Supporting a Tsonga learner living with Bardet-Biedl syndrome, a rare complex disability.

Background: Bardet-Biedl syndrome (BBS) is a rare, systemic, hereditary disorder characterised by obesity, polydactyly, visual and auditory impairment, and cognitive disability. Providing quality education in appropriate schools for children who present with such complex chronic conditions is challenging. Objectives: This study explored the dimensions of psycho-educational support needs for a child with BBS in South Africa to contribute to the improvement of early detection and holistic interventions. Method: A descriptive in-depth qualitative case study of Gezani, an adolescent Tsonga boy diagnosed with BBS, was undertaken. Semi-structured interviews were conducted with his parents and teachers to ascertain the boy's psycho-educational support needs. Medical reports provided information on the complexities and prognosis of the syndrome. Observations in the classroom corroborated the learner's symptoms and behaviours. Results: Thematic content analysis revealed the key areas of support needs. Gezani's cognitive disability required a modified, slow-paced curriculum. His visual impairment required mobility orientation training and learning Braille. His emotional needs were supported with psychotherapy to maintain a sense of well-being. Medical monitoring was recommended with interventions for walking and managing his diet and weight. Speech therapy supported his communication skills. Conclusion: Learners with multiple disabilities require carefully planned, individualised psycho-educational support programmes addressing their unique needs and delays with targeted remedial interventions in appropriate special needs schools. Contribution: This study informs educators about BBS and provides multi-faceted, holistic support. The Department of Basic Education could bring special schools and national policies in tighter alignment for learners presenting with complex disabilities.

Journeying with developmental coordination disorder: The family experience.

Background: Developmental coordination disorder (DCD) is a neurodevelopmental disorder impacting 5% - 6% of children and continues into adulthood for 50% - 70% of cases. Despite the multidomain and lifelong influence of this disorder, little consideration has been given to the experiences of the family. Post-diagnostic support has been recommended however, the specific areas requiring support remain vague. Objectives: This study described the familial experiences of living with a member diagnosed with DCD. Method: A qualitative descriptive study using a phenomenological approach allowed insight into the lived experiences of families journeying with DCD. Forty-four participants representing 8 countries participated in an online questionnaire with 12 participating in an online semi-structured interview. Results: Themes generated reveal that obtaining a diagnosis and navigating the healthcare and education systems can be troublesome. Upon diagnosis, families tend to experience positive emotions such as relief. However, the daily challenges soon result in dominant negative emotional responses. DCD places significant financial burdens on families and impacts marital, parental and sibling relationships. Families often feel isolated from their communities as DCD is poorly understood. Conclusion: DCD places families at risk as daily struggles require support which targets identified motor, cognitive, academic and emotional challenges. Creating awareness in society, education and healthcare would alleviate continual frustrations. Contribution: This study provides insight into the wide-ranging impact that DCD has on families so that individualised support can be tailored, and general awareness raised.

Oxygen as a drug and scarce commodity: Do we use it rationally?

BACKGROUND: Medical grade oxygen is classified as a drug and needs to be prescribed by a qualified healthcare professional. Oxygen therapy is prescribed to people who cannot maintain normal blood oxygen saturation while breathing atmospheric air. The coronavirus disease 2019 (COVID-19) pandemic highlighted the importance of the rational use of this scarce commodity. This study investigated oxygen therapy practices in adult ward patients. METHODS: A cross-sectional study design with an analytical component was used in the adults wards at a National District Hospital and the Pelonomi Academic Hospital in Bloemfontein. Data were collected from patient files, interviews and oxygen measurements of adult patients that received oxygen. RESULTS: One hundred and fifteen patients were included in the study, of whom 47.0% received oxygen without an oxygen prescription. Around 62.3% of the patients with prescriptions did not receive oxygen as prescribed. The prescriptions and oxygen administration for COVID-19 patients were better than for non-COVID-19 patients. A quarter of the patients possibly received oxygen therapy unnecessarily. CONCLUSION: Poor oxygen therapy practices were identified, including prescription errors, oxygen administration errors and oxygen wastage. A protocol should be developed and implemented for the prescription and administration of oxygen therapy. Training should occur to prevent oxygen wastage.Contribution: This study highlighted poor oxygen practices and prescriptions, as well as oxygen wastage in the absence of local oxygen therapy guidelines.

PASCAR and WHF Cardiovascular Diseases Scorecard project.

Data collected for the World Heart Federation's Scorecard project regarding the current state of cardiovascular disease prevention, control and management, along with related non-communicable diseases in Kenya are presented. Furthermore, the strengths, threats, weaknesses and priorities identified from these data are highlighted in concurrence with related sections in the accompanying infographic. Information was collected using open-source data sets from the World Bank, the World Health Organization, the Institute for Health Metrics and Evaluation, the International Diabetes Federation and relevant government publications.

PASCAR and WHF Cardiovascular Diseases Scorecard project.

Data collected for the World Heart Federation's Scorecard project regarding the current state of cardiovascular disease prevention, control and management, along with related non-communicable diseases in Ethiopia are presented. Furthermore, the strengths, threats, weaknesses and priorities identified from these data are highlighted in concurrence with related sections in the accompanying infographic. Information was collected using open-source data sets from the World Bank, the World Health Organization, the Institute for Health Metrics and Evaluation, the International Diabetes Federation and relevant government publications.

PASCAR and WHF Cardiovascular Diseases Scorecard project.

Data collected by the Pan-African Society of Cardiology for the World Heart Federation's Cardiovascular Diseases Scorecard project in Africa are presented. We summarise the strengths, threats, weaknesses and priorities identified from the collected data for South Africa, which need to be considered in conjunction with the associated sections in the accompanying infographic. Data sets that were used include open-source data available online and government publications. In the section on priorities and the way forward, we highlight the multifactorial health challenges with which South Africa has had to deal and the progress that has been made.

PASCAR and WHF Cardiovascular Diseases Scorecard project.

Data collected by the Pan-African Society of Cardiology for the World Heart Federation's scorecard project regarding the current state of cardiovascular disease prevention, control and management along with related non-communicable diseases in Tunisia are presented. Furthermore, the strengths, threats, weaknesses and priorities identified from these data are highlighted in concurrence with related sections in the incorporated infographic. Information was collected using open-source data sets available online and relevant government publications.

PASCAR and WHF Cardiovascular Diseases Scorecard project.

Data collected by PASCAR for the World Heart Federation's Cardiovascular Diseases Scorecard project in Africa are presented. We summarise the strengths, threats, weaknesses and priorities identified from the collected data, which need to be considered in conjunction with the associated sections in the accompanying infographic. Data sets that were used include open-source data from the World Bank, World Health Organization and government publications.

Learning support strategies for learners with neurodevelopmental disorders: Perspectives of recently qualified teachers.

BACKGROUND: Inclusive education envisages the improvement of the quality of education for all learners. This further implies that schools must adjust all systems of teaching and learning to accommodate all learners regardless of their diverse needs. The reduction of educational inequalities through inclusive practices is aimed at supporting the accomplishment of academic outcomes for all. Learners presenting with neurodevelopmental disorders (NDDs) place specific requirements on teachers, particularly when they find themselves in mainstream classrooms. OBJECTIVES: This study focused on the learning support strategies used by recently qualified teachers in accommodating learners with NDDs in mainstream classrooms in the Gauteng province of South Africa. METHOD: A qualitative approach was used to explore the support strategies used by recently qualified teachers in mainstream classrooms when dealing with learners with NDDs. Purposive sampling was used to select six recently qualified teachers from different mainstream classroom. Data were collected using semi-structured interviews, observations and critical incident reports. RESULTS: The findings revealed that teachers employ a variety of support strategies such as cooperative learning, peer learning, ability grouping, extensive visual aids and curriculum differentiation in an attempt to support learners. The support provided by the teachers was evident in their performance as learners with NDD were able to learn and understand the lessons irrespective for their barrier to learning. CONCLUSION: Contrary to literature findings that teachers do not support learners with diverse needs because of lack of skills, training and knowledge, this study revealed that recently qualified teachers employ a variety of support strategies to support learners with NDDs. However, it appeared that these support strategies were rather general teaching and learning strategies. More support strategies should be applied to help learners with NDD in the mainstream classroom.

PASCAR and WHF Cardiovascular Diseases Scorecard project.

On behalf of the World Heart Federation, the Pan-African Society of Cardiology (PASCAR) co-ordinated data collection and reporting for the country-level Cardiovascular Diseases (CVD) Scorecard to be used in Africa. The objective of the scorecard is to create a clear picture of the current state of CVD prevention, control and management per country for 12 African countries. The Sudan Heart Society assisted PASCAR in collating and verifying the data through Drs Awad Mohamed (president, Sudan Heart Society) and Saad Subahi (PASCAR president, based in Sudan). Based on the data collected, we summarise the strengths, threats, weaknesses and priorities identified, which need to be considered in conjunction with the associated sections provided in the infographic published with this report. Data sets used included open-source data from the World Bank, World Health Organisation and government publications.

Impact of a South African School-based Intervention, HealthKick, on Fitness Correlates.

OBJECTIVES: To assess the impact of a whole-of-school health promotion program targeting healthy eating and physical activity on physical fitness levels, and physical activity-related knowledge, attitudes and behavior of primary school children. METHODS: Sixteen primary schools were randomly assigned as intervention (N = 8) and control (N = 8) schools. A selection of tests from the Eurofit testing battery was used to assess changes in fitness levels over the 3 years of the intervention. Anthropometric measurements included height and weight. A physical activity knowledge, attitude and behavior (KAB) questionnaire was administered to participants. Multi-level mixed effect linear models were used to assess differences between intervention and control schools. RESULTS: No overall improvement in physical fitness was found. The sit-ups score improved significantly in the intervention group (p < .05). No overall intervention effects were found on the determinants of physical activity behavior. Knowledge improved in both the intervention (p = .005) and control (p < .001) groups. CONCLUSION: The lack of a specific intervention effect on fitness levels and physical activity-related KAB indicates that a "low intensity" intervention is not effective in South African primary school settings.

Implementation of the HealthKick intervention in primary schools in low-income settings in the Western Cape Province, South Africa: a process evaluation.

BACKGROUND: The HealthKick intervention, introduced at eight primary schools in low-income settings in the Western Cape Province, South Africa, aimed to promote healthy lifestyles among learners, their families and school staff. Eight schools from similar settings without any active intervention served as controls. METHODS: The Action Planning Process (APP) guided school staff through a process that enabled them to assess areas for action; identify specific priorities; and set their own goals regarding nutrition and physical activity at their schools. Educators were introduced to the APP and trained to undertake this at their schools by holding workshops. Four action areas were covered, which included the school nutrition environment; physical activity and sport environment; staff health; and chronic disease and diabetes awareness. Intervention schools also received a toolkit comprising an educator's manual containing planning guides, printed resource materials and a container with physical activity equipment. To facilitate the APP, a champion was identified at each school to drive the APP and liaise with the project team. Over the three-years a record was kept of activities planned and those accomplished. At the end of the intervention, focus group discussions were held with school staff at each school to capture perceptions about the APP and intervention activities. RESULTS: Overall uptake of events offered by the research team was 65.6% in 2009, 75% in 2010 and 62.5% in 2011. Over the three-year intervention, the school food and nutrition environment action area scored the highest, with 55.5% of planned actions being undertaken. In the chronic disease and diabetes awareness area 54.2% actions were completed, while in the school physical activity and sport environment and staff health activity areas 25.9 and 20% were completed respectively. According to educators, the low level of implementation of APP activities was because of a lack of parental involvement, time and available resources, poor physical environment at schools and socio-economic considerations. CONCLUSIONS: The implementation of the HealthKick intervention was not as successful as anticipated. Actions required for future interventions include increased parental involvement, greater support from the Department of Basic Education and assurance of sufficient motivation and 'buy-in' from schools.

The feasibility of implementing food-based dietary guidelines in the South African primary-school curriculum.

OBJECTIVE: To explore the perceptions of educators from the Western Cape Province about the feasibility of implementing South African food-based dietary guidelines (FBDG) in the national curriculum of primary schools. DESIGN: Combined quantitative and qualitative methods. We report on the quantitative component. SETTING: Twelve public primary schools of different socio-economic status in three education districts of the Western Cape: Metro Central, Metro East and Cape Winelands. SUBJECTS: Educators (n 256) participated in the self-completed questionnaire survey. RESULTS: Educators assessed that FBDG were appropriate to South African schoolchildren (94%), could be used as an education tool (97%) and fill gaps in the current curriculum about healthy dietary habits (91%). Besides Life Orientation, FBDG could be taught in other learning areas from grades 3 to 7 (9-13 years old). Important barriers to implementing FBDG in the curriculum were educators' workload (61%), insufficient time (46%), learners' disadvantaged background (43%) and educators' lack of knowledge (33%). Other approaches to teach children about FBDG included linking these to the National School Nutrition Programme (82%), school tuck shops (79%), parent meetings (75%), school nutrition policy (73%) and school assembly (57%). Educators in high-income schools perceived that learners' lifestyle was significantly worse (P < 0·001) and that tuck shops and the school assembly were the best means to teach pupils about FBDG (P < 0·001 and P < 0·05). CONCLUSIONS: Implementing FBDG in the national school curriculum is seen as important together with optimizing the school physical environment. Key factors required for successful implementation in the curriculum are sufficient educational materials, adequate time allocation and appropriate educator training.

Factors Influencing Break-Time Physical Activity of South African Primary School Learners From Low-Income Communities.

BACKGROUND: The purpose of this study was to assess factors that influence physical activity (PA) levels during break-times in South African primary school children. METHODS: The System for Observing Play and Leisure Activities in Youth (SOPLAY) was used to observe PA levels during break-times at low-income schools (4 intervention, 4 control). The intervention was based on action-planning including: school environment, curriculum, and family involvement. Categories of observed activity included Sedentary, Eating, Walking, or Vigorous PA. Contextual factors assessed included teacher supervision, equipment, and crowding. Chi-square tests were used to determine associations between PA levels and contextual factors. RESULTS: In the 970 observations made, 31% of learners were sedentary, 14% were eating, 29% were walking, and 26% were engaged in vigorous PA. There were no differences in break-time PA between intervention and control groups (NS). With supervision, children were more likely to eat and less likely to do vigorous PA (P = .035). Playground crowding was associated with lower levels of vigorous activity and more sedentary behavior (P = .000). CONCLUSIONS: PA during break-time was adversely affected by over-crowding and lower with supervision. The results suggest that interventions may be targeted at the school policy environment to reduce these barriers to PA.

Implementation of national guidelines, incorporated within structured diabetes and hypertension records at primary level care in Cape Town, South Africa: a randomised controlled trial.

BACKGROUND AND OBJECTIVES: Many clinical management guidelines for chronic diseases have been published, but they have not been put into practice by busy clinicians at primary care levels. This study evaluates the implementation of national guidelines incorporated within a structured diabetes and hypertension clinical record (SR) in Cape Town in a randomised controlled trial (RCT). METHODS: Eighteen public sector community health centres (CHC) were randomly selected and allocated as intervention or control CHC. At each clinic, 25 patients with diabetes and 35 patients with hypertension were enrolled at baseline. Questionnaires were completed, blood samples were collected, blood pressure (BP) and anthropometric measures were taken and patient records were audited. SR with clinical guideline prompts were introduced at the intervention clinics after training doctors in their use and suggestions to incorporate them in regular patient records. Contact was maintained during the year of intervention with the clinic staff. A follow-up survey was conducted 1 year later to assess BP and HbA1c, and the patient records were examined to ascertain the extent of use of the SR in the intervention clinics. In-depth interviews were conducted with doctors and nurses to record their response to the intervention. RESULTS: The intervention evaluated in this RCT had no impact on either diabetes or hypertension control. In the intervention clinics, less than 60% of the patient folders contained the SR and when present was seldom used. Although the staff were well disposed to the research team, their workload prohibited them from undertaking a true evaluation of the SR, and overall they did not perceive the SR as supporting their current process of patient care. CONCLUSIONS: No benefit to diabetes of hypertension care by introducing and availability of the staff in the use of the SR was shown in this RCT. The process measures suggest that the SR was not widely used by the healthcare provided in the primary care clinics.

Experiences in Developing and Implementing Health Clubs to Reduce Hypertension Risk among Adults in a South African Population in Transition.

Chronic noncommunicable diseases (NCDs) are increasing substantially as a cause of death and disability in all strata of the South African society, particularly among the urbanised poor. Hypertension is a risk factor for many of these diseases and becoming a burden in a growing population in a Cape Town township, Khayelitsha. To alleviate healthcare demands at clinics in this area, a health club was initiated and community health workers (CHWs) were trained to empower community members about NCDs and create public awareness. After training, a health club was initiated. Three months after initiation of the health club, 76 participants had been recruited of whom 22 were regular attenders. New members joined the health club weekly. Anthropometric and blood pressure measurements were taken, and various hypertension topics were covered at the club meetings which included healthy behaviours, such as the benefits of being physically active and eating healthy. Nutrition education sessions based on the South African food-based dietary guidelines were also held. Consequent to the initial group that was established, two more clubs were formed in the area. Health clubs are sustainable and culturally appropriate when facilitated by local people who have an insight and deeper understanding of the culture and environment of the people they serve.

"HealthKick": formative assessment of the health environment in low-resource primary schools in the Western Cape Province of South Africa.

BACKGROUND: This study evaluated the primary school environment in terms of being conducive to good nutrition practices, sufficient physical activity and prevention of nicotine use, with the view of planning a school-based health intervention. METHODS: A sample of 100 urban and rural disadvantaged schools was randomly selected from two education districts of the Western Cape Education Department, South Africa. A situation analysis, which comprised an interview with the school principal and completion of an observation schedule of the school environment, was done at all schools. RESULTS: Schools, on average, had 560 learners and 16 educators. Principals perceived the top health priorities for learners to be an unhealthy diet (50%) and to far lesser degree, lack of physical activity (24%) and underweight (16%). They cited lack of physical activity (33%) and non-communicable diseases (NCDs; 24%) as the main health priorities for educators, while substance abuse (66%) and tobacco use (31%) were prioritised for parents. Main barriers to health promotion programmes included lack of financial resources and too little time in the time table. The most common items sold at the school tuck shops were crisps (100%), and then sweets (96%), while vendors mainly sold sweets (92%), crisps (89%), and ice lollies (38%). Very few schools (8%) had policies governing the type of food items sold at school. Twenty-six of the 100 schools that were visited had vegetable gardens. All schools reported having physical activity and physical education in their time tables, however, not all of them offered this activity outside the class room. Extramural sport offered at schools mainly included athletics, netball, and rugby, with cricket and soccer being offered less frequently. CONCLUSION: The formative findings of this study contribute to the knowledge of key environmental and policy determinants that may play a role in the health behaviour of learners, their parents and their educators. Evidently, these show that school environments are not always conducive to healthy lifestyles. To address the identified determinants relating to learners it is necessary to intervene on the various levels of influence, i.e. parents, educators, and the support systems for the school environment including the curriculum, food available at school, resources for physical activity as well as appropriate policies in this regard.

What's in the lunchbox? Dietary behaviour of learners from disadvantaged schools in the Western Cape, South Africa.

OBJECTIVE: To identify and describe factors associated with food shop (known as tuck shop in South Africa) and lunchbox behaviours of primary-school learners in South Africa. DESIGN: Analysis of data collected in 2008 from a cross-sectional survey. SETTING: Sixteen primary schools in the Western Cape, South Africa. SUBJECTS: A total of 717 grade 4 learners aged 10-12 years. RESULTS: A 24 h recall established that 69 % of learners carried a lunchbox to school and 49 % had consumed at least one item purchased from the school food shop/vendor. Most lunchboxes contained white bread with processed meat, whereas the most frequent food shop/vendor purchase comprised chips/crisps. Learners who carried a lunchbox to school had significantly lower BMI percentiles (P = 0·002) and BMI-for-age (P = 0·034), compared with their counterparts. Moreover, they were younger, had higher standard-of-living and dietary diversity scores, consumed more meals per day, had greater self-efficacy and came from predominantly urban schools, compared with those who did not carry a lunchbox to school. Learners who ate food shop/vendor purchases had a lower standard-of-living score and higher dietary diversity and meal scores. Only 2 % of learners were underweight, whereas 19 % were stunted and 21 % were overweight/obese (BMI ≥ 25 kg/m2). CONCLUSIONS: Children who carried a lunchbox to school appeared to have greater dietary diversity, consumed more regular meals, had a higher standard of living and greater nutritional self-efficacy compared with those who did not carry a lunchbox to school.

Price and availability of healthy food: a study in rural South Africa.

OBJECTIVE: We investigated the availability of healthier food choices and whether a healthier diet costs more than a diet commonly eaten by low-income families in South Africa. METHODS: We visited 21 food stores in 14 rural towns of the Western Cape province of South Africa. We recorded the price and availability of 66 food items, including both commonly consumed foods as well as healthy options. RESULTS: Healthier food choices are available in supermarkets. However, many towns only have small food stores with a limited selection of healthy foods. We compared the prices of six commonly consumed foods with healthier versions of those foods (e.g., whole-wheat bread in place of white bread). Healthier foods typically cost between 10% and 60% more when compared on a weight basis (Rand per 100 g), and between 30% and 110% more when compared based on the cost of food energy (Rand per 100 kJ). Next, we compared the extra cost of a healthier diet compared to a typical South African menu. On average, for an adult male, the healthier diet costs Rand 10.2 (US$1.22) per day more (69% more). For a household with five occupants, the increased expenditure on food by eating a healthier diet is approximately Rand 1090 per month (US$140); this represents a high proportion (>30%) of the total household income for most of the population. CONCLUSION: Healthier food choices are, in general, considerably more expensive than commonly consumed foods. As a result, a healthy diet is unaffordable for the large majority of the population.

HealthKick: a nutrition and physical activity intervention for primary schools in low-income settings.

BACKGROUND: The burden of non-communicable diseases, including type 2 diabetes, is growing in South Africa. This country has a complex mix of over- and under-nutrition, especially in low-income communities, and concerning levels of physical inactivity in children and youth. This paper describes HealthKick, a school-based nutrition and physical activity intervention in primary schools in these settings aimed at reducing diabetes risk factors. METHODS/DESIGN: This study includes schools within historically disadvantaged, low-income communities from an urban area close to the city of Cape Town and from two rural areas outside of Cape Town, South Africa. The three Educational Districts involved are Metropole North, Cape Winelands and the Overberg. The study has three phases: intervention mapping and formative assessment, intervention development, and outcome and process evaluation. Sixteen schools were purposively selected to participate in the study and randomly allocated as intervention (eight schools) and control (eight schools).The primary aims of HealthKick are to promote healthful eating habits and increase regular participation in health-enhancing physical activity in children, parents and teachers, to prevent overweight, and reduce risk of chronic diseases (particularly type 2 diabetes); as well as to promote the development of an environment within the school and community that facilitates the adoption of healthy lifestyles.The components of HealthKick are: action planning, toolkit (resource guide, a resource box and physical activity resource bin), and an Educators' Manual, which includes a curriculum component. DISCUSSION: This study continues to highlight the key role that educators play in implementing a school-based intervention, but that developing capacity within school staff and stakeholders is not a simple or easy task. In spite of the challenges experienced thus far, valuable findings are being produced from this study, especially from Phase 1. Materials developed could be disseminated to other schools in low-income settings both within and outside of South Africa. Owing to the novelty of the HealthKick intervention in low-income South African primary schools, the findings of the evaluation phase have the potential to impact on policy and practice within these settings.