Using Data Tools and Systems to Drive Change in Early Childhood Education for Disadvantaged Children in South Africa.

In line with United Nations Sustainable Development Goal (SDG) 4.2, South Africa's National Development Plan commits to providing high-quality early childhood education to all children by 2030 to drive improved child outcomes. Prior to 2016, South Africa lacked reliable, locally standardised, valid, and cross-culturally fair assessment tools for measuring preschool quality and child outcomes, suitable for use at scale within a resource-constrained context. In this paper we detail the development and evolution of a suite of early learning measurement (ELOM) tools designed to address this measurement gap. The development process included reviews of literature and other relevant assessment tools; a review of local curriculum standards and expected child outcomes; extensive consultation with government officials, child development experts, and early learning practitioners, iterative user testing; and assessment of linguistic, cultural, functional, and metric equivalence across all 11 official South African languages. To support use of the ELOM tools at scale, and by users with varying levels of research expertise, administration is digitised and embedded within an end-to-end data value chain. ELOM data collected since 2016 quantify the striking socio-economic gradient in early childhood development in South Africa, demonstrate the relationship between physical stunting, socio-emotional functioning and learning outcomes, and provide evidence of the positive impact of high-quality early learning programmes on preschool child outcomes. To promote secondary analyses, data from multiple studies are regularly collated into a shared dataset, which is made open access via an online data portal. We describe the services and support that make up the ELOM data value chain, noting several key challenges and enablers of data-driven change within this context. These include deep technical expertise within a multidisciplinary and collaborative team, patient and flexible capital from mission-aligned investors, a fit-for-purpose institutional home, the appropriate use of technology, a user-centred approach to development and testing, sensitivity to children's diverse linguistic and socio-economic circumstances, careful consideration of requirements for scale, appropriate training and support for a non-professional assessor base, and a commitment to ongoing learning and continuous enhancement. Practical examples are provided of ways in which the ELOM tools and data are used for programme monitoring and enhancement purposes, to evaluate the relative effectiveness of early learning interventions, to motivate for greater budget and inform more effective resource allocation, to support the development of enabling Government systems, and to track progress towards the attainment of national and global development goals. We share lessons learnt during the development of the tools and discuss the factors that have driven their uptake in South Africa.

The development of a South African Early Learning Outcomes Measure: A South African instrument for measuring early learning program outcomes.

BACKGROUND: Assessment of early childhood development programme effectiveness in South Africa is hampered by a lack of suitable measures that account for variations in cultural and socio-economic backgrounds and can be administered by non-professionals. This contribution reports the standardisation of the South African Early Learning Outcomes Measure (ELOM), an instrument designed for population level monitoring of the developmental status of children aged 50-69 months and for evaluation of early learning programmes. METHODS: The development of the ELOM was informed by South Africa's National Curriculum Framework from Birth to Four and its National Early Learning and Development Standards. ELOM items were drawn from reliable and valid instruments, particularly those used in Africa and other developing regions and were clustered in five domains: gross motor development, fine motor coordination and visual motor integration, emergent numeracy and mathematics, cognition and executive functioning, emergent literacy and language. The ELOM was standardised on a sample of 1,331 children aged 50-69 months, from five South African official languages and five socio-economic strata. Item Response Theory techniques were used to establish reliability, validity, and differential item functioning. RESULTS: Confirmatory Factor Analysis established that ELOM domains are unidimensional and internally consistent. Items discriminate reliably between more and less able children and do not discriminate unfairly between children of the same ability from different language backgrounds. Socio-economic gradients were evident in children's performance. South African Early Learning Development Standards (ELDS) based on standard scores were developed and set at the 60th percentile of the sample standard score distribution. CONCLUSIONS: This research produced the first South African, age-validated population-level standardised instrument that can be administered relatively cheaply by trained non-professionals. This will facilitate the assessment of the efficacy of early learning programmes in enabling children to reach ELDS prior to entering Grade R and track progress toward Sustainable Development Goal 4.2.

Klebsiella pyomyositis with complications: a quadriceps quandary in a dialysis patient.

The authors report an extremely rare case of Klebsiella pneumoniae pyomyositis of the left thigh in a patient with type II diabetes mellitus on renal replacement therapy (haemodialysis), with untreated hepatitis C. This patient presented via the dialysis unit with fevers, rigors and a swollen left thigh and knee. Initial differential diagnoses included deep vein thrombosis with systemic inflammatory response syndrome, septic arthritis and crystal arthropathy-all of which were subsequently excluded. Although missed on ultrasound duplex scan, lower limb magnetic resonance imaging (MRI) revealed communicating abscesses in the anterior and medial compartments of the left thigh, with associated inflammation of the muscle. Blood cultures on admission and cultures from direct aspiration of the abscesses grew Klebsiella pneumoniae. The abscesses were managed with a computed tomography-guided drain and combination antibiotic therapy.

Violence, violence prevention, and safety: a research agenda for South Africa.

Violence is a serious problem in South Africa with many effects on health services; it presents complex research problems and requires interdisciplinary collaboration. Two key meta-questions emerge: (i) violence must be understood better to develop effective interventions; and (ii) intervention research (evaluating interventions, assessing efficacy and effectiveness, how best to scale up interventions in resource-poor settings) is necessary. A research agenda to address violence is proposed.

Child and adolescent mental health in South Africa.

Mental health problems in childhood and adolescence pose a major threat to public health. Epidemiological studies in high, middle and low income countries indicate that approximately one in five children and adolescents suffer from a mental disorder. In many instances these persist into adulthood. In South Africa, HIV infection, substance use, and exposure to violence increase vulnerability to mental disorders. Child and adolescent mental health services play a key role in reducing the burden of mental disorders in childhood and later in adulthood. This paper focuses on service needs for children and adolescents in South Africa. It commences with a discussion of the prevalence of child and adolescent psychiatric disorders after which the legal and policy context of child and adolescent psychiatric services is described. A framework for child and adolescent mental health service provision is presented, following which steps for reducing the extent of unmet service need are considered. The paper concludes with a call to scale up child and adolescent mental health services in South Africa, based on the stark realities of unmet need and the constitutional rights of children and adolescents to appropriate mental health care.

Scaling up child and adolescent mental health services in South Africa: human resource requirements and costs.

BACKGROUND: Children and adolescents with mental health problems have poor service cover in low- and middle-income countries. Little is known about the resources that would be required to provide child and adolescent mental health services (CAMHS) in these countries. The purpose of this study was to calculate the human resources and associated costs required to scale up CAMHS in South Africa. METHODS: A spreadsheet model was developed to calculate mental health service resources, based on an estimation of the need for services in a given population. The model can be adapted to specific settings by adjusting population size, age distribution, prevalence, comorbidity, levels of coverage, service utilisation rates, workloads, length of consultations and staff profile. Steps in the modelling include population identification; estimates of prevalence, service utilisation and staffing; and costing. RESULTS: Using a nominal total population of 100,000 (of which 43,170 would be children and adolescents under 20 years of age), the following full-time equivalent staff are required at minimum coverage level: 5.8 in PHC facilities, .6 in general hospital outpatient departments (OPDs), .1 in general hospital inpatient facilities, 1.1 in specialist CAMHS OPDs, .6 in specialist CAMHS inpatient facilities, .5 in specialist CAMHS day services, and .8 in regional CAMHS teams. This translates into roughly $21.50 and $5.99 per child or adolescent per annum nationally for the full coverage and minimum coverage scenarios respectively. When comparing the results of this model with current realities in South Africa, there remains a substantial shortfall in existing levels of CAMHS provision. CONCLUSIONS: The model can be used as an advocacy tool to engage with planners and policy makers on a rational basis. It can also be adapted for use in other countries, and is intended to support wider calls for a global scaling up of mental health services.

Youth violence risk assessment: gaps in local knowledge and directions for future research.

There is a lack of research on violence risk assessment in South Africa, particularly on the assessment of risk for violence in children and adolescents. This is problematic, because of the strong association between conducting sound assessments and the appropriate referral of youths to intervention programmes. Considering the very high levels of violence in our country, the effective treatment of violent youths is imperative. International literature on violence risk assessment indicates that although a number of instruments designed to assess youth violence risk exist, many primarily focus on identifying psychopathic tendencies in young people, which has stimulated much debate amongst scholars. In addition to paying careful attention to the content of youth violence risk instruments, their administration should be monitored, to ensure that assessment practice is up to standard. Future research efforts in South Africa should be dedicated towards testing the applicability of instruments developed internationally in local settings, and towards the development and testing of local instruments.

Youth violence: A review of risk factors, causal pathways and effective intervention.

This paper presents a review of theoretical and empirical research on risk factors for: 1) the development of violent and other antisocial behaviour; 2) international interventions targeting antisocial, including violent youths; and 3) outcome evaluations and meta-analyses of interventions targeting antisocial, including violent youths. Taken together, the international literature indicates that interventions which effectively reduce violent and other antisocial behaviours are informed by a number of generic principles which should guide the development and implementation of South African violence-prevention programmes. Common characteristics of interventions which effectively reduce youth violence are presented, with the aim of informing the design and delivery of local interventions. In light of the alarmingly high levels of violence in South Africa, there is an urgent need to develop intensive, multi-modal, evidence-based, structured, cognitive-behavioural programmes for violent adolescents and young adults. Furthermore, it is imperative that efforts are directed at developing a reliable local evidence base of 'what works' for young offenders generally, and violent young offenders specifically.

Absorption-induced trapping in an anisotropic magneto-optical trap.

We report on a simple anisotropic magneto-optical trap for neutral atoms that produces a large sample of cold atoms confined in a cylindrically-shaped volume with a high aspect ratio (100:1). Due to the large number of trapped atoms, the laser beams that propagate along the optically thick axis of the trap to cool the atoms are substantially attenuated. We demonstrate that the resulting intensity imbalance produces a net force that spatially localizes the atoms. This limits both the trap length and the total number of trapped atoms. Rotating the cooling beams by a small angle relative to the trap axis avoids the problem of attenuation, and atoms can be trapped throughout the entire available trapping volume. Numerical and experimental results are reported that demonstrate the effects of absorption in an anisotropic trap, and a steady-state, line-center optical path length of 55 is measured for a probe beam propagating along the length of the trap.

Women coping with AIDS in Africa: contributions of a contextually grounded research methodology.

The primary objective of this report is to describe a contextually grounded approach to the investigation of coping and psychological functioning in AIDS-sick mothers. Five AIDS-sick women on antiretroviral therapy who had at least one child under 6 years of age living in their households were interviewed. Among the issues that emerged was the complexity of the women's psychological functioning, the fact that they made strategic decisions about disclosure aimed at protecting important social support networks, and that their well-being was dynamically influenced by factors in the home and community. The study provides evidence for the value of a contextual approach when investigating the psychological functioning of HIV positive mothers living in poor high-HIV prevalence communities in developing countries.

Direct observation of optical precursors in a region of anomalous dispersion.

We create optical precursors by propagating a step-modulated optical pulse through a linear resonant dielectric absorber. The field emerging from the dielectric consists of a several-nanosecond-long spike with near 100% transmission, which decays to a constant value expected from Beer's law. This high-transmission spike might be useful for imaging applications requiring penetrating optical radiation. We compare our observations to two different theories, revealing that the spike consists of both the Sommerfeld and Brillouin precursors.

Epidemiological measurement of children's and adolescents' exposure to community violence: working with the current state of the science.

A number of measures have been used in epidemiological studies of children's exposure to community violence, yet the quality of these instruments is not uniformly good. This paper undertakes a systematic review of the most commonly used (or most promising) self-report or interview-administered instruments, with regard to their conceptual bases and psychometric properties. Based on the review, recommendations are made for working with the current state of the science in order to move the field forward. A key recommendation is for sounder conceptualization of work in the field and greater transparency in the reporting of research, in order to facilitate the comparability of studies.

All-optical switching in rubidium vapor.

We report on an all-optical switch that operates at low light levels. It consists of laser beams counterpropagating through a warm rubidium vapor that induce an off-axis optical pattern. A switching laser beam causes this pattern to rotate even when the power in the switching beam is much lower than the power in the pattern. The observed switching energy density is very low, suggesting that the switch might operate at the single-photon level with system optimization. This approach opens the possibility of realizing a single-photon switch for quantum information networks and for improving transparent optical telecommunication networks.

Distortion management in slow-light pulse delay.

We describe a methodology to maximize slow-light pulse delay subject to a constraint on the allowable pulse distortion. We show that optimizing over a larger number of physical variables can increase the distortion-constrained delay. We demonstrate these concepts by comparing the optimum slow-light pulse delay achievable using a single Lorentzian gain line with that achievable using a pair of closely-spaced gain lines. We predict that distortion management using a gain doublet can provide approximately a factor of 2 increase in slow-light pulse delay as compared with the optimum single-line delay. Experimental results employing Brillouin gain in optical fiber confirm our theoretical predictions.