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Cyanotic Heart Disease research can help restructure health care, do better planning

11 July 2022 | Story Andre Damons | Photo Supplied

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

Honorary doctorate to Archbishop Emeritus Desmond Tutu attracts wide attention

2011-01-27

Archbishop Emeritus Desmond Tutu after receiving his honorary doctorate in Theology at the UFS.
- Photo: Hannes Pieterse

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The University of the Free State (UFS) awarded an honorary doctorate to Archbishop Emeritus Desmond Tutu on Thursday, 27 January 2011. The graduation ceremony, which was attended by guests from across the country marks a milestone in the history of the university.

Amongst the guests were the ambassador of the USA to South Africa, Mr Donald Gips; the British High Commissioner to South Africa, Dr Nicola Brewer; members of the local government; Ms Barbara Hogan, former Minister of Public Works and the daughters of Bram Fischer, Ruth Fischer-Rice and Ilse Fischer-Wilson. Friends of Dr Tutu, Dr Ahmed Kathrada, Ms Barbara Hogan and Dr Allan and Ms Elna Boesak also attended the occasion.

The UFS also received a message of congratulations from the Deputy President of South Africa, Mr Kgalema Motlanthe. “The choice to honour this exemplar of virtue to which most of the world still look for direction as it buckles under social, political and economic difficulties is laudable in all respects,” he said.

Prof. Jonathan Jansen, Vice-Chancellor and Rector of the UFS, said: “We honour a great son of South Africa who made a tremendous contribution to peace, reconciliation and justice in South Africa and in the world.

“There were times when few of us thought apartheid would end in our lifetime, yet you stood as a rock reassuring us, not about a black future, but about our common future. For this reason, Arch, we would not miss this opportunity to honour you for any reason whatsoever.

“You, Sir, are a Jew among Muslims, a Christian among Hindus, a Catholic among Anglicans, a bridge-builder among all of us. That is why we love you; because you look deeper and see further than all of us.”

According to Prof. Francois Tolmie, Dean of the UFS’s Faculty of Theology, the university honours Dr Tutu for his contribution as theologian – through his teaching and the books he wrote – as well as for the role he played in bringing about reconciliation in South Africa as well as in the rest of the world. The university also honours Dr Tutu as a moral and spiritual leader who never sacrificed his integrity as a Christian.

Apart from being a church leader and a leading world figure, Dr Tutu is the author of several books and also held a number of teaching posts at various tertiary institutions.

In 1984, he received the Nobel Peace Prize for his role as a unifying leader figure in the campaign to abolish apartheid in South Africa. A further highlight in his career was his election as Archbishop of Cape Town in 1986. He was the first black African to serve in this position, which placed him at the head of the Anglican Church in South Africa.

Many South Africans also remember the role he played when President Nelson Mandela appointed him in December 1995 to chair the Truth and Reconciliation Commission, which was established to investigate human rights violations during the apartheid era. The Archbishop guided the nation in the process of choosing forgiveness over revenge and in so doing set a historic international precedent.

In 1996, he retired as Archbishop of Cape Town but continues to speak out in favour of human rights, equality and social justice in South Africa and throughout the world.

In August 2009, President Barack Obama presented him with the Medal of Freedom, the United States of America’s highest civilian honour. Dr Desmond Tutu is recognised around the world as a moral leader committed to the human rights of all people.

Today he is chairman of The Elders, a group of world leaders who, in view of their integrity and leadership, are equipped to deal with some of the world’s most pressing problems.

Prof. Tolmie says: “It is often asked how Dr Tutu could have achieved all this in the span of one lifetime. Some people would refer to his warm personality or his humanness, his deep sense of humility or his wonderful sense of humour. Probing a little deeper, however, one is struck by Dr Tutu’s deep relationship with God. He is known as a man of faith, a man of prayer. He lives his life coram Deo, in the presence of God.”

Dr Tutu also lead the introduction ceremony of the UFS’s International Institute for Studies in Race, Reconciliation and Social Justice.

Media Release
27 January 2011
Issued by: Lacea Loader
Director: Strategic Communication (actg)
Tel: 051 401 2584
Cell: 083 645 2454
E-mail: news@ufs.ac.za

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