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    An analysis of extreme temperature events (ETEs) of Namibia
    (University of the Witwatersrand, Johannesburg, 2021) Steyn, Christiaan; Dr Adriaan van der Walt; Professor Jennifer Fitchett
    Heatwaves, warm spells, cold waves, and cold spells are examples of extreme temperature events (ETEs) that have catastrophic consequences for human health and ecosystems. Climate change is expected to increase the frequency, intensity, and length of ETEs. Effective adaptation to ETEs necessitates an appreciation of their current frequency and likelihood of occurrence in the face of climate change. Extreme events have received very little attention, especially in developing countries, including Namibia. Due to Namibia’s low adaptive ability, urgent development needs, and relatively poor infrastructure, these events pose a significant danger. This research examines extreme weather events over time, both annually and seasonally, as well as spatially over the period 2008-2018. The World Meteorological Organisation Expert Team on Climate Change Detection (ETCCDI) and the World Meteorological Organisation Commission for Climatology and Indices Expert Team on SectorSpecific Climate Indices (ET-SCI) were used to determine ETEs, using ClimPACT and RClimDex. The non-parametric Mann-Kendall, Spearman Rank Correlation Coefficient, and Sen's slope estimates were used to quantify trends. Annual and seasonal cold spell duration were identified as 4.86 days. An average of 1.99 cold waves was identified with an average duration of 4.59 days. The results identified an average number of heatwaves of 1.6 lasting 3.2 days. The majority of ETEs occur in the central, northeast and southeast of the country. The west coast has experienced ETEs, but with less intensity. Since studies indicate that unusually temperature events may persist in a warming world, these findings help raise awareness and recognise the frequency and length of extreme events in Namibia.
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    The Impact of learning mathematical vocabulary of functions using the frayer model on conceptual understanding and mathematical performance of Grade 11 learner
    (2023-03) Madzore, Edwin
    This study investigated the impact of integrating the learning of mathematical vocabulary and the learning of mathematical content by Grade 11 learners in secondary schools in Gauteng province, South Africa. The main research question of the study is: what affordances does the integration of focused vocabulary and mathematical content learning provide for conceptual understanding and performance in mathematics? A cohort of Grade 11 learners (n=157) took part in this quasi-experimental study with control (n=83) and experimental (n=74). The experimental group was exposed to explicit learning of mathematical vocabulary using the Frayer model, while the control group used any other method preferred by their teachers. During the posttest, learners from the experimental group outperformed their counterparts in associating mathematical vocabulary with a mathematical graph. The study showed that the Frayer model is an effective strategy for learning mathematical vocabulary. When learners learnt mathematical vocabulary using the Frayer model, they mastered more vocabulary than their peers in the control group and this translated into improved conceptual understanding and performance in mathematics. There is a positive moderate correlation (r = 0.61) between the quantity of correct mathematical vocabulary that learners know and the marks those learners obtain in a mathematics test. The study further showed that it is possible to adopt Content and Language Integrated Learning (CLIL) in South African Schools
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    Conceptualisation of Inclusive education: Impact on primary school principals and foundation phase teachers
    (2023-09) Dewa, Nokuthula Ntombiyelizwe
    This study investigated how the conceptualisations of Inclusive Education (IE) by primary school principals and Foundation Phase teachers impact teaching practices. The study places a high value on participants' IE conceptualisations because they have an impact on teachers' actions in their classrooms, which can either support or limit teachers' inclusive practices in granting epistemic access to learning to all learners. The study addressed the question of how primary school principals and Foundation Phase teachers conceptualise IE and considered the implications of these conceptualisations on their practice. Conceptualisations inform pedagogical practice, and I argue that a pedagogical shift that takes accountability for providing learning opportunities for all learners regardless of difference is necessary. A qualitative transformational research method was used to collect data, and thirteen Foundation Phase (FP) teachers and three school principals were conveniently and purposefully chosen from three Government primary schools, in Johannesburg South. Individual semi-structured interviews and focus group interviews were used to collect data, which was then thematically analysed using both inductive and deductive methods. With some extensions and adjustments, two theoretical frameworks were used for this study: the Inclusive Pedagogical Approach (IPA) and Bronfenbrenner's Ecological Systems Theory. Although Black-Hawkins (2017) argues for three required inclusive pedagogical shifts for teachers to teach inclusively, this study’s findings reveal that teachers in South Africa are currently at three different levels of development toward the required pedagogical shift, which is why IE implementation is hampered despite the numerous IE issues raised by previous studies. According to the findings of this study, there are teachers who have little to no pedagogical shift toward inclusive practices, teachers who have an emerging shift, and teachers who have an established shift. These stages of the pedagogical shift are supported by various conceptualisations that influence teachers' actions, leading to a variety of teaching strategies, some of which do not involve all learners in teaching and learning. The study recommended that the actual stage of shift be considered to support continued progress toward inclusive practice. Teachers who have made little or nopedagogical shift toward inclusivity should be made aware of IE policies and practices, while those who have made an emerging pedagogical shift should be encouraged and assisted in including everyone in their teaching and learning, and those who have made an established pedagogical shift should be developed further in maintaining and improving inclusive practices
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    Children moving across borders: equitable access to education for undocumented migrants in South Africa
    (2023-09) Blessed-Sayah, Sarah Enaan-Maseph
    South Africa is experiencing an increase in intra-regional migration, and the management of migration in the country is increasingly becoming highly securitised. Individuals who move intra-regionally across borders include children – accompanied by parents or caretakers, unaccompanied, and those seeking refuge because of untenable and oppressive circumstances in their home country. Also, individuals who move to South Africa without legal documentation often give birth to children within the State, who are then undocumented. Without documentation, these children cannot access education, which means that achieving their educational right becomes impossible. This happens partly because of legal contradictions that exist in immigration and education policy frameworks. For instance, the Bill of Rights, as contained in Section 29(1)(a) of the Constitution of South Africa (The Constitution of the Republic of South Africa No. 108, 1996), states that everyone has the right to basic education, and further states in subsection 2 that the State (being South Africa) is obligated to respect this right. Additionally, the South African Schools Act 84 of 1996 (Republic of South Africa, 1996) states that public schools are obliged to admit children without any form of discrimination on any grounds. However, the Immigration Act No 13 of 2002 states that no ‘illegal foreigner’ should be allowed on the premises of any learning institution (Republic of South Africa The Presidency, 2002). Thus, the question remains whether undocumented migrant children are included in the ‘all’ or ‘every’ because of existing legal contradictions between the Constitution and the Immigration Policy. Furthermore, the need to consider how the educational right of undocumented migrant children is upheld comes from the evident nationalist view on migration in South Africa, which is projected through government, and in local communities. Although some studies have evaluated the extent to which this right is protected or ensured, and others have considered the barriers to exercising the right to education in South Africa, only a few specifically focus on the right of undocumented migrant children to equitable education, and strategies to ensure its fulfilment. Thus, an explanation of equitable access to education in South Africa entails developing an approach for understanding undocumented migrant children’s educational experience, because this approach would provide a platform to achieve workable ways to ensure the fulfilment of their right to basic education. This research explores the difficulties undocumented migrant children experience in relation to education. Given this, an explanation regarding access to education for undocumented migrant children, from an equity viewpoint in South Africa, is developed. Thus, this study had three major aims. Firstly, to develop an understanding of equity in relation to access to education. Secondly, to investigate the impact (problems) of migration on undocumented migrant children in relation to equitable access to education in South Africa. Thirdly, to develop strategies that can ensure that these undocumented migrant children have their right to basic education protected in South Africa. Using the capability approach combined with Unterhalter’s (2009) description of equity as a three-fold concept as the study’s conceptual framework, I argue that ensuring equitable access to education for undocumented migrant children in South Africa requires an integrated approach, which goes beyond top-down strategies and highlights the role of agency. Each finding under the study’s objectives serves as evidence that support my overall argument for an integrated approach. A qualitative research design, from an interpretivist phenomenological lens provided me with the opportunity to carefully interact and bring forward the contextualised lived experiences of undocumented migrant children. This brought about an in-depth description of equitable access to education for them. The study was conducted with an NGO working with undocumented migrant children in the eastern region of the Johannesburg area in the Gauteng province of South Africa. The criterion used for selecting participants was based on the fact that the Project staff members, children who attend the Project, and their parents understand the social environment in which the children reside. They were able to give detailed and in-depth explanations on the impact of migration on their access to education, in an equitable manner. Gauteng Department of Education (GDE) officials who deal with undocumented migrant children, and South African Human Rights Commission (SAHRC) staff who deal with education also understand the impact of migration on these children’s chance to equitably access education and were included in the study. A total of 45 participants who were conveniently selected, based on the inclusion criteria, made up the sample size. Nineteen undocumented migrant children (n=19), eleven parents of undocumented migrant children (n=11), and fifteen professionals participated in this study (n=15). I served as the primary tool for data collection while employing different qualitative methods, including individual semiistructured interviews and focus group discussions. The method of data analysis I used for this study included an inductive and deductive approach using the NVivo QSR 12 software. From this method of data analysis, I identified three key themes relating to the specific objectives of the study. Objective 1: I found that undocumented migrant children, their parents, and professionals who deal with this group of children perceive equity to mean ‘the opportunity to thrive’ and ‘fairness’. In addition, under the first objective, it was found that equitable access to education is closely linked to being able to attend schools. While the undocumented migrant children described this in terms of the right to attend school and learn educational skills, the parent and professional participants explained it as a fundamental human right which should not be constrained by one’s legal status in South Africa. Along this line, it was also revealed that equitable access to education is important for various reasons including access to other services; capabilities, functioning, and the platform to achieve other human rights; and the avoidance of social ills. In all, equitable access to education strongly supports the human dignity of undocumented migrant children. Objective 2: Under objective two, I found that the impact of migration to South Africa, as it concerns equitable access to education for undocumented migrant children, was negative. Various problems faced by these children were identified. Firstly, the overarching problem was the lack of documentation which affects the opportunity for undocumented migrant children to equitably access school. This lack of documentation includes the non-issuance of proper birth certificates and so, the non-registration of the births of these children; and the fear of going to renew or apply for permits at the South African Department of Home Affairs (DHA) because of fear of police arrest. Secondly, the problem of continued discrimination, and xenophobic attacks and attitudes was also experienced by undocumented migrant children and their parents. These attacks affected their chance to access education. Thirdly, the lack of access to basic services presented itself as a difficulty which affects the opportunity to access schools, in an equitable way. Fourth, policy gaps, including ambiguities and non-implementation of recent court judgments, also served as problems which affect access to education for these children. Lastly, Covid-19 and the effects of the pandemic further compounded already existing difficulties undocumented migrant children face concerning their equitable access to education. Objective 3: The study revealed that strategies to address the problems experienced by undocumented migrant children include government-level, community-level, and individual-level strategies, and a combined, planned approach (integrated approach). Under government-level strategies, it was found that undocumented migrant children need to be issued birth certificates with identification or registration numbers and so, be appropriately registered at birth. Existing policies about education and immigration also need to be revised, and recent court judgments like the Phakamisa Judgment must be implemented. Also, stakeholders must be trained to ensure the proper implementation, monitoring, and evaluation of policies and recent judgments on equitable access to education for undocumented migrant children. As part of community level strategies more assistance from NGOs, who bridge educational gaps for undocumented migrant children, would be useful in ensuring undocumented migrant children get educated. Individually, promoting social cohesion between migrants and non-migrants was highlighted. Also, parents of the identified children were encouraged to acquire documentation for their children. However, these different levels, on their own, are not sufficient to ensure equitable access to education. Thus, this study advocates an integrated approach to addressing the problems experienced by undocumented migrant children and their parents, regarding their children’s equitable access to education. Supporting this, the professionals interviewed recommend that all levels of society need to work together, in an organised way, to achieve access to education for the identified group of children. Also, the role of the agency and a bottom-up approach to ensuring access to education in an equitable way were highlighted through the integrated approach. Based on the findings, I argue that the various strategies identified require an integrated approach (for thinking and doing), which includes recognising the agency (individually and collectively) of undocumented migrant children. This approach draws on both top-down and bottom-up approaches with the significant roles of policy implementation, monitoring, and evaluation as well as agency (in both individual and collective forms) highlighted. Important is that this integrated approach (for thinking and doing) will be based on a thorough knowledge of the context. The findings thus serve as supporting empirical evidence for the overall thesis which is that to ensure equitable access to education is achieved, equity must be explained in detail, as a multi-faceted notion, and combined with the capability approach, which allows us to identify and interrogate specific structural limitations.
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    Exploring a culture of reading: a case study in an under-resourced South African primary school
    (2023-09) Claire, Biesman-Simon
    South Africa faces an undeniable literacy crisis. Since 2000, there have been increasing calls for the creation of a culture of reading to address this crisis. This has been on the part of the South African government, academia and civil society. However, this has occurred without clear consensus on the term’s meaning and with little explanation of how a poorly-defined concept with its origins in the Global North would achieve this outcome. How this term has achieved such national prominence and the ways it affects school practices motivated this research. The first phase of the study investigated how the term “culture of reading” functions in national government education discourse, and its impact on the country’s reading landscape. This was followed by an ethnographic-style case study exploring the factors that shaped a culture of reading at a no-fee primary school, situated on the Cape Flats in Cape Town. Drawing on a review of more than 400 South African, African and global texts that reference “culture of reading”, this study provides a definition of a culture of reading that is appropriate for the African context, and central to the analysis of this study. To investigate how the term “culture of reading” functions in government discourse, I performed a textual analysis of a corpus of 58 publicly available texts produced by the South African government from 2000 to 2019. The analysis reveals an uncritical faith in a culture of reading as fundamental to improved reading levels despite there being no clarity on the term’s meaning or evidence of tangible outcomes in learners’ reading achievement. Bourdieu’s notion of doxa is drawn on to demonstrate how the government’s consistent return to an ill-defined Global Northern ideal is indicative of a misunderstanding of what reading is and can achieve, and of a need to further grapple with the complexities of South Africa’s reading landscape. Approaching reading from a socio-cultural perspective, the ethnographic-style case study investigates how habitus, capital and field (Bourdieu, 1990b) interact to shape school reading practices, and how the resulting culture of reading is reflected in one school’s reading practices. The case study shows the contextual realities and conditions in the field that affect the promotion of a culture of reading. Data was generated from interviews with 51 participants, classroom and schoolwide observations, photo elicitation, and document reviews which were subjected to a thematic analysis. Findings indicate that despite the evident value that staff and most learners attribute to reading and their positive dispositions towards reading (i.e. their habitus), the school’s culture of reading is undermined by external and internal forces. This is most notably with regard to inappropriate curriculum demands, a multilingual learner body restricted to learning in English, the impact of a community fraught with violence, as well as a dysfunctional culture of teaching and learning that has resulted in a divided staff body and poor discipline. Bourdieu’s attention to how no field exists in isolation is demonstrated by educators’ battles to promote reading in an education field that does not account sufficiently for social, cultural and economic contextual realities. Data generated in the Grade 5 classroom evidenced that agentive educators, equipped with the necessary cultural capital, can construct a sub-field that supports a culture of reading in spite of these constraints. However, this is precarious, and findings from the Grade 1 classroom demonstrated how overlapping fields and a dysfunctional culture of teaching and learning constrained an experienced educator, impacting on her wellbeing. The study highlights that there are many ways in which schools and educators can navigate and overcome institutional constraints that threaten South African learners’ reading development. The research highlights the need for closer alignment between government’s expectations of schools and their contextual realities, with educators’ professional and emotional wellbeing needing to be prioritised. Recommendations for research include further investigation into learners’ home and community language and literacy practices and how these practices can be built on at school.
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    Punctuated lives: the (un)making of Thwalwa’ed Subjects in Engcobo, South Africa
    (2022-08) Ndlovu, Thatshisiwe
    This study is about a particular group of women who were married through a specific cultural practice commonly known as ukuthwala (bride abduction) in South Africa, and it details the lives and experiences of these women. The study examines the technologies and mechanisms that sustain this cultural practice, and raises questions on who sanctions this cultural practice, how it is sustained and why. While arguing that ukuthwala is a violent cultural practice, it also uncovers women’s responses to this practice in their everyday lives. The thesis departs from the mainstream arguments on ukuthwala that focus on describing and detailing its scandalous nature by bringing into sharp focus discussions of the women’s own experiences and representations of this practice as one of the entry points in revealing the complex multiplicity of dynamics at play that are often missed in mainstream studies. While acknowledging that women have been silenced through and by this practice, the thesis brings women’s voices to the centre of its discussions and to knowledge production about the practice. It does so by prioritising the experiences of ukuthwalwa (those being abducted). Drawing on ethnographic research, including the life histories of thwalwa’ed women based on their own narration of their experiences, I ask how ukuthwala is perceived and experienced by these women and what the impact of dominant ideas is on women’s experiences of ukuthwalwa. I explore two related phenomena. Firstly, the complexities that pervade thwalwa’ed women’s lived lives, how these women live through ukuthwalwa, including ways that they find to resist, negotiate or adapt to their subjectivation. Secondly, the entities and technologies that ensure the continued existence of this practice, in particular, the ways in which culture works to enforce patriarchy through sanctioned forms of violence. The findings indicate that a thwala’ed subject is created through complex operations of violent power relations and within a framework of pain and suffering. I argue that understanding this complexity requires attention to how culture works in the interests of patriarchy as an ideological tool to impose a script on the lives of women such that they must come to terms with a new self – a thwalwa’ed self that struggles with itself. In that vein, I employ the notion of embodiment as the condition of “being in the world” (Csordas,1994) to uncover how the violence of ukuthwala, and the consequent pain and suffering are lived and embodied. Additionally, through the examination of the everyday tactics that these women utilise to navigate their lives, I argue that thwalwa’ed women are neither victims nor are they victors. I try to understand the women’s relationship to their constrained agency through the conceptual lens of ‘shifting vulnerabilities’ where women find ways of using their vulnerabilities to exercise their power in small acts in their everyday lives that sometimes exhibit resistance. Mostly, though, these acts exist within the accepted norms and expectations of the system that is designed to keep them in positions of subordination. In this way, I offer a reading of ukuthwalwa as one of a process of subjectivation (after Foucault) in which those on whom violence is enacted, act in their own interests, without accepting that which is imposed on them, even if only in small and hidden ways, reclaiming their own power to shape their subjectivities, albeit often without contesting or changing the system that oppresses them in its entirety.
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    Professional learning communities for inclusive pedagogy: What teacher talk in professional communities reveals about teacher professional identity and agency
    (2023-09) Kimani, Wacango Muguro
    In-service teacher learning for inclusive pedagogy seeks to address the perceived lack of capacity for teaching in inclusive classrooms in South Africa. Research suggests that teachers feel underprepared for this task, and that the prevalent delivery models for this learning, workshops, and short courses, have done little to enable sustained inclusive practices. This study took a new direction, arguing that simply acquiring knowledge and skills for inclusive teaching misses the need to focus on teacher professional identity and agency. The professional and institutional change required for teachers to be pedagogically responsive to a range of learners, demands that professional learning address teachers’ immediate realities, be a long-term, school-based professional learning programme. A three-year study in a full-service school in Johannesburg, South Africa, investigated teacher talk within professional learning communities (PLCs). PLCs are situated in practice and can promote and sustain teachers’ learning over an extended period. Wenger’s (1998) theory of learning as social practice and Sfard and Prusak’s (2005) theory of identity as narrative provided analytical insights into identity and agency in the PLCs. The subject focus of the PLCs was inclusive pedagogy, and the analysis was based on the Inclusive Pedagogical Approach in Action (IPAA) (Florian & Spratt, 2013). Using a Critical interpretivism perspective, teacher talk in the PLCs and individual teacher interviews were analysed. Analysis of teacher talk in relation to the IPAA revealed two themes of talk: Inclusive Talk and Difference Talk. “Difference Talk” showed that the enactment of inclusion cannot be rigidly defined and demarcated in advance in every situation or in every instance or be abstracted from time and place. A nuanced interpretation of difference may help researchers avoid the binary distinctions about inclusive education and inclusive pedagogy and deficit interpretations about teachers’ practices. The findings show that even though teachers talked about enacting inclusive pedagogy they did not consider themselves inclusive educators. They implied that since they had not had ‘special 5 education training’ they could not consider themselves as inclusive educators despite saying that they had taught in an inclusive manner. Participation in the PLCs enabled teachers to negotiate meaning and create a coherent community. A coherent community allowed teachers to challenge their perspectives about teaching inclusively and to share their experiences. This study contributes a conceptual understanding of the interplay between teachers’ professional identity and the sociocultural contexts of PLCs, and how teacher talk can mediate teacher learning for inclusive pedagogy. The findings could be of interest to teacher educators in designing professional learning communities for inclusive pedagogy.
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    Ventilatory support and surfactant use in extremely low birth weight infants over a decade at a tertiary hospital in Johannesburg, South Africa
    (2024) Mavunda, Minah Nthodi
    Background: In Southern Africa, extremely low birth weight infants (ELBWI) are a major contributor to neonatal mortality and morbidity. The ELBWI are at the greatest risk of respiratory distress syndrome (RDS), and the severity of RDS is inversely related to gestational age. Objective: To review ventilatory support and surfactant use in ELBWI and its effect on survival of ELBWI at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), South Africa. Methods: This was a secondary analysis of an existing database of ELBWI admitted at CMJAH neonatal unit from 01 January 2008 to 31 December 2017. The different modes of respiratory support were compared for survivors and non survivors. Results: A total of 1 184 ELBWI were enrolled in the study with a mean birth weight of 823.6g. Respiratory distress syndrome was diagnosed in 93.2% (1 103/1 184) infants, with 88.2% (1 044/1 184) receiving respiratory support. Respiratory support was offered in the form of surfactant replacement therapy (SRT), nasal continuous positive airway pressure (NCPAP) and/or conventional mechanical ventilation (CMV). Eighty one percent (706/902) of the infants received SRT, 62% (706/1 146) received NCPAP and 20% (225/1 135) received CMV. The survival of ELBWI who received SRT was 88.3% (p<0.001) and for infants who received NCPAP was 65.2% (p=0.019). Conventional mechanical ventilation was not associated with increased survival, 19.2% (p=0.677). The overall survival of ELBWI during the study period was 46% (540/1184). Conclusion: The implementation of SRT and NCPAP are effective in the management of RDS in ELBWI.
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    The impact of the COVID-19 pandemic on orthopaedic trauma admissions in a central academic hospital in Johannesburg
    (2024) Foster, Matthew
    Background: The Novel Coronavirus (SARS-CoV-2), commonly known as COVID-19, has caused a global economic and healthcare crisis. In response, many countries tried to curb the spread of the virus with the introduction of various lockdown alert levels to restrict transmission and prepare health care systems for an increase in COVID-19 admissions. The Republic of South Africa (RSA) implemented an alcohol ban as one of the lockdown restrictions. Objectives: To describe the effect of the lockdown alert levels and alcohol availability on orthopaedic trauma admissions, compared to the preceding two years. Patients and methods: A retrospective review of clinical records was conducted. The data collected included orthopaedic trauma admissions for the six-month time-period in a quaternary facility in Johannesburg from 01 March to 31 August in the years: 2018, 2019 and 2020, respectively. Lock down alert levels were categorised according to the Department of Health which included the ban, re-introduction and re-banning of alcohol consumption. Data collected for 2018, 2019 and 2020 included demographics of sex and age, as well as fracture location, open or closed injuries, polytrauma patients and those who suffered gun-shot wounds. Results: Overall, 785, 718 and 556 patients were admitted in 2018, 2019 and 2020, respectively. There was a significant decrease of 22.56% of orthopaedic trauma admissions during the five-month lockdown time-period in 2020 compared to 2019 (p-value = 0.01) and 29.17% from 2020 compared to 2018 ( p-value = 0.011). In 2020, admissions increased by 112% (n = 82) from alert level 4, when alcohol was banned, to alert level 3 (3a), when alcohol was reintroduced. Admissions decreased by 32.9% (n = 51) from alert level 3 (3a) to alert level 3 (3b), when alcohol was re-banned. Patients were 1.27 times more likely to be admitted in alert level 3 (3a) than alert level 3 (3b) (95% CI: 0.99, 1.65). Motor vehicle accidents (MVAs) were the commonest cause of admissions in alert level 3 (3a), accounting for 40.6% (n = 56) whereas in alert level 3 (3b), MVAs decreased to 12.4% (n = 12). COVID-19 tests were positive in 10.18% (n = 34) of the 346 tests performed on orthopaedic trauma admissions. 3 Conclusion: Our study showed the decrease in orthopaedic trauma admissions due to the COVID-19 lockdown regulations. Furthermore, our study demonstrated the impact of alcohol availability on orthopaedic trauma admissions in a central academic hospital in Johannesburg.
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    Thyroidectomies at an academic hospital in Johannesburg-correlation between pre-operative cytology findings and post-operative histology results
    (2024) Kilani, Lydia
    BACKGROUND Pre-operative cytological assessments of thyroid nodules have become an inexpensive, uncomplicated and reliable way of making a diagnosis of malignancy, as well as useful in stratifying thyroid nodules according to risk. The Bethesda system for reporting thyroid cytopathology (BSRTC) provides a standardized method for reporting this and more accurately estimating risk. This study examines the correlation between BSRTC and final histology in patients undergoing Thyroidectomies at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) OBJECTIVES To determine the accuracy of pre-operative cytological diagnosis in patients undergoing thyroidectomies at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), and also to determine the rate of reporting of each BSRTC category, the rate of malignancy of each category, and the demographics of the study population, which includes age, gender and race. METHODS This was a retrospective, observational study, which looked at 113 thyroidectomies performed between July 2013 and December 2016 at CMJAH. Data from each case was captured and analyzed, specifically analyzing pre-operative cytopathological diagnosis which is performed via ultrasound-guided fine needle aspiration FNA, with the post-operative histopathological diagnosis. RESULTS- A total of 174 patients underwent thyroid procedures during the study period, of which 113 fit the inclusion criteria. The majority of the patients were African (79%) and female (88%). A preoperative diagnosis of indeterminate (BSRTC categories 3 and 4) was made in 30.1% of cases. The most reported BSRTC category was category 2 which made up 42.5% of all pre-operative reports, and all v were confirmed benign on post-operative histology. BSRTC category 3 of “Atypia of unknown significance” (AFLUS) was made in 19 patients of whom 3 had thyroid cancer. BSRTC category 4 describes a “follicular neoplasm”: there were 15 patients in this category of whom 8 were found to be malignant. The diagnosis of BSRTC category 5 or “suspicious of malignancy” and category 6 of “proven malignancy” were made in 14 and 17 times, respectively. Only five of 14 BSRTC category 5 were confirmed cancers. The cancer risk for BSRTC 6 was 82.4% (14 of 17 patients). CONCLUSION Pre-operative cytological diagnosis was more accurate in BSRTC categories 2 and 6. A diagnosis of ‘indeterminate’ was made in a significant number of patients (n=19), where more than half of them were found to be malignant. Malignancy risk is lower than expected for BSRTC categories 5 and 6, which may indicate an element of ‘over-diagnosis’ in this institution. Further studies are required
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    The prevalence of basal cell carcinoma and squamous cell carcinoma at the Helen Joseph Hospital
    (2024) Mosojane, Karen Itumeleng
    Background Basal cell carcinoma and squamous cell carcinoma account for the majority of nonmelanoma skin cancers. Although the diagnosis has a relatively low mortality in comparison to other malignancies, the patients incur significant morbidity and there is an immense financial burden on health care systems. Objectives To study the prevalence, demographic and histologic pattern of patients with basal cell carcinoma and squamous cell carcinoma at the Helen Joseph Hospital. Methods This was a retrospective study of adults who had histologically confirmed basal cell carcinoma and squamous cell carcinoma at Helen Joseph Hospital, Dermatology department for the duration of 1st June 2014 to 30th June 2019. Results Basal cell carcinoma A total of 394 patients were included. The prevalence was 1.4% with a mean age of 69.4 years (standard deviation of 11.5). Males were 209 (53.0%) and 137 (34.8%) were female, gender was not documented in 48 (12.2%). The male to female ratio was 1.5:1. HIV negative patients were 62 (15.7%) and 5 (1.3%) were HIV positive. Actinic keratosis was a risk factor for all the patients. A total of 393 (99.7%) patients were of Fitzpatrick’s skin phototype I or II, 1 (0.3%) patient had oculocutaneous albinism and 4 (1.0%) patients were smokers. A previous diagnosis of skin cancer was observed in 87 (22.1%) patients. The histologic subtypes that were diagnosed included nodular (69, 17.5%), metatypical/basosquamous and superficial both at 12 (3.1%) and ulcerated (11, 2.8%), however most patients (200, 50.7%) had a mixed subtype. Most of the lesions were located on the face 194 (49.2%) and upper limb 53 (13.5%). vi Squamous cell carcinoma Overall 85 patients were diagnosed with squamous cell carcinoma. The prevalence was 0.3%. The mean age was 68.7 years (standard deviation of 12.8). In the cohort, majority of our patients were male (61, 71.8%), 17 (20.0%) were female, and the male to female ratio was 3.6:1. Gender was not documented in 7(8.2%). There was no statistical significance between gender and age (p>0.05). HIV negative patients were 12 (14.1%) and 3 (3.5%) were HIV positive. Almost all patients in this cohort were of a lighter skin phototype 83 (97.6%). Most patients had multiple risk factors, except 1 (1.2%) who had epidermodysplasia verruciformis as the only risk factor identified. Moderately differentiated squamaous cell carcinoma was diagnosed in majority of the patients 59 (69.4%) and 3 (3.5%) patients had poorly differentiated squamous cell carcinoma. Most patients had an undocumented histologic variant 67 (85.9%). Squamous cell carcinoma occurred most commonly on the face 30 (35.3%), upper limb 16 (18.8%) and scalp 13 (15.2%) Conclusion Our findings are generally in line with other published reports. We noted that BCC has a higher prevalence than SCC. Both cancers were more common in elderly males. Fitzpatrick skin phototype 1 and 2, history of sun exposure, actinic keratosis and prior skin cancer are some of the risk factors that we elucidated. In our cohort these cancers occurred more frequently on sun exposed sites. Majority of our patients did not have a documented HIV status. There is lack of standardisation in history taking and documentation in our dermatology clinic, as well as histopathology reports which leads to important prognostic factors not being documented. These factors form a basis for patient treatment options and inform follow up plans.
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    The frequency of HIV in patients with newly diagnosed Bell’s palsy at a tertiary centre
    (2024) Visagi, Jan Christoffel
    Background: Bell’s palsy is the most common disease affecting the facial nerve and presents with unilateral lower motor neuron (LMN) facial weakness. An immunologicallymediated pathophysiological process is suspected, with a viral pathogen being one of the possible precipitating factors. The exact cause is however still unknown, with numerous associated diseases that have been described, one of which is HIV, with facial palsy being the most common cranial neuropathy in HIV. Aims: To describe the sociodemographic characteristics and frequency of HIV in patients with newly diagnosed Bell’s palsy. Furthermore, to determine the mean CD4 and viral load of the HIV positive subgroup. Methods: This retrospective-prospective observational and descriptive study evaluated 58 adult patients (18 years and older) that presented with atraumatic LMN facial weakness (Bell’s palsy) between January 2019 and November 2021 at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), Chris Hani Baragwanath Academic Hospital (CHBAH) and Helen Joseph Hospital (HJH). Data was obtained from patients’ files and prospective patient interviews and annotated on data capturing sheets. It included demographic information, date of diagnosis of Bell’s and side of the face involved, as well as the HIV status and the CD4/Viral Load (VL) for all HIV positive patients. Furthermore, the HbA1c, TPHA/RPR and ANA tests were also obtained. Descriptive statistics were used to determine the frequency of HIV. For continuous variables (CD4/VL), the mean and standard deviation were determined for normally distributed data, whereas the median and interquartile range were determined for data not normally distributed. This was subsequently presented in a tabulated format. Results: Of the 58 patients included, the mean age was 42.2 years with an equal number of males and females. More than half (55.2%) of the patients had right sided weakness (p = vii 0.025), with only one patient that had bifacial weakness. The HIV frequency was 34.5% (20/58) of which 11/20 (55%) were known HIV positive prior to Bell’s diagnosis, and 9/20 (45%) were newly diagnosed HIV at the time of Bell’s diagnosis. Known HIV positive patients were more likely to present with right sided weakness (10/11; 90.9%). The mean CD4 count at Bell’s diagnosis did not show a statistically significant difference (p = 0.553) between the known HIV and newly diagnosed HIV group, namely 335 cells/µL for the former, and 243 cells/µL for the latter group. Among the HIV negative and newly diagnosed HIV positive patients, diabetes mellitus was the most common other associated co-morbidity. Conclusions: In this cohort of patients in whom LMN facial weakness (Bell’s palsy) was the presentation in all the patients, an HIV frequency of 34.5% was found. It can be the presenting problem in HIV or occur in the later stages of the disease. Right sided weakness was significantly more common in patients previously diagnosed with HIV and the mean CD4 count was > 200 cells/µL at presentation with Bell’s in both HIV positive subgroups. Diabetes mellitus is a co-morbidity commonly associated with Bell’s in HIV negative patients
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    The training and knowledge of radiation exposure among Wits University Orthopaedic Registrars and their implementation of radiation protective measures
    (2024) Suliman, Imraan
    Introduction: The use of fluoroscopy in the management of orthopaedic injuries has increased significantly in recent decades, particularly in the trauma setting. However, this has exposed the surgeon, hospital staff and patient to higher levels of radiation. This study aimed to evaluate the knowledge of WITS orthopaedic registrars on ionising radiation and assess their use of radiation protection. Methods: A survey addressing the knowledge of radiation and methods of protection was conducted amongst 50 registrars enrolled at the WITS training centre. Results: There was a 76% response rate and the data obtained was statistically evaluated. Although 87% know what ionising radiation is, only 34% believe they are adequately familiar with the effects of radiation and methods of protection. Focused education was particularly low with 26% of registrars having received formal lectures. Fifty percent of registrars were unfamiliar with the guidelines of radiation optimisation, and more concerning, even fewer implemented the basic methods of protection. There was no accurate record of individualised annual radiation exposure with only 3 registrars being equipped with dosimeters. Furthermore, registrars were found to be indifferent to the harmful effects of radiation with 76% of trainees regularly obtaining unjustified post-operative x-rays. ii Conclusion: Knowledge about ionising radiation and utilisation of protective measures were insufficient amongst Wits Orthopaedic trainees. These findings are consistent with other training institutions in South Africa and around the world. Authors recommend a structured program on radiation and radiation protection be introduced as part of the training program to reduce the detrimental effects of radiation on the surgeon, theatre staff and patient
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    Factors associated with mortality in very low birth weight neonates treated with invasive mechanical ventilation at a tertiary hospital in South Africa
    (2024) Goldstein, Rowan Clive
    Introduction: Respiratory support with invasive mechanical ventilation (IMV) is a critical intervention available to neonates, especially amongst very low birthweight (VLBW) neonates. Since its introduction in the 1960s it has been associated with an increased survival amongst VLBW neonates. Objectives: To describe the characteristics and outcomes of VLBW neonates who received IMV in the neonatal intensive care unit (NICU) at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). Methods: This was a retrospective, descriptive study of neonates who required IMV admitted to the NICU at CMJAH, between 1 January 2013 and 31 December 2019. The characteristics and outcomes of these neonates were described using univariate analysis. The NICU is combined with the paediatric ICU and comprises of 15 beds. Results: There were 3 484 VLBW neonates admitted during the study period of which 849 required IMV (24.4%). Of the 849, 445 survived (52.4%). 44 infants required high frequency oscillatory ventilation, 16 of whom survived (16/44, 36.4%) making the need for HFOV one of the factors strongly associated with a poor outcome (p<0.001). Other significant associations with poor outcomes were lower birth weight (p<0.001), lower gestational age (p=0.003), the presence of metabolic acidosis (p<0.001), the diagnosis of NEC (p<0.001), pathological cranial sonar findings (p<0.001), and longer length of hospital admission (p<0.001) Conclusion: One quarter of VLBW neonates admitted at CMJAH required IMV during their hospital admission. We demonstrated a survival rate of 52% for ventilated VLBW infants. The only predictive factor for mortality was the presence of metabolic acidosis, likely a surrogate for severity of illness
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    Rate of neonatal birth HIV positive tests and description of related risk factors in Johannesburg: can point of care testing be targeted effectively?
    (2024) Wannenburg, Elzette
    Background Prompt diagnosis of Human Immunodeficiency Virus (HIV) in South Africa and early initiation of antiretroviral therapy in infected newborns remains a challenge in South Africa. Point of Care Testing could expedite this process. This study describes the rate of, and risk factors associated with birth detectable HIV infection in a South African setting. Methods A secondary data analysis of infant HIV polymerase chain (PCR) reaction results was done at Rahima Moosa Mother and Child Hospital in Johannesburg between June 2014 to June 2019. Annual positivity rates were calculated and association tested against characteristics (maternal, delivery and infant) using descriptive statistical methods. Results 12466 infants had a final HIV result. The yearly positivity rate did not show significant fluctuation, ranging from 1.2-1.7%. Maternal risk factors for infant infection included adolescent age (3.6% vs 1.8% for mothers aged 20-30) (p1000 (8.9% vs 1.3% if 50-1000) (p<0.001); CD4 count <200 (3.3% vs 0.75% at CD4 200- 300) (p<0.001); antiretroviral therapy for less than a month (5.1% vs 2.3% after 1 month) (p<0.001); HIV diagnosis within a month of delivery (10.1% vs 1% preconception) (p<0.001) and those with viral loads >1000 (8.9% vs 1.3% if 50-1000) (p<0.001). Infant risk factors for infection were prematurity (2.3% vs 1.4%) (p=0.012); low birth weight (2.2% vs 1.4%) (p=0.009); ill infants warranting admission (3% vs 1.5%) (p<0.001) and infants born in cold seasons (1.8 vs 1.3%) (p=0.016). Conclusion Various maternal and infant factors were associated with HIV infection at birth while the birth positivity rate remained relatively constant across the study period. While universal birth point of care testing is ideal, high risk infant groups could be identified and targeted in resource constrained settings to expedite HIV diagnosis and treatment
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    The spectrum of male breast disease at Charlotte Maxeke Johannesburg Academic Hospital: a 3 year retrospective review
    (2024) Rattray, Darren
    Background: The spectrum of male breast disease (MBD) and their relative proportions is not well documented. This study aims to describe the demographics, clinical, radiological and histopathological characteristics of the spectrum of male breast disease managed at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). Methods: This is a retrospective, descriptive study of all male patients diagnosed with MBD at CMJAH between 1 January 2016 and 31 December 2018. Patients’ data was extracted from the Breast Imaging Department, CMJAH Breast Clinic and the National Health Laboratory Services patients’ records. Data collected included patients’ demographics, clinical presentation, radiological findings and histopathological diagnosis, where available. The collected data was captured using REDCap™ and was analysed using Statistica 13 and SAS version 9.2. P value of 0.05 was used for statistical significance. Results: Of the 269 males imaged, 244 (91%) had a diagnosed breast condition, 90% of which were benign. Gynaecomastia accounted for 85% of all breast disease diagnosed. Patients who presented with benign breast disease were significantly younger than those with malignant breast disease, with a mean age of 45.59 years vs 58.29 years (p = 0.0007). 71% of patients had a known HIV status with 39% being HIV positive. There was a significant association between patients with HIV and benign breast disease (P=0.0129). Conclusion: Gynaecomastia is the most common male breast disease seen at CMJAH. There was a significant association between HIV and benign breast disease. This association should be explored further with respect to the direct effects of the virus and to those of the antiretroviral medication
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    Vitamin D levels in young children with femur fractures at Charlotte Maxeke Johannesburg Academic Hospital
    (2024) Pinkus, Daniella
    Introduction: Fractures are common in children with healthy bones. However, the literature has shown that some of these fractures may be related to underlying bone pathology such as vitamin D deficiency. The aim of this study was to determine if there is vitamin D insufficiency or deficiency in children five years of age and younger with femur fractures at Charlotte Maxeke Johannesburg Academic Hospital. Methods: This study was a retrospective review of children with femur fractures admitted to the Charlotte Maxeke Johannesburg Academic Hospital paediatric orthopedic unit. The records of children admitted between 1 January 2017 and 31 December 2017 were retrieved. Demographic data were collected from clinical notes and electronic discharge summaries. Radiographs were assessed and blood results were retrieved. Results: Forty-five (n = 45) patients were enrolled for this study. The study sample comprised of 30 (66.7%) males with a mean age of 2.9 ± 1.3 (SD) years and 15 (33.3%) females with a mean age of 1.9 ± 1.1 (SD) years. The overall mean age for the sample population was 2.56 years (SD = 1.3, CI = 2.21 – 2.95). Of these patients, 42 (93.3%) were Black, 2 (4.5%) were White and 1 (2.2%) was Coloured. Falls accounted for the only mechanism of injury (n = 45). Spiral fractures accounted for the greatest proportion of fractures, followed by transverse fractures. Most patients (n = 34, 75.6%) came from inner city areas whilst the minority were from outer city areas (n = 11, 23.4%). Most children (68.9%) with femur fractures had low levels of serum 25-hydroxyvitamin D compared to children (31.1%) who had sufficient levels of serum 25-hydroxyvitamin D. Conclusion: This study showed that 68.9% of the children were vitamin D deficient or insufficient and 75.6 % were from inner city areas. This suggests that children aged five years and younger with femur fractures in our hospital may benefit from routine blood testing and vitamin D supplementation.
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    The role of geographical distance and referral patterns on stage at presentation in South Africa: a review of two South African breast units
    (2024) Pothas, Catharina
    Introduction: Historically breast cancer incidence has been low in Africa but now accounts for most cancer deaths in women in many sub-Saharan African countries. The purpose of this study is to examine the role of referral patterns and geographical distance on the stage at presentation. Methods: This retrospective cross-sectional study was undertaken at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) and Chris Hani Baragwanath Academic Hospital (CHBAH) breast units from July 2015 to September 2017. The participants were grouped into both early (I and II) and advanced (III and IV) stage breast cancer. Demographic data (age, residential distance, referral pattern) and histological characteristics (immunohistochemistry and grade) were compared. Bivariate logistic regression models were applied on all variables with a subsequent multivariate analysis on all statistically significant variables. Results: Of the 1008 participants enrolled in the cohort, 55% presented with advanced stage disease. Referral pattern was statistically significant on bi- and multivariate analyses with a 50% increased risk of having advanced disease following indirect referral (from secondary hospital or specialist) regardless of other socio-demographic or histological characteristics (p<0.001, OR = 1.49, 95%CI 1.13-1.97). Geographical distance had no influence on stage at presentation (p=0.075, OR = 1.36, 95%CI 1.03-1.80). Conclusion: Referral patterns play an important role as a barrier to care in the South African public sector. Direct referral routes are needed with simple access to specialised breast units
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    Adult intracranial neoplasms: radiologic and histopathological correlation
    (2024) Mojapelo, Besley
    Background: Imaging plays an important part in the management and prognosis of an intracranial neoplasm. MRI and its advancement with the addition of DWI/ ADC, PWI and MRS have greatly enhanced the diagnostic accuracy of MRI in that there is better characterisation and differentiation of intracranial neoplasms. Aim: To document and evaluate the histopathological diagnoses and the MRI imaging findings of intracranial neoplasms in adult patients at CHBAH. Method: A retrospective study was conducted using MRI and histopathology reports from January 2017 to September 2019. Statistical significance was met when p-value <0.05. Results: The study included 53 (N=53) adult patients with confirmed intracranial neoplasms. There were 26 (49%) males and 27 (51%) females with an age range of 18 to 71 years. The most frequent anatomical sites were the sellar/suprasellar region 22 (42%) and the frontal lobe 8 (15%). Pituitary adenoma 18 (34%) was the most common neoplasm followed by meningioma 14 (26%) and glioblastoma 7 (13%). Low-grade (WHO I/II) neoplasms were more frequent 37 (70%) than the high-grade neoplasms (WHO III/IV) [16 (30 %)]. The overall concordance between the MRI and the histopathology diagnoses and grading demonstrated a good agreement with Kappa values of 0.63 and 0.71, respectively. Conclusion: Conventional MRI constitutes the most utilised MRI technique in the characterisation of intracranial neoplasms. Due to limitations thereof, advanced MRI techniques may improve the diagnostic accuracy. Conventional MRI, advanced MR techniques and histopathology are complementary diagnostic modalities for the classification of intracranial neoplasms.
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    The relationship between increased Body Mass Index and primary headache disorders in a group of antiretroviral therapy induced overweight and obese patients
    (2024) Ganesh, Annsureeka
    Introduction: Primary headache disorders are highly prevalent and may be found co-morbid with other diseases, including Human Immunodeficiency Virus (HIV). Recent literature has suggested a relationship between increased Body Mass Index (BMI) and primary headaches, although the exact mechanisms are largely unknown and likely diverse. Weight gain following initiation of Antiretroviral therapy (ART) has recently emerged as a complication amongst people living with HIV. This unique population with primary headaches may exhibit an artificially-induced state of obesity, which forms the basis of this study in order to describe the relationship between increased BMI and primary headache disorders. Methods: This was a cross-sectional study involving HIV positive patients on ART who had primary headaches. Participants who fulfilled inclusion criteria were enrolled in the study during their routine clinic visits. An anonymous interviewer-based questionnaire was used to record clinical and demographic data. Participants’ height and weight were measured in order to calculate BMI. Fischer’s exact test was used to investigate the association between the presence of primary headache, severity and frequency of headache and increased BMI. A pvalue of less than 0.05 was considered evidence for statistical significance. Results: There was a statistically significant association between female gender and increased BMI (OR 6.02, 95% CI, 1.32-26.21, p-value <0.02) Multivariate regression analysis demonstrated a higher risk of increased BMI amongst participants with features of tension type headache when compared to those with migraine, however this was not statistically significant (OR 2.47, 95% CI, 0.25-24.88, p-value 0.44). There was no statistically significant relationship 7 between increased BMI and the presence of primary headache, type of primary headache, severity, or frequency of headache in this study. Conclusion: This study did not find any statistically significant relationship between increased BMI and primary headache disorders, nor any of their associated characteristics. This may be due to the small sample size, and further studies are needed to corroborate these findings.