Exploring strategies for including visually impaired students in online learning.

Online learning has gained prominence in higher education institutions globally. Its actual and potential benefits are linked to improving access to and quality of education. It is also considered as a vital strategy for contributing to the UN SDG 4 agenda which aims at ensuring inclusive, equal and equitable lifelong education for all by the year 2030. Unfortunately, not much has been documented on how visually impaired students (VIS) have been included in online learning. To extend our understanding of this neglected but significant topic, this qualitative developmental phenomenographic study engages 14 faculty and six Administrators from two Ghanaian higher education institutions to explore challenges and possible strategies for the inclusion of VIS in online learning. The findings indicate that general policy frameworks are available in the studied universities but they are limited in salience and significance as they do not consider the inclusion of VIS in online learning. Some forms of digital technology are also available in the studied institutions but their accessibility and usability remain a challenge to the VIS. Besides, the universities have specialized units to support students with special needs generally but their practices to support VIS in online settings have remained a challenge. Consequently, universities need to develop adaptive and agile policies through inclusive and participatory approaches. Additionally, higher education institutions should strategically build the capacities of their faculty and staff to better serve VIS in online learning settings. The creation of strategic partnerships with civil society, intergovernmental and non-governmental organizations and the private sector generally is deemed vital for the mobilization of resources to support VIS in online learning spaces.

Is tuberculous lymphadenitis over-diagnosed in Ethiopia? Comparative performance of diagnostic tests for mycobacterial lymphadenitis in a high-burden country.

Ethiopia reports the third highest number of extrapulmonary TB cases globally, most of which are lymph node TB (TBLN). We investigated the performance of the available diagnostic tests for TBLN. Fine needle aspirate (FNA) and excision biopsy samples from affected lymph nodes were collected from 150 consenting patients with suspected TBLN visiting regional hospitals in Ethiopia. The sensitivity, specificity, positive (PPV) and negative predictive value (NPV) of histopathology against culture as reference was 92%, 88%, 97% and 77% and of FNA cytology (FNAC) 76%, 88%, 100% and 55%, respectively. Naked eye examination of FNA had 67% sensitivity and 64% specificity. HIV coinfection did not diminish the performance of macroscopic examination, Ziehl-Neelsen stain, histology or cytology examinations. When any positive result in ZN, histopathology or culture was considered confirmatory, clinical diagnosis could be confirmed in 85% of the patients, suggesting that TBLN is over-diagnosed in up to 15% of cases. With combined criteria as reference standard, the sensitivity, specificity, PPV and NPV of FNAC was 72%, 100%, 100% and 55%, respectively. FNAC is a practical tool that can improve the diagnosis of TBLN in high-burden settings. Over-diagnosis alone cannot explain the high burden of LNTB in Ethiopia.