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Contributions of a community health worker program in improving district health system performance in South Africa, using routine health service variables in a quasi-experimental study design
(BioMed Central, 2025-08) Thomas, Leena Susan; Jordaan, Joyce; Pillay, Yogan; Buch, Eric; leena.thomas@up.ac.za
BACKGROUND : Globally low- and middle-income countries are investing in community health worker (CHW) programs. These programs are viewed as fundamental to ensuring universal health coverage for all. Where CHW programs are doing what they should be doing and doing it adequately, they should make a difference in population health outcomes, reflecting health system changes.
However, there are not many studies exploring the contributions and effectiveness of large-scale, comprehensive community health worker programs on health system performance.
METHODS : This study takes place in the Ekurhuleni health district, in urban South Africa.
A before (pre) and after (post) intervention study (quasi-experimental) using routine health service variables (secondary data) from district clinics over nine years was conducted. Performance of intervention clinics with community health worker teams that had more than 60% population coverage were compared to similar control clinics that had no teams or teams with less than 30% coverage.
RESULTS : Both groups of clinics generally improved over time for routine health service variables for maternal, child health, infectious diseases, and cervical cancer programmes. Over nine years, intervention clinics showed more improved performance, statistically significant, in six health variables while controls improved in four. But importantly, intervention clinics improved proportionately better pre to post in seven of the nine (78%) variables studied compared to controls, demonstrating reduced diarrhoeal disease and pneumonia in children, better Vitamin A coverage, fewer severely malnourished children, better testing for HIV, and better screening for Tuberculosis and cervical cancer. Illustrating the comprehensive range of services provided by CHWs, the seven routine health service variables represented maternal, child health, infectious and non-communicable diseases. We also observed less uncontrolled hypertensive and diabetics in intervention clinics compared to control clinics.
CONCLUSION : Large-scale, sustained and comprehensive community health worker programs adequately covering populations contributed to improved urban district health system performance in Ekurhuleni, demonstrating their effectiveness. This was explored through improvements in health system performance over time. These findings, using routine health service variables, have policy implications for financial and other resource allocations in health districts in low- and middle-income countries.
The effect of semiorganic iodine-containing compounds on the antibiotic susceptibility of pathogenic microorganisms
(MDPI, 2025-08) Kenesheva, Sabina T.; Turganbay, Seitzhan; Jumagaziyeva, Ardak B.; Askhatkyzy, Gaukhar; Askarova, Dana A.; Azembayev, Amir A.; Ilin, Alexandr I.; Reva, Oleg N.; Karpenyuk, Tatyana A.; oleg.reva@up.ac.za
OBJECTIVES : The global rise in multidrug resistance underscores the urgent need for the development of novel and effective antimicrobial agents. Semi-organic iodine-containing complexes, owing to their unique properties, low likelihood of resistance development, and stability under various conditions, represent a promising avenue for the design of new therapeutic strategies. This study describes the synthesis of semi-organic iodine-containing complexes and the in vitro evaluation of their impact on antibiotic susceptibility modulation in the multidrug-resistant pathogenic microorganisms S. aureus and E. coli.
METHODS: The physicochemical properties of the semiorganic compounds were characterized using UV-Vis spectroscopy, potentiometric, and titrimetric methods. Evaluation of antimicrobial activity was obtained according to CLSI protocols. The impact of semiorganic compounds on the in vitro susceptibility of MDR strains was evaluated by the disk diffusion method.
RESULTS : This study evaluated the effects of iodine-containing complexes KC-270 and KC-271 on the antibiotic susceptibility of Staphylococcus aureus BAA-39 and Escherichia coli BAA-196. The most pronounced effect was observed with KC-270 applied during the lag phase, which enhanced the activity of several antibiotics and, in some cases, restored susceptibility. KC-271 exhibited a weaker and more limited impact. The findings suggest that KC-270 has potential as a modulator of antibiotic susceptibility, particularly when administered at early stages of bacterial growth.
CONCLUSIONS : The results support the ability of amino acid-based iodine coordination compounds to influence the antibiotic susceptibility of pathogenic bacteria, highlighting their potential as adjuvant agents to improve the effectiveness of current antimicrobial therapies. However, although changes in susceptibility were detected, neither compound fully eliminated resistance in the multidrug-resistant strains, indicating the necessity for further research into their mechanisms of action and possible synergistic interactions with antibiotics.
In vitro photoprotective and skin aging-related enzyme in-hibitory activities of Cylindrospermum alatosporum (NR125682) and Loriellopsis cavernicola (NR117881) extracts
(MDPI, 2025-09) Sithole, Siphesihle Z.; Ikhane, Albert O.; Osunsanmi, Foluso Oluwagbemiga; Mosa, Rebamang Anthony; Opoku, Andrew Rowland; rebamang.mosa@up.ac.za
The use of cyanobacteria has gained considerable interest in many industries, including the cosmetic industry, due to its rich array of bioactive metabolites. This study evaluates the in vitro photoprotective properties and the effect of Cylindrospermum alatosporum (NR125682) and Loriellopsis cavernicola (NR117881) extracts on slowing down the enzymes associated with skin aging. Various crude extracts were prepared using hexane, dichloromethane, and ethanol solvents. The resulting crude extract solvents were completely distilled to obtain their bioactive compounds, based on selected polarities. The sulfhydryl content of the crude extracts was determined and the aging-associated enzymes’ activity (collagenase, elastase, hyaluronidase, and tyrosinase) in the crude extracts was investigated. Furthermore, the in vitro photoprotective activity of the extracts was assessed by measuring UVA and UVB photoprotection. Most of the extracts contained varying amounts of sulfhydryl compounds (10.88–78.15 mg/g). All of the extracts demonstrated in vitro inhibitory activity against tyrosinase, hyaluronidase (IC50 6 µg/mL), and collagenase (IC50 50–70 µg/mL); weak elastase inhibitory activities were also observed. The crude extracts also showed appreciable UVA and UVB photoprotective activity. Meanwhile, L. cavernicola extracts demonstrated the highest UVB photoprotective activity (SPF 14.67–78.96). It is noteworthy that the crude extracts possessed anti-skin-aging potency with notable photoprotective capability.
Oligochitosan conjugates of the antimalarials dihydroartemisinin and lumefantrine : synthesis, stability, cell viability, and antiplasmodial studies
(Wiley, 2025-10) Matshe, William; Mvango, Sindisiwe; Malabi, Rudzani; Tantoh, Asongwe; Andraos, Charlene; Famuyide, Ibukun Michael; McGaw, Lyndy Joy; Baijnath, Sooraj; Pilcher, Lynne A.; Balogun, Mohammed; mohammedbalogun@tuks.co.za
Malaria is treatable with several combinations of drugs, the most well-known and currently most effective being artemisinin-based therapies. Gastrointestinal absorption of these drugs can be poor and erratic if not taken with a fatty meal. Nausea and the loss of appetite, common symptoms of even mild malaria, can therefore jeopardize the effectiveness of the treatment. To enhance the bioavailability of artemisinin-based combination therapies, several lipid-based formulations and delivery systems have been investigated. In this study, we synthesized oligochitosan conjugates of the antimalarial drugs dihydroartemisinin and lumefantrine and examined their physical stability and biological activities. The hydrodynamic properties of both conjugates varied unpredictably under pH conditions like those found at different stages along the gastrointestinal tract and in plasma. The viability of Caco-2 cells exposed to the conjugates was also investigated in comparison to the free drugs. Both conjugates demonstrated significantly lower cytotoxicity compared to the free drugs at concentrations up to 0.5 mg/mL, particularly during the first 24 h of exposure. Despite this, they retained their antiplasmodial effect against Plasmodium falciparum in an in vitro assay at 1 µg/mL and 5 µg/mL. These new chitosan biomaterials hold great potential for further development into oral therapeutics that would not require fatty meal intake due to the intrinsic mucoadhesiveness of chitosan.
PrEP awareness and willingness to use oral PrEP among males ≥ 18 years attending VMMC services in Gauteng, South Africa
(Springer, 2025) Shangase, Nosipho; Tobaiwa, Ocean; Cutler, Ewalde; Singh, Beverley; Brukwe, Zinhle; Pillay, Erushka; Dorrell, Philip; Moyo, Khumbulani; Zondi, Lindokuhle; Pillay, Yogan; Patrick, Sean Mark; Puren, Adrian; Kufa, Tendesayi
Integration of voluntary medical male circumcision (VMMC) with pre-exposure prophylaxis (PrEP) services may increase access to and/or uptake of combination HIV prevention strategies. We examined awareness of and willingness to use oral PrEP among adult males attending VMMC services in Gauteng province, South Africa. A cross-sectional study was conducted among HIV-negative males aged ≥ 18 years seeking healthcare at one of six high-volume public VMMC clinics from June-October 2021. Participants provided written informed consent, completed an interviewer-administered questionnaire (covering demographics, clinical history, sexual behavioural and risk perception, PrEP eligibility, PrEP awareness and PrEP willingness), and underwent a rapid dual HIV/syphilis test. Logistic regression models (adjusted for education, age and sexual debut) were used to determine factors associated with PrEP awareness and PrEP willingness. Among the participants, 40% were at substantial risk of HIV and thus eligible for PrEP, 45% were aware of PrEP and 80% were likely/highly likely to use oral PrEP. Awareness of PrEP was lower among males who reported being at substantial risk of HIV than males not at substantial risk (aOR = 0.59, 95% CI: 0.41–0.86). PrEP willingness was higher in males who reported: (1) not being married, separated or widowed compared to married males (aOR = 2.28, 95% CI: 1.14–4.54); (2) being aware of PrEP (aOR = 1.91, 95% CI: 1.19–3.08) than those who were not aware of PrEP; and (3) having high/very high self-perceived HIV risk compared to those with lower self-perceived HIV risk (aOR = 1.94, 95% CI: 1.01–3.73). Considering the significant proportion of males attending VMMC who are at risk of HIV, integrating PrEP and VMMC services can significantly impact HIV prevention efforts by increasing awareness and uptake. Programs should prioritize PrEP awareness campaigns and highlight the combined benefits of VMMC and PrEP.