapy and social welfare. Laboratory analyses will include full blood count, urea and electrolyte measurements, urine examination, and creatine and glucose measurements. Special investigations will mainly be radiology and cardiology sonar examination. How well we care for elderly patients in the future will be an indicator of the quality of our healthcare system in general. We need to redesign our social insurance and welfare systems to fit the realities of our current situation. South African Family Practice Vol. 49 (2) 2007: pp. 1

Banana cultivar distribution in Rwanda

Rwanda is part of the East African plateau where banana (Musa spp.) reach their greatest importance as a staple food crop, covering 23% of land and grown by 90% of households. The region is considered a secondary centre of diversity for banana and many cultivars do exist although limited information is available on the diversity andtheir distribution in the country. In the past, banana have been a highly sustainable crop in Rwanda, but with the introduction of various diseases and pests in the last 10 -20 years, production has fallen by over 40%. The objectives of this study were to (i) establish the current diversity and distribution of banana cultivars, (ii) understand factors that affect the distribution, and (iii) identify possible synonyms and material for expansion of the National Banana Germplasm Collection. A study was conducted in four major banana growing regions ofRwanda. Twelve sites and sixty farms were used in this study. A quadrat method was used to make observations and counts of cultivars grown per farm. Farmer interviews were carried out on each farm to make assessments on the distribution of cultivars. Cultivar identification was done by farmers and subsequently verified using the national banana germplasm collection database of the ISAR-Rubona Research Institute. Clone set identification was done using the Karamura classification system. The Kigali region had the highest diversity index, followedby Kibungo and Cyangugu; while Lake Kivu border region scored the lowest diversity index. Cultivar evenness also differed, with Cyangugu being the highest and Kivu Lake the lowest. There were two major banana subgroups determined at all sites, Lujugira-Mutika with 77.8% abundance and Pisang Awak with 11.9% abundance.A total of 104 cultivar names were recorded, with 53 synonyms identified for 51 cultivars. Forty cultivars belonged to Lujugira-Mutika subgroup, with ‘Intuntu’, ‘Intokatoke’, ‘Injagi’, ‘Mbwaziruma’ being the most abundant cultivars, while eleven cultivars were exotic. Gisubi (ABB), Gros Michel (AAA), and ‘Kamaramasenge’ (AAB) were the most abundant. Farms with a higher proportion of Gisubi contained fewer other cultivars. Also, new cultivars were identified and these should be added to the National Banana germplasm collection

Turbidity removal at twenty-one South African water treatment plants

Abstract: The Water Research Group at the Rand Afrikaans University undertook an ambitious sampling and monitoring programme at twenty-one South African water treatment plants during 2000 and 2001. At some of these plants, there were parallel but different treatment trains due to plant extensions being made at different times. A total of 25 full or partial treatment trains could therefore be monitored. A total of 115 plant visits were made over a period of fifteen months, with samples taken throughout the plant, covering the complete treatment train from raw to final water. Amongst other parameters, the turbidity of each sample was determined on site immediately upon sampling. This paper will summarise and interpret the resulting data set of approximately 1300 turbidity values. The paper will firstly characterise the raw and final waters respectively. In other words, how does typical raw water vary, and how good is the typical final water produced? The second part will summarise the typical performance of each of the treatment processes. In other words, what reduction in turbidity is typically achieved during settling, dissolved air flotation and filtration? The paper will make a practical contribution in providing a benchmark to all operators of treatment plants by: · being able to immediately "position" themselves within a typical range of raw water values. · judging their final water quality against what is generally achieved, and · evaluating and troubleshooting their individual process units against what is generally achieved

Corrigendum: A Review: The Fate of Bacteriocins in the Human Gastro-Intestinal Tract: Do They Cross the Gut–Blood Barrier?

The intestinal barrier, consisting of the vascular endothelium, epithelial cell lining, and mucus layer, covers a surface of about 400 m2. The integrity of the gut wall is sustained by transcellular proteins forming tight junctions between the epithelial cells. Protected by three layers of mucin, the gut wall forms a non-permeable barrier, keeping digestive enzymes and microorganisms within the luminal space, separate from the blood stream. Microorganisms colonizing the gut may produce bacteriocins in an attempt to outcompete pathogens. Production of bacteriocins in a harsh and complex environment such as the gastro-intestinal tract (GIT) may be below minimal inhibitory concentration (MIC) levels. At such low levels, the stability of bacteriocins may be compromised. Despite this, most bacteria in the gut have the ability to produce bacteriocins, distributed throughout the GIT. With most antimicrobial studies being performed in vitro, we know little about the migration of bacteriocins across epithelial barriers. The behavior of bacteriocins in the GIT is studied ex vivo, using models, flow cells, or membranes resembling the gut wall. Furthermore, little is known about the effect bacteriocins have on the immune system. It is generally believed that the peptides will be destroyed by macrophages once they cross the gut wall. Studies done on the survival of neurotherapeutic peptides and their crossing of the brain–blood barrier, along with other studies on small peptides intravenously injected, may provide some answers. In this review, the stability of bacteriocins in the GIT, their effect on gut epithelial cells, and their ability to cross epithelial cells are discussed. These are important questions to address in the light of recent papers advocating the use of bacteriocins as possible alternatives to, or used in combination with, antibiotics

A Review: The Fate of Bacteriocins in the Human Gastro-Intestinal Tract: Do They Cross the Gut–Blood Barrier?

The intestinal barrier, consisting of the vascular endothelium, epithelial cell lining, and mucus layer, covers a surface of about 400 m2. The integrity of the gut wall is sustained by transcellular proteins forming tight junctions between the epithelial cells. Protected by three layers of mucin, the gut wall forms a non-permeable barrier, keeping digestive enzymes and microorganisms within the luminal space, separate from the blood stream. Microorganisms colonizing the gut may produce bacteriocins in an attempt to outcompete pathogens. Production of bacteriocins in a harsh and complex environment such as the gastro-intestinal tract (GIT) may be below minimal inhibitory concentration (MIC) levels. At such low levels, the stability of bacteriocins may be compromised. Despite this, most bacteria in the gut have the ability to produce bacteriocins, distributed throughout the GIT. With most antimicrobial studies being performed in vitro, we know little about the migration of bacteriocins across epithelial barriers. The behavior of bacteriocins in the GIT is studied ex vivo, using models, flow cells, or membranes resembling the gut wall. Furthermore, little is known about the effect bacteriocins have on the immune system. It is generally believed that the peptides will be destroyed by macrophages once they cross the gut wall. Studies done on the survival of neurotherapeutic peptides and their crossing of the brain–blood barrier, along with other studies on small peptides intravenously injected, may provide some answers. In this review, the stability of bacteriocins in the GIT, their effect on gut epithelial cells, and their ability to cross epithelial cells are discussed. These are important questions to address in the light of recent papers advocating the use of bacteriocins as possible alternatives to, or used in combination with, antibiotics