Cape Town Research Articles

Precarious work and constructions of masculinities: the case of day labour workers in Cape Town, South Africa

Masculinities are organised hierarchically, and how a man sees himself is often informed by his positioning within this hierarchy. The context within which men are located determines which factors or markers of masculinity become more salient at different times, and so do the social situations and spaces men are interacting within, and with whom they are interacting. Their socio-cultural, political, and economic positioning inform not only how they construct their gendered identities, but also where they are located within social hierarchies of masculinity. This article examines constructions of masculinities among economically marginalised men who seek work on the side of the road in Cape Town, South Africa. In-depth qualitative interviews were conducted with 10 Black African men and the findings suggest that economic provision remains a central feature in participants’ constructions of masculinity. Men’s experiences of precarious work not only impact how they see themselves but also their ability to establish and maintain romantic relationships which, as argued in this study, serve an important role in validating and affirming participants’ masculinity. This study shows that when some men are not able to provide, their romantic relationships fail, which adversely impacts their self-esteem. In response, some of the participants in this study turned towards alcohol abuse, and neglecting/abandoning their homes and families as a way to avoid the shame and humiliation they experience as ‘men who cannot provide’.

Associations between childbirth, gang exposure and substance use among young women in Cape Town, South Africa

The prevalence and influence of gangs on adolescents and young adults remain a concern in Western Cape, South Africa—particularly as they have one of the largest gang presence. While less attention has been focused on young women, there is a need to elucidate the relationship between gang exposure and health behaviors, such substance use, in addition to understanding whether becoming a caregiver impacts this relationship. This study uses baseline data from 496 participants enrolled in a NIDA-funded R01 trial that recruited young women aged 16 to 19 who were out of school and reported recent alcohol or other drug use and sexual risk behavior. At enrollment, a risk behavior survey was administered, and urine drug screening was conducted. Multivariable logistic regression analyses were conducted to examine baseline associations between childbirth, a gang exposure index based on eight items, and positive drug screens of the most prevalent drugs in the Western Cape (marijuana, methaqualone, and methamphetamine). At enrollment, approximately 39% of the sample had a positive urine screen for marijuana, 17% for methaqualone, and 11% for methamphetamine. Additionally, 28% had ever given birth. While only 6% reported ever being a member of a gang, most reported exposure to gangs through their physical and social environments. For all three drugs, gang exposure was associated with statistically significantly higher odds of a positive screen. Every one-point increase in the gang exposure index was associated with a 31% increase in the odds of a positive marijuana screen (p < .001), a 26% increase for methaqualone (p = 0.005) and a 37% increase in the odds of a positive methamphetamine screen (p < .001). Ever given birth was associated with lower odds of marijuana use (adjusted odds ratio [AOR]: 0.63; 95% CI: 0.42–0.96), but it was not associated with methaqualone or methamphetamine use. The findings suggest that exposure to gangs through young women’s social and physical environment is positively associated with drug use. Childbirth was also protective for marijuana use, indicating there may be something unique about this type of drug, such as one’s ability to more easily stop use. Although very few young women reported gang membership, a majority reported some exposure, indicating the need to address how pervasive this exposure is and the potential risk.

Incidence, aetiology and short term outcomes of extreme hyperbilirubinaemia, in term infants born in the Western health subdistrict of Cape Town, South Africa between 2019 and 2020.

Extreme levels of bilirubin in newborn is a major cause of lifelong neurodevelopmental impairment, which places a financial burden on healthcare resources and caregivers. To determine the incidence, aetiology and short-term outcomes of extreme hyperbilirubinaemia in term infants born in a resource-limited setting. This is a retrospective observational study looking at term neonates with a birth weight ≥2500 g, born in the Western health subdistrict of Cape Town, South Africa, between 1 January 2019 and 31 December 2020, who were exposed to a serum bilirubin level of ≥430 μmol/L in the first week of life and received care in the public health system. Extreme hyperbilirubinaemia occurred in 59 term infants. The incidence was 74 cases per 100 000 (<0.01%) live births equating to 1 case in every 1345 live births. The cause of hyperbilirubinaemia was identified in 51 of the cases (86%), the most common being ABO incompatibility (31/51, 61%), followed by glucose-6-phosphate dehydrogenase deficiency (11/51, 22%). Twelve infants (20 %) underwent an exchange transfusion. Six infants were encephalopathic. Forty-seven infants (80%) were readmitted after initial post-natal discharge, with a mean age of readmission of 113 h old (SD 31 h). The incidence of extreme hyperbilirubinaemia in the Western health subdistrict of Cape Town is higher than in high-income settings. Further work should focus on training of healthcare workers and education of caregivers, for the early detection of significant hyperbilirubinaemia to prevent neurological complications caused by bilirubin toxicity.

Rediscovering the unusual Cancellus makrothrix Stebbing, 1924 (Crustacea: Decapoda: Diogenidae) in the “Great African Seaforest”

The rare diogenid hermit crab Cancellus makrothrix Stebbing, 1924, previously known from only a few specimens collected a century ago from Algoa Bay, South Africa, has been found to be common in the kelp forest known as the “Great African Seaforest”, and rocky reefs, of False Bay, South Africa. This poorly known species, considered “aberrant” by some carcinologists, is one of 17 known in the genus Cancellus H. Milne Edwards, 1836, and the only of the genus known to occur in the coast of southern Africa. Cancelllus makrothrix lives in gastropod shells, whereas all other congenerics live in a variety of petricolous dwellings that are either excavated or worn away into cylindrical cavities. The newly collected material of C. makrothrix in South Africa, together with the study of historical museum specimens has made possible the detailed redescription and taxonomic discussion of this species presented herein, using full illustrations, photographs, and microCT scans. For future reference, the molecular CO1 genetic barcode is reported. A lectotype is selected from Stebbing’s original syntype material found to consist of two specimens: a female of which only several appendages remain, in the Natural History Museum, London, and a male, illustrated in the original description, in the Iziko South African Museum, Cape Town. Taxonomic remarks, comments on biological oddities, brief in situ and laboratory observations of live specimens, and a map summarizing the world distribution of species of Cancellus, are included.

SARS-CoV-2 seroepidemiology in Cape Town, South Africa, and implications for future outbreaks in low-income communities.

In low- and middle-income countries where SARS-CoV-2 testing is limited, seroprevalence studies can help describe and characterise the extent of the pandemic, as well as elucidate protection conferred by prior exposure. We conducted repeated cross-sectional serosurveys (July 2020 -November 2021) using residual samples from patients from Cape Town, South Africa, sent for routine laboratory studies for non-COVID-19 conditions. SARS-CoV-2 anti-nucleocapsid antibodies and linked clinical information were used to investigate: (1) seroprevalence over time and risk factors associated with seropositivity, (2) ecological comparison of seroprevalence between subdistricts, (3) case ascertainment rates, and (4) the relative protection against COVID-19 associated with seropositivity and vaccination statuses. Among the subset sampled, seroprevalence of SARS-CoV-2 in Cape Town increased from 39.19% (95% confidence interval [CI] 37.23-41.19) in July 2020 to 67.8% (95%CI 66.31-69.25) in November 2021. Poorer communities had both higher seroprevalence and COVID-19 mortality. Only 10% of seropositive individuals had a recorded positive SARS-CoV-2 test. Using COVID-19 hospital admission and death data at the Provincial Health Data Centre, antibody positivity before the start of the Omicron BA.1 wave (28 November 2021) was strongly protective for severe disease (adjusted odds ratio [aOR] 0.15; 95%CI 0.05-0.46), with additional benefit in those who were also vaccinated (aOR 0.07, 95%CI 0.01-0.35). The high population seroprevalence in Cape Town was attained at the cost of substantial COVID-19 mortality. At the individual level, seropositivity was highly protective against subsequent infections and severe COVID-19 disease. In low-income communities, where diagnostic testing capacity is often limited, surveillance systems dependent on them will underestimate the true extent of an outbreak. Rapidly conducted seroprevalence studies can play an important role in addressing this.

Working toward infrastructural citizenship: state-society relations and community waste labor in Cape Town

ABSTRACT As a conceptual device, infrastructural citizenship looks to bridge performed and legal interpretations of citizenship, recognizing infrastructure as a space where citizenship is practiced and upon which political identities are based. While emerging discussions surrounding infrastructural citizenship have largely focused on issues of access, this article proposes engaging with infrastructural labor as a way of extending and developing how infrastructural citizenship is understood and leveraged. I begin by bringing infrastructural citizenship into conversation with ongoing geographic discussions surrounding infrastructural labor, and grounding analysis within the particularities of waste geographies and South African community waste schemes. Attending to the labored dimensions of infrastructural citizenship within a state-led community-waste initiative in Cape Town, I outline how community facilitators perceived their labor contributions, and expectations of the state. On this basis, I propose that infrastructural labor merits further consideration within infrastructural citizenship’s emergent framework.

Control or coexist with urban baboons: Exploring residents' views and values in Cape Town

AbstractHumans and wildlife increasingly share urban space, which elevates the risk of negative interactions. Management efforts conventionally focus on controlling species that are considered problematic, but polarization in affected communities' perceptions and values may pose a greater problem for management in cities where ideas about preferred human–wildlife interactions vary greatly. This study uses Q‐method to investigate what type of human‐baboon relations are desirable among residents from seven areas in Cape Town regularly visited by chacma baboons. Two main perspectives emerged, each is motivated by a distinct set of values: 'Live with Baboons' is focused on positive outcomes for nature and society, recognizing humans' responsibility to mitigate negative interactions; whereas 'Control and Manage Baboons' views nature as something that should be controlled in order to maintain a stable and safe human society. Despite differences, the two perspectives also agree in rejecting abusive language toward baboons, recognizing that contexts differ and require different solutions, and acknowledging that resolving conflict requires collaboration. This has important bearing for recent public engagement processes led by local authorities to review management strategies. Residents' values and perceptions are manifestations of different lived realities and actively engaging with them can help to nuance dichotomies in the baboon discourse.

Exploring urban community gardens as ‘third places’: fostering social interaction in distressed neighbourhoods of Cape Town, South Africa

ABSTRACT The process of urbanisation and the associated urban lifestyle have been linked to social isolation and negative mental health impacts. As urbanisation and mobility continue to surge in African cities, urban planners face the challenge of creating inclusive spaces that encourage social interaction among urbanites. This research utilises the conceptual lens of ‘Third places’ to assess the role of urban community gardens in cultivating spaces that mitigate the negative effects of urbanisation within distressed communities in Cape Town, South Africa. A qualitative approach, involving open-ended questions and semi-structured interviews, along with observations, was employed to achieve the research aims. Findings revealed that individuals perceive community gardens as a channel for breaking free from isolation and fostering informal interactions among neighbourhood residents. However, the effectiveness of these gardens is hindered by several factors, such as their location and land tenure insecurity, which impede their ability to bring about meaningful changes within their communities. This research urges scholars to critically reconsider established criteria for third places, advocating for a nuanced understanding that acknowledges the diverse dynamics of community gardening in global South cities, thereby enriching theoretical discourse and informing practical interventions for fostering inclusive and sustainable urban communities.

Including the Household: Individual, Community and Household Factors Affecting Antiretroviral Therapy Adherence After ART Initiation in Cape Town, South Africa

Antiretroviral therapy (ART) adherence is crucial for health outcomes of people living with HIV (PLHIV), influenced by a complex interplay of individual, community, and household factors. This article focuses on the influence of household factors, as well as individual and community factors, on ART adherence among PLHIV in Cape Town who have recently initiated ART. Baseline data for a cluster-randomized controlled trial were collected from 316 PLHIV in 12 districts in Cape Town between 6th May 2021 and 22nd May 2022. Zero-inflated Poisson models, with cluster-adjusted standard errors, were used to analyse the association between individual, household, and community factors and ART adherence measures. At the household-level, household support was associated with both better self-rated adherence (exp(β) = 0.81, z = − 4.68, p < 0.001) and fewer days when pills were missed (exp(β) = 0.65, z = − 2.92, p = 0.003). Psychological violence (exp(β) = 1.37, z = 1.97, p = 0.05) and higher household asset scores (exp(β) = 1.29, z = − 2.83, p = 0.05) were weakly associated with poorer ART adherence. At the individual-level, male gender (exp(β) = 1.37, z = 3.95, p < 0.001) and reinitiating ART (exp(β) = 1.35, z = 3.64, p < 0.001) were associated with worse self-rated ART adherence; higher education levels (exp(β) = 0.30 times, z = − 3.75, p < 0.001) and better HIV knowledge (exp(β) = 0.28, z = − 2.83, p = 0.005) were associated with fewer days where pills were missed. At the community-level, community stigma was associated with worse self-rated ART adherence (exp(β) = 1.24, z = 3.01, p = 0.003). When designing interventions to improve ART adherence, household, individual and community factors should all be considered, particularly in addressing gender-based disparities, reducing stigma, tackling violence, and enhancing household support.Clinical Trial Number: Pan African Clinical Trial Registry, PACTR201906476052236. Registered on 24 June 2019.

Investigating the altered expression of miR-486-5p and miR-novel-chr1_40444 in dysglycemia in a South African population.

This study aims to investigate miR-486-5p and miR-novel-chr1_40444 expressions in dysglycemic individuals. Validating RNA-sequencing findings in a larger sample via reverse transcription qPCR (RT-qPCR), we aim to address global diagnostic and screening limitations, using an African cohort as an example. This cross-sectional study involved 1,271 individuals [normoglycemic (n = 974), prediabetic (n = 206), screen-detected type 2 diabetes (n = 91)] from the ongoing Vascular and Metabolic Health (VMH) study in Cape Town, South Africa. Whole blood miRNA expression was assessed using TaqMan-based RT-qPCR, with data normalized to an endogenous control (miR-16-5p). Significant underexpression was observed in prediabetes vs normoglycemia for miR-486-5p (P = 0.038), whilst both miRNAs demonstrated significant upregulation in screen-detected type 2 diabetes vs normoglycemia (miR-486-5p, P = 0.009; miR-novel-chr1_40444, P < 0.001), and screen-detected type 2 diabetes in comparison with prediabetes (miR-486-5p, P < 0.001; miR-novel-chr1_40444, P < 0.001). Multivariable regression analyses revealed pronounced interrelations between miR-novel-chr1_40444 and screen-detected type 2 diabetes in unadjusted and adjusted models (Model 1: P < 0.001, Model 2: P < 0.001, Model 3: P = 0.030). Moreover, receiver operating characteristic (ROC) curves revealed significantly enhanced diagnostic capabilities for screen-detected type 2 diabetes vs either normoglycemia (AUC = 0.971, P < 0.001), non-diabetes (AUC = 0.959, P < 0.001), or prediabetes (AUC = 0.902, P < 0.001) when combining the miRNAs with 2 h postprandial glucose. This study demonstrated the enhanced power of incorporating miRNAs with traditional markers in distinguishing screen-detected type 2 diabetes, warranting further investigations on their unique role in the development of type 2 diabetes.

The provision of goods and governance in local communities during an emergency: Findings from an urban space in southern Africa

The provision of political goods and governance in marginalised local communities, located in Cape Town, South Africa, during the national lockdown periods (due to the COVID-19 pandemic) is described. The focus is on an African city, drawing attention to the growing importance of urban governance on the continent. Rapid urbanisation and emergency periods (such as the pandemic) are adding to the complexity of the urban space. This study found that communities in the city relied mostly on themselves for the provision of goods, and that the provision of security remains a critical political good, informing governance. However, the findings confront literature on a hierarchy of political goods, in which security is at the apex. In the given context, the sequence of the provision of goods changes to a non-hierarchical process. The fulfilment of other political goods will facilitate improved provision of security. Good governance needs to be informed by an integrated approach to, and the synchronous fulfilment of, political goods.

Unidirectional dispersal of blow fly larvae following decomposition fluids from a pig carcass

The decomposition of a body, and the associated gaseous and liquid discharges emanating from it, attract gravid female blow flies which lay their eggs in or on the body. After the eggs have hatched, the emerging larvae start feeding on the body. As decomposition progresses, the blow fly larvae often migrate away, typically in a random manner in search of favourable conditions for pupation. In this paper, we report on a rarely described phenomenon of unidirectional mass migration of blow fly larvae and postulate on the factors which may drive this process. A decomposition trial utilising a 60-kg pig carcass, deployed in the summer months in Table Mountain National Park, Cape Town, South Africa, was conducted in 2022. On the fifth day of the trial, simultaneous unidirectional mass dispersal of blow fly larvae was observed. The larvae moved downhill in a southeasterly direction, following the flow of decomposition fluids oozing out from the pig carcass. The ‘larval migration stream’ had a length of approximately 1.5 m with a width of 40 cm, tapering to 17 cm at the terminal point. The larval migration stream consisted of the larvae of Chrysomya albiceps and Chrysomya chloropyga. This study demonstrates the importance of understanding the timing and pattern of dispersal of post-feeding blow fly larvae in each geographical region. This is crucial as the minimum post-mortem interval can be miscalculated if older immature insects dispersing from the corpse are not considered and collected during crime scene investigations.

Healthcare workers' knowledge of indicators for a palliative care approach.

Palliative care is an essential element of universal healthcare, yet not all people who need palliative care are able to receive it. One of the barriers to ensuring access for people who require palliative care is the identification of those eligible. This study evaluated healthcare workers' ability to identify patients who are eligible for palliative care based on their training or experience in palliative care. The setting for the study comprised the Heideveld Emergency Centre and Heideveld Community Day Centre in the Cape Metro, Cape Town, South Africa. This study made use of a cross-sectional survey of healthcare workers. Of the 55 participants in this study, most were able to correctly identify patients with cancer and chronic kidney disease as needing palliative care, but less accurate with other organ failure categories, trauma indications, or functional assessment of the patient. Participants who reported previous awareness training reported improved knowledge on the indications for a palliative care approach compared to no prior training. Our cohort was too small to analyse the results statistically. From what was analysed, the ability of healthcare workers to identify a person in need of palliative care could be better; more work is needed on our awareness training and basic training courses to improve this vital step.Contribution:This research highlights the fact that existing training for palliative care needs to be more applicable to the setting and that training of staff with existing courses does make a difference in knowledge.

Challenges with measures used for assessing research impact in higher education institutions

Internationally, there has been a push for the prioritisation of research impact beyond its scholarly contribution. Traditionally, research impact assessments have focused on academic impact and quantitative measures, at the expense of researchers for whom research impact cannot be quantified. Bibliometric indicators and other quantitative measures are still the most widely used method for evaluating research impact because these measures are easy to use and provide a quick solution for evaluators. Conversely, metric indicators fail to capture important dimensions of high-quality research. Hence, in this study, we explored challenges with metric indicators. We adopted a case study of the University of Cape Town and used document analysis, a questionnaire survey to collect data from academics and researchers, as well as semi-structured interviews with a sample of academic and research staff. The findings highlight common challenges with quantitative measures, such as bias and discipline coverage, and the ability of measures to drive researchers’ behaviour in another direction. We propose the adoption of responsible research metrics and assessment in South African higher education institutions for more inclusive and equitable research impact assessments.

NUS so fast: the social and ecological implications of a rapidly developing indigenous food economy in the Cape Town area

The modern global food system is highly unsustainable, shaped by industrialisation and corporate consolidation, with negative repercussions on the environment and biodiversity as well as human health. This paper looks at the burgeoning economy in neglected and underutilised species (NUS) in the Western Cape, South Africa, as a potential innovation that could make the local food system more socially and ecologically resilient. Although, at present, NUS are only marginally included in the local food system and policy discussions, NUS increasingly appear in the high-end food industry, driven by international gastronomic trends. These species hold potential as climate resilient, nutritionally dense, and socially and culturally significant foods in the region, but they also carry ecological and social risks. We critically examine the fledgling NUS economy in the Cape Town area to unpack the motivations and challenges associated with the potentially transformative inclusion of these foods into the local food system. We demonstrate that the main risks associated with NUS are negative ecological repercussions, privatisation of the NUS economy, and the reproduction and further entrenchment of unequal power and race dynamics in the region. To mitigate these risks and actualise the related benefits associated with NUS, engagement with the ecological, social, and political context of NUS needs to be significantly deepened. This is particularly true for those working in the high-end food industry, who appear to be driving the NUS economy, and will require education around sustainability and Traditional Ecological Knowledge (TEK), as well as a foregrounding awareness of power dynamics.

Expanding the footprint of a CapeTown-based non-profit to the Wild Coast

Learning outcomes The case study’s primary learning objectives are to develop a number of professional competencies, such as personal ethics and citizenship, decision-making acumen and business acumen. Students deal with a novel situation, underpinned by four Sustainable Development Goals (reduced poverty, quality education, decent work and economic growth, and reduced inequalities) and are required to consider a broad range of historical and cultural nuances in a resource-constrained environment, to address the dilemma at hand. Case overview/synopsis This case study tracks the efforts of a non-profit company called Just Grace, which was established in 2012 in Cape Town. Just Grace’s mission is to uplift the Langa community, an underprivileged urban suburb in Cape Town, via educational, career development and social programmes. Just Grace’s programmes have achieved success in Langa. The dilemma now facing Just Grace is whether their existing model is transferable to a rural community in the Eastern Cape in South Africa. Complexity academic level The case study is aimed at both local and international postgraduate students studying an honours or master’s degree in a business-related field such as accounting or an MBA. Subject code CSS 1: Accounting and finance. Supplementary materials Teaching notes are available for educators only.

Common Arterial Trunk Repair at the Red Cross War Memorial Hospital, Cape Town: A 20-Year Review of Surgical Practice and Outcomes.

This study describes the 20-year experience of managing common arterial trunk (CAT) in a low-and-middle-income country and compares the early and medium-term outcomes following the transition from conduit to nonconduit repair at the Red Cross War Memorial Children's Hospital. Single-center retrospective study of consecutive patients aged less than 18 years who underwent repair of CAT from January 1999 to December 2018 at the Red Cross War Memorial Children's Hospital. Patients with interrupted aortic arch or previous pulmonary artery banding were excluded. Fifty-four patients had CAT repair during the study period. Thirty-four (63.0%) patients had a conduit repair, and 20 (37.0%) patients had a nonconduit repair. There were two intraoperative deaths. Thirty-day in-hospital mortality was 22.2% (12/54). Overall, in-hospital mortality was 29.6% (16/54). Eight (21.1%) late mortalities were observed. The actuarial survival for the conduit group was 77.5%, 53.4%, and 44.5% at 6, 12, and 27 months, respectively, and the nonconduit group was 58.6% at six months. The overall freedom from reoperation between the conduit group and nonconduit group was 66.2% versus 86.5%, 66.2% versus 76.9%, and 29.8% versus 64.1% at 1, 2, and 8 years, respectively. The outcomes following the transition to nonconduit repair for CAT in a low- and middle-income setting appear to be encouraging. There was no difference in mortality between conduit and nonconduit repairs, and importantly the results suggest a trend toward lower reintervention rates.

Criticality assessment and cascading effects: impacts of COVID-19 disruptions in public transport on marginalized groups in Dortmund, Germany, São Paulo, Brazil, and Cape Town, South Africa

The COVID-19 pandemic has underscored the interconnectedness of critical infrastructure systems and their profound impact on marginalized communities. This study investigates the cascading effects of reduced mobility and infrastructure disruptions caused by COVID-19 response strategies on marginalized households across three diverse urban settings: Dortmund, São Paulo, and Cape Town. Employing a criticality assessment, we examine disruptions in healthcare, food and nutrition, social work, education, and childcare sectors, highlighting interdependencies and their implications for marginalized communities. Our findings reveal that disruptions in one sector, such as public transportation, can trigger adverse consequences across interconnected systems, amplifying vulnerabilities and exacerbating social inequalities. Furthermore, limited digital accessibility compounds these challenges, particularly for marginalized groups who may lack access to necessary technologies or digital literacy skills. Addressing these disparities in digital access is crucial for ensuring equitable access to essential services and support networks, especially in times of crisis. The study underscores the importance of mobility and accessibility in addressing systemic vulnerabilities and advocates for comprehensive resilience strategies that prioritize the needs of marginalized communities. Recommendations for policymakers, urban planners, and community stakeholders are provided to enhance infrastructure resilience and mitigate the indirect effects of disruptions on marginalized groups. The study contributes to a deeper understanding of cascading effects within critical infrastructure networks and informs future research and policy initiatives aimed at building resilient communities in an interconnected world.

Corrigendum: Gardasil® as adjunctive therapy for respiratory papillomatosis at Red Cross Children’s Hospital, Cape Town

Corrigendum: Gardasil® as adjunctive therapy for respiratory papillomatosis at Red Cross Children’s Hospital, Cape Town

A prospective randomised controlled trial investigating household SARS-CoV-2 transmission in a densely populated community in Cape Town, South Africa – the transmission of COVID-19 in crowded environments (TRACE) study

BackgroundSouth Africa’s first SARS-CoV-2 case was identified 5th March 2020 and national lockdown followed March 26th. Households are an important location for secondary SARS-CoV-2 infection. Physical distancing and sanitation – infection mitigation recommended by the World Health Organization (WHO) at the time – are difficult to implement in limited-resource settings because of overcrowded living conditions.MethodsThis study (ClinicalTrials.gov NCT05119348) was conducted from August 2020 to September 2021 in two densely populated, low socioeconomic Cape Town community sub-districts. New COVID-19 index cases (ICs) identified at public clinics were randomised to an infection mitigation intervention (STOPCOV) delivered by lay community health workers (CHWs) or standard of care group. STOPCOV mitigation measures included one initial household assessment conducted by a CHW in which face masks, sanitiser, bleach and written information on managing and preventing spread were provided. This was followed by regular telephonic follow-up from CHWs. SARS-CoV-2 PCR and IgM/IgG serology was performed at baseline, weeks 1, 2, 3 and 4 of follow-up.ResultsThe study randomised 81 ICs with 245 HHCs. At baseline, no HHCs in the control and 7 (5%) in the intervention group had prevalent SARS-CoV-2. The secondary infection rate (SIR) based on SARS-CoV-2 PCR testing was 1.9% (n = 2) in control and 2.9% (n = 4) in intervention HHCs (p = 0.598). At baseline, SARS-CoV-2 antibodies were present in 15% (16/108) of control and 38% (52/137) of intervention participants. At study end incidence was 8.3% (9/108) and 8.03% (11/137) in the intervention and control groups respectively. Antibodies were present in 23% (25/108) of control HHCs over the course of the study vs. 46% (63/137) in the intervention arm. CHWs made twelve clinic and 47 food parcel referrals for individuals in intervention households in need.DiscussionParticipants had significant exposure to SARS-CoV-2 infections prior to the study. In this setting, household transmission mitigation was ineffective. However, CHWs may have facilitated other important healthcare and social referrals.