Voices of the hungry: a qualitative measure of household food access and food insecurity in South Africa
- Chakona, Gamuchirai, Shackleton, Charlie M
- Authors: Chakona, Gamuchirai , Shackleton, Charlie M
- Date: 2013
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/10962/67277 , vital:29066 , https://doi.org/10.1186/s40066-017-0149-x
- Description: publisher version , Background: South Africa is rated a food secure nation, but large numbers of households within the country have inadequate access to nutrient-rich diverse foods. The study sought to investigate households’ physical and economic access and availability of food, in relation to local context which influences households’ access to and ability to grow food which may affect the dietary quality. We sought to understand self-reported healthy diets, food insecurity from the perspective of people who experienced it, barriers to household food security and perceptions and feelings on food access as well as strategies households use to cope with food shortages and their perceptions on improving household food security. Methods: Focus group discussions were conducted along a rural–urban continuum in three South African towns situated along an agro-ecological gradient. Participants were asked about their knowledge of healthy diets, factors influencing their food consumption, their perceptions regarding food insecurity, barriers to food security, coping strategies and solutions to improve access to nutrient-rich foods. Results: A total of 91 people participated in 11 focus groups, with 76% females. The majority of participants aged between 31 and 50 years. Participants were knowledgeable about healthy diets but had limited access to it hence consumed monotonous diets. The perceptions provided insights into the pressing issues of inadequate access to food, food insecurity, coping strategies and ideas on improving food security. The majority of participants reported on experiencing food insecurity and female-headed households, unemployed and orphaned children were most vulnerable. Focus group participants highlighted the complexity of the food system in their communities which relies on own production, collecting from open spaces, donations and to a larger extent purchase, in the context of unemployment, low income, water and land shortages as well as theft. Conclusion: The results provide a significant contribution from a needs assessment perspective from the communities, identify “hidden” constrains in household food access and provide effective future solutions for improving food security in the communities. Government should assist with capacity building, employment creation and providing resources (especially, land and water) for communities to practise agriculture which they all agreed can improve food security.
- Full Text:
- Date Issued: 2013
- Authors: Chakona, Gamuchirai , Shackleton, Charlie M
- Date: 2013
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/10962/67277 , vital:29066 , https://doi.org/10.1186/s40066-017-0149-x
- Description: publisher version , Background: South Africa is rated a food secure nation, but large numbers of households within the country have inadequate access to nutrient-rich diverse foods. The study sought to investigate households’ physical and economic access and availability of food, in relation to local context which influences households’ access to and ability to grow food which may affect the dietary quality. We sought to understand self-reported healthy diets, food insecurity from the perspective of people who experienced it, barriers to household food security and perceptions and feelings on food access as well as strategies households use to cope with food shortages and their perceptions on improving household food security. Methods: Focus group discussions were conducted along a rural–urban continuum in three South African towns situated along an agro-ecological gradient. Participants were asked about their knowledge of healthy diets, factors influencing their food consumption, their perceptions regarding food insecurity, barriers to food security, coping strategies and solutions to improve access to nutrient-rich foods. Results: A total of 91 people participated in 11 focus groups, with 76% females. The majority of participants aged between 31 and 50 years. Participants were knowledgeable about healthy diets but had limited access to it hence consumed monotonous diets. The perceptions provided insights into the pressing issues of inadequate access to food, food insecurity, coping strategies and ideas on improving food security. The majority of participants reported on experiencing food insecurity and female-headed households, unemployed and orphaned children were most vulnerable. Focus group participants highlighted the complexity of the food system in their communities which relies on own production, collecting from open spaces, donations and to a larger extent purchase, in the context of unemployment, low income, water and land shortages as well as theft. Conclusion: The results provide a significant contribution from a needs assessment perspective from the communities, identify “hidden” constrains in household food access and provide effective future solutions for improving food security in the communities. Government should assist with capacity building, employment creation and providing resources (especially, land and water) for communities to practise agriculture which they all agreed can improve food security.
- Full Text:
- Date Issued: 2013
Conceptualising the more knowledgeable other within a multi-directional ZPD:
- Authors: Graven, Mellony
- Date: 2009
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/10962/69519 , vital:29545 , https://doi.org/10.1007/s10649-017-9768-1
- Description: From a Marxian/Vygotskian perspective, learning is social in origin and it happens in the presence of others that are more knowledgeable. Extending this view to the learning of mathematics, such learning also becomes inseparable from the presence of others (people and artefacts). Researchers over decades have studied different interactions to see how such learning with others occurs, what is the role of the (more knowledgeable) other, and if at all this role alternates between the participants. In this paper, we looked at a 5-year-old’s (Lila) interaction with her mother (Mellony) and a television remote control as Lila attempted to count in threes using the three by three physical layout of the numbered buttons 1–9 on the remote control. We specifically looked at the emergence of the Zone of Proximal Development (ZPD) as Lila’s attention was caught by the properties of the remote control and by her mother’s questions. We also pay attention to how the role of the more knowledgeable other alternates among the participants. Our findings suggest that Lila, at times, used resources provided by the physical properties of the remote control and sometimes, used resources provided by Mellony to think about the task of counting in threes. In Lila’s interaction, we interpreted a multi-directional ZPD as the role of the more knowledgeable other alternated between Mellony, Lila and the remote control.
- Full Text:
- Date Issued: 2009
- Authors: Graven, Mellony
- Date: 2009
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/10962/69519 , vital:29545 , https://doi.org/10.1007/s10649-017-9768-1
- Description: From a Marxian/Vygotskian perspective, learning is social in origin and it happens in the presence of others that are more knowledgeable. Extending this view to the learning of mathematics, such learning also becomes inseparable from the presence of others (people and artefacts). Researchers over decades have studied different interactions to see how such learning with others occurs, what is the role of the (more knowledgeable) other, and if at all this role alternates between the participants. In this paper, we looked at a 5-year-old’s (Lila) interaction with her mother (Mellony) and a television remote control as Lila attempted to count in threes using the three by three physical layout of the numbered buttons 1–9 on the remote control. We specifically looked at the emergence of the Zone of Proximal Development (ZPD) as Lila’s attention was caught by the properties of the remote control and by her mother’s questions. We also pay attention to how the role of the more knowledgeable other alternates among the participants. Our findings suggest that Lila, at times, used resources provided by the physical properties of the remote control and sometimes, used resources provided by Mellony to think about the task of counting in threes. In Lila’s interaction, we interpreted a multi-directional ZPD as the role of the more knowledgeable other alternated between Mellony, Lila and the remote control.
- Full Text:
- Date Issued: 2009
Household wealth status and natural resource use in the Kat River valley, South Africa
- Shackleton, Charlie M, Shackleton, Sheona E
- Authors: Shackleton, Charlie M , Shackleton, Sheona E
- Date: 2006
- Subjects: To be catalogued
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/10962/181301 , vital:43717 , xlink:href="https://doi.org/10.1016/j.ecolecon.2005.04.011"
- Description: Much work has demonstrated the significant role and value of non-timber forest products (NTFPs) in the livelihoods of rural people in southern Africa and elsewhere. The findings provide a mean or composite picture, averaged across the sample households within each community. Yet, within any given community, there is significant socio-economic differentiation. It is important to acknowledge such differentiation when considering policy and management interventions to support rural livelihoods and promote sustainable resource use. This paper reports on a study in South Africa, the objective of which was to explore wealth-related differences and similarities in the use and value of NTFPs. Data on NTFP consumption, purchase, and sale were collected from households in three rural villages. Households were divided into three wealth classes and patterns of NTFPs use between the classes examined. There was no difference in the proportions of households in each wealth class using NTFPs, nor the total number of NTFPs used per household. Yet, there was some supporting evidence that poorer households derive greater benefits from NTFPs than do wealthy or intermediate households. One clear difference was that, with increasing wealth, households purchased significantly more NTFPs, and a greater proportion of wealthy households did so. Conversely, a greater proportion of poor households were involved in the sale of one or more NTFPs, and they sold a greater number per household, compared to wealthy and intermediate households. Detailed examination of use and value of four NTFPs (fuelwood, wild fruits, edible herbs, and grass hand brushes) revealed that in all instances, the poorest households used more of the resource per capita than the other wealth classes. This was not the case for comparisons based on the total household as the unit of analysis. Gross annual direct-use value did not differ between the wealth classes for any of the four NTFPs examined, at the household level. But on a per capita basis, a significantly higher gross annual direct-use value was evident within poorer households for fuelwood and edible herbs. The significance of these differences is discussed.
- Full Text:
- Date Issued: 2006
- Authors: Shackleton, Charlie M , Shackleton, Sheona E
- Date: 2006
- Subjects: To be catalogued
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/10962/181301 , vital:43717 , xlink:href="https://doi.org/10.1016/j.ecolecon.2005.04.011"
- Description: Much work has demonstrated the significant role and value of non-timber forest products (NTFPs) in the livelihoods of rural people in southern Africa and elsewhere. The findings provide a mean or composite picture, averaged across the sample households within each community. Yet, within any given community, there is significant socio-economic differentiation. It is important to acknowledge such differentiation when considering policy and management interventions to support rural livelihoods and promote sustainable resource use. This paper reports on a study in South Africa, the objective of which was to explore wealth-related differences and similarities in the use and value of NTFPs. Data on NTFP consumption, purchase, and sale were collected from households in three rural villages. Households were divided into three wealth classes and patterns of NTFPs use between the classes examined. There was no difference in the proportions of households in each wealth class using NTFPs, nor the total number of NTFPs used per household. Yet, there was some supporting evidence that poorer households derive greater benefits from NTFPs than do wealthy or intermediate households. One clear difference was that, with increasing wealth, households purchased significantly more NTFPs, and a greater proportion of wealthy households did so. Conversely, a greater proportion of poor households were involved in the sale of one or more NTFPs, and they sold a greater number per household, compared to wealthy and intermediate households. Detailed examination of use and value of four NTFPs (fuelwood, wild fruits, edible herbs, and grass hand brushes) revealed that in all instances, the poorest households used more of the resource per capita than the other wealth classes. This was not the case for comparisons based on the total household as the unit of analysis. Gross annual direct-use value did not differ between the wealth classes for any of the four NTFPs examined, at the household level. But on a per capita basis, a significantly higher gross annual direct-use value was evident within poorer households for fuelwood and edible herbs. The significance of these differences is discussed.
- Full Text:
- Date Issued: 2006
Harvesting impacts on commonly used medicinal tree species (Catha edulis and Rapanea melanophloeos) under different land management regimes in the Mpumalanga Lowveld, South Africa
- Botha, Jenny, Witkowski, Ed T F, Shackleton, Charlie M
- Authors: Botha, Jenny , Witkowski, Ed T F , Shackleton, Charlie M
- Date: 2004
- Subjects: To be catalogued
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/10962/181379 , vital:43728 , xlink:href="https://doi.org/10.4102/koedoe.v47i2.77"
- Description: Harvesting of products from plants in the wild is widespread throughout southern Africa. Particularly important products are plant parts used in traditional medicine. However, the impacts of harvesting practices are rarely quantified, with as yet insufficient generic rules across species and life forms. This limits the predictive ability to monitor and manage the affected populations. This paper examines the harvesting impact on two popular woody medicinal species used throughout sub-Saharan Africa, namely Catha edulis (Vahl) Forssk. ex Endl. (bushman’s tea) and Rapanea melanophloeos (L.) Mez. (Cape beech). In both species, basal diameters, heights, and the number of size classes in the harvested populations were lower than in unharvested. Densities of harvested populations were higher in both species, including densities of young plants, but the frequency of individuals in larger size classes was lower. The populations of both species being harvested for medicinal products appeared to be withstanding the current levels of harvesting, but the population structure of C. edulis populations being harvested for poles on the roadside and near human settlements had been substantially altered. Despite the resilience of the two species to harvesting for medicinal products, loss of habitat or changes in land use pose a threat to a number of the assessed populations.
- Full Text:
- Date Issued: 2004
- Authors: Botha, Jenny , Witkowski, Ed T F , Shackleton, Charlie M
- Date: 2004
- Subjects: To be catalogued
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/10962/181379 , vital:43728 , xlink:href="https://doi.org/10.4102/koedoe.v47i2.77"
- Description: Harvesting of products from plants in the wild is widespread throughout southern Africa. Particularly important products are plant parts used in traditional medicine. However, the impacts of harvesting practices are rarely quantified, with as yet insufficient generic rules across species and life forms. This limits the predictive ability to monitor and manage the affected populations. This paper examines the harvesting impact on two popular woody medicinal species used throughout sub-Saharan Africa, namely Catha edulis (Vahl) Forssk. ex Endl. (bushman’s tea) and Rapanea melanophloeos (L.) Mez. (Cape beech). In both species, basal diameters, heights, and the number of size classes in the harvested populations were lower than in unharvested. Densities of harvested populations were higher in both species, including densities of young plants, but the frequency of individuals in larger size classes was lower. The populations of both species being harvested for medicinal products appeared to be withstanding the current levels of harvesting, but the population structure of C. edulis populations being harvested for poles on the roadside and near human settlements had been substantially altered. Despite the resilience of the two species to harvesting for medicinal products, loss of habitat or changes in land use pose a threat to a number of the assessed populations.
- Full Text:
- Date Issued: 2004
Impact of fire frequency on woody community structure and soil nutrients in the Kruger National Park
- Shackleton, Charlie M, Scholes, Robert J
- Authors: Shackleton, Charlie M , Scholes, Robert J
- Date: 2000
- Subjects: To be catalogued
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/10962/181874 , vital:43776 , xlink:href="https://doi.org/10.4102/koedoe.v43i1.210"
- Description: Although fire is recognised as an important determinant of the structure and function of South African savannas, there are few studies of long-term impacts. Controlled burning blocks of contrasting fire season and frequency have been maintained throughout the Kruger National Park for almost 50 years. This paper reports on a quantitative study of the Satara plots to determine the long-term impacts of fire frequency on woody community structure and soil nutrients. Increasing fire frequency significantly decreased woody plant basal area, biomass, density, height, and mean stem circumference. The number of stems per plant and the proportion of regenerative stems increased with increasing fire frequency. Effects on species richness of woody plants were inconsistent. There were no significant differences attributable to fire frequency for any of the soil variables except organic matter and magnesium. Organic carbon was highest in the fire exclusion treatment and lowest in soils from plots burnt triennially. Magnesium levels were greatest in the annually burnt soils and least in the triennial plots.
- Full Text:
- Date Issued: 2000
Impact of fire frequency on woody community structure and soil nutrients in the Kruger National Park
- Authors: Shackleton, Charlie M , Scholes, Robert J
- Date: 2000
- Subjects: To be catalogued
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/10962/181874 , vital:43776 , xlink:href="https://doi.org/10.4102/koedoe.v43i1.210"
- Description: Although fire is recognised as an important determinant of the structure and function of South African savannas, there are few studies of long-term impacts. Controlled burning blocks of contrasting fire season and frequency have been maintained throughout the Kruger National Park for almost 50 years. This paper reports on a quantitative study of the Satara plots to determine the long-term impacts of fire frequency on woody community structure and soil nutrients. Increasing fire frequency significantly decreased woody plant basal area, biomass, density, height, and mean stem circumference. The number of stems per plant and the proportion of regenerative stems increased with increasing fire frequency. Effects on species richness of woody plants were inconsistent. There were no significant differences attributable to fire frequency for any of the soil variables except organic matter and magnesium. Organic carbon was highest in the fire exclusion treatment and lowest in soils from plots burnt triennially. Magnesium levels were greatest in the annually burnt soils and least in the triennial plots.
- Full Text:
- Date Issued: 2000
Medical Education in Decentralized Settings: How Medical Students Contribute to Health Care in 10 Sub-Saharan African Countries
- Talib, Zohray, van Schalkwyk, Susan, Cooper , I, Pattanaik , Swaha, Turay , Khadija, Sagay, Atiene S, Baingana , Rhona, Baird , Sarah, Gaede , Bernhard, Iputo, Jehu, Kibore , Minnie, Manongi , Rachel, Matsika , Antony, Mogodi , Mpho, Ramucesse , Jeremais, Ross, Heather, Simuyeba, Moses, Haile-Mariam, Damen
- Authors: Talib, Zohray , van Schalkwyk, Susan , Cooper , I , Pattanaik , Swaha , Turay , Khadija , Sagay, Atiene S , Baingana , Rhona , Baird , Sarah , Gaede , Bernhard , Iputo, Jehu , Kibore , Minnie , Manongi , Rachel , Matsika , Antony , Mogodi , Mpho , Ramucesse , Jeremais , Ross, Heather , Simuyeba, Moses , Haile-Mariam, Damen
- Date: 10-2017
- Subjects: Sub Sahara Africa Medical Education Health Care Medical Students Computer File
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/5786 , vital:44644 , https://doi:10.1097/ACM.0000000000002003
- Description: Purpose: African medical schools are expanding, straining resources at tertiary health facilities. Decentralizing clinical training can alleviate this tension. This study assessed the impact of decentralized training and contribution of undergraduate medical students at health facilities. Method: Participants were from 11 Medical Education Partnership Initiative-funded medical schools in 10 African countries. Each school identified two clinical training sites-one rural and the other either peri-urban or urban. Qualitative and quantitative data collection tools were used to gather information about the sites, student activities, and staff perspectives between March 2015 and February 2016. Interviews with site staff were analyzed using a collaborative directed approach to content analysis, and frequencies were generated to describe site characteristics and student experiences. Results: The clinical sites varied in level of care but were similar in scope of clinical services and types of clinical and nonclinical student activities. Staff indicated that students have a positive effect on job satisfaction and workload. Respondents reported that students improved the work environment, institutional reputation, and introduced evidence-based approaches. Students also contributed to perceived improvements in quality of care, patient experience, and community outreach. Staff highlighted the need for resources to support students. Conclusions: Students were seen as valuable resources for health facilities. They strengthened health care quality by supporting overburdened staff and by bringing rigor and accountability into the work environment. As medical schools expand, especially in low-resource settings, mobilizing new and existing resources for decentralized clinical training could transform health facilities into vibrant service and learning environments.
- Full Text:
- Date Issued: 10-2017
- Authors: Talib, Zohray , van Schalkwyk, Susan , Cooper , I , Pattanaik , Swaha , Turay , Khadija , Sagay, Atiene S , Baingana , Rhona , Baird , Sarah , Gaede , Bernhard , Iputo, Jehu , Kibore , Minnie , Manongi , Rachel , Matsika , Antony , Mogodi , Mpho , Ramucesse , Jeremais , Ross, Heather , Simuyeba, Moses , Haile-Mariam, Damen
- Date: 10-2017
- Subjects: Sub Sahara Africa Medical Education Health Care Medical Students Computer File
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/5786 , vital:44644 , https://doi:10.1097/ACM.0000000000002003
- Description: Purpose: African medical schools are expanding, straining resources at tertiary health facilities. Decentralizing clinical training can alleviate this tension. This study assessed the impact of decentralized training and contribution of undergraduate medical students at health facilities. Method: Participants were from 11 Medical Education Partnership Initiative-funded medical schools in 10 African countries. Each school identified two clinical training sites-one rural and the other either peri-urban or urban. Qualitative and quantitative data collection tools were used to gather information about the sites, student activities, and staff perspectives between March 2015 and February 2016. Interviews with site staff were analyzed using a collaborative directed approach to content analysis, and frequencies were generated to describe site characteristics and student experiences. Results: The clinical sites varied in level of care but were similar in scope of clinical services and types of clinical and nonclinical student activities. Staff indicated that students have a positive effect on job satisfaction and workload. Respondents reported that students improved the work environment, institutional reputation, and introduced evidence-based approaches. Students also contributed to perceived improvements in quality of care, patient experience, and community outreach. Staff highlighted the need for resources to support students. Conclusions: Students were seen as valuable resources for health facilities. They strengthened health care quality by supporting overburdened staff and by bringing rigor and accountability into the work environment. As medical schools expand, especially in low-resource settings, mobilizing new and existing resources for decentralized clinical training could transform health facilities into vibrant service and learning environments.
- Full Text:
- Date Issued: 10-2017
Fundal pressure during the second stage of labour
- Hofmeyr, Georges Justus, Vogel, Joshua. P, Cuthbert, Anna, Singata, Mandisa
- Authors: Hofmeyr, Georges Justus , Vogel, Joshua. P , Cuthbert, Anna , Singata, Mandisa
- Date: 03-2017
- Subjects: South Africa Pregnancy Computer File
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/5766 , vital:44640 , https://DOI:10.1002/14651858.CD006067.pub3
- Description: Background Fundal pressure during the second stage of labour (also known as the 'Kristeller manoeuvre') involves application of manual pressure to the uppermost part of the uterus directed towards the birth canal, in an attempt to assist spontaneous vaginal birth and avoid prolonged second stage orthe need for operative birth. Fundal pressure has also been applied using an inflatable belt. Fundal pressure is widely used, however methods of its use vary widely. Despite strongly held opinions in favour of and against the use of fundal pressure, there is limited evidence regarding its maternal and neonatal benefits and harms. There is a need for objective evaluation of the eGectiveness and safety of fundal pressure in the second stage of labour. Objectives To determine if fundal pressure is eGective in achieving spontaneous vaginal birth, and preventing prolonged second stage or the need for operative birth, and to explore maternal and neonatal adverse eGects related to fundal pressure. Search methods We searched Cochrane Pregnancy and Childbirth's Trials Register (30 November 2016) and reference lists of retrieved studies. Selection criteria Randomised and quasi-randomised controlled trials of fundal pressure (manual or by inflatable belt) versus no fundal pressure in women in the second stage of labour with singleton cephalic presentation. Data collection and analysis Two or more review authors independently assessed potential studies for inclusion and quality. We extracted data using a pre-designed form. We entered data into Review Manager 5 soAware and checked for accuracy. Main results Nine trials are included in this updated review. Five trials (3057 women) compared manual fundal pressure versus no fundal pressure. Four trials (891 women) compared fundal pressure by means of an inflatable belt versus no fundal pressure. It was not possible to blind women and staG to this intervention. We assessed two trials as being at high risk of attrition bias and another at high risk of reporting bias. All other trials were low or unclear for other risk of bias domains. Most of the trials had design limitations. Heterogeneity was high for the majority of outcomes. Manual fundal pressure versus no fundal pressure Manual fundal pressure was not associated with changes in: spontaneous vaginal birth within a specified time (risk ratio (RR) 0.96, 95% confidence interval (CI) 0.71 to 1.28; 120 women; 1 trial; very low-quality evidence), instrumental births (RR 3.28, 95% CI 0.14 to 79.65; 197 women; 1 trial), caesarean births (RR 1.10, 95% CI 0.07 to 17.27; 197 women; 1 trial), operative birth (average RR 0.66, 95% CI 0.12 to 3.55; 317 women; 2 studies; I2 = 43%; Tau2 = 0.71; very low-quality evidence), duration of second stage (mean diGerence (MD) -0.80 minutes, 95% CI -3.66 to 2.06 minutes; 194 women; 1 study; very low-quality evidence), low arterial cord pH in newborn babies (RR 1.07, 95% CI 0.72 to 1.58; 297 women; 2 trials; very low-quality evidence), or Apgar scores less than seven at five minutes (average RR 4.48, 95% CI 0.28 to 71.45; 2759 infants; 4 trials; I2 = 89%; Tau2 = 3.55; very low-quality evidence). More women who received manual fundal pressure had cervical tears than in the control group (RR 4.90, 95% CI 1.09 to 21.98; 295 women; 1 trial). No neonatal deaths occurred in either of the two studies reporting this outcome (very low-quality evidence). No trial reported the outcome severe maternal morbidity or death. Fundal pressure by inflatable belt versus no fundal pressure Fundal pressure by inflatable belt did not reduce the number of women havinginstrumental births (average RR 0.73, 95% CI 0.52 to 1.02; 891 women; 4 trials; I2 = 52%; Tau2 = 0.05) or operative births (average RR 0.62, 95% CI 0.38 to 1.01; 891 women; 4 trials; I2 = 78%; Tau2 = 0.14; very low-quality evidence). Heterogeneity was high for both outcomes. Duration of second stage was reported in two trials, which both showed that inflatable belts shortened duration of labour in nulliparous women (average MD -50.80 minutes, 95% CI -94.85 to -6.74 minutes; 253 women; 2 trials; I2 = 97%; Tau2 = 975.94; very low-quality evidence). No data on this outcome were available for multiparous women. The inflatable belt did not make any diGerence to rates of caesarean births (average RR 0.56, 95% CI 0.14 to 2.26; 891 women; 4 trials; I2 = 70%; Tau2 = 0.98), low arterial cord pHin newborn babies (RR 0.47, 95% CI 0.09 to 2.55; 461 infants; 1 trial; low-quality evidence), or Apgar scores less than seven atfive minutes (RR 4.62, 95% CI 0.22 to 95.68; 500 infants; 1 trial; very low-quality evidence). Third degree perinealtears were increased in the inflatable belt group (RR 15.69, 95% CI 2.10 to 117.02; 500 women; 1 trial). Spontaneous vaginal birth within a specified time, neonatal death, andsevere maternal morbidity or death were not reported in any trial. Authors' conclusions There is insuGicient evidence to draw conclusions on the beneficial or harmful eGects of fundal pressure, either manually or by inflatable belt. Fundal pressure by an inflatable belt during the second stage of labour may shorten duration of second stage for nulliparous women, and lower rates of operative birth. However, existing studies are small and their generalizability is uncertain. There is insuGicient evidence regarding safety for the baby. There is no evidence on the use of fundal pressure in specific clinical settings such as inability of the mother to bear down due to exhaustion or unconsciousness. There is currently insuGicient evidence for the routine use of fundal pressure by any method on women in the second stage of labour. Because of current widespread use of the procedure and the potential for use in settings where other methods of assisted birth are not available, further good quality trials are needed. Further evaluation in other groups of women (such as multiparous women) will also be required. Future research should describe in detail how fundal pressure was applied and consider safety of the unborn baby, perineal outcomes, longer-term maternal and infant outcomes and maternal satisfaction.
- Full Text:
- Date Issued: 03-2017
- Authors: Hofmeyr, Georges Justus , Vogel, Joshua. P , Cuthbert, Anna , Singata, Mandisa
- Date: 03-2017
- Subjects: South Africa Pregnancy Computer File
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/5766 , vital:44640 , https://DOI:10.1002/14651858.CD006067.pub3
- Description: Background Fundal pressure during the second stage of labour (also known as the 'Kristeller manoeuvre') involves application of manual pressure to the uppermost part of the uterus directed towards the birth canal, in an attempt to assist spontaneous vaginal birth and avoid prolonged second stage orthe need for operative birth. Fundal pressure has also been applied using an inflatable belt. Fundal pressure is widely used, however methods of its use vary widely. Despite strongly held opinions in favour of and against the use of fundal pressure, there is limited evidence regarding its maternal and neonatal benefits and harms. There is a need for objective evaluation of the eGectiveness and safety of fundal pressure in the second stage of labour. Objectives To determine if fundal pressure is eGective in achieving spontaneous vaginal birth, and preventing prolonged second stage or the need for operative birth, and to explore maternal and neonatal adverse eGects related to fundal pressure. Search methods We searched Cochrane Pregnancy and Childbirth's Trials Register (30 November 2016) and reference lists of retrieved studies. Selection criteria Randomised and quasi-randomised controlled trials of fundal pressure (manual or by inflatable belt) versus no fundal pressure in women in the second stage of labour with singleton cephalic presentation. Data collection and analysis Two or more review authors independently assessed potential studies for inclusion and quality. We extracted data using a pre-designed form. We entered data into Review Manager 5 soAware and checked for accuracy. Main results Nine trials are included in this updated review. Five trials (3057 women) compared manual fundal pressure versus no fundal pressure. Four trials (891 women) compared fundal pressure by means of an inflatable belt versus no fundal pressure. It was not possible to blind women and staG to this intervention. We assessed two trials as being at high risk of attrition bias and another at high risk of reporting bias. All other trials were low or unclear for other risk of bias domains. Most of the trials had design limitations. Heterogeneity was high for the majority of outcomes. Manual fundal pressure versus no fundal pressure Manual fundal pressure was not associated with changes in: spontaneous vaginal birth within a specified time (risk ratio (RR) 0.96, 95% confidence interval (CI) 0.71 to 1.28; 120 women; 1 trial; very low-quality evidence), instrumental births (RR 3.28, 95% CI 0.14 to 79.65; 197 women; 1 trial), caesarean births (RR 1.10, 95% CI 0.07 to 17.27; 197 women; 1 trial), operative birth (average RR 0.66, 95% CI 0.12 to 3.55; 317 women; 2 studies; I2 = 43%; Tau2 = 0.71; very low-quality evidence), duration of second stage (mean diGerence (MD) -0.80 minutes, 95% CI -3.66 to 2.06 minutes; 194 women; 1 study; very low-quality evidence), low arterial cord pH in newborn babies (RR 1.07, 95% CI 0.72 to 1.58; 297 women; 2 trials; very low-quality evidence), or Apgar scores less than seven at five minutes (average RR 4.48, 95% CI 0.28 to 71.45; 2759 infants; 4 trials; I2 = 89%; Tau2 = 3.55; very low-quality evidence). More women who received manual fundal pressure had cervical tears than in the control group (RR 4.90, 95% CI 1.09 to 21.98; 295 women; 1 trial). No neonatal deaths occurred in either of the two studies reporting this outcome (very low-quality evidence). No trial reported the outcome severe maternal morbidity or death. Fundal pressure by inflatable belt versus no fundal pressure Fundal pressure by inflatable belt did not reduce the number of women havinginstrumental births (average RR 0.73, 95% CI 0.52 to 1.02; 891 women; 4 trials; I2 = 52%; Tau2 = 0.05) or operative births (average RR 0.62, 95% CI 0.38 to 1.01; 891 women; 4 trials; I2 = 78%; Tau2 = 0.14; very low-quality evidence). Heterogeneity was high for both outcomes. Duration of second stage was reported in two trials, which both showed that inflatable belts shortened duration of labour in nulliparous women (average MD -50.80 minutes, 95% CI -94.85 to -6.74 minutes; 253 women; 2 trials; I2 = 97%; Tau2 = 975.94; very low-quality evidence). No data on this outcome were available for multiparous women. The inflatable belt did not make any diGerence to rates of caesarean births (average RR 0.56, 95% CI 0.14 to 2.26; 891 women; 4 trials; I2 = 70%; Tau2 = 0.98), low arterial cord pHin newborn babies (RR 0.47, 95% CI 0.09 to 2.55; 461 infants; 1 trial; low-quality evidence), or Apgar scores less than seven atfive minutes (RR 4.62, 95% CI 0.22 to 95.68; 500 infants; 1 trial; very low-quality evidence). Third degree perinealtears were increased in the inflatable belt group (RR 15.69, 95% CI 2.10 to 117.02; 500 women; 1 trial). Spontaneous vaginal birth within a specified time, neonatal death, andsevere maternal morbidity or death were not reported in any trial. Authors' conclusions There is insuGicient evidence to draw conclusions on the beneficial or harmful eGects of fundal pressure, either manually or by inflatable belt. Fundal pressure by an inflatable belt during the second stage of labour may shorten duration of second stage for nulliparous women, and lower rates of operative birth. However, existing studies are small and their generalizability is uncertain. There is insuGicient evidence regarding safety for the baby. There is no evidence on the use of fundal pressure in specific clinical settings such as inability of the mother to bear down due to exhaustion or unconsciousness. There is currently insuGicient evidence for the routine use of fundal pressure by any method on women in the second stage of labour. Because of current widespread use of the procedure and the potential for use in settings where other methods of assisted birth are not available, further good quality trials are needed. Further evaluation in other groups of women (such as multiparous women) will also be required. Future research should describe in detail how fundal pressure was applied and consider safety of the unborn baby, perineal outcomes, longer-term maternal and infant outcomes and maternal satisfaction.
- Full Text:
- Date Issued: 03-2017
Research in financial services: professing a way forward
- Authors: Rootman, Chantal
- Subjects: Financial services industry -- South Africa , Financial services industry -- Customer services -- South Africa , f-sa
- Language: English
- Type: text , Lectures
- Identifier: http://hdl.handle.net/10948/21066 , vital:29435
- Description: Outline: What do we know about financial services research? What is the current state of financial services in South Africa? Professing the way forward for financial services research.
- Full Text:
- Authors: Rootman, Chantal
- Subjects: Financial services industry -- South Africa , Financial services industry -- Customer services -- South Africa , f-sa
- Language: English
- Type: text , Lectures
- Identifier: http://hdl.handle.net/10948/21066 , vital:29435
- Description: Outline: What do we know about financial services research? What is the current state of financial services in South Africa? Professing the way forward for financial services research.
- Full Text:
The Interplay between Universal and Unique Contexts in Shaping Child Developmental Assessment
- Authors: Stroud, Louise
- Subjects: Child development -- Testing , Developmental psychology , f-sa
- Language: English
- Type: text , Lectures
- Identifier: http://hdl.handle.net/10948/21088 , vital:29437
- Description: In this lecture the revision of the Griffiths Scales of Child Development, or Griffiths III as it is now known, will be described. It is not a description or story that falls easily and smoothly into sequence. It is one that has been garnered from many sources and from many people. Some of it comes in the form of fragments from professional men and women who have looked upon developing children with a unique and unrelenting eye. It comes from men and women who carry the germ of knowledge, implanted somewhere deeply in their beings, a place where a curious, natural rhythm exists and a kind of magic. Additionally a suggested plan for the future or “what next” phase in the interplay between universal and unique contexts in shaping child developmental assessment specifically using the Griffiths III will be described and proposed.
- Full Text:
- Authors: Stroud, Louise
- Subjects: Child development -- Testing , Developmental psychology , f-sa
- Language: English
- Type: text , Lectures
- Identifier: http://hdl.handle.net/10948/21088 , vital:29437
- Description: In this lecture the revision of the Griffiths Scales of Child Development, or Griffiths III as it is now known, will be described. It is not a description or story that falls easily and smoothly into sequence. It is one that has been garnered from many sources and from many people. Some of it comes in the form of fragments from professional men and women who have looked upon developing children with a unique and unrelenting eye. It comes from men and women who carry the germ of knowledge, implanted somewhere deeply in their beings, a place where a curious, natural rhythm exists and a kind of magic. Additionally a suggested plan for the future or “what next” phase in the interplay between universal and unique contexts in shaping child developmental assessment specifically using the Griffiths III will be described and proposed.
- Full Text: