Scientific innovation combats lung diseases in children

Innovation in crisis: The burden of respiratory diseases among children in Africa creates opportunities for innovation, said Prof Heather Zar.

The main cause of death and of morbidity in children globally is lung illness - predominantly childhood pneumonia, tuberculosis and asthma. African children bear the major brunt of this burden, which is largely preventable and treatable.

If the picture Professor Heather Zar (head of the Department of Paediatrics and Child Health, and director of the School of Child and Adolescent Health) painted of the current state of child lung health in Africa appeared gloomy at times, she was at pains to point out that medical scientists and clinicians have made impressive strides in turning the tide.

Yes, Africa's under-five mortality rate - a widely-used gauge for health status and socio-economic development - is on the rise. Yes, pneumonia is the leading cause of child deaths on the continent. (So shocking are the numbers that Zar drew a comparison to a packed jumbo jet crashing, every hour, 24 hours a day, every day.) Yes, sub-Saharan Africa - and, notably, the Western Cape - also bear the brunt of the world's tuberculosis burden, and of that "cursed duet", TB and HIV. And, yes, there is a growing prevalence of asthma among children aged 13 to 14 years in Cape Town and in Africa, making asthma the most common chronic illness in children.

But as Zar stressed in her inaugural lecture, Child Lung Health in Africa: Challenges and opportunities, delivered on 28 July, in the face of these challenges clinicians and scientists have developed many tools and treatments to prevent these illnesses, or treat them better.

Specialists and sub-specialists working in an academic centre can have a real impact on health care at all levels, far beyond that of a tertiary centre, said Zar. And some of these innovations have been rolled out across the globe.

For example, Zar and colleagues have developed better ways of identifying the causes of childhood pneumonia, so improving diagnosis, treatment and the use of preventative strategies. They have pioneered techniques for testing mucus from a child's chest and nose. These samples can then be tested for the causes of pneumonia, using new and better laboratory tests.

Zar and colleagues have also shown that sputum induction - a technique that involves nebulising children with hypertonic (high salt-containing) saline and then asking them to cough, or suctioning their mucus - is more effective for diagnosing tuberculosis than the commonly-used gastric lavage, which involves passing a tube into the stomach and suctioning the stomach contents. (For obvious reasons, it is also more comfortable, and there is no need to hospitalise the child.)

This research, published in the prestigious journal The Lancet, has changed global practice in diagnosing TB in children.

More recently, Zar and colleagues have shown that use of isoniazid or INH (a cheap and readily-available drug for TB) is very effective in preventing TB in HIV-infected children. Published in the British Medical Journal, this research showed that INH reduced mortality by more than 60% and TB by more than 70%. These are exciting findings, which may offer a potentially important public health intervention opportunity in areas of high HIV and TB prevalence, such as South Africa.

In addition, Zar has contributed to a number of national and international guidelines on child lung diseases. Such guidelines have the potential to influence clinical practices globally.

"We have a large number of vulnerable children in Africa," she noted. "But working in an academic centre, we have a real challenge and opportunity to advance-care for children by developing new strategies and treatments."

(Zar's full inaugural lecture is available as a podcast here)