Machakos School

Mortality among adults admitted to hospital with community acquired pneumonia in resource-limited settings is high. Recent studies conducted in high-income settings have demonstrated beneficial effects of low-dose corticosteroids in reducing mortality in patients with severe community acquired pneumonia. It is unknown whether these findings apply to low-income settings such as sub-Saharan Africa.This pragmatic randomized-controlled open-label trial will determine the effect of adjunctive low-dose corticosteroids in the management of adults admitted to hospital with community acquired pneumonia on mortality 30-days post-randomization. We will enroll and randomize 2180 patients admitted with a diagnosis of community acquired pneumonia into two arms: the control and intervention arm. Those in the control arm will receive standard care for the treatment of community acquired pneumonia i.e., combination therapy with a beta-lactam and macrolide antibiotic. Those in the intervention arm will receive up to 10-days treatment with low-dose oral corticosteroids in addition to standard care. All participants will be followed up to 30- days post randomization and their final status recorded (alive or dead). If adjunctive low-dose oral corticosteroids are found to be beneficial, this easily scalable intervention would significantly reduce the currently high mortality associated with community acquired pneumonia.Pan-African Clinical Trials Registry: PACTR202111481740832; ISRCTRN registry: ISRCTN36138594.

Purpose of the study: This study aims to explore the use of ICT-based physics learning media by physics teachers in high schools in Demak Regency. In addition, this study identifies challenges and opportunities in the application of ICT to improve the quality of physics learning. Methodology: This study uses a qualitative approach with a case study method. Data were collected through structured interviews using a questionnaire, as well as documentation related to ICT infrastructure. Purposive sampling technique was used to select two physics teachers and six students at State Senior High School 3 Demak. Data analysis refers to the Miles and Huberman model, which includes data reduction, data presentation, and drawing conclusions. Main Findings: This study found that the use of ICT-based learning media in physics learning at State Senior High School 3 Demak can improve students' understanding of abstract concepts. Teachers used PowerPoint, learning videos, simulations, and digital platforms. The main challenges included limited ICT facilities, unstable internet connections, and teachers' diverse technological skills. Students showed positive responses to ICT-based learning, but still needed a combination of conventional methods. Adaptive strategies are needed to overcome the constraints of technology accessibility. Novelty/Originality of this study: This study enriches the literature with an in-depth case study approach, reveals practical solutions in ICT integration, and emphasizes the importance of a combination of conventional and digital methods for learning effectiveness.

Over the past two decades, wide-awake local anesthesia no-tourniquet (WALANT) surgery has gained substantial popularity, challenging conventional assumptions regarding the safety of epinephrine. This report investigates the unprecedented expansion of the wide-awake local anesthesia technique beyond hand surgeries. It meticulously documents its successful application in a peri-implant proximal humerus fracture, presenting a fresh perspective on its safety and viability for managing intricate orthopedic injuries. The subject of this study is a 61-year-old HIV-positive male with a history of recurrent falls, seeking treatment for a peri-implant proximal humerus fracture. Electing the wide-awake local anesthesia option due to financial constraints, the patient underwent a successful surgery. The technique employed involved precise administration of local anesthetic, facilitating fracture reduction, and plate replacement. Notably, the emphasis was placed on active patient participation during intraoperative assessment. This report extends the recognized utility of WALANT surgery beyond hand surgeries, demonstrating its versatility and potential transformative impact on health-care delivery. The study underscores the pivotal role played by wide-awake local anesthesia surgery in addressing challenges related to health-care accessibility. It presents a promising avenue for future orthopedic interventions and positions itself as a safe and viable option for patients in underserved areas globally.

ObjectivesTo create an otolaryngology‐specific needs assessment tool for short‐term global surgical trips and to describe our findings from its implementation.MethodsSurveys 1 and 2 were developed based on a literature review and disseminated to Low‐Middle Income (LMIC) hosting institutions in Kenya and Ethiopia and to High‐Income surgical trip participants (HIC), respectively. Respondents were otolaryngologists identified online, through professional organizations, and by word‐of‐mouth, who had participated in a surgical trip of <4 weeks.ResultsHIC and LMIC respondents shared similar goals of expanding host surgical skills through education and training while building sustainable partnerships. Discrepancies were identified between LMIC desired surgical skills and supply needs and HIC current practices. Microvascular reconstruction (17.6%), advanced otologic surgery (17.6%), and FESS (14.7%) were most desired skills and high‐demand equipment needs were FESS sets (89%), endoscopes (78%), and surgical drills (56%). Frequently taught techniques included advanced otologic surgery (36.6%), congenital anomaly surgery (14.6%), and FESS (14.6%) with the largest gap between LMIC‐need and HIC‐offerings being in microvascular reconstruction (17.6% vs. 0%). We also highlight the discrepancy in expectations of responsibility for trip logistics, research, and patient follow‐up.ConclusionWe created and implemented the first otolaryngology‐specific needs assessment tool in the literature. With its implementation in Ethiopia and Kenya, we were able to identify unmet needs as well as attitudes and perceptions of LMIC and HIC participants. This tool may be adapted and utilized to assess specific needs, resources, and goals of both host and visiting teams to facilitate successful global partnerships.Level of EvidenceLevel VI.

aENT Department of Otorhinolaryngology, Machakos Level 5 Hospital, Machakos, Kenya bDepartment of Otolaryngology, Université Assane Seck, Ziguinchor, Senegal cDepartment of Surgery, Kamuzu University of Health Sciences, Blantyre, Malawi dProfessor and Chairman, Division of Otorhinolaryngology, University of Cape Town, Cape Town, South Africa Correspondence to Johannes J. Fagan, MBChB, MMed, FCS (ORL), Professor and Chairman, Division of Otorhinolaryngology, University of Cape Town, H53 OMB, Groote Schuur Hospital, Observatory, Cape Town 7925, South Africa. Tel: +27828973473; e-mail: [email protected]

Equitable research collaborations benefit the quality and relevance of global otolaryngology–head and neck surgery research. However, analyses of existing global health literature have shown disproportionate representation by foreign authors. To avert this inequity and improve global otolaryngology–head and neck surgery research, we propose a framework that emphasizes local representation and capacity building in research.

Private tuition refers to tutoring offered outside mainstream teaching. The study sought to establish the difference in prevalence for private tuition among parents, teachers and pupils in public primary schools in Machakos County. The study employed descriptive survey design. The target populations were all teachers, parents and pupils of public primary schools in Machakos County. A total of 405 respondents were sampled for the study and comprised of 27 parents, 27 teachers and 351 pupils. Data was collected by use of questionnaires and interview guide. Descriptive as well as inferential statistics were used to analyze data and results presented in tables showing frequency, standard deviations and means. The hypothesis was tested using ANOVA which showed the tuition mean prevalence between groups as 1.457 and within groups as 0.056. The post hoc analysis was done using the Scheffe test and the mean difference between teachers and pupils gave a mean of 0.228 and between pupils and parents gave a mean of 0.260. The findings indicate that private tuition is still being offered despite the government ban and that the main reasons given for engagement in holiday tuition include desire to get high marks, stiff competition for placement into particular secondary schools, inadequate teacher pupil ratio and as a way of earning extra income by teachers. The study recommends that the government remunerates teachers adequately and to have other measures of rewarding performance other than academics. The study also recommends that the government needs to improve infrastructure in all secondary schools to minimize the stiff competition for those schools perceived to be prestigious. In addition, there should be stakeholders' awareness of other ways of engaging pupils constructively during their free time other than in private tuition.