2 resultados para Primary level

em Dalarna University College Electronic Archive


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This study has investigated the question of relation between literacy practices in and out of school in rural Tanzania. By using the perspective of linguistic anthropology, literacy practices in five villages in Karagwe district in the northwest of Tanzania have been analysed. The outcome may be used as a basis for educational planning and literacy programs. The analysis has revealed an intimate relation between language, literacy and power. In Karagwe, traditional élites have drawn on literacy to construct and reconstruct their authority, while new élites, such as individual women and some young people have been able to use literacy as one tool to get access to power. The study has also revealed a high level of bilingualism and a high emphasis on education in the area, which prove a potential for future education in the area. At the same time discontinuity in language use, mainly caused by stigmatisation of what is perceived as local and traditional, such as the mother-tongue of the majority of the children, and the high status accrued to all that is perceived as Western, has turned out to constitute a great obstacle for pupils’ learning. The use of ethnographic perspectives has enabled comparisons between interactional patterns in schools and outside school. This has revealed communicative patterns in school that hinder pupils’ learning, while the same patterns in other discourses reinforce learning. By using ethnography, relations between explicit and implicit language ideologies and their impact in educational contexts may be revealed. This knowledge may then be used to make educational plans and literacy programmes more relevant and efficient, not only in poor post-colonial settings such as Tanzania, but also elsewhere, such as in Western settings.

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BACKGROUND: Misoprostol is established for the treatment of incomplete abortion but has not been systematically assessed when provided by midwives at district level in a low-resource setting. We investigated the effectiveness and safety of midwives diagnosing and treating incomplete abortion with misoprostol, compared with physicians. METHODS: We did a multicentre randomised controlled equivalence trial at district level at six facilities in Uganda. Eligibility criteria were women with signs of incomplete abortion. We randomly allocated women with first-trimester incomplete abortion to clinical assessment and treatment with misoprostol either by a physician or a midwife. The randomisation (1:1) was done in blocks of 12 and was stratified for study site. Primary outcome was complete abortion not needing surgical intervention within 14-28 days after initial treatment. The study was not masked. Analysis of the primary outcome was done on the per-protocol population with a generalised linear-mixed effects model. The predefined equivalence range was -4% to 4%. The trial was registered at ClinicalTrials.gov, number NCT01844024. FINDINGS: From April 30, 2013, to July 21, 2014, 1108 women were assessed for eligibility. 1010 women were randomly assigned to each group (506 to midwife group and 504 to physician group). 955 women (472 in the midwife group and 483 in the physician group) were included in the per-protocol analysis. 452 (95·8%) of women in the midwife group had complete abortion and 467 (96·7%) in the physician group. The model-based risk difference for midwife versus physician group was -0·8% (95% CI -2·9 to 1·4), falling within the predefined equivalence range (-4% to 4%). The overall proportion of women with incomplete abortion was 3·8% (36/955), similarly distributed between the two groups (4·2% [20/472] in the midwife group, 3·3% [16/483] in the physician group). No serious adverse events were recorded. INTERPRETATION: Diagnosis and treatment of incomplete abortion with misoprostol by midwives is equally safe and effective as when provided by physicians, in a low-resource setting. Scaling up midwives' involvement in treatment of incomplete abortion with misoprostol at district level would increase access to safe post-abortion care. FUNDING: The Swedish Research Council, Karolinska Institutet, and Dalarna University.