Photographers report moderation, enhancement, and staging of global health images to meet the marketing goals of clients – while photographers react to these practices with resistance and routinely push back, the problem persists as the demand for global heath visuals continues
Global health photography is often caught between photojournalistic intentions of accurately reflect local communities, and marketing directives to create attention-grabbing imagery, according to a study published February 14, 2024 in the open-access journal PLOS Global Public Health by Arsenii Alenichev from Oxford Population Health, the University of Oxford, United Kingdom, and colleagues. Standing at such representational crossroads, photographers are forced to engage with numerous – and often unresolvable – ethical and practical dilemmas.
Photographers are often commissioned by non-governmental organisations and agencies to document the pain and empowerment of others, with a goal to yield donations and attract attention to issues in communities. While photojournalism is often framed as objective, simply by being present, photographers interfere with local communities and can face challenging ethical dilemmas. To better understand how global health photographers operate and ethically obtain consent from subjects, the authors interviewed 29 photographers reflecting the demographic realities of the field about the moral and practical challenges they face on the job. The authors identified common themes across the anonymized interview transcripts to highlight major issues faced by global health photographers.
The authors found that in the current global health landscape, organisations often direct photographers to quickly create attention-grabbing marketing images to compete with mainstream ads. Photographers typically have to work with client-created ‘briefs’ detailing what images they need to take, and with limited time and resources. In practice, it pushes photographers to increasingly sanitise, sensationalise, or stage scenes to produce the desired image – misrepresenting the realities of local communities, especially in the Global South, to which photographers react with resistance. Acquiring ethical consent from subjects is also complicated by power imbalances, language barriers and illiteracy, and misplaced fear and trust in both the photographer and the legal documents they are asked to sign. Given these emergent themes, the authors argue that organizations should push for a more photojournalistic approach to the creation of global health images, weighing ethical clarity over potential economic sacrifice. While their sample of respondents may have been biased towards critical perspectives, the authors believe that this broad overview of tensions will equip other researchers to conduct future studies of more localised, nuanced experiences.
The authors add: “Decolonisation of global health and its visual culture will prove impossible without taking the ethical experiences of photographers seriously, especially the local ones. Global health images should not be understood as neutral depictions of interventions – they are in fact political agents participating in the formulation of stereotypes about people and entire communities.”
During the 2023 Christmas holidays, a freezer failure occurred at the Karolinska Institutet’s Neo building, where the automatic refilling of cryotanks with liquid nitrogen was interrupted for some reason. As a result, the temperature in 16 of 19 cryogenic tanks rose and large amounts of biological research material have been destroyed, including medical research samples which stretch back for decades.
An investigation with internal and external experts is now underway to find out how this failure could have happened, although there are no signs of sabotage. On the evening of 22 December, the level of liquid nitrogen in the Neo building’s cryo tanks, which contain biomaterial and cell lines from multiple departments, was due to be routinely topped up from an external tank.
The automatic refilling of nitrogen ensures that the correct temperature of -190°C can be maintained in the isothermal (cryo) tanks.
However, for reasons unknown, the flow of nitrogen from the external storage tank malfunctioned that evening, and the temperature in 16 of the tanks rose.
Automatic alarm
The cryotanks are able to maintain a sufficiently low temperature for up to 96 hours without refilling. During the Christmas break, they remained un-refilled for around 120 hours, and their internal temperature increased.
“When the flow of nitrogen ceased on 22 December, an automatic alert was supposed to be sent out, both by email and SMS, to registered owners of material in the freezers. However, a malfunction in the alarm unit meant that the alerts did not work properly. The email reached the recipients, but the texts got stuck in the server and never arrived,” explains Elisabeth Raschperger, researcher and senior lab manager at Neo.
According to Dr Raschperger, there has been a history of false alarms from freezers and cryotanks at Neo, partly caused by overly sensitive settings for when alarms should go off.
The alarm supplier inspected the system in 2023 and gave approval for its continued use in November.
Troubleshooting by the suppliers
Five days after the incident when the Neo service team found out what had happened, they called in the suppliers to make an initial check of the valves, pipes and pressure regulation tanks. The alarm was also tested.
“The companies went through every part of the system and found no faults or indications that any piece of equipment was faulty or broken, with the exception of the SMS alarm,” says Dr Raschperger. “We also looked through the operational logbook for the external nitrogen tank for October, November and December, and the refilling system had been working perfectly.”
The affected departments
From a research perspective, the Department of Medicine, Huddinge (MedH), was most affected, but so too were researchers at the Department of Biosciences and Nutrition (BioNut).
“At MedH, the research areas of haematology, endocrinology and cardiology have been particularly affected by the crash. It involves a very large amount of irreplaceable research material with samples, cell lines and biomaterials collected over decades,” says Professor Petter Höglund, head of MedH. He continues:
“The affected research teams are now working to take stock of the full extent of the losses. The analyses made so far speak for themselves: the malfunction will have far-reaching consequences for the department’s research in the affected areas.”
The staff at Neo, BioNut and MedH receive regular updates on the incident and the steps being taken to investigate the cause. They are also receiving crisis support from HR.
Expert inquiry
An inquiry to ensure that the incident never happens again is now underway. The inquiry will take a technical and procedural – rather than a personal – approach to chart and analyse the incident and look into how KI can build sustainable, robust systems going forward. Pending the inquiry’s report, it is important not to make a bad situation worse.
“Rumours are circulating that the malfunction was an act of sabotage,” says Dr Raschperger. “I would like to emphasise that there are at the present no such indications, and urge everyone to wait for the experts’ conclusions.”
A course of acupuncture may curb the heightened risk of stroke associated with rheumatoid arthritis, finds a comparative study published in the open access journal BMJ Open.
The effects seem to be independent of sex, age, medication use, and co-existing conditions, the findings indicate, prompting the researchers to suggest that the procedure may reduce levels of pro-inflammatory proteins (cytokines) in the body that are linked to cardiovascular disease.
The principal cause of death in people with rheumatoid arthritis is cardiovascular disease. And they are more likely to have a stroke than the general population, note the researchers.
Acupuncture is already used to control pain and dampen down inflammation, and the researchers wanted to find out if it might also lower the risk of ischaemic stroke that is associated with systemic inflammation.
They drew on national medical records from the Registry for Catastrophic Illness Patients Database (RCIPD), for 47 809 adults newly diagnosed with rheumatoid arthritis between 1997 and 2010.
The final analysis included 23 226 patients with complete data, 12 266 of whom were treated with acupuncture following their diagnosis up until the end of December 2010.
Of these, 11 613 were each matched for age, sex, co-existing conditions (diabetes, high blood pressure, high blood fats, congestive heart failure, anxiety/depression, obesity, atrial fibrillation, alcohol dependency, and smoking), medication use (non-steroidal anti-inflammatory drugs, statins, and disease modifying drug) and year of diagnosis with a patient who hadn’t been treated with acupuncture.
Women, those aged 40–59, and participants with high blood pressure predominated in both groups.
Most (87%) of those in the acupuncture group were treated with manual acupuncture (87%); 3% were treated with electroacupuncture, whereby an electrode producing a low pulse of electricity is attached to the needle; and 10% received both types.
On average, 1065 days elapsed between a rheumatoid arthritis diagnosis and receipt of the first acupuncture treatment, with the number of treatments averaging around 10 in total.
During the monitoring period up to the end of 2011, 946 patients had an ischaemic stroke. Unsurprisingly, risk rose in tandem with increasing age, and with the number of co-existing conditions.
Those with high blood pressure, for example, were more than twice as likely to have a stroke as those with normal blood pressure, while those with diabetes were 58% more likely to do so.
But there were significantly fewer cases of ischaemic stroke among the acupuncture group: 341 vs 605, equivalent to a 43% lower risk. And this was independent of age, sex, medication use, and co-existing conditions.
This is an observational study, and as such, no firm conclusions can be drawn about cause and effect, and the researchers also acknowledge that they were only able to estimate disease severity from the drugs the patients took.
Nor did they have information on potentially influential factors, such as height, weight, lab tests or physical activity levels, and not everyone would have had the same pressure points needled, they add.
But they point out: “Inflammation is a consistent and independent predictor of cardiovascular disease in [rheumatoid arthritis],” so acupuncture may lower pro-inflammatory proteins, thereby reducing the risk of cardiovascular disease, including ischaemic stroke, they suggest.
“Unstable blood pressure and lipid profiles are the two risk factors for ischaemic stroke, and acupuncture therapy has the advantage of controlling both hypertension and dyslipidaemia,” they explain, adding: “If acupuncture relieves morning stiffness and joint pain, patients might also benefit from increasing daily activities, which might also reduce the risk of stroke.”
Researchers at the University of Cape Town (UCT) have found that in most cases, the Older Persons Grant is not sufficient to meet the needs of elderly people in South Africa.
Professor Elena Moore and other researchers from Family Caregiving, based in the Department of Sociology at UCT, interviewed 30 families in rural KwaZulu-Natal and 50 families in the Western Cape to find out how families headed by pensioners are making ends meet and whether older persons are able to get the care they need.
About 3.9 million people in South Africa receive the monthly Older Persons Grant, also known as the Old Age Grant, currently at R2080 per person per month.
Family Caregiving analysed data from Wave 5 of UCT’s National Income Dynamics Study (NIDS), which shows that the vast majority of beneficiaries live in households of five people where the average household income is R6850.
Older people have significant and unique care needs, the researchers argue. According to StatsSA data from 2021, the majority of older people need chronic medication and need to access healthcare facilities: 24% of older persons in South Africa have diabetes, 68% live with hypertension, and 14% have arthritis. Older people also often have difficulties with sight, mobility and cognition, meaning they need additional support to go about their day-to-day lives, say the researchers.
In a rural area in KwaZulu-Natal, Family Caregiving found that most households had between eight and nine members and were struggling to cover the cost of food, medical supplies, and transport to clinics.
In this area, accessing healthcare is expensive, the team found. A round trip to town by taxi cost R46 and a trip to the closest clinic and back costs R82. Physically disabled older people often have to hire a car for between R200 and R600 to get to a clinic and back. A pack of adult incontinence products costs R219 and lasts only seven days.
Because of the costs of transport and medical supplies, many of these large households were spending an average of only R1000–R1500 a month on food, according to the report. A lack of access to water and electricity creates an additional burden for older people in rural areas.
In urban areas, such as Cape Town, there is greater access to water and electricity, health facilities are closer, and households are smaller, meaning the Older Persons Grant is not stretched as far. But still, the researchers found, older people are often required to carry households at the expense of their own care.
Low income and low-middle income families in Khayelitsha and Eerste River told the researchers that the only way to make ends meet is to spend less on food. Many families are stuck in debt cycles, borrowing from loan sharks from month-to-month with extremely high interest rates. Unpaid utility bills stack up, and electricity tariff hikes and rising rental prices put further pressure on older persons.
The monthly cost of nutritious food for a family of seven is R5324, according to Pietermaritzburg Economic Justice and Dignity’s household affordability index. Family Caregiving found that low-income households headed by older persons are often spending less than half that amount on food because of other household expenses. This has serious consequences for older people, especially those who need to eat before taking medication.
The report recommends additional investment by the government to care for older people, such as free transport to health facilities and consistent supply of incontinence products.
Researchers from Institut Pasteur have discovered that the immune impacts of smoking can last for many years, leaving smokers with effects on some of their bodies’ defence mechanisms acquired while smoking. These findings, which for the first time reveal a long-term memory of the effects of smoking on immunity, are published in the journal Nature.
Individuals’ immune systems vary significantly in terms of how effectively they respond to microbial attacks. But how can this variability be explained? What factors cause these differences? “To answer this key question, we set up the Milieu Intérieur cohort comprising 1000 healthy individuals aged 20 to 70 in 2011,” explains Darragh Duffy, Head of the Translational Immunology Unit at the Institut Pasteur and last author of the study. While certain factors such as age, sex and genetics are known to have a significant impact on the immune system, the aim of this new study was to identify which other factors had the most influence.”
The scientists exposed blood samples taken from individuals in the Milieu Intérieur cohort to a wide variety of microbes and observed their immune response by measuring levels of secreted cytokines(1). Using the large quantities of data gathered for individuals in the cohort, the team then determined which of the 136 investigated variables (body mass index, smoking, number of hours’ sleep, exercise, childhood illnesses, vaccinations, living environment, etc) had the most influence on the immune responses studied. Three variables stood out: smoking, latent cytomegalovirus infection(2) and body mass index. “The influence of these three factors on certain immune responses could be equal to that of age, sex or genetics,” points out Darragh Duffy.
As regards smoking, an analysis of the data showed that the inflammatory response, which is immediately triggered by infection with a pathogen, was heightened in smokers, and moreover, the activity of certain cells involved in immune memory was impaired. In other words, this study shows that smoking disrupts not only innate immune mechanisms, but also some adaptive immune mechanisms. “A comparison of immune responses in smokers and ex-smokers revealed that the inflammatory response returned to normal levels quickly after smoking cessation, while the impact on adaptive immunity persisted for 10 to 15 years,” observes Darragh Duffy. “This is the first time it has been possible to demonstrate the long-term influence of smoking on immune responses.”
Basically, the immune system appears to have something resembling a long-term memory of the effects of smoking. But how? “When we realised that the profiles of smokers and ex-smokers were similar, we immediately suspected that epigenetic processes were at play(3),” says Violaine Saint-André, a bioinformatician in the Institut Pasteur’s Translational Immunology Unit and first author of the study. “We demonstrated that the long-term effects of smoking on immune responses were linked to differences in DNA methylation(4) – with the potential to modify the expression of genes involved in immune cell metabolism – between smokers, ex-smokers and non-smokers.” It therefore appears that smoking can induce persistent changes to the immune system through epigenetic mechanisms.
“This is a major discovery elucidating the impact of smoking on healthy individuals’ immunity and also, by comparison, on the immunity of individuals suffering from various diseases,” concludes Violaine Saint-André.
Notes:
(1) proteins secreted by a large number of immune cells to communicate among themselves and participate in immune defense.
(2) a virus in the herpes family that is often asymptomatic though dangerous to foetuses.
(3) changes in DNA that affect how genes are expressed, i.e. how they are used by cells.
(4) methylation is a type of chemical modification. Methyl groups position themselves on DNA, changing the way in which the genome is read in the cell.
Scientists have long thought of the pleural cavity merely as a cushion from external damage. Turns out, it also houses macrophages that rush into the lungs during flu infections.
“We were surprised to find them in the lungs because nobody has seen this before, that these cells go into the lung when there’s an infection,” said UC Riverside virologist Juliet Morrison, who led the discovery team.
A paper published in the Proceedings of the National Academy of Sciences details how during an influenza infection, macrophages leave the exterior cavity and cross into the lungs where they decrease inflammation and reduce levels of disease.
“This study shows it’s not just what happens in the lung that matters, but also what’s outside of the lung. Cell types not normally connected to the lung can have outsized impacts on lung disease and health,” Morrison said.
There are three main cavities in the body: one around the heart, the abdominal cavity, and the pleural cavity surrounding the lungs.
“Because it contains fluid, it prevents the lungs from collapsing. However, people have not thought much about the pleural cavity being a whole organ within itself. This research may change that perception,” Morrison said.
Initially, the researchers set out to understand the more general question of what types of cells are present in the lungs during flu infections. They took existing data on lung-related genes from studies of mice that either died from the flu or survived. They then mined the data using an algorithm to predict cell types that change in the lungs during infections.
“We took big data and broke it down to assign which potential immune cells are in the lung tissues. That’s where I got a hint that maybe we had a previously unknown external source of cells in the lung,” Morrison said.
Next, using a laser-based technique, the team tracked macrophages going into the lungs of mice, and observed what happened if they took these cells out of the equation.
“When you take them out of the mouse you see more disease and more lung inflammation,” Morrison said.
Morrison says she hopes this study will encourage other scientists to reevaluate data sets from older studies.
“Our approach was to take information already out there and put it to new use, and we were able to see something new,” she said.
Moving forward, the research team is hoping to determine which proteins “tell” the macrophages to move into the lungs. Once the protein signals have been identified, it may be possible to create drugs that boost either the number of macrophages, or their activity.
The strategy of boosting human defences to infection, rather than developing another antiviral to which viruses could become resistant, could offer people a flu treatment that would be more effective for much longer.
“If we can boost what resolves infection in us, we probably have a better shot. We’re less likely to have resistance. The immune system is so complicated, but it’s our best bet in the long run to work with what we have rather than chase viruses that continue to escape our therapeutics,” Morrison said.
Athletes often suffer injuries to ligaments in their knees, particularly to the anterior cruciate ligament or ACL. While surgery to replace these torn ligaments is becoming increasingly common around the world it often needs to be repeated. That’s because it has proved challenging to anchor fibrous, soft and wet ligament grafting material into hard bone.
Now, McGill University researchers have new information from the eggshell membrane in chicken eggs that could help change this picture thanks to the potential it offers for improvements in tissue engineering and biomaterial grafts.
Their findings also have the potential to reduce losses for commercial egg and poultry producers.
Anchoring soft and wet fibres by “nailing” them in place
The researchers discovered how the hard shell of a bird egg attaches to the underlying wet fibrous membrane of the egg (the thin membranous layer found inside the shell seen when peeling a hard-boiled egg). By using advanced 3D imaging X-ray and electron microscopes together with cryo-preservation methods the research team were able to peer into this interface in three dimensions to visualize and quantify the interlocking phenomenon.
“Until now, no one had considered how this interface between these two very dissimilar substances, one a hard biorock, and the other a soft fibrous membrane, might be secured at the nanoscale,” says Marc McKee, a professor in the Faculty of Dental Medicine and Oral Health Sciences, and in the Department of Anatomy and Cell Biology, and the principal investigator of the study conducted by doctoral student Daniel Buss and published recently in iScience. “What we found about this soft-hard interface is quite remarkable.”
Nanospikes increase the surface area of contact between soft and hard materials and ensure food safety
The McGill team discovered that, at a certain stage in the development of an egg prior to laying, the shell sends mineral nanospikes into the soft and compliant surface fibres of the underlying eggshell membrane.
This membrane surrounds the soft contents of the egg interior, being either the egg white and yolk from table eggs, or the developing chick embryo in a fertilized and incubated egg.
This nanospiking attachment process between two highly dissimilar materials substantially increases the surface area of the interface between the soft and wet organic fibres and the hard and largely dry inorganic mineral.
Such an attachment importantly anchors and secures this soft-hard interface to prevent slipping and sliding of the fibres within the shell.
Otherwise, detachment of the membrane from the shell can be lethal for the embryonic chick, can weaken the shell, and/or can allow the invasion of pathogens (such as salmonella) into the interior contents of the egg.
Food safety of the table egg relies on an intact shell that is well-integrated with its underlying membrane.
Implications for medical procedures and commercial egg production
With this new understanding of the shell-membrane interface as being a characteristic feature of strong, safe and healthy eggs, losses for table egg producers and poultry breeders might be reduced through the establishment of commercial genetic breeding programs that maintain or maximize this interfacial structure.
The findings might also potentially lead to new engineered, hybrid composite material designs, and to new procedures to improve the outcomes of various medical and dental reconstructive surgeries, both of which may require attaching soft wet fibres to hard materials.
Using the old anaesthesia drug ketamine to pull people out of the depths of severe depression has gone from fringe idea to widespread use in just a few years. Sparked by promising studies and stories of lives transformed, clinics offering intravenous infusions of ketamine have popped up in the US. Some also offer a newer, more expensive, nasal spray version.
But major questions remain about who ketamine can help, why some people get tremendous relief within days or weeks while others don’t, and the costs and benefits of different ways of delivering the drug.
New findings just came out from a study that seeks to answer some of those questions. They add more evidence about the power of IV ketamine to help some of the most severely ill people with depression or bipolar disorder who haven’t gotten relief from other treatments, including many who have frequent suicidal thoughts.
Called Bio-K, the study involved 74 people treated at four clinics in Michigan, Maryland and Minnesota. After just three infusions of ketamine over 11 days, 52% of participants saw their severe depression ease so much they achieved remission. Another 15% responded somewhat.
Half of those who had thought often of suicide before receiving ketamine experienced a dramatic drop in those impulses. The results are published in the Journal of Affective Disorders.
“These participants are very representative of the sickest patients we see, with more than 80% reporting suicidality that would have excluded them from other depression treatment studies,” said University of Michigan Health psychiatrist and study leader Sagar Parikh, MD.
“As in other studies of ketamine, the initial response to treatment was a strong predictor of who would do well,” he added. “Two-thirds of those who responded after one infusion went on to achieve remission, while those who hadn’t responded measurably after two infusions were unlikely to start to respond after an additional one.”
Who responds and why?
What’s the difference between them and those who responded? That’s a key focus of Bio-K, which is funded by donors to the U-M Eisenberg Family Depression Center.
A third of all Bio-K participants didn’t respond to ketamine by the end of the three infusions provided under the study, leaving them to cope with one more failure in a series of attempted treatments.
The team’s in-depth interviews with some of these non-responders show how difficult that can be, as the team reported in a paper last year.
By studying molecules in blood samples from the study’s participants, the Bio-K team hopes to find biomarkers that could predict who is most likely to get relief from ketamine, and who should try other options.
The study is evaluating cell signaling proteins, inflammatory markers and molecules that can indicate rates of cell metabolism in mitochondria. Early results from those analyses should be available in the next year.
From research to clinical use
In the meantime, the strength of the response in Bio-K participants helped fuel the founding of an IV ketamine clinic at University of Michigan Health, says Parikh, who oversees the clinic.
U-M now accepts referrals from providers across the region who have patients with treatment-resistant depression and need another option after trying at least four medications.
Patients come to the main U-M medical campus around eight times during the span of a month for infusions under the care of psychiatrists, anaesthesiologists and other clinicians.
Parikh and his colleagues even wrote a guide for other hospitals on how best to set up and run such a clinic.
A newer version
Meanwhile, the nasal spray form of ketamine, called esketamine and sold under the name Spravato, has captured attention in recent years for its potential to ease disabling and life threatening symptoms without requiring an IV.
The spray involves a form of the drug manufactured by a pharmaceutical company in a way that isolates just one variety of the ketamine molecule, which allowed the company to seek a specific FDA approval.
Parikh notes that U-M was one of the sites for the original small study that led to Spravato’s approval by the FDA, and another larger study sponsored by Janssen, the drug’s manufacturer, that recently concluded. In addition to serving as the local principal investigator for these studies, Parikh also briefly served as a consultant to the company.
Based on the experience in these studies, U-M hopes to start offering Spravato alongside IV ketamine on a clinical basis. Even though it’s not given through an intravenous drip, the nasal spray still requires careful observation of patients under the FDA’s approval conditions.
IV vs nasal spray
Even as researchers search for biomarkers to predict ketamine response, clinicians find themselves with a conundrum: Which patients should start with IV ketamine, and which with Spravato? And how do the two compare head to head in actual response to treatment?
That’s what researchers at Yale University, U-M and their colleagues will soon try to find out, through a new study just funded by the federal Patient-Centered Outcomes Research Institute.
The study, which will begin enrolling up to 400 people at six sites nationwide later this year, will randomly assign people with treatment resistant depression to either the IV or nasal spray form of the drug. They’ll then receive that treatment for about four weeks, and have their symptoms monitored during treatment and for months afterward.
Such a head-to-head study might help inform insurers that haven’t yet started covering one or both forms of ketamine, Parikh noted.
More about the Bio-K results
In the meantime, the treatment response results from the Bio-K study and other studies can help more patients and clinicians understand the impact of IV ketamine.
Although Bio-K accepted people who were suicidal, which many antidepressant medication studies do not, it did not include people who use cannabis or those who have an active substance use disorder, schizophrenia or psychosis. But participants had to have failed to respond to at least two antidepressant or mood stabilising medications after at least eight weeks, or failed to respond to six sessions of ECT, the treatment based on electric stimulation of the brain that has been seen as the last resort for many patients.
The study found that it did not matter if they got their infusions slowly over 100 minutes or in a standard session of 40 minutes.
At the start of the study, the average score of participants on a standard depression scale called MADRS was 28; that average dropped to 11 at 24 hours after the third infusion. A score of 10 or below is considered depression free, or remission, and a drop in score of at least 50% of the total score is considered response. In all, 67% achieved what is considered response, and 52% reached remission.
Chronic exposure of human skin to ultraviolet light causes premature aging, or photoaging. As the skin undergoes photoaging, type I collagen bundles, which are found in the dermis beneath the top layer of the skin and provide strength and support to skin, become fragmented. This leads to wrinkles, fragility and loss of support and elasticity.
“The best way to prevent damage to type I collagen by sunlight is to wear sunscreen consistently, daily if possible and particularly when spending time outdoors,” said Frank Wang, MD, the William B. Taylor Endowed Professor of Clinical Dermatology at U-M Medical School.
Experts observed in a new study that injection of the most popular type of dermal filler, cross-linked hyaluronic acid, into photoaged skin could reverse the dermal changes associated with photoaging.
These fillers are typically injected into the skin to reduce lines and wrinkles.
They are thought to provide clinical improvement by adding volume to the skin, but researchers have found that cross-linked hyaluronic acid also stimulates production of new type I collagen in the dermis.
The filler does so rapidly, stimulating collagen production within several weeks of injection, and is long-lasting, promoting the accumulation of more collagen over the course of a year.
These findings indicate how the filler improves the appearance of skin in the short-term – a combination of space-filling and collagen.
Additionally, since newly formed dermal collagen lasts many years, the findings also provide insight into how the filler can promote long-term clinical improvement, months or even a year after injection.
“A single injection of cross-linked hyaluronic acid dermal filler can lead to rapid and long-lasting improvement of skin by stimulating collagen deposition, and furthermore, repeat injections may add more collagen, eventually reducing the need for re-treatment,” Wang said.
The common yellow commelina, one of the popular plants used to treat children. Photo by Bernard DUPONT via Wikimedia Commons. CC2.0
In 2021, almost 33 of every 1 000 South African children under five years old died.
This under-five mortality rate is far worse than in similar middle-income countries such as Brazil (14.4 per 1000 births), Cuba (5 per 1000), India (30.6), Indonesia (22.2) and Egypt (19.0).
South Africa’s under-five mortality rate also lags behind the UN’s Sustainable Development Goal of reducing these figures worldwide by 2030 to 25 deaths per 1000.
Significant progress has been made. In 1994, South Africa’s under-five mortality rate was 60.4 per 1000. The government’s Expanded Programme on Immunisation was one health intervention that made a difference.
However, inequalities persist. The underfunded public health sector has been stretched to serve 71% of the population.
Worldwide, many people, particularly those in rural settlements, depend on medicinal plants for their health. In August 2023, the World Health Organization held the first global summit on traditional medicine, in India.
Of the province’s population, 49.2% live below the poverty line with no access to proper housing, water and sanitation. These conditions have an impact on children’s health.
Despite the high reliance on traditional medicine by rural populations, the role of medicinal plants for the treatment of childhood diseases remains speculative and lacks systematic documentation.
Our study yielded the first comprehensive inventory of medicinal plants and indigenous knowledge related to children’s healthcare in the area.
Evidence shows traditional health practitioners continue to play an important role in managing childhood illness in sub-Saharan Africa.
South Africa is endowed with a rich wealth of flora and is often acclaimed as a biodiversity hotspot. Thousands of plants are used for traditional medicine for the management of diverse health conditions.
In the North West, we interviewed 101 participants, including traditional health practitioners, specifically those with expertise in managing and treating diseases among children, and herbal vendors operating in the selected study areas.
Gender distribution among the participants was 78% female and 21% male. This signifies the importance of women as active custodians of indigenous knowledge related to childhood health needs.
Of the participants, 63% had completed a secondary level of education, 21.8% had no formal education and 5% had attended primary school. Although 79% of the participants lived in villages, 15.8% were based in urban areas.
The participants were asked which plants they used to treat children. Of the 61 plants identified, 89% were recorded for the first time as botanicals used for childhood-related diseases by traditional health practitioners.
Carpet plant (Geranium incanum), common yellow commelina (Commelina africana) and elephant’s root (Elephantorrhiza elephantina) were the most popular medicinal plants.
Carpet plant was used as a treatment for diverse health problems such as umbilical cord conditions, muscle fits, measles, weight loss and appetite loss.
Roots and rhizomes were the parts most frequently used as treatments (40%), followed by leaves (23%) and whole plants (20%).
Boiling plants or softening them in liquid were the main preparation methods. The plant remedies were mainly administered orally (60%) and used on the skin (39%).
The study also confirmed there are similarities in indigenous practices, techniques and plant matter for specific conditions that were previously reported in other provinces: KwaZulu-Natal and the Eastern Cape.
The way forward
There is increasing support from governments for promoting traditional medicine as part of primary healthcare in African countries such as Cameroon and South Africa.
We recommend that:
Government provide institutional and financial support to determine the role of herbal medicine in primary healthcare. Working with traditional health practitioners, medicinal plants must be documented and testing laboratories need to be set up to establish their efficacy and to determine appropriate dosages.
Botanical gardens should be created to ensure the sustainability of plants and their continued role in providing much-needed medical care. In the North West province, 40% of the ecosystems are under severe stress, with 11 of the 61 vegetation and 14 of the 18 river types classified as threatened. Medicinal plants are mostly harvested from the wild, so it’s possible that many could face extinction from uncontrolled harvesting.
Authors
Tshepiso Ndhlovu Lecturer and researcher, University of Mpumalanga
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