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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

Student leaders 2012/13 announced

2012-08-30

Ready for the task - Sabelo Khumalo, SRC President of the Qwaqwa Campus and William Clayton, SRC President of the Bloemfontein Campus.
Photo: Johan Roux
31 August 2012

The 2012/13 elections for the Student Representative Councils (SRC) of the University of the Free State were completed successfully and show meaningful support for the changes in student governance adopted by students across campuses over the past two years.

The SRC elections at the Qwaqwa Campus were completed on 23 August 2012, while the elections at our Bloemfontein Campus took place on 27 and 28 August 2012.

The SRC Elections at our Bloemfontein Campus showed a voter turnout of 4516 votes (30.8%), with the elections at the Qwaqwa Campuses showing 1753 votes (46%) – both campuses reached the required quorums and the IEA (Bloemfontein Campus) and IEC (Qwaqwa Campus) declared the elections free and fair and announced the results as a true reflection of the will of the student bodies at the campuses.

The full SRC at Bloemfontein Campus now consists of 62% black and 38% white, and 53% female and 47% male members.

In the Qwaqwa elections, SADESMO achieved 46, 38% of the vote, with SASCO, PASMA and NASMO each achieving 30,23% and 8,39% and 14,26%, respectively.

The successful elections at Bloemfontein Campus show that the detailed transformation of student governance introduced by students at the Campus in 2010 and adopted by the university in 2011, succeeded in mobilizing greater participation of students in governance and representation. These changes in the main included a shift to independent candidacy for elective portfolios (12 seats) and organizational candidacy in nine sub-councils that holds ex officio seats on the SRC. Changes also included the establishment of student representative seats in faculty governance and management forums and the adoption of a reviewed Central SRC Constitution. Ex officio seats hold full and equal constitutional authority in the SRC.

Students at Qwaqwa Campus introduced additional portfolios to its SRC, including ex-officio seats for academic affairs, arts and culture, commuter students, Rag Community Service, religious affairs, residences and sports.

A joint sitting of the Campus SRCs will establish the Central SRC 2012/13 on 9 September 2012.

As a further opportunity for participation in and the development of student governance and representation, the current Central SRC herewith also announces its recent adoption of a student governance advisory programme, namely the UFS Student Elders Council (SEC).

The SEC is established as a combined programme between the Central SRC and the Dean of Student Affairs and will consist of selected senior student leaders from all campuses who completed their terms of office, apply and are appointed to the Elders Council by the Central SRC.

The Council will serve as an advisory structure to the Central SRC and other student structures in support of the continuous development of student governance and representation of the student body at the university.

The SEC will advise the Central SRC to be constituted following the constitution of the respective Campus SRCs.

The SRC members at the Bloemfontein Campus are:

President: Mr William Clayton

Vice-President: Mr Bonolo Thebe

Secretary: Ms Karis-Robin Topkin

Treasurer: Mr Pieter Coetzee

Arts & Culture: Ms Chanmari Erasmus

Accessibility & Student Support: Ms Gene McCaskill

First-generation Students: Ms Tanya Calitz

Legal and Constitutional Affairs: Ms Nokuthula Sithole

Media, Marketing & Liaison: Ms Neo Chere

Sport: Mr Tshepo Moloi

Student Development & Environmental Affairs: Ms Thabisile Mgadi

Transformation: Ms Koketso Mofokeng

Dialogue & Ex officio: Associations Council: Mr Anesu Ruswa

Academic Affairs & Ex officio: Academic Affairs Council: Ms Nombuso Ndlovu

Residence Affairs & Ex officio: Residences Council: Mr Johann Steyn

City Residence Affairs & Ex officio: Commuter Council: Mr Michael van Niekerk

Postgraduate Affairs & Ex officio: Postgraduate Council: Mr Fadeyi Akinsuyi

International Affairs & Ex officio: International Council: Ms Tumelo Moreri

Student Media Affairs & Ex officio: Media Council: Mr Jamal-Dean Grootboom

RAG Community Service & Ex officio: RAG Fundraising Council: Mr Jaco Faul

RAG Community Service & Ex officio: RAG Community Service Council: Ms Keneue Mahloana

The SRC members at the Qwaqwa Campus are:

President General: Mr S Khumalo

Deputy President: Mr P T Lenka

Secretary General: Mr D Khethang

Treasurer General: Mr S I Sithole

Media & Publicity: Mr S N Ntombela

Politics & Transformation: Tbc

Student Development & Evironmental Affairs: Tbc Academic Affairs: Mr T Molawude

Arts & Cultural Affairs: Mr T Nkohli

Off-Campus Students: Mr B Mtshali

RAG, Community Service & Dialogue: Ms S F Mlotya

Religious Affairs: Ms D C Khau

Residence & Catering Affairs: Ms Z Mzolo

Sports Council: Mr S Mngomezulu

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