Month: July 2026

Categories : Expert Opinion Lab Tests and ImagingTags : Leave a comment

Provinces Owe the NHLS Billions, Patients Could Pay the Price. It’s Time to Crack the Whip

On By ModernMedia
Through its countrywide network of quality-assured diagnostic laboratories, the NHLS is the sole provider of diagnostic pathology services to over 80% of the South African population. Photo by National Cancer Institute on Unsplash

Comment & Analysis

By Faith Muthambi

Provincial debt to the National Health Laboratory Service is not just a financial governance matter, but also a public healthcare service delivery risk that affects diagnoses, treatment, disease surveillance, and government’s ability to protect vulnerable patients, writes Faith Muthambi, chairperson of the Portfolio Committee on Health in the National Assembly.

When *Lungile Mbonambi, a hypothetical healthcare user, waits for a blood test at a public hospital, she is not thinking about all the zeros in provincial budgets or intergovernmental disputes. She is thinking about her health. Like some 80% of people in South Africa, she places her trust in the public healthcare system, the inner workings of which she will never see, and in laboratory professionals she will likely never meet. However, in using the system, she experiences its impact.

For her blood test, a nurse will draw the sample, seal the vial and send it to the closest National Health Laboratory Service (NHLS) facility. For patients, waiting for the results often feels uneasy and ridden with dread. In addition to the immediate health concern, patients also find themselves in the hands of a system that needs to function well, not only on paper and in policy, but also in the concrete reality of their particular case.

The NHLS plays a big role in public health in South Africa through epidemiology, surveillance and responding to public health outbreaks. Among other things, it is involved in HIV and TB programmes, conducting diagnostic tests for non-communicable diseases, and the screening for cervical cancer. In essence, contemporary healthcare would grind to a halt without the robust laboratory infrastructure that the NHLS provides.

Ballooning debt

Just recently at the end of May, the Portfolio Committee on Health in Parliament, which is tasked with overseeing the National Department of Health, met with representatives from the NHLS and all nine provincial health departments. The meeting revealed that outstanding debt to the NHLS had climbed to an imposing R11 billion as of March this year. Most of this debt stemmed from KwaZulu-Natal with around R3.94 billion, and Gauteng with roughly R3.3 billion, both of which include debt from previous years.

This meeting confirmed what many in the public health system have warned about for years. This outstanding debt is not merely a matter of the numbers not adding up, but is symptomatic of a serious failure in financial governance. Failing to pay or delaying payments for critical services already rendered to the public health system also reflects poor coordination among government departments and entities.

The consequences of this can be dire.

For the NHLS, without these funds, the institution cannot sustain research, do proper disease surveillance, detect outbreaks or monitor antimicrobial resistance, or upgrade equipment. When a laboratory cannot replace ageing instruments on time, fill critical posts, modernise information technology or plan procurement with certainty, it is felt in hospitals and clinics.

For patients, it means delayed diagnoses and disrupted care, and those living in rural and under-resourced communities often bear the brunt.

Time to act

Listening to presentations from all nine provincial health departments showed that this crisis can be prevented. There are provinces that are getting this right and paying their invoices to the NHLS within the required 30-day period. This shows that, even with budget constraints, laboratory services can be prioritised.

As Chairperson of the Portfolio Committee on Health, I have made it clear that it is now time to shift our oversight from concern to action that leads to actual consequences for those provinces that fail to pay their NHLS debts.

There had been instances in the past where National Treasury intervened by withholding or redirecting funds when provinces failed to fulfil their responsibilities. The committee may need to engage the National Treasury on ways to protect funding for laboratory services, including the possibility of direct transfers or ring-fenced funding where provinces fail to prioritise their obligations to the NHLS. The message is clear: We cannot allow a situation in which a province destabilises another public institution by failing to pay for services central to healthcare provision.

Our next step cannot be to just accept more vague commitments and assurances that the debt will be paid. Provinces with outstanding debt must provide clear repayment plans linked to strict timelines, while continuing to pay current invoices within the required period. The committee will request quarterly progress reports on payments made to reduce the debt, as well as on actions taken against officials involved in this non-payment.

We live in an era marked by emerging health threats and increasing demands on health services. It is therefore important to remind ourselves that health systems do not collapse overnight. They deteriorate gradually through deferred payments and normalised delays, among other things. By the time patients experience the full impact, the horse may have already bolted because we ignored the warning signs.

To be clear – this, here, is a serious warning sign.

Yet notwithstanding these pressures, laboratory professionals continue to demonstrate extraordinary commitment. Samples are being processed, and results are verified. I commend these public servants who work beyond ordinary expectations to protect the service. However, we cannot bank on this devotion to become a permanent substitute for responsible governance.

The decision before us is whether we allow patients’ experience of the public health value chain between health facilities and NHLS laboratories to continue to be determined by delay and uncertainty, or by a public health system that understands the seriousness of its responsibilities and acts accordingly.

Patients like Mbonambi are placing their trust in the state. We must do better.

*Muthambi is a Member of the National Assembly and Chairperson of the Portfolio Committee on Health.

Note: Spotlight aims to deepen public understanding of important health issues by publishing a variety of views on its opinion pages. The views expressed in this article are not necessarily shared by the Spotlight editors.

Republished from Spotlight under a Creative Commons licence.

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Categories : Metabolic Disorders PaediatricsTags : Leave a comment

Link Between Parents’ and Children’s Weight is Mostly Genetic, Study Finds

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An analysis of 86 000 Norwegian children found that the association between parental and childhood body weight is largely explained by shared genetics

AI image created with Gencraft

The association between parents’ body mass index (BMI) and their children’s childhood BMI may be primarily due to genetic inheritance rather than to any direct biological effect of parental weight during pregnancy, according to a new study published June 23rdin the open access journal PLOS Medicine by Tom Bond of the University of Bristol, UK, and colleagues from the University of Queensland, Australia and more.

Higher parental BMI is consistently associated with higher childhood BMI. It has been difficult for researchers to disentangle how much of this association is due to genetics and how much is due to biological effects of maternal weight during pregnancy. This may have implications for interventions that aim to control childhood BMI by targeting pre-conception parental weight.

In the new study, researchers analysed data from the Norwegian Mother, Father and Child Cohort Study, a prospective birth cohort of children born between 1999 and 2009. Data on 86 000 children, including their birth weight and BMI from six months to eight years of age, as well as appetite-related eating behaviours at age eight, was available in the dataset. The researchers looked at twin, sibling, and half-sibling relationships across multiple generations to directly quantify how much of the parent-child BMI association could be attributed to genetic confounding.

Maternal BMI was more strongly associated with offspring birth weight than paternal BMI, consistent with an effect of maternal body weight on birthweight through the environment inside the uterus. However, after birth the associations of maternal and paternal BMI with offspring BMI were broadly similar from age two to eight. Models showed that genetic effects explained an estimated 79% of the statistical association between a mother’s BMI and her child’s BMI at age 8, and 94% of the association for fathers. Higher parental BMI was also associated with obesity-related eating behaviours in children, including greater food responsiveness and emotional overeating, although the study was not able to conclusively determine how much of this was genetically driven.

The authors caution that these findings do not support the idea that childhood obesity is inevitable for children of heavier parents. Children who inherit a genetic predisposition to higher BMI may still express those genes differently depending on their environment. The results also do not argue against the importance of maternal health in pregnancy, the authors say. Maternal obesity is well established to increase risk of adverse perinatal outcomes for both mother and child.

“Our results may have important public health implications, when considered alongside prior evidence,” they write. “Maternal BMI may be unlikely to have a large causal effect on child BMI beyond birth… and any causal effect of paternal BMI on offspring childhood BMI is likely to be similar to or smaller than that of maternal BMI. Consequently, reductions in the BMI of either parent before pregnancy may be unlikely to cause large reductions in childhood adiposity.”

Tom Bond states, “Obesity runs in families, but it is difficult to work out why this is. Our results suggest that the link between a mother’s or father’s body mass index (BMI) and their children’s BMI up to age 8 is mostly due to inherited genes. Expectant parents should be encouraged to maintain a healthy weight, but this may not be enough to ensure that their children also have a healthy weight.”

David Evans notes, “We were interested in examining whether obesity in mothers during pregnancy might also have adverse effects on the risk of obesity in their offspring when the children get older. We found that whilst maternal body mass index during pregnancy was likely to adversely affect offspring birthweight, it didn’t appear to have large effects on risk of offspring obesity in later life beyond that explained through the transmission of genes from mothers to their offspring.”

Alexandra Havdahl adds, “Our findings suggest that the link between parents’ and children’s body mass index is driven largely by shared genes rather than by the intrauterine environment or parenting behaviour.”

Provided by PLOS

Categories : Injury & TraumaTags : Leave a comment

High-dose IV Vitamin C May Lower Risks of Death and Sepsis in Trauma Patients

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Biologically plausible, but more rigorous research needed before it can be recommended

Photo by Furkan İnce

High doses of intravenous (IV) vitamin C may lower the risks of death and sepsis in trauma patients, as well as shortening hospital stay, suggests a review of the available evidence published online in the journal BMJ Military Health.

Although its effects are biologically plausible, especially given its role in aiding tissue repair and recovery, among other things, the quality of the available evidence isn’t currently good enough to recommend the use of vitamin C in trauma patients, say the researchers.

Major trauma triggers a complex physiological response in those affected and carries a high risk of death. And vitamin C, which helps to boost blood pressure, regulate the vital interface between blood and tissues (endothelial function), and neutralise harmful free radicals, is rapidly depleted in critical illness, explain the researchers.

As such, vitamin C has been mooted as a potentially promising treatment to aid the recovery of trauma patients, including in the context of the war in Ukraine. But this approach is yet to be rigorously reviewed or formally implemented, they add.

In a bid to extend the evidence base, the researchers scoured research databases for relevant published studies on high dose IV vitamin C, published up to the end of 2025.

They focused on its impact on death within 30 days of hospital discharge; prognostic scoring systems (Apache II, SOFA); incidence of complications, including sepsis and organ failure; and length of hospital stay.

Out of an initial haul of 108 studies, six, involving a total of 5171 patients, were eligible for systematic review. Three studies were randomised controlled clinical trials; 3 were observational studies.

The included studies reported a significant reduction in 30 day mortality, with significantly shorter intensive care unit and hospital stays. And 4 studies showed lower rates of sepsis in patients receiving vitamin C; 2 found lower rates of multi-organ failure.

“Overall, our findings demonstrate evidence of possible benefit in using high-dose vitamin C in the management of trauma patients,” but the variation in the reported effects “suggests that treatment effects may be context-dependent rather than generalisable across all critical illnesses,” write the researchers.

And they highlight several limitations to their findings: namely, the small number of studies, half of which were observational; and differences in patient groups, methodology, dosing regimens, co-interventions and outcome reporting.

“As our included studies did not use IV vitamin C monotherapy, we cannot truly associate our results with vitamin C alone. No studies investigated the timing of vitamin C, and therefore the optimal timing to administer vitamin C remains unclear.

“These methodological constraints limit the ability to draw firm conclusions about the optimal treatment protocols to use the potential benefits of vitamin C and contribute to the low certainty of evidence identified in this review,” they add.

But they suggest: “Even slight reductions in mortality, sepsis, organ failure or critical care requirement could be used to consider its use in current operational settings, providing a clear rationale for future trauma-specific research before clinical adoption.”

Source: The BMJ Group

Categories : GastrointestinalTags : Leave a comment

Analysis Reveals Path to More Effective Probiotic Supplements

On By ModernMedia
Photo by Harrison Cohen on Unsplash

Commonly available probiotic supplements contain an assortment of microbes sold for specific health purposes despite limited understanding of the microbes’ connections to their marketed use, new University of Virginia School of Medicine research reveals. But the scientists have assembled sophisticated computer models that could lead to more effective products to shape our microbiomes to improve health.

UVA researchers led by Jason Papin, PhD, analysed more than 350 over-the-counter probiotics sold at the three largest pharmacy chains in the United States – CVS, Walgreens and Walmart. Those 352 products were found to contain, collectively, only 36 unique species of bacteria. The most common species were forms of Lactobacillus, a type of bacteria commonly found in yogurt. 

More than half the products contained only one probiotic species. The products with the most unique species topped out at 17. Some brands maintained a consistent number of bacterial strains across products, while others did not.

Based on their analysis, the scientists concluded that there was no real consistency in the combination of species used to support gut health, vaginal health or other health claims. 

“It is truly fascinating to discover that these probiotic bacteria hold a unique, specialized niche among the trillions of microbes in and on the human body,” said Glynis Kolling, PhD, a research faculty member in UVA’s Department of Biomedical Engineering who works closely with Papin. “By combining our advanced methods, we have the potential to vastly expand the pool of beneficial bacteria and pave the way for targeted solutions to support human health.”

Targeting the Microbiome

We have at least as many microorganisms living on and inside us than we have cells in our bodies. Scientists have increasingly come to appreciate the role these microorganisms – collectively known as the microbiome – play in maintaining our health. We can get beneficial bacteria from our diets, such as from yogurt and fermented foods, but there has also been an explosion in “probiotic” products over the last two decades.

So far, the federal Food and Drug Administration has approved only two microbial products for therapeutic purposes, and both are used to treat recurrent C. difficile infections in the colon. Supplements, however, are not regulated as strictly as drugs in the United States, and there is limited understanding of connections between bacteria and marketed use for many probiotic products, the UVA researchers found.

To improve the effectiveness of probiotic products, Papin and his team have developed HaPaPro, a collection of more than 1000 computer models of bacterial metabolism. They used these models to see if they could identify probiotics with the potential to improve women’s vaginal health.

The vaginal microbiome is a natural ecosystem of bacteria, fungi and other microbes that help support health. Bacterial vaginosis occurs when this natural ecosystem is disrupted, leading to pregnancy complications, pelvic inflammatory disease, higher risk of sexually transmitted disease and general discomfort. The researchers were able to use their models to identify microbes that have the potential to help prevent bacterial vaginosis

The successful results, Papin says, demonstrates HaPaPro’s potential for identifying ways to manipulate the microbiome will have concrete benefits. Such insights, he hopes, will lead to better probiotic products that deliver on their promises.

“It is remarkable how much microbes play a role in human health and well-being,” Papin said. “I love seeing how computational models of these complex biological systems are leading to new ideas for therapies and helping us understand such fundamental biological processes.”

Findings Published

The researchers have published their findings in the scientific journal Nature Microbiology. The research team consisted of Emma M. Glass, Kolling and Papin. The scientists have no financial interest in the probiotic industry, but Papin disclosed he has a stake in Cerillo, the manufacturer of instrumentation used in some of the analyses.

Source: University of Virginia