5 research outputs found
Exploring the opportunities and challenges of teaching controversial topics in Social Sciences at the Intermediate Phase
No full textDissertation (M.Ed.(Curriculum Studies))--University of the Free State, 2024The study investigated the challenges and opportunities that teachers face when teaching controversial topics in the Social Sciences at the Intermediate Phase. Controversial topics, which involve conflicting interests and perspectives, can be emotionally charged and challenging because they arouse emotions among learners. However, teaching such topics can empower learners, foster diversity, enhance subject knowledge, and promote a deeper understanding of justice and inclusivity. This study utilised critical social theory to explore the influence of power dynamics, ideology, and societal structures on knowledge creation. Its goal was to challenge existing norms and promote equity by encouraging critical thinking and open dialogue among learners.
A qualitative approach was employed, utilising open-ended interviews and focus group discussions, to investigate teachers’ experiences in teaching controversial topics. A narrative research design was used to explore the complexity and perspectives surrounding the teaching of contentious topics in Social Science classrooms. By comparing and contrasting different narratives, a deeper understanding of the opportunities and challenges encountered by Intermediate Phase teachers when engaging learners on controversial topics was achieved. Thematic analysis was used to generate themes and sub-themes from the transcribed data.
Findings revealed that topics like racism, tribal discrimination, gender roles, and religious diversity spark debate and opposing views within communities and the classroom. During interviews teachers explained that inclusive learning settings and critical social theory are essential for transformative learning. By teaching controversial topics, teachers play a crucial role in fostering social awareness, critical thinking and active citizenship skills which expose conscious and unconscious biases among learners. Controversial topics align with curriculum guidelines, such as the United Nations Declaration on the Rights of Indigenous Peoples and South Africa's Social Sciences curriculum, encouraging critical citizenship and understanding of social justice concerns.
Teachers in this study acknowledged the impact of cultural origins on teaching contentious subjects such as gender norms, religious diversity, racial and tribal discrimination, and xenophobia. Teachers emphasised the importance of promoting tolerance and diversity in their teaching methods by using case studies, role-playing and multimedia content. They used these techniques to develop empathy and a sense of diversity among learners. They also employed coping strategies, active learning techniques, debates, and multimodal approaches to address systematic disparities and promote inclusivity among learners.
The study recommended six strategies for teaching controversial topics in the Intermediate Phase. These are facilitating structured debates, examining the causes of intolerance, community involvement, fostering a culture of trust in teachers, and using case studies. These strategies promote self-reflection, critical thinking and effective communication by exposing learners to diverse perspectives
Neonatal resuscitation: in pursuit of evidence gaps in knowledge
No full textGuidelines for the techniques of resuscitating newly born infants have undergone major revisions over the past 25 years. the International Liaison Committee on Resuscitation (ILCOR) is committed to periodically developing and publishing a consensus on resuscitation science every five years with the most recent Consensus on Science and Treatment Recommendations (CoSTR) statement published in 2010. the CoSTR document is used as a basis for developing specific resuscitation guidelines felt to be appropriate for implementation in respective countries. A gaps in knowledge summary is created at the conclusion of a cycle. It is a goal that identification of these knowledge gaps will stimulate investigators to pursue more targeted studies to help close the gaps. the current document is based on the gaps in knowledge summary for neonatal resuscitation that was created at the conclusion of the 2005-2010 ILCOR cycle. (c) 2012 Elsevier Ireland Ltd. All rights reserved.Weill Cornell Med Coll, New York Presbyterian Hosp, Div Newborn Med, Neonatal ILCOR Task Force,Amer Heart Assoc,Amer A, New York, NY 10065 USAUniv Virginia, Dept Pediat, Div Neonatol, Neonatal ILCOR Task Force,Amer Heart Assoc,Amer A, Charlottesville, VA USAJames Cook Univ, Dept Neonatol, UK Resuscitat Council, Neonatal ILCOR Task Force,European Resuscitat Cou, Middlesbrough TS4 3BW, Cleveland, EnglandUniversidade Federal de São Paulo, Div Neonatal Med, Brazilian Resuscitat Council, Neonatal ILCOR Task Force, BR-01410011 São Paulo, BrazilUniv Witwatersrand, Chris Hani Hosp, Div Newborn Med, Neonatal Task Force,Resuscitat Council So Afr, ZA-2050 Wits, South AfricaCalgary Reg Hlth Author, Div Neonatal Perinatal Med, Canadian Resuscitat Council, Neonatal Task Force, Calgary, AB T2N 2T9, CanadaUniversidade Federal de São Paulo, Div Neonatal Med, Brazilian Resuscitat Council, Neonatal ILCOR Task Force, BR-01410011 São Paulo, BrazilWeb of ScienceLaerdal Foundation for Acute Medicin
Single surgeon case series of myelomeningocele repairs in a developing world setting: Challenges and lessons
No full textPurpose: Neural Tube Defects are the second most common group of birth malformations following congenital heart anomalies, with myelomeningoceles being the most severe manifestation (MMC). They require expedited surgical repair, preferably within 72 h of birth. In low- and middle-income countries (LMIC) where resources are limited, timing to MMC repair is not optimal and leads to undesirable outcomes. The purpose of this study was to determine whether a proactive approach in a setting from a LMIC could achieve repair within 72 h. Methods: A concerted effort to expedite repair of all neonates referred with a MMC was undertaken from 01 January 2014 to 1 August 2015. A consensus was reached between neonatologists and neurosurgeons that neonates born or admitted with a MMC are referred immediately to surgeons and that repair will be performed within 72 h of birth. Hospital records of neonates who had MMC repaired during this period were reviewed for infant characteristics and hospital outcomes. Results: 24 patients with a MMC were operated upon by the senior author (CP) during the study period. Only 13 of these patients were born at the treating institution and 11 were referred from outside hospitals. Most MMCs were in the lumbosacral region and mean MMC surface area was 19.4 cm2. Mean time to repair for the entire series was 13.6 days. Patients born at the treating institution has a mean time to repair of 10.5 days and patients referred from outside had a mean time to repair of 17.3 days. Series wide, only 21% of neonates were operated upon in less than 72 h. Conclusion: Despite a pro-active commitment to repairing MMCs within 72 h for the duration of this series, satisfactory time to repair was not achieved. Late referral, referral from outside hospitals and operating theatre availability were the predominant factors leading to delay in MMC repair. Nevertheless, time to repair in our series was significantly shorter than that reported in MMC repair series based in similar environments. This suggests that even if the gold-standard of a 72-h window cannot be achieved, neonates benefit from much quicker repair when a concerted effort to minimise repair time is employed. This study also highlights the urgent need to address health care constraints in LMIC to improve outcomes for this vulnerable group
Initial findings from a novel population-based child mortality surveillance approach : a descriptive study
No full textPublisher Copyright: © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Sub-Saharan Africa and south Asia contributed 81% of 5·9 million under-5 deaths and 77% of 2·6 million stillbirths worldwide in 2015. Vital registration and verbal autopsy data are mainstays for the estimation of leading causes of death, but both are non-specific and focus on a single underlying cause. We aimed to provide granular data on the contributory causes of death in stillborn fetuses and in deceased neonates and children younger than 5 years, to inform child mortality prevention efforts. Methods: The Child Health and Mortality Prevention Surveillance (CHAMPS) Network was established at sites in seven countries (Baliakandi, Bangladesh; Harar and Kersa, Ethiopia; Siaya and Kisumu, Kenya; Bamako, Mali; Manhiça, Mozambique; Bombali, Sierra Leone; and Soweto, South Africa) to collect standardised, population-based, longitudinal data on under-5 mortality and stillbirths in sub-Saharan Africa and south Asia, to improve the accuracy of determining causes of death. Here, we analysed data obtained in the first 2 years after the implementation of CHAMPS at the first five operational sites, during which surveillance and post-mortem diagnostics, including minimally invasive tissue sampling (MITS), were used. Data were abstracted from all available clinical records of deceased children, and relevant maternal health records were also extracted for stillbirths and neonatal deaths, to incorporate reported pregnancy or delivery complications. Expert panels followed standardised procedures to characterise causal chains leading to death, including underlying, intermediate (comorbid or antecedent causes), and immediate causes of death for stillbirths, neonatal deaths, and child (age 1–59 months) deaths. Findings: Between Dec 10, 2016, and Dec 31, 2018, MITS procedures were implemented at five sites in Mozambique, South Africa, Kenya, Mali, and Bangladesh. We screened 2385 death notifications for inclusion eligibility, following which 1295 families were approached for consent; consent was provided for MITS by 963 (74%) of 1295 eligible cases approached. At least one cause of death was identified in 912 (98%) of 933 cases (180 stillbirths, 449 neonatal deaths, and 304 child deaths); two or more conditions were identified in the causal chain for 585 (63%) of 933 cases. The most common underlying causes of stillbirth were perinatal asphyxia or hypoxia (130 [72%] of 180 stillbirths) and congenital infection or sepsis (27 [15%]). The most common underlying causes of neonatal death were preterm birth complications (187 [42%] of 449 neonatal deaths), perinatal asphyxia or hypoxia (98 [22%]), and neonatal sepsis (50 [11%]). The most common underlying causes of child deaths were congenital birth defects (39 [13%] of 304 deaths), lower respiratory infection (37 [12%]), and HIV (35 [12%]). In 503 (54%) of 933 cases, at least one contributory pathogen was identified. Cytomegalovirus, Escherichia coli, group B Streptococcus, and other infections contributed to 30 (17%) of 180 stillbirths. Among neonatal deaths with underlying prematurity, 60% were precipitated by other infectious causes. Of the 275 child deaths with infectious causes, the most common contributory pathogens were Klebsiella pneumoniae (86 [31%]), Streptococcus pneumoniae (54 [20%]), HIV (40 [15%]), and cytomegalovirus (34 [12%]), and multiple infections were common. Lower respiratory tract infection contributed to 174 (57%) of 304 child deaths. Interpretation: Cause of death determination using MITS enabled detailed characterisation of contributing conditions. Global estimates of child mortality aetiologies, which are currently based on a single syndromic cause for each death, will be strengthened by findings from CHAMPS. This approach adds specificity and provides a more complete overview of the chain of events leading to death, highlighting multiple potential interventions to prevent under-5 mortality and stillbirths. Funding: Bill & Melinda Gates Foundation
Global burden of bacterial antimicrobial resistance in 2019 : a systematic analysis
No full textAbstract: Background Antimicrobial resistance (AMR) poses a major threat to human health around the world. Previous publications have estimated the effect of AMR on incidence, deaths, hospital length of stay, and health-care costs for specific pathogen-drug combinations in select locations. To our knowledge, this study presents the most comprehensive estimates of AMR burden to date. Methods We estimated deaths and disability-adjusted life-years (DALYs) attributable to and associated with bacterial AMR for 23 pathogens and 88 pathogen-drug combinations in 204 countries and territories in 2019. We obtained data from systematic literature reviews, hospital systems, surveillance systems, and other sources, covering 471 million individual records or isolates and 7585 study-location-years. We used predictive statistical modelling to produce estimates of AMR burden for all locations, including for locations with no data. Our approach can be divided into five broad components: number of deaths where infection played a role, proportion of infectious deaths attributable to a given infectious syndrome, proportion of infectious syndrome deaths attributable to a given pathogen, the percentage of a given pathogen resistant to an antibiotic of interest, and the excess risk of death or duration of an infection associated with this resistance. Using these components, we estimated disease burden based on two counterfactuals: deaths attributable to AMR (based on an alternative scenario in which all drug-resistant infections were replaced by drug-susceptible infections), and deaths associated with AMR (based on an alternative scenario in which all drug-resistant infections were replaced by no infection). We generated 95% uncertainty intervals (UIs) for final estimates as the 25th and 975th ordered values across 1000 posterior draws, and models were cross-validated for out-of-sample predictive validity. We present final estimates aggregated to the global and regional level. Findings On the basis of our predictive statistical models, there were an estimated 4.95 million (3.62-6.57) deaths associated with bacterial AMR in 2019, including 1.27 million (95% UI 0.911-1.71) deaths attributable to bacterial AMR. At the regional level, we estimated the all-age death rate attributable to resistance to be highest in western subSaharan Africa, at 27.3 deaths per 100 000 (20.9-35.3), and lowest in Australasia, at 6.5 deaths (4.3-9.4) per 100 000. Lower respiratory infections accounted for more than 1.5 million deaths associated with resistance in 2019, making it the most burdensome infectious syndrome. The six leading pathogens for deaths associated with resistance (Escherichia coli, followed by Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa) were responsible for 929 000 (660 000-1 270 000) deaths attributable to AMR and 3.57 million (2.62-4.78) deaths associated with AMR in 2019. One pathogen-drug combination, meticillin-resistant S aureus, caused more than 100 000 deaths attributable to AMR in 2019, while six more each caused 50 000-100 000 deaths: multidrug-resistant excluding extensively drug-resistant tuberculosis, third-generation cephalosporin-resistant E coli, carbapenem-resistant A baumannii, fluoroquinolone-resistant E coli, carbapenem-resistant K pneumoniae, and third-generation cephalosporin-resistant K pneumoniae. Interpretation To our knowledge, this study provides the first comprehensive assessment of the global burden of AMR, as well as an evaluation of the availability of data. AMR is a leading cause of death around the world, with the highest burdens in low-resource settings. Understanding the burden of AMR and the leading pathogen-drug combinations contributing to it is crucial to making informed and location-specific policy decisions, particularly about infection prevention and control programmes, access to essential antibiotics, and research and development of new vaccines and antibiotics. There are serious data gaps in many low-income settings, emphasising the need to expand microbiology laboratory capacity and data collection systems to improve our understanding of this important human health threat. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd
