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11 July 2022 | Story Andre Damons | Photo Supplied
Prof Stephan Brown
Prof Stephan Brown is a Principal Specialist and Head of the Division of Paediatric Cardiology in the Department of Paediatrics and Child Health in the Faculty of Health Sciences at the University of the Free State (UFS).

Paediatric heart specialists at the Universitas Academic Hospital and the University of the Free State (UFS) hope their research into the deadly Cyanotic Heart Disease amongst newborns will assist health authorities in central South Africa to restructure healthcare services and do better health-planning to save more lives.

Prof Stephen Brown, Principal Specialist and Head of the Division of Paediatric Cardiology in the Department of Paediatrics and Child Health in the Faculty of Health Sciences at the UFS, says children from poor and rural areas in central South Africa are dying of Cyanotic Heart Disease. One of the main contributors to these deaths is the distance patients have to travel to regional hospitals. 

The research was done under the auspices of the Robert W M Frater Cardiovascular Research Centre in the department of cardiothoracic surgery in the UFS School of Medicine. The results are still in the preliminary stage as the final data is still being analysed. The Robert W M Frater Cardiovascular Research Centre (the Frater Centre) was established in 2015 under the leadership of Prof. Francis E Smit. This was made possible through donor funding, especially by Dr Robert W M Frater MD PhD (honoris causa, UFS), a South Africa-born New York-based cardiothoracic surgeon, researcher and innovator as infrastructure and project support by the UFS.

The vision of the Frater Centre is to be a leading cardiovascular research institution in South Africa and sub-Saharan Africa. It provides an interdisciplinary training and research platform for scientists and clinicians from different backgrounds to develop as researchers and collaborators in cardiovascular and thoracic surgery and related domains. Activities are focused on the development of African solutions for African problems.

According to Prof Brown, who is also a paediatric cardiologist at the Universitas Hospital, children with this disease present with a blueish colour because the oxygenated and desaturated blood mixes, leading to the blue discoloration. Prof Brown and his master’s degree researcher (Marius van Jaarsveld) focused on single ventricle physiologies; children who effectively have a single pumping chamber which means one of the chambers is underdeveloped or not developed at all. A normal person has two pumping chambers.  

“With this study we looked over 20 years of cases. Over this period we saw 154 children. It is a retrospective study because we are fortunate to have a very extensive database dating back to 1987. One thing of concern is that we should have seen a lot more children if you look at the worldwide statistics,” says Prof Brown.

Treatment 

According to him, 40 of these children never received any form of therapy for the simple reason that a lot of them presented too late while others had severe birth asphyxia when they got to the hospital. 

Treatment for Cyanotic Heart Disease usually involves up to three operations before the children become pink again. “The first operation is called palliation to ensure we control the lung blood. That is usually in the first to two to six weeks after birth. The second operation is done between six months to a year of age when we do to what we call a bidirectional Glen – second-stage palliation. Also to improve general condition and take some of the volume off the heart. The last operation, called the Fontan operation, happens between six to seven years of age and that’s when they become pink,” explains Prof Brown.

Prof Brown says the results from the study compare favorably with the rest of South Africa and Africa but do not compare that well to high-income countries because they have more resources available. 

They have seen children from Northern Cape, North West, some parts of the Eastern Cape and Lesotho. According to Prof Brown, once they looked closer, they discovered that the closer the patients are to the hospital, the sooner they present to hospital. The further away they are, the longer it takes them to present at a hospital with congenital cardiac facilities. 

“In Mangaung we saw the kids when they were around about four days old. At Thabo Mofutsanyana district in Qwaqwa we saw them three to four days after birth. So they presented early. Lejweleputswa and Xhariep districts we saw the patients after they were one month old. In densely populated areas it is picked up early, as they are closer to the referral hospitals. The further, away from a hospital, the longer it takes to get to us. In Lesotho it takes up to six months [for them to get to us] and the Northern Cape up to two months of age,” explains Prof Brown.

This is most likely an indication that distance from the hospitals plays a major role in deaths. 

How will the study help? 

Though a part of the study is for epidemiological information, Prof Brown hopes that the health authorities will take stock of the findings. “These studies are important to make health authorities aware of the challenges and to assist in health planning. What can we do better for the people? We are doing clinical research. This is important because we are a mid- to low-income country with limited resources and it is important for the population we are dealing with.”
“Our prime aim is if one knows what is going on in your population you can restructure your health care accordingly. That is our ultimate aim. Get it published and talk to the authorities. Now we can scientifically prove instead of relying on perception.”

The solution

Prof Brown says this disease can potentially be prevented by doing foetal heart sonar scans. If there is a huge screening project, a large number of deaths can potentially be prevented. Maternal screening is very important. Early referrals are also a step in the right direction. “Our parents, caregivers, and nurses need to be educated. Another solution is to do a simple saturation screening monitor prior to discharge after birth. I have been advocating for this for years and hopefully, before I retire, it will become routine procedure. Obviously there will be a lot of false positives, but we can help our people by earlier recognition of cyanosis.”

• Prof Brown, who is passionate about the health of children, says a life-saving collaboration initiative between the UFS, the Mother and Child Academic Hospital (MACAH) Foundation, and the Discovery Fund started five years ago to help curb the death of young patients due to congenital heart disease, and to make services more accessible to rural communities. With this outreach initiative, Prof Brown travels to rural areas in the Free State to diagnose heart defects in babies early. 

News Archive

UFS to honour past and present Cabinet ministers
2010-04-19

The University of the Free State (UFS) is going to confer honorary doctoral degrees on former Minister of Arts, Culture, Science and Technology, Dr Ben Ngubane, and the current Minister of Finance, Mr Pravin Gordhan, during the university’s autumn graduation ceremony next month.

They will receive their honorary doctorates on 18 and 19 May respectively.

“It is an honour for the UFS to confer these honorary doctorates on people like these who have made, and continue to make outstanding contributions towards the wellbeing of this beautiful country. Being associated with people of this stature signifies the direction that the UFS is taking in our quest to be a great university, one of the best in the world,” said Prof. Jonathan Jansen, the Rector and Vice-Chancellor of the UFS.

Dr Ngubane will be honoured for his immense contribution towards positioning South Africa as a major and an influential player in the development of arts, culture, science and technology internationally.

He was the first Minister of Arts, Culture, Science and Technology in the new, democratic South Africa appointed by the former President, Nelson Mandela, in 1994. He was re-appointed to lead this ministry again by former President Thabo Mbeki in 1999.

As Premier of KwaZulu-Natal from 1996 to 1999, Dr Ngubane is credited for his role in bringing about peace and reducing the political violence that ravaged the province at that time.

In 2004 he was appointed as Ambassador to Japan where he initiated, among other projects, the South Africa-Japan University Forum (SAJU).
He has been honoured for outstanding contributions to higher education and community development and holds Honorary Doctorates from the universities of Natal, Zululand, the Medical University of South Africa (Medunsa) and the Tshwane University of Technology.

He is currently the Chairperson of the SABC Board.

Minister Gordhan, on the other hand, formed an integral part of the constitutional transition of South Africa between 1991 and 1994. He chaired the Convention for a Democratic South Africa (CODESA) Management Committee – the midwife and negotiating forum for a free South Africa. He was also co-chair of the Transitional Executive Council, which was a governance structure tasked with ensuring South Africa’s transition process prior to the historic 1994 elections.

In 1994, with the dawn of a new democracy in South Africa, Mr Gordhan became a Member of Parliament and was elected as Chairperson of the Parliamentary Constitutional Committee, which oversaw the implementation of the new constitutional order. At the same time he played a leading role in drafting the present constitution of the democratic South Africa. He also led the process of formulating a new policy framework for local government transformation.

Mr Gordhan was appointed as Deputy Commissioner at the South African Revenue Service (SARS) in March 1998 after being deployed from Parliament as part of the government’s drive to transform the public service. The following year he was appointed as Commissioner for SARS with the important task, amongst others, to transform South Africa’s Customs and Revenue administration – a strategic governmental institution.

He has represented South Africa in many international undertakings, including several peacekeeping missions, as Chairperson of the Customs Workshop for the Second Global Forum on Fighting Corruption and Safe-Guarding Integrity (2001), and is often called upon to make presentations at tax seminars and customs conferences.

In 2000 he was appointed Chairperson of the Council of World Customs Organisation (WCO), based in Brussels, a position to which he was re-elected twice, thus serving from 2000 to 2006.

Media Release
Issued by: Mangaliso Radebe
Assistant Director: Media Liaison
Tel: 051 401 2828
Cell: 078 460 3320
E-mail: radebemt@ufs.ac.za  
19 April 2010
 

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