The study assessed the health records of 2776 women with a child diagnosed with congenital heart disease who were matched to 13 880 women whose children did not have this condition.
Investigators found that 4.4% of children with congenital heart disease and 2.8% of children with normal heart function had anaemia. After adjusting for potential influencing factors, the odds of giving birth to a child with congenital heart disease was 47% higher among anaemic mothers.
“We already know that the risk of congenital heart disease can be raised by a variety of factors, but these results develop our understanding of anaemia specifically and take it from lab studies to the clinic. Knowing that early maternal anaemia is so damaging could be a gamechanger worldwide,” said corresponding author Duncan B. Sparrow, PhD, of the University of Oxford. “Because iron deficiency is the root cause of many cases of anaemia, widespread iron supplementation for women—both when trying for a baby and when pregnant—could help prevent congenital heart disease in many newborns before it has developed.”
Getting a timely diagnosis of autism spectrum disorder is a major challenge, but new research out of York University shows that how young adults, and potentially children, grasp objects could offer a simpler way to diagnose someone on the autism spectrum.
The team, part of an international collaboration, used machine learning to analyse naturalistic hand movements – specifically, finger motions during grasping – in autistic and non-autistic individuals. Surprisingly, none of the simpler measures, such as time to grasp (reported to be slower in autistic adults), proved to be a reliable predictor.
“Our models were able to classify autism with approximately 85 per cent accuracy, suggesting this approach could potentially offer simpler, scalable tools for diagnosis,” says lead author, Associate Professor Erez Freud of York’s Department of Psychology and the Centre for Vision Research.
“Autism currently affects about one in 50 Canadian children, and timely, accessible diagnosis remains a major challenge. Our findings add to the growing body of research suggesting that subtle motor patterns may provide valuable diagnostic signals – something not yet widely leveraged in clinical practice.”
In addition to social and communication challenges, autism, a neurodevelopmental disorder, can include motor abnormalities which often show up in early childhood. The researchers say testing for these motor movements early could lead to faster diagnoses and intervention.
“The main behaviours markers for diagnosis are focused on those with relatively late onset and the motor markers that can be captured very early in childhood may thus lower age of diagnosis,” says Professor Batsheva Hadad of the University of Haifa, an expert in autism research and a key collaborator in this study.
Autistic and non-autistic young adult participants were asked to use their thumbs and index fingers, which had tracking markers attached, to grasp different blocks of varying size, lift each one and replace it in the same spot, and put their hand back in the starting position. The researchers used machine learning to analyse the participants’ finger movements as they made grasping motions.
Both groups of participants had normal IQ and were matched on age and intelligence. Young adults were used instead of children to rule out any differences in the findings due to delayed development.
The research found that subtle motor control differences can be captured effectively with more than 84% accuracy. The study also showed there were distinct kinematic properties in the grasping movements between autistic and non-autistic participants.
Analysis of naturalistic precision grasping tasks has not typically been used in previous studies, says Freud. Machine learning, however, provides researchers with a powerful new tool to analyse motor patterns, opening new ways to use movement data in the assessment of autism spectrum disorder.
The findings, says Freud, could lead to the development of more accessible and reliable diagnostic tools as well as timely intervention and support that could improve outcomes for autistic individuals in the future.
Jorunn Pauline Cavanagh holds up a petri dish with the newly discovered bacterium.
In 2020, a research group at UiT The Arctic University of Norway in Tromsø discovered a previously unknown bacterium. Named Staphylococcus borealis (S. borealis) after the Northern Lights, the researchers investigated whether this newly discovered bacterium was a potential threat. Their findings were published in the journal Microbiology Spectrum.
33% Antibiotic Resistance
To investigate, researchers collected bacterial samples stored in freezers at several Norwegian hospitals.
The samples went as far back as 2014, and the researchers conducted new tests to see if they could identify the new bacterium in the old samples. Meanwhile, new samples arriving at the UiT lab from 2020 to 2024 were tested continuously. In total, the researchers collected and analysed 129 samples from seven Norwegian hospitals.
It turns out that S. borealis is resistant to more than three different classes of antibiotics in one-third of the cases where it was tested.
Moreover, the bacterium also appears to be highly adept at acquiring protective mechanisms from other bacterial species. This means it could potentially develop antibiotic resistance quickly, when attacked with the medicines currently available.
“We see the most resistance against the antibiotic classes fusidic acid, cephalosporins, penicillins, macrolides, and fluoroquinolones,” explains Jorunn Pauline Cavanagh, who led the work on bacterial analyses.
A Problem for the Elderly
S. borealis is a bacterium that lives on our skin, and researchers have found that it can become problematic when your immune system is weakened. This makes it particularly concerning for the elderly and for those who have had knee or hip replacements.
“This bacterium is an opportunist that can cause illness when your immune system is compromised. For example, we see that it can form what’s called biofilm around knee prostheses and cause infections that can be difficult to treat,” explains Jorunn Pauline Cavanagh.
Researchers are now working to determine which diseases this bacterium can cause. Preliminary findings suggest it may lead to urinary tract infections, as well as inflammation in areas where implants are present.
“We do know that it causes mastitis in dromedary camels. This is because we’ve published the bacterium’s genetic profile in international databases, which other researchers use to compare their own bacterial findings. So, more possibilities may emerge,” says Cavanagh.
Intermittent fasting is not only a useful tool for weight loss, it’s also shown to have many benefits for metabolic health – independent of weight loss. Yet many people may find intermittent fasting to be a challenge, especially if following the 5:2 version of the diet where calories are severely restricted two days a week.
But my latest study shows that you don’t need to severely restrict your calories to get the metabolic benefits of intermittent fasting. Even just restricting the number of carbs you eat twice a week may be enough to improve your metabolic health.
Intermittent fasting appears to be so beneficial for health because of the way it alters our metabolism.
After a meal, our body enters the postprandial state. While in this state, our metabolism pushes our cells to use carbohydrates for immediate energy, while storing some of these carbs as well as fat for later use. But after several hours without food, in the postabsorptive “fasted” state, our metabolism switches to using some of our fat stores for energy.
In this regard, intermittent fasting ensures a better balance between the sources it uses for energy. This leads to improved metabolic flexibility, which is linked with better cardiometabolic health. In other words, this means lower risk of cardiovascular disease, insulin resistance and type 2 diabetes.
My colleagues and I previously ran a study to demonstrate the effects of a fast on the body. We observed that following a day of both total fasting or severe calorie restriction (eating around only 25% of each person’s daily calorie requirements), the body was better at clearing and burning the fat of a full English breakfast the next day. Fasting shifted the body from using carbs to using fat. This effect carried on both during the fast and the next day.
Our research has also compared the effects of intermittent fasting to a calorie-matched or calorie-restricted diet. Both groups followed the diet until they lost 5% of their body weight.
Despite both groups losing the same 5% of body weight, and at the same rate, the intermittent fasting group had greater improvements in their metabolic handling, similar to what we saw in the previous trial.
Other researchers who have compared the effects of the 5:2 variant of the intermittent fasting diet to a calorie-matched, calorie-restricted diet have also found fasting is beneficial for metabolic health.
For people who follow the 5:2 intermittent fasting diet, typical fasting days are, by their nature, very low in calories – equating to only a few hundred calories per day. Because people are consuming so few calories on fasting days, it also means they’re consuming very few carbohydrates. Given the postprandial state is governed by carbohydrate availability, this begged the question as to whether it’s the calorie restriction or the carbohydrate restriction that’s creating the metabolic effect when intermittent fasting.
We recruited 12 overweight and obese participants. Participants were first given a very low-carb diet one day. Another day, they were given a severely calorie-restricted diet (around 75% fewer calories than they’d normally eat). After each fasting day, we gave them a high-fat, high-sugar meal (similar to an English breakfast) to see how easily their bodies burned fat.
What we found was that the shift to fat burning and improved fat handling of the high-calorie meal were near identical following both the traditional calorie-restricted “fast” day and the low-carb day. In other words, restricting carbs can elicit the same favourable metabolic effects as fasting.
It will be important now for more studies to be conducted using a larger cohort of participants to confirm these findings.
Such findings may help us address some of the practical problems we face with intermittent fasting and traditional low-carb diets.
The other limitation of both intermittent fasting and continuous carb restriction is that weight loss is a likely outcome. Hence these approaches are not universally beneficial for those who need to improve their health without losing weight or those looking to maintain their weight.
We are now testing the feasibility of an intermittent carb restriction diet, or a low-carb 5:2. So instead of restricting calories two days a week, you would restrict the number of carbs you consume twice a week. If this is proven to be beneficial, it would offer the benefits of fasting without restricting calories on “fast” days.
Sex workers in Vosloorus, Johannesburg and Springs talked to GroundUp about their struggle to access health services, particularly antiretroviral treatment, since the closures of US funded clinics. Photos: Kimberly Mutandiro
It’s afternoon on Boundary Road in Vosloorus. Sex worker Simangele (not her real name) hopes to secure her next client.
Making enough money to pay rent has always been a concern for Simangele. But now she has a new worry: how to keep up with her antiretroviral treatment.
Two months ago the closure of a mobile clinic — where Simangele and other sex workers in Vosloorus went for checkups and to collect their treatment — left her without access to the life-saving medication.
The mobile clinic was run by the Wits Reproductive Health and HIV Institute (WITS RHI) which heavily relied on US funding. The institute has been providing critical sexual and reproductive health services since 2018. The programme was one of many health facilities forced to halt services at the end of January in the wake of US funding cuts for global aid.
Speaking to GroundUp, Simangele says she ran out of antiretroviral medicines (ARVs) over a month ago and has resorted to borrowing a few tablets from a friend. “I don’t know what I will do because the tablets my friend gets give me side effects,” she says. (Antiretrovirals treat HIV. They have to be taken daily for life.)
She says the clinic closed without any warning or before they could give them transfer letters to public healthcare facilities. She is now dreading having to go to a public facility where she says sex workers are frequently discriminated against, particularly those who are undocumented.
We spoke to a dozen other sex workers in Joburg and in Springs who are worried about defaulting on their antiretroviral treatment following the closure of the Wits RHI clinics. The clinics also provided pre-exposure prophylaxis (PrEP) (to prevent HIV-negative people contracting HIV), and treatments for sexually transmitted infections, TB, sexual reproductive health services, and counselling.
A sex worker shows the last few ARVs she has left.
Another sex worker said, “The minute we go to public clinics, they will need documents, which some of us do not have … Wits made time to listen to our problems as sex workers. Even when we faced challenges with clients, they never judged us.”
Sisi (not her real name), who rents rooms and assists sex workers in Vosloorus, said she’s aware of several sex workers who have defaulted and no longer have access to condoms, lubricants, and treatment for sexually transmitted infections. “The Wits clinic did not discriminate against people without documents and would sometimes provide food, branded T-shirts, caps, and even jobs,” she said.
“Many of us will die”
We visited Zig Zag Road in Springs, where several sex workers said they were out or almost out of ARVs. When asked why they didn’t just go to a local clinic, they told GroundUp about instances where they experienced stigma while trying to access treatment at public clinics.
“I used to receive PrEP to help prevent HIV (from the Wits clinic). We would also receive birth control services. Now I can’t go to a public clinic because we are mocked for being sex workers,” said Siphesihle.
Ntombi, who waits for clients along End Street, attended one of the Wits clinics in Hillbrow which closed down. She said those on PrEP were given transfer letters before the clinic closed.
Other workers nearby told GroundUp that they now pay up to R250 for PrEP, which is more than they can afford.
Sisonke calls for urgent response to crisis
The Sisonke National Movement, which advocates for the rights of sex workers, has been raising the alarm since the closure of US-funded facilities. Before the closures, Sisonke was in talks with National Department of Health through the South African National AIDS Council about the provision of services to sex workers and other vulnerable groups, said the organisation’s spokesperson Yonela Sinqu.
She said that the department never answered activists when they asked what would happen should donor funds no longer be available for these facilities.
She said the plea for assistance without referral letters is made to all provinces, not only Gauteng. However, Gauteng is the only province that has approached us with the crisis of people without referrals, she said.
Department of Health spokesperson Foster Mohale has not responded to requests for comment.
Women diagnosed with breast cancer who carry particular BRCA1 and BRCA2 genetic variants are offered surgery to remove the ovaries and fallopian tubes as this dramatically reduces their risk of ovarian cancer. Now, Cambridge researchers have shown that this procedure – known as bilateral salpingo-oophorectomy (BSO) – is associated with a substantial reduction in the risk of early death among these women, without any serious side-effects.
Women with certain variants of the genes BRCA1 and BRCA2 have a high risk of developing ovarian and breast cancer. These women are recommended to have their ovaries and fallopian tubes removed at a relatively early age – between the ages 35 and 40 years for BRCA1 carriers, and between the ages 40 and 45 for BRCA2 carriers.
Previously, BSO has been shown to lead to an 80% reduction in the risk of developing ovarian cancer among these women, but there is concern that there may be unintended consequences as a result of the body’s main source of oestrogen being removed, which brings on early menopause. This can be especially challenging for BRCA1 and BRCA2 carriers with a history of breast cancer, as they may not typically receive hormone replacement therapy to manage symptoms. The overall impact of BSO in BRCA1 and BRCA2 carriers with a prior history of breast cancer remains uncertain.
Ordinarily, researchers would assess the benefits and risks associated with BSO through randomised controlled trials, the ‘gold standard’ for testing how well treatments work. However, to do so in women who carry the BRCA1 and BRCA2 variants would be unethical as it would put them at substantially greater risk of developing ovarian cancer.
To work around this problem, a team at the University of Cambridge, in collaboration with the National Disease Registration Service (NDRS) in NHS England, turned to electronic health records and data from NHS genetic testing laboratories collected and curated by NDRS to examine the long-term outcomes of BSO among BRCA1 and BRCA2 PV carriers diagnosed with breast cancer. The results of their study, the first large-scale study of its kind, are published today in The Lancet Oncology.
The team identified a total of 3400 women carrying one of the BRCA1 and BRCA2 cancer-causing variants (around 1700 women for each variant). Around 850 of the BRCA1 carriers and 1,000 of the BRCA2 carriers had undergone BSO surgery.
Women who underwent BSO were around half as likely to die from cancer or any other cause over the follow-up period (a median follow-up time of 5.5 years). This reduction was more pronounced in BRCA2 carriers compared to BRCA1 carriers (a 56% reduction compared to 38% respectively). These women were also at around a 40% lower risk of developing a second cancer.
Although the team say it is impossible to say with 100% certainty that BSO causes this reduction in risk, they argue that the evidence points strongly towards this conclusion.
Importantly, the researchers found no link between BSO and increased risk of other long-term outcomes such as heart disease and stroke, or with depression. This is in contrast to previous studies that found evidence in the general population of an association between BSO and increased risk of these conditions.
First author Hend Hassan, a PhD student at the Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, and Wolfson College, Cambridge, said: “We know that removing the ovaries and fallopian tubes dramatically reduces the risk of ovarian cancer, but there’s been a question mark over the potential unintended consequences that might arise from the sudden onset of menopause that this causes.
“Reassuringly, our research has shown that for women with a personal history of breast cancer, this procedure brings clear benefits in terms of survival and a lower risk of other cancers without the adverse side effects such as heart conditions or depression.”
Most women undergoing BSO were white. Black and Asian women were around half as likely to have BSO compared to white women. Women who lived in less deprived areas were more likely to have BSO compared to those in the most-deprived category.
Hassan added: “Given the clear benefits that this procedure provides for at-risk women, it’s concerning that some groups of women are less likely to undergo it. We need to understand why this is and encourage uptake among these women.”
Professor Antonis Antoniou, from the Department of Public Health and Primary Care, the study’s senior author, said: “Our findings will be crucial for counselling women with cancer linked to one of the BRCA1 and BRCA2 variants, allowing them to make informed decisions about whether or not to opt for this operation.”
Professor Antoniou, who is also Director of the Cancer Data-Driven Detection programme, added: “The study also highlights the power of exceptional NHS datasets in driving impactful, clinically relevant research.”
The research was funded by Cancer Research UK, with additional support from the National Institute for Health and Care Research (NIHR) Cambridge Biomedical Research Centre.
The University of Cambridge is fundraising for a new hospital that will transform how we diagnose and treat cancer. Cambridge Cancer Research Hospital, a partnership with Cambridge University Hospitals NHS Foundation Trust, will treat patients across the East of England, but the research that takes place there promises to change the lives of cancer patients across the UK and beyond. Find out more here.
That’s the takeaway from new research from a team of scientists, including researchers from the University of Colorado Boulder. The findings suggests that long-term exposure to Martian dust could create a host of health problems for future astronauts – leading to chronic respiratory problems, thyroid disease and more.
The study, published in the journal GeoHealth, is the first to take a comprehensive look at the chemical ingredients that make up Martian dust, and their possible impacts on human health. It was undertaken by a team from the worlds of medicine, geology and aerospace engineering.
“This isn’t the most dangerous part about going to Mars,” said Justin Wang, lead author of the study and a student in the Keck School of Medicine at the University of Southern California in Los Angeles. “But dust is a solvable problem, and it’s worth putting in the effort to develop Mars-focused technologies for preventing these health problems in the first place.”
Wang, a CU Boulder alumnus, noted that Apollo era astronauts experienced runny eyes and irritated throats after inhaling dust from the moon. Apollo 17’s Harrison Schmitt likened the symptoms to hay fever.
But scientists know a lot less about the potential harms of Martian dust. To begin to answer that question, Wang and his colleagues drew on data from rovers on Mars and even Martian meteorites to better understand what makes up the planet’s dust. The group discovered a “laundry list” of chemical compounds that could be dangerous for people—at least when inhaled in large quantities and over long periods of time.
They include minerals rich in silicates and iron oxides, metals like beryllium and arsenic and a particularly nasty class of compounds called perchlorates.
In many cases, those ingredients are present in only trace amounts in Mars dust. But the first human explorers on Mars may spend around a year and a half on the surface, increasing their exposure, said study co-author Brian Hynek.
“You’re going to get dust on your spacesuits, and you’re going to have to deal with regular dust storms,” said Hynek, a geologist at the Laboratory for Atmospheric and Space Physics (LASP) at CU Boulder. “We really need to characterize this dust so that we know what the hazards are.”
Into the bloodstream
One thing is clear, he added: Mars is a dusty place.
Much of the planet is covered in a thick layer of dust rich in tiny particles of iron, which gives the planet its famous red colour. Swirling dust storms are common and, in some cases, can engulf the entire globe.
“We think there could be 10 metres of dust sitting on top of the bigger volcanoes,” said Hynek, a professor in the Department of Geological Sciences. “If you tried to land a spacecraft there, you’re going to just sink into the dust.”
Wang found his own way to Martian dust through a unique academic path. He started medical school after earning bachelor’s degrees from CU Boulder in astronomy and molecular, cellular and developmental biology, followed by a master’s degree in aerospace engineering sciences. He currently serves in the Navy through its Health Professions Scholarship Program.
He noted that the biggest problem with Martian dust comes down to its size. Estimates suggest that the average size of dust grains on Mars may be as little as 3 micrometers across, or roughly one-ten-thousandth of an inch.
“That’s smaller than what the mucus in our lungs can expel,” Wang said. “So after we inhale Martian dust, a lot of it could remain in our lungs and be absorbed into our blood stream.”
An ounce of prevention
In the current study, Wang and several of his fellow medical students at USC scoured research papers to unearth the potential toxicological effects of the ingredients in Martian dust.
Some of what they found resembled common health problems on Earth. Dust on Mars, for example, contains large amounts of the compound silica, which is abundant in minerals on our own planet. People who inhale a lot of silica, such as glass blowers, can develop a condition known as silicosis. Their lung tissue becomes scarred, making it hard to breath—symptoms similar to the “black lung” disease that coal miners often contract. Currently, there is no cure for silicosis.
In other cases, the potential health consequences are much less well-known.
Martian dust carries large quantities of highly oxidising compounds called perchlorates, which are made up of one chlorine and multiple oxygen atoms. Perchlorates are rare on Earth, but some evidence suggests that they can interfere with human thyroid function, leading to severe anaemia. Even inhaling a few milligrams of perchlorates in Martian dust could be dangerous for astronauts.
Wang noted that the best time to prepare for the health risks of Martian dust is before humans ever make it to the planet. Iodine supplements, for example, would boost astronauts’ thyroid function, potentially counteracting the toll of perchlorates – although taking too much iodine can also, paradoxically, lead to thyroid disease. Filters specifically designed to screen out Martian dust could also help to keep the air in living spaces clean.
“Prevention is key. We tell everyone to go see their primary care provider to check your cholesterol before it gives you a heart attack,” Wang said. “The best thing we can do on Mars is make sure the astronauts aren’t exposed to dust in the first place.”
New research from the University of Sydney reveals that obesity, having a knee injury and occupational risks such as shift work and lifting heavy loads are primary causes of knee osteoarthritis.
The study also found that following a mediterranean diet, drinking green tea and eating dark bread could reduce the risk of developing knee osteoarthritis.
Using data from 131 studies conducted between 1988 to 2024, the researchers examined over 150 risk factors in participants ranging from 20 to 80 years old to determine which were associated with an increased risk of developing knee osteoarthritis.
“Our research found that while factors such as eating ultra-processed foods and being overweight increase the risk, addressing lifestyle factors – such as losing weight or adopting a better diet – could significantly improve people’s health,” Associate Professor Abdel Shaheed said.
Co-author Professor David Hunter, a researcher at the Kolling Institute and Professor of Medicine at the University of Sydney, said: “Women were twice as likely to develop the condition than men, and older age was only mildly associated with increased risk.”
Reducing the risk of knee osteoarthritis
Dr Duong, lead author and post-doctoral researcher at the Kolling Institute, said: “Eliminating obesity and knee injuries combined could potentially reduce the risk of developing knee osteoarthritis by 14 percent across the population.
“We urge governments and the healthcare sector to take this seriously and to implement policy reforms that address occupational risks, subsidise knee injury prevention programs, and promote healthy eating and physical activity to reduce obesity.”
Trade unions, medical associations and universities are raising the alarm that Gauteng budget cuts at the cost of doctors’ take-home pay will have dire consequences for public sector health. Meanwhile, the National Minister of Health has convened a committee to review the future of overtime for state doctors.
Dysfunction in the Gauteng Department of Health hit home hard for many public sector doctors on 29 April when their overtime payments due for the month went unpaid.
The non-payment came without notice and affected medical staff in facilities across the province, according to the South African Medical Association (SAMA). Only by 6 May did some doctors start to see payments reflect in their bank accounts. More payments are expected soon given that, according to the Basic Conditions of Employment Act, the employer has seven days to settle, said SAMA.
But tensions are rising as this payment blunder follows a protracted row over the department’s unilateral decision to cut and change the terms of commuted overtime in the province. Proposals to cut down on commuted overtime come in the light of a very tight provincial health budget. As with most other provincial health departments, Gauteng’s health budget has been shrinking in real terms for several years.
The delayed payments and the ongoing review of cuts and changes to commuted overtime pay has led to threats of protests and legal action. SAMA says they will make civil claims for salaries owed, including for interest and legal costs. Registrars and medical officers at Dr George Mukhari Academic Hospital in Ga-Rankuwa collectively wrote to the hospital giving notice of withdrawal of overtime services until the non-payment issue is completely resolved. By 7 May, the head of anaesthesiology at Sefako Makgatho Health Sciences University wrote to the CEO of George Mukhari Hospital informing him that no anaesthesia services would take place at the hospital starting 8 May, given the decision by registrars and medical officers to down tools outside of regular work hours.
Those from the medical fraternity that Spotlight spoke to have set out a series of concerns. These include resignations; an exodus of doctors, especially specialists from the public sector; plummeting staff morale; negative impacts on the training of doctors as fewer consultants and seniors are available to supervise – which then puts universities’ training accreditations at risk. Ultimately, several sources point out, it is the services offered to the public that suffer.
Committee appointed
By the beginning of April, there appeared to be some walking back by the Gauteng health department of its unilateral cutback proposals after meeting with the South African Medical Association Trade Union (SAMATU). In the same week, a circular was issued announcing that the national health department was conducting a review of its own, instructing provinces to hold off on their plans. Health Minister Dr Aaron Motsoaledi then set up a committee of experts to review certain human resource policies in the public healthcare sector. This includes a review of community service, commuted overtime, remunerative work outside the public service for health professionals, and rural and related allowances.
Commuted overtime is a pre-determined amount of overtime that doctors employed by provincial health departments are allowed to work. The amount is historically decided by hospital management and is based on an employee’s role, seniority, the department they work in and the amount of overtime they are allowed to safely work. It’s a fixed rate of 1.3 times the applicable hourly tariff for a specific work grade.
There are five contract options. A is no overtime worked; B is overtime of between four and eight hours a week; C is overtime between 9 and 12 hours a week; D is overtime between 13 and 20 hours per week; and an option E is where, on approval, a doctor can be authorised to work more than 20 hours of overtime a week.
As a fixed amount, commuted overtime is predictable supplemental income and for many doctors, it amounts to about a third of their take-home pay.
The long rumblings to cut their overtime pay has seen doctors being required to motivate why they should remain on contracts that pay for more overtime hours and junior doctors say they are being pressured to sign option C contracts, which will pay for fewer overtime hours. There are also proposals to change some of the terms relating to overtime, including scrapping overtime payments for doctors who are on call but not physically present at a facility.
Many doctors already exceed the maximum hours of their contracts because of the emergency nature of their work, gross understaffing and backlogs at their hospitals.
Costly, but essential?
The commuted overtime pay model has been contentious for years because it adds up to a sizeable chunk of the healthcare budget. According to a spending review conducted in 2022 on behalf of National Treasury, the country’s health departments spent R6.9 billion on commuted overtime in 2021. This made up about 70% of the total R9.9 billion spent on all types of overtime.
In an editorial published in the South African Medical Journal in April 2025, health sciences academics, associations, and unions slammed the Gauteng health department’s handling of pay issues. They argue that the basic salaries of medical professionals in the public health sector are already much lower than what would be considered fair pay.
“COT [commuted overtime] has long served as a critical mechanism to ensure that doctors are available beyond the standard workday, safeguarding round-the-clock care in the public health system…The abrupt curtailment of this framework risks hollowing out the after-hours safety net, leaving emergency rooms, wards and clinics dangerously under-resourced,” they wrote.
A co-author of the editorial, SAMA CEO Dr Mzulungile Nodikida, told Spotlight: “Medical doctors in South Africa’s public sector are severely underpaid. A study by SAMA has shown that even the annual cost of living adjustments that have been made on the salaries have not matched inflation in the last 5 years. Commuted overtime has had the effect of masking a deficient salary.”
He said the Gauteng health department has shown itself to be an “unreliable employer”, adding that its relationship with doctors remains fractured as a loss of confidence in the department deepens.
“This breach of the most basic employment obligation: timely remuneration, has cascading effects. It jeopardises morale, compromises service delivery, and calls into question the department’s commitment to its workforce. Doctors now operate under a cloud of uncertainty, unsure whether they will receive their salaries at month-end. This anxiety permeates every aspect of the employment relationship, from retention efforts to the willingness to engage in additional responsibilities,” said Nodikida.
View from the wards
Two doctors who spoke to Spotlight independently, and from two different Gauteng hospitals, say the commuted overtime pay disaster is yet another symptom of weak human resources and poor management from the department of health. For them, proposals to cut commuted overtime is the department shirking from addressing the staffing crisis; the need to improve human resources systems; and rooting out corruption, maladministration and wasteful expenditure. Both doctors asked not to be named for fear of reprisals.
Dr A, who is based at Charlotte Maxeke Johannesburg Academic Hospital, said: “Instead of having a system in place to record how many hours each doctor is actually working and what overtime that person should be paid, the department pays everyone this commuted overtime fixed sum….[Y]ou could be a dermatologist or a psychologist and have very few overtime hours or be a surgeon who is doing a lot of overtime but you all get paid the same if you’re on the same contract option,” she said. “But right now, in my career I’m working way more overtime hours than my contract and I’m not being reimbursed for any of it.”
Dr A said the overtime pay cuts and proposed changes will impact her decision to stay in the public sector.
“It used to be the case that you were happy, once specialised, to stay because the overall lump sum of money from your salary and commuted overtime made up a decent pay – not comparable to what you could earn in private – but decent enough to stay,” she said.
She said she feels like doctors are now being under-valued and coming under attack by their own employer. “The message we are getting is that ‘if you’re not happy, there’s the door’ – but what the department doesn’t understand is that you can’t just replace someone with 10 years’ experience or someone who has 30 years’ experience, it has a huge impact,” she said.
“Our patients are suffering; and every day it’s like a game of Survivor. We run multiple clinics in one clinic space at Charlotte Maxeke, but you can’t offer a functioning service like that. It’s noisy, the computers don’t work, and the intercom is going off the whole time.
“The other day, I had a 90-year-old patient have a panic attack in the waiting room. He had been waiting for a while and left his wife, who is blind, in the car. He had to park far from the hospital building because the parking lot from the hospital fire [in April 2021] is still not properly repaired and he was overcome with worry,” she said.
Dr B works at Chris Hani Baragwanath Hospital and he said the debacle over doctors’ overtime pay has pushed him to the edge. He said doctors are already overworked and disheartened from working within a failing system. He sent photos to Spotlight of theatres and wards in darkness as power went off at the Soweto hospital for days at the end of April.
Chris Hani Baragwanath Hospital plunged in darkness after days-long power outage in late April. (Supplied)
He said staff bring in their own toilet paper because they’re told there’s none. Most alarming, he said “doctors are not getting the training and supervision they need” and regularly perform surgeries and procedures without adequate experience and with no supervision.
“They are overwhelmed, overworked and doing way too many overtime hours that they’re not being paid for. Then they go home overtired, eat a pizza and crash, sleep a few hours then do it all over again the next day, and the next day,” he said.
“We, doctors, are literally the ones putting patients’ lives at risk,” he said, adding that he is “surviving on anti-depressants” and has sometimes shut himself away in hospital storerooms crying tears of sheer frustration, exhaustion and exasperation.
Dr B does still count the wins though. It’s days when he clears an impossibly long patient list of children who need procedures done. It’s when he and his colleagues decide to push through to make sure no child’s procedure gets cancelled.
“Those are the good days – they’re just few and far between. And now the department is coming for us by cutting our overtime pay and forcing us to sign contracts to downgrade our overtime pay,” he said.
Resignations and impact on training
Professor Shabir Madhi is dean of the faculty of Health Sciences at the University of Witwatersrand. He said the proposed cuts and freezing of posts and changes to commuted overtime pay has already resulted in resignations of some senior staff at state hospitals.
“If we don’t have the proper consultant staff complement in these hospitals who can provide supervision throughout the day, it compromises our training of specialists as well as of undergraduate students.
“If the Health Professions Council of South Africa were to do an audit and find that there isn’t adequate consultant cover and supervision, they could remove the accreditation of the training programmes offered by the universities.
“The medical schools are completely dependent on the Gauteng Department of Health to retain consultants and other categories of staff, and to ensure that staff are allocated time for supervision and training of future medical doctors, including specialist, as well as other academic activities.
“It means decision-making around cuts to overtime pay need to be cognisant of the overall impact that it would have, and not only in how it would assess budget constraints. This situation needs meaningful and informed decision-making,” he said.
Dr Phuti Ratshabedi, Gauteng chairperson of SAMATU, said the non-payment of commuted overtime pay in April was a slap in the face from the provincial health department as the union had a meeting with the department that month and left with the department agreeing to uphold their contractual agreements to leave contracts terms for commuted overtime pay unchanged at least till the end of March 2026 – the end of the financial year.
“What we saw is that the department will promise one thing and do another. But we will be holding them to what they stated in their own circular or we will look to legal action.
“What we want to see in this review period is that they go after departments [where overtime is not being performed, but being paid for] but leave other departments alone – they cannot put everyone under the same blanket.
“If the government is able to bail out over and over things like Eskom and Transnet, how can they not prioritise healthcare – this sets our country way back and we doctors will no longer be silent about this,” said Ratshabedi.
Spotlight sent questions to the Gauteng health department, including on how the payment delay happened; the number of people affected; how the department is addressing the wide-spread knock-on effects of their proposed commuted overtime cuts; and what amendments they hope will come out of the national review. Despite several reminders, the department did not respond to our questions.
Healthy hearts are adaptable, and heartbeats exhibit complex variation as they adjust to tiny changes in the body and environment. Mass General Brigham researchers have applied a new way to measure the complexity of pulse rates, using data collected through wearable pulse oximetry devices. The new method, published in the Journal of the American Heart Association, provides a more detailed peek into heart health than traditional measures, uncovering a link between reduced complexity and future cognitive decline.
“Heart rate complexity is a hallmark of healthy physiology,” said senior author Peng Li, PhD, of the Department of Anesthesia, Critical Care and Pain Medicine at Massachusetts General Hospital (MGH) and the Division of Sleep and Circadian Disorders at Brigham and Women’s Hospital (BWH). “Our hearts must balance between spontaneity and adaptability, incorporating internal needs and external stressors.”
The study used data from 503 participants (average age 82, 76% women) in the Rush Memory and Aging Project. The researchers analysed overnight pulse rate measurements – collected by a fingertip pulse oximetry device known as the Itamar WatchPAT 300 device – and comprehensive measures of cognitive functions, collected around the same time as the pulse rate measurement and at least one annual follow-up visit up to 4.5 years later.
The team found that people with greater complexity in their heartbeats at baseline tend to experience slower cognitive decline over time. They determined that the conventional measures of heart rate variability did not predict this effect, indicating their measure was more sensitive in capturing heart functions predictive of cognitive decline.
The researchers plan to investigate whether pulse rate complexity can predict development of dementia, which would make it useful for identifying people at an early stage who might benefit from therapeutic interventions.
“The findings underscore the usefulness of our approach as a noninvasive measure for how flexible the heart is in responding to nervous system cues,” said lead author Chenlu Gao, PhD, also in the Department of Anesthesia, Critical Care and Pain Medicine at MGH. “It is suitable for future studies aimed at understanding the interplay between heart health and cognitive aging.”
