Using Blended Learning To Facilitate The Mathematical Thought Processes Of Primary School Learners In A Computer Laboratory: A Case Study In Calculating Simple Areas

Primary school learners’ first encounters with mathematics in a traditional learning environment often create lifelong ‘math phobia.’(Papert 1980) The situation in a country emerging from an oppressive education system designed to educationally disempower the majority of the population is much worse. The typical scenario in a previously disadvantaged South African primary school is a classroom filled beyond capacity with the educator struggling to establish an effective learning environment. Thus the educator resorts to rote learning, drill and practice and ‘chalk and talk’ methods of teaching.  The individual needs and levels of learners are disregarded and blanket assessment methods are employed (Naidoo and Naidoo 2006b). Collaborative learning is minimal or non-existent. These traditional teaching strategies often disregard cultural and social factors, and pre-knowledge frames of learners.  Furthermore there is a dire shortage of qualified mathematics educators in the South African schooling system. Therefore there is an urgent need for alternative teaching and learning strategies to address the teaching of mathematics in primary schools. The introduction of networked computer laboratories to previously disadvantaged South African primary schools enables the use of computers as powerful tools to analyze the thought processes of learners during their early encounters with mathematics. A blended learning approach using a networked computing environment and LOGO mathematics to facilitate the teaching and learning of area in a Grade 5 class produced significantly higher grades and an enhanced learning experience, both for learners and the educator, as compared to a second Grade 5 class utilizing traditional teaching and learning methods only. This study entailed the use of software to promote collaborative learning encompassing both learner-learner and learner-educator interaction. Apart from the educator using the computer as a medium of instruction via the software, learners were allowed to actively provide input. Furthermore the software allowed the educator to view learners’ progress during activities and provide real-time input via the computer

Rising rates of Caesarean sections: an audit of Caesarean sections in a specialist private practice

Background: Caesarean section (CS) rates are increasing worldwide; rates in the private sector in South Africa are reported to be particularly high.To the best of our knowledge there has been no recent audit of Caesarean sections performed by the private health sector in KwaZulu-Natal. The aimof this study was to carry out an audit of CS in a private practice.Methods: An audit of the patient records over a period of one year was done. No personal identifiers were noted or reported on. All relevant clinicaldata were pooled and used to analyse the clinical information.Results: There were 364 deliveries in the study period and 209 of these were CS, giving a rate of 60.4%. Most of the caesarean sections were carriedout because of a previous CS; maternal request and HIV status also contributed to the high rate.Conclusion: The high CS rate in private practice is probably a window to the increased rates of Caesarean section being performed worldwide.This high rate is in keeping with trends in countries such as South America, and is considerably higher than the ideal rate of 10 to 15% in low-riskobstetric populations suggested by the WHO

Incidence of Hodgkin lymphoma in HIV-positive and HIV-negative patients at a tertiary hospital in South Africa (2005 - 2016) and comparison with other African countries

Background. Hodgkin lymphoma (HL) is the most common non-AIDS-defining cancer in HIV-positive patients. Studies on South African (SA) populations have described the prevalence as 7 - 17% of all lymphomas, 8 - 27% of head and neck lymphomas, 9% of lymph node biopsies and 4% of HIV-related malignancies. Objectives. To describe the incidence of HL at our centre between 2005 and 2016 by year, gender, HIV status, histological subclassification and bone marrow involvement, and compare these findings with similar SA and African studies. Methods. This was a retrospective study of all incident HL cases diagnosed in the Department of Pathology, National Health Laboratory Service, Tygerberg Academic Hospital, Cape Town. Follow-up, relapsed and referral cases were excluded. A positive diagnosis of HL was confirmed by either lymph node or bone marrow biopsy and was based on morphological and immunohistochemical findings in accordance with the World Health Organization classification. Results. There were 303 incident cases of HL diagnosed. The incidence increased from 2005 to 2011, with a spike in cases in 2008 and a subsequent decline overall after 2011. The highest proportion of cases was in the 25 - 49-year-old age category (51.1%). There were 77 HIV-positive patients (25.4%), of whom 53 (68.8%) had CD4+ counts <500 cells/μL. In keeping with other African studies, the main subtypes were nodular sclerosis HL (49.8%) and mixed-cellularity HL (23.1%). Bone marrow biopsy following lymph node diagnosis of HL confirmed involvement in 23.7% of patients. Conclusions. Absolute numbers of cases of HL at our centre have increased since the roll-out of antiretroviral therapy (ART) to the public sector. The recent change in policy to make ART available to all HIV-positive patients independent of CD4+ count suggests that patients will survive longer and are therefore at increased risk of developing HL. We anticipate that numbers of HL cases will increase or remain high in the coming years, and we need to prepare for this.S Afr Med J 2018;108(7):563-567

Family planning dialogue: Identifying the key determinants of young women’s use and selection of contraception in Namibia

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Incorporating Africanness into the legal curricula: The case for criminal and procedural law

Criminal and procedural law has recently come under scrutiny and been criticised as being the ‘white-man’s law’. The claim is that this academic discipline of law, as conceptualised and studied thus far, has remained too Eurocentric and lego-centric, incorporating only Western legal concepts and not embodying African values and cultures. Criminal and procedural law studies are described as Western concepts created from the viewpoint of a dominant Western culture which does not take sufficient cognisance of other cultural traditions and therefore lacks certain elements of legitimacy. There has been increasing pressure on these subjects to Africanise the law and to make it relevant to the greater South African population. Combining indigenous legal concepts and general legal theory, this article examines the current situation and endeavours to develop methods to account for the effect of African law on criminal and procedural law. The article concludes that recognition should be given to the Africanisation (or South Africanisation) of law. Law students need to be better equipped to understand the manifold pluralities within and between legal systems in order to produce lawyers and judges who are “thoroughly grounded in the cultural milieu of the society in which the courts are based”

Dose-related adverse events in South African patients prescribed clofazimine for drug-resistant tuberculosis

Background. Optimal drug levels and minimal toxicity are critical factors in improving treatment outcomes for patients prescribed new and repurposed medicine for drug-resistant (DR) tuberculosis (TB). The optimal dose and dose-related safety of clofazimine (CFZ), a repurposed medicine for DR TB, in the South African (SA) population are unknown.Objectives. To report on dose-related adverse events in patients receiving CFZ plus a background regimen for DR TB.Methods. In a retrospective review of patient folders from 2012 to 2014, adverse events documented for patients receiving high- (≥200 mg) and low-dose (100 mg) CFZ in a centralised DR TB hospital in KwaZulu-Natal Province, SA, were investigated for an association between dose-weight interactions and adverse events.Results. Of 600 patients included, 78.7% (n=472) weighed ≥50 kg. Of these, 17.4% (n=82) received 100 mg CFZ and 82.6% (n=390) received >200 mg. Of 128 patients (21.3%) who weighed <50 kg, 68.0% (n=87) received 100 mg CFZ and 32.0% (n=41) received ≥200 mg. Of 463 patients (77.2%) who were HIV-positive, 94.0% were on antiretrovirals. There was no difference between the dose-weight cohorts in the background regimen given in addition to high- or low-dose CFZ. The frequency and types of adverse events observed were similar to the published literature. When analysed per dose-weight cohort, patients weighing <50 kg and receiving high-dose CFZ (≥200 mg) had a 2.6 times higher risk of any adverse event (adjusted odds ratio (aOR) 2.57; 95% confidence interval (CI) 1.02 - 6.05; p=0.05: reference category <50 kg and 100 mg). Patients weighing <50 kg and receiving high-dose CFZ had a 3.3 times higher risk of gastrointestinal adverse events than patients weighing <50 kg and receiving 100 mg CFZ (aOR 3.30; 95% CI 1.51 - 7.19; p=0.003). A high risk of chest pain was observed in patients receiving high- and low-dose CFZ, irrespective of weight. Patients weighing <50 kg receiving high-dose CFZ had a slightly higher risk of adverse events related to the skin (aOR 1.2; 95% CI 0.55 - 2.62; p=0.7) There were no documented reports of the CFZ dose being reduced or the drug being stopped due to adverse events in the sample population.Conclusions. There is an association between dose-weight interaction and adverse events. The odds of any adverse event occurring were higher when low-weight patients (<50 kg) received high-dose CFZ (≥200 mg). Gastrointestinal and skin-related adverse events were more common when high-dose CFZ was used in patients weighing <50 kg. Chest pain was reported in patients receiving high- and low-dose CFZ, irrespective of weight, and may be a symptom of cardiac toxicity. Plasma concentrations of CFZ may be affected by drug-drug interactions, so active drug safety monitoring including electrocardiograms is recommended routinely when CFZ is part of the regimen

The wrong and wounding road: Paediatric polytrauma admitted to a level 1 trauma intensive care unit over a 5-year period

Background. Injury in childhood is a major cause of potentially preventable morbidity and mortality. In order to implement effective preventive strategies, epidemiological data on mechanisms of injury and outcome are essential.Objectives. To assess the causation, severity of injury, morbidity and mortality of paediatric trauma admitted to a level 1 trauma intensive care unit (TICU).Methods. Children were defined as being <16 years of age. The study covered the 5-year period January 2008 - December 2012. Eligible patients were identified from a prospective database maintained in the level 1 TICU at Inkosi Albert Luthuli Central Hospital, Durban, South Africa. Data extracted were referral source, mechanism of injury, age and gender distribution, injury severity score (ISS), anatomical distribution of injury and mortality.Results. A total of 181 patients admitted during the study period accounted for 15.9% of all admissions. There were 84 females (46.4%) and 97 males (53.6%), with a median age of 7 years (interquartile range (IQR) 4 - 10). Sources of admission were directly from the scene in 38 cases (21.0%), from a primary healthcare facility in 47 (26.0%), from a regional hospital in 56 (31.0%) and from a tertiary facility in 40 (22.0%). Mortality rates according to location of transfer were regional hospital 8 deaths (30.8%), tertiary facility 7 (26.9%), primary health clinic 7 (26.9%), and from the scene 4 (15.4%). Mechanisms of injury were pedestrian-motor vehicle collision (PMVC) in 105 cases (58.0%), motor vehicle passenger in 38 (21.0%), non-vehicular blunt trauma in 18 (10.0%), gunshot wounds (GSWs) in 12 (6.6%), stab wounds in 6 (3.3%), bull goring in 1 (0.5%) and bicycle accident 1 (0.5%). The median ISS for all admissions was 25 (IQR 16 - 38). ISSs were >25 in 98 patients (54.1%), 16 - 25 in 51 (28.2%), 9 - 15 in 9 (4.9%) and <9 in 13 (7.2%); 61.9% of patients had head injuries, 48.1% injuries to the extremities, 41.4% abdominal trauma, 40.3% thoracic trauma, 20.4% external soft-tissue trauma, 9.9% cervical injury and 9.4% facial trauma. There were 26 deaths (14.4%), of which PMVCs accounted for 16 (61.5%), motor vehicle passengers for 7 (26.9%), blunt trauma for 2 (7.7%) and GSWs for 1 (3.8%). The majority of deaths (92%) were of patients with an ISS >25. Of the 26 patients who died, 88.4% had a head injury, 46.2% an extremity injury, 38.5% an external injury, 34.6% abdominal or chest injuries, 19.2% neck injury and 11.5% facial injury.Conclusions. Motor vehicle-related injuries, especially PMVCs, dominate severe paediatric trauma and there is an urgent need for more road traffic education and stringent measures to decrease the incidence and associated morbidity and mortality

Conspicuous by its absence: Domestic violence intervention in South African pre-hospital emergency care

Domestic violence (DV) is common globally. In South Africa, emergency care providers (ECPs) lack a clear policy framework and the necessary training to identify DV and intervene when it is encountered. We investigate the knowledge, attitudes and beliefs of ECPs towards DV, and identify factors affecting early identification and its appropriate management in South Africa. A survey of 154/266 registered operational ECPs of different qualification levels and employed by a provincial emergency medical service was conducted. Each participant voluntarily and anonymously self-completed a customised questionnaire. Some 75 (49%) ECPs had an acceptable understanding of DV, although those with higher level qualifications were significantly more knowledgeable (p = 0.017). Most (147,97%) identified that alcohol and drugs were the main cause of DV. A few ECPs (15, 10%) reported having had experience of safety-focused and appropriate gender-sensitive handling of DV victims. The ECPs’ qualification levels were not significantly associated with their knowledge of the legislation about DV or with whether they had referred victims of DV. Only 49 (22%) ECPs reported having occasionally referred victims. By their own admission these ECPs expressed inadequate ability to assess and manage DV cases in current ECP practices. There was poor understanding of the extent, nature, detection and referral of DV cases by ECPs relative to their incidence. This may be due to incorrect beliefs or myths about DV, inadequate training and problematic emergency system design. Our findings support the need for a comprehensive emergency care response to guide and standardise DV management with better understanding of gender-based violence in order for the emergency medical service to play a more preventive and holistic role in its responses.Keywords: Emergency care provider, domestic violence, crisis intervention, universal/selective screening, clinical case finding, emergency medical servic

Effects of greywater irrigation on germination, growth and photosynthetic characteristics in selected African leafy vegetables

The reuse of greywater, wastewater from sources other than toilets, could enable low-income  households to save potable water for drinking and cooking. Greywater irrigation of food crops is widely practised but its effects on African leafy vegetables (ALVs), which hold potential for cultivation to improve food security, are unknown. This study investigated the effects of synthetic greywater  irrigation on germination in three ALVs, viz., Amaranthus dubius, Cleome gynandra and Solanum nigrum, and subsequent seedling growth in A. dubius and S. nigrum. Seeds and seedlings were treated with chlorinated and dechlorinated greywater and tap water, supplemented with nutrients. Greywater application decreased germination capacity (by 23–25%) when assessed in Petri dishes in A. dubius only. However, greywater application was less harmful to A. dubius seeds sown in soil. Vigour was compromised in greywater-treated seeds of all three species but greywater can be used to irrigate freshly-sown seeds of A. dubius without reducing percentage seedling production. However, greywater irrigation reduced capacity (by 21–23%) and rate of shoot emergence in S. nigrum, and growth and chlorophyll content in both species. These negative effects were accompanied by increased soil  electrical conductivity (after 21 d) and pH (after 14 d). The reduced growth under greywater irrigation was most likely based on a reduction in light-harvesting capacity and/or nutrient availability. Overall, S. nigrum seedlings were significantly more sensitive to the negative effects of greywater, possibly due to increased transpirational water loss under greywater irrigation. The effects of greywater were largely independent of chlorine content. Applying greywater in excess of plant requirements and/or alternating greywater irrigation events with freshwater watering events could promote leaching of salts found in greywater. The effects of greywater irrigation on soil water and nutrient availability demand further investigation for ALVs.Keywords: African leafy vegetables, greywater irrigation, germination, seedling growt