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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

During 2011: Sport

2011-12-01

Our sports stars set their gaols high and with hard work, dedication a good measure of determination they show that they will not give up until these goals are met. A place in the national team or a medal or award in hand is enough proof that our Kovsie sportsmen and women are serious about their successes on the sports field.

Description: 2011 Sport_Cricket Tags: 2011 Sport_Cricket

Description: 2011 Sport_Karate Tags: 2011 Sport_Karate

Description: 2011 Sport_Hockey Tags: 2011 Sport_Hockey

Description: 2011 Sport_Netball Tags: 2011 Sport_Netball

Description: 2011 Sport_Rugby Tags: 2011 Sport_Rugby

Some of our stars this year were:

Athletics:

Thuso Mpuang, our Kovsie Sportsman of the year, represented South Africa during the World Athletic Championships in Deague, Korea. He obtained the silver medal in the 200m during the World Student Games in Shenzhen, China and a gold medal as a member of the 4 x 100m relay team.

Janette Siebert represented South Africa during the Southern Africa Championships in Maputo, Mozambique.

Boy Soke represented South Africa during the Africa Cross Country Championships in Cape Town. He also represented South Africa during the World Cross Country Championships in China.

Cricket:

The 21-year-old former Kovsie, Obus Pienaar, who was still playing cricket for our university club until the end of the season (end of March), has been playing abroad for the Irish cricket club Waringstown from the end of April 2011.
We are proud of Obus’ achievements, in particular his contribution to the match against the CIYMS. During this game, Obus hit the highest score ever in the Northern Cricket Unions when he scored 244 runs in only 114 balls. This included 22 sixes and 13 fours. During his innings in this match, Obus also broke the July 2004 record of his compatriot, AB de Villiers of the Proteas.

Hockey:

Lesley Ann George represented the Protea Women’s Hockey Team during the series against China, Belgium and Azerbaijan. She was also a member of the Protea Women’s Hockey Team during the Champs Challenge in Ireland. The team finished fifth.

Nicole de Vries represented the Protea Women’s Hockey Team during the series against China, Belgium and Azerbaijan. She was also a member of the Protea Women’s Hockey Team during the Africa Cup in Bulawayo. The team obtained a gold medal.

Hettie Oosthuizen represented the Protea Women’s Hockey Team during the series against China, Belgium and Azerbaijan.

Izelle Lategan represented the Protea Women’s Hockey Team during the series against China, Belgium and Azerbaijan.

Nicole Kemp was a member of the Protea Women’s Hockey Team during the Africa Cup in Bulawayo. The team obtained a gold medal.

Karate:

Elsabe le Roux was a member of the Protea JKA Shotokan Karate Team that participated in the Africa Zone 6 Championships in Maputo where she obtained a gold and silver medal.

Bruno Schwalbach was a member of the Protea JKA Shotokan Karate Team that participated in the Africa Zone 6 Championships in Maputo where he obtained two gold medals. He was also a member of the Protea JKA Shotokan Karate Team that participated in the Common Wealth Karate Championship in Australia where he obtained one silver and two bronze medals. He was a member of the Protea JKA Shotokan Karate Team that participated in the All Africa Games in Maputo Mozambique where he obtained a bronze medal.

Balungile Nchofe was a member of the Protea JKA Shotokan Karate Team that participated in the Africa Zone 6 Championship in Maputo, where he obtained a gold medal.

Netball:

Kovsies’ netball team has performed well over the past year with, amongst others, the inclusion of players in the SA Universities World-cup Group.

Karla Mostert and Maryka Holtzhausen participated during the World Cup in Singapore in the SPAR SA Protea team.

We are also proud of the eight players who have been included in the SA team. They are Zimari Smit, Sheri Duimpies, Ane Botha, Danique du Toit, Nieke Loubser, Karla Mostert, Fikile Mkhuzangwe and Lauren-lee Christians.

At the SA tournament, Ane Botha was named as the centre-court player of the tournament, whilst Karla Mostert was named as the best defending player. Karla has also been included in the SPAR SA Protea team to the All African Games, which start in Mozambique at the end of August.

Rugby:

Boom Prinsloo and Robert Ebershohn are representing the Springboks in the HSBC Sevens World Series.

Soccer:

Gabisile Hlumbane, our Kovsie Sportswomanof the year, is a member of the Banyana Banyana National Soccer Team. The team obtained a bronze medal at the African Women’s Championships during October 2010, a gold medal at the Unity Cup Hosted during December 2010, a silver medal at the COSAFA Women’s Championship hosted during July 2011 and qualified for the London Olympics in 2012.

Squash:

Paul Rodrigues represented the South African U/ 23 team at the All Africa Squash Championships in Johannesburg.

Triathlon:

Nelmaré Loubser represented the SA Elite Team during the World Championships in Spain.

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