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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

Is milk really so well-known, asks UFS’s Prof. Osthoff
2011-03-17

Prof. Garry Osthoff
Photo: Stephen Collett

Prof. Garry Osthoff opened a whole new world of milk to the audience in his inaugural lecture, Milk: the well-known (?) food, in our Department of Microbial, Biochemical and Food Biotechnology of the Faculty of Natural and Agricultural Sciences.

Prof. Osthoff has done his research in protein chemistry, immuno-chemistry and enzymology at the Council for Scientific and Industrial Research (CSIR) in Pretoria and post-doctoral research at the Bowman-Grey School of Medicine, North Carolina, USA. That was instrumental in establishing food chemistry at the university.
 
He is involved in chemical aspects of food, with a focus on dairy science and technology. He is also involved in the research of cheese processing as well as milk evolution and concentrated on milk evolution in his lecture. Knowledge of milk from dairy animals alone does not provide all the explanations of milk as food.
 
Some aspects he highlighted in his lecture were that milk is the first food to be utilised by young mammals and that it is custom-designed for each species. “However, mankind is an opportunist and has found ways of easy access to food by the practice of agriculture, where plants as well as animals were employed or rather exploited,” he said.
 
The cow is the best-known milk producer, but environmental conditions forced man to select other animals. In spite of breeding selection, cattle seem not to have adapted to the most extreme conditions such as high altitudes with sub-freezing temperatures, deserts and marshes.
 
Prof. Osthoff said the consumption of the milk as an adult is not natural; neither is the consumption of milk across species. This practice of mankind may often have consequences, when signs of malnutrition or diseases are noticed. Two common problems are an allergy to milk and lactose intolerance.
 
Allergies are normally the result of an immune response of the consumer to the foreign proteins found in the milk. In some cases it might help to switch from one milk source to another, such as switching from cow’s milk to goat’s milk.
 
Prof. Osthoff said lactose intolerance – the inability of adult humans to digest lactose, the milk sugar – is natural, as adults lose that ability to digest lactose. The symptoms of the condition are stomach cramps and diarrhoea. This problem is mainly found in the warmer climates of the world. This could be an indication of early passive development of dairy technology. In these regions milk could not be stored in its fresh form, but in a fermented form, in which case the lactose was pre-digested by micro-organisms, and the human population never adapted to digesting lactose in adulthood.
 
According to Prof. Osthoff, it is basically the lactose in milk that has spurred dairy technology. Its fermentation has resulted in the development of yoghurts and all the cheeses that we know. In turn, the intolerance to lactose has spurred a further technological solution: lactose-free milk is currently produced by pre-digestion of lactose with enzymes.
 
It was realised that the milks and products from different species differed in quality aspects such as keeping properties and taste. It was also realised that the nutritional properties differed as well as their effects on health. One example is the mentioned allergy against cow’s milk proteins, which may be solved by the consumption of goat’s milk. The nutritional benefits and technological processing of milk aroused an interest in more information, and it was realised that the information gained from human milk and that of the few domesticated species do not provide a complete explanation of the properties of milk as food. Of the 250 species of milk which have been studied, only the milk of humans and a few domesticated dairy animals has been studied in detail.

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

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