ETD Collection

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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