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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 honours young researchers
2006-02-10

Some of the guests attending the recognition function were from the left:  Prof Magda Fourie (Vice-Rector:  Academic Planning at the UFS), Mr Joseph Smiles (lecturer at the UFS Department of Political Science and Thuthuka grant holder), Prof Frans Swanepoel (Director:  Research Development at the UFS) and Dr Carlien Pohl (lecturer at the UFS Department of Microbial,  Biochemical and Food Biotechnology and Thuthuka grant holder).
Photo: Leonie Bolleurs

The guest speaker was Prof Jonathan Jansen, Dean:  Faculty of Education at the University of Pretoria (UP).  He gave tips to young and promising researchers on how to be an outstanding scholar. 
What is a Scholar 

UFS honours young researchers       

The University of the Free State (UFS) last night honoured 24 young researchers who are taking part in the National Research Fund’s (NRF) Thuthuka programme.

The recognition function is the first of its kind at the UFS.  “The renewed focus on research development that was recently announced at the official opening of the UFS by the Rector and Vice-Chancellor, Prof Frederick Fourie, is an indication of the institution’s endeavour to create an environment in which research can be improved and flourish.  This can only be obtained when researchers are being valued and that is why it is important to honour our young researchers,” said Mrs Annelize Venter, researcher at the UFS Research Development Directorate and coordinator of the programme.
 
The focus on research was also touched on recently by President Thabo Mbeki during the opening of Parliament when he said:  “We will continue to engage the leadership of our tertiary institutions focused on working with them to meet the nation’s expectations with regard to teaching and research. For its part, the government is determined to increase the resource allocation for research and development and innovation, and increase the pool of young researchers."

According to Mrs Venter, research done in 2004 shows that the majority researchers who publish are white males above the age of 50.  “Many students who undertake magister studies choose not to conduct research, but rather to do a thesis and additional subjects.  This means that research is not stimulated.  Students also find it difficult to obtain financial support for postgraduate studies,” she explained.
“Thutuka is a capacity building programme of the NRF that is aimed to 
fund and support the qualifications of women and young black scientists and other researchers who do not have a rating for postgraduate research.  It is based on a funding partnership between the UFS and the NRF,” said Mrs Venter.

Last night Prof Frans Swanepoel, Director: Research Development at the UFS, added to his by saying:  “With the Thuthuka programme we aim to create and sustain a research culture at the UFS, promote international research and train researchers of a high quality and enhance the research capacity at the UFS by focusing on women, black researchers and other promising researchers.”
 
The programme was started by the NRF in 2001.  At that stage only 17 grants were made countrywide.  Last year 370 postgraduate students took part in the programme.

According to Mrs Venter the programme was implemented at the UFS in 2003.  “At that stage we only had 5 grant holders.  This year there are 24 Ph D and magister students on the programme,” she said. 

A couple of young promising researchers, who will be participating in the programme in 2007, also attended last night’s recognition function.

The guest speaker was Prof Jonathan Jansen, Dean:  Faculty of Education at the University of Pretoria (UP).  He gave tips to young and promising researchers on how to be an outstanding scholar.

Nine professors were also congratulated with their promotion to senior research professor, namely Proff Louise Cilliers (Department of English and Classical Languages), James du Preez (Department of Microbial,  Biochemical and Food Biotechnology), Johan Grobbelaar (Department of Plant Sciences), Dingie Janse van Rensburg (Centre for Health Systems Research and Development), Dap Louw (Department of Psychology), Philip Nel (Department of Afro-asiatic Studies and Language Practice and Sign Language), Louis Scott (Department of Plant Sciences), Dirk van den Berg (Department of History of Art) and  Andries Raath (Department of Constitutional Law and Philosophy of Law).

Media release
Issued by: Lacea Loader
Media Representative
Tel:   (051) 401-2584
Cell:  083 645 2454
E-mail:  loaderl.stg@mail.uovs.ac.za
10 February 2006

 

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