Advancing community health measurement, policy, and practice

Pioneering study of Egyptian Neem and Jojoba extracts with molecular docking combat hospital multidrug resistant bacteria

Hospital surfaces are often contaminated with multidrug-resistant pathogenic bacteria that cause healthcare-associated infections and lead to increased mortality and morbidity. There is a need for new alternative antibacterial agents to overcome antibiotic resistance. Azadirachta indica and Simmondsia chinensis have been found to possess antibacterial activity and medicinal value. The antibacterial activity of these plant extracts against clinical isolates was investigated using the agar disc diffusion method. These clinical isolates included E. coli, Pseudomonas aeruginosa, Acinetobacter spp., Klebsiella pneumoniae, Stenotrophomonas maltophilia, and methicillin-resistant Staphylococcus aureus (MRSA), which were identified by the vitek-2 system, and resistance genes of selected bacterial strains were identified by using the bioFire FilmArray test. The most potent extract of these plants was the ethanolic extract, where the inhibition percentage of ethanolic Jojoba and Neem extracts was 90.9% and 74.5%, respectively against all the tested pathogens. On the other hand, the methanolic extracts of Neem and Jojoba have different degrees of antibacterial activity against the tested pathogens. The phytochemical components of the most potent extracts (ethanolic extracts) were investigated by gas chromatography‒mass spectrometry (GC\MS), which revealed that the ethanolic extracts were enriched in phenolics, flavonoids, and sugars. FTIR analyses of the plant extracts confirmed the presence of alcoholic, carboxylic, and aldehydic moieties. The 2,2-diphenyl-1-picrylhydrazyl (DPPH) activity of the ethanolic extracts of Neem and Jojoba increased in a dose-dependent manner, with average IC50 values of 98.17 ± 0.85, 4.95 ± 0.06, and 4.17 ± 0.04 mg/mL, respectively, for the ethanolic Neem extract, the ethanolic Jojoba extract, and ascorbic acid (standard). Furthermore, increased cytotoxicity was demonstrated in the HFB4 cell line in a dose-dependent manner. The average IC50s of the ethanolic Neem extract and the ethanolic Jojoba extract were 18.18 ± 0.15 and 76.16 ± 1.49 mg/mL, respectively. Moreover, the results for the antibiofilm activity of the ethanolic Neem extract showed that 99.5% of the biofilms formed at 25 mg/ml. In addition, 50 mg/ml of the ethanolic extract of Jojoba had a suppressive effect of 98.2%. The significant components Nonanoic acid (21.9405%) and Palmitic Acid (16.0869%) from Neem and pinitol from Jojoba (82.85%) were selected throughout the molecular docking investigation, by which the chosen constituents inhibited the crystal structure of penicillin-binding protein 4 (PBP4) from Staphylococcus aureus (PDB ID: 1TVF) and the crystal structure of the OXA-48 beta-lactamase (PDB ID: 7AUX) from K. pneumoniae. Overall, our study reveals the effectiveness of antimicrobial plant extracts as therapeutic solutions for antibiotic resistance in Egypt and worldwide with some modifications to decrease their cytotoxicity.

Radiation safety: knowledge, attitudes, practices and perceived socioeconomic impact in a limited-resource radiotherapy setting

Healthcare workers in teaching-hospital settings face numerous occupational hazards, necessitating comprehensive safety protocols to protect both staff and patients. Radiation safety is particularly critical in regions like sub-Saharan Africa, where the sharp rise in radiological procedures and radiation treatments demands stringent protocols to mitigate health risks. The study aimed to assess the knowledge, attitudes and practices related to radiation safety among healthcare workers in a limited-resource setting, as well as evaluate the perceived socioeconomic impact of implementing radiation safety protocols. The research was a quantitative case study of one of the largest radiotherapy centres in Africa. Participants were selected using a stratified random sampling technique. Data were collected using a modified structured questionnaire based on the validated International Atomic Energy Agency radiation safety knowledge, attitudes and practice questionnaire. Data were analysed with the Statistical Package for Social Sciences software. Both descriptive and inferential statistical analyses were performed. Data were summarized using frequencies, percentages, means and standard deviations. The study involved 78 participants, comprising 13 physicians, 40 nurses and 25 other health workers. In all, 53.8% were males, whereas 46.2% were females. The mean age was 24.9 years (SD 4.7) ranging from 23 to 47 years. A significant majority (82%) were knowledgeable about effective ways of reducing radiation exposure. All participants considered radiation safety extremely important, with 55% feeling extremely confident in their ability to practice radiation safety measures. The majority (92%) believed that radiation safety was a shared responsibility within the organization. Only 51% frequently checked radiation safety equipment. There was a strong consensus that these protocols positively affect healthcare worker well-being (a mean score of 4.49) and benefit patient care (a mean score of 4.45). Implementation of workplace safety protocols was perceived to improve worker well-being (B = 0.337 and p = 0.001) and benefit patient care (B = 0.391 and p = 0.014). The study highlights a high level of knowledge and positive attitudes towards radiation safety among healthcare workers in a limited-resource radiotherapy setting. While most participants recognized the importance of radiation safety and its shared responsibility, less than half regularly checked safety equipment. There were significant perceptions of the socioeconomic benefits of implementing safety protocols.

Strength in Diversity: Integrating Community in Primary Health Care to Advance Universal Health Coverage

The supplement highlights a systems approach that recognizes the communities' roles and their interactions with other health system actors to accelerate outcomes and reflect the diversity of the community health ecosystem. Several cross-cutting priorities emerge from the articles, namely coverage, community health financing, policy change, institutionalization, resilience, accountability, community engagement, and whole-of-society efforts.