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Doctor helps African kids breathe easy

Professor Heather Zar is the head of paediatrics and child health at the Red Cross War Memorial Children's Hospital and the University of Cape Town. As a clinician scientist, her research addresses the leading causes of childhood illness and death: tuberculosis (TB), pneumonia, HIV-associated respiratory illness­ and asthma. The output from this research has influenced child health globally, improving diagnostic, preventative and management strategies.

Zar has contributed to a body of work on childhood pneumonia that looks at causes, therapy and preventative strategies. This focus area is critical because pneumonia is a major cause of death in children under five years of age, especially in Africa. Her studies on the causes and prevention of pneumonia in HIV-infected African infants have contributed­ to shifting global practice and have helped to change World Health Organisation and South African guidelines.

Zar's team also pioneered the procedure of sputum induction for TB diagnosis in children.

"Conventional practice was that TB was difficult to confirm in children," says Zar. Sputum induction has now become the standard procedure for microbiological diagnosis in many areas of the world.

Zar's research into TB shows that the use of molecular diagnostic methods – allowing for the DNA and resistance patterns of TB to be identified – enables rapid diagnosis of TB using induced sputum, with results available within one day.

Health intervention
She has also addressed ways to prevent tuberculosis. A study showed that the prophylactic isoniazid in HIV-infected children substantially reduces TB and also reduces mortality in those children not taking anti-retrovirals. Zar says this has the potential to be an important public health intervention.

She has done extensive research into asthma and was the South African principal investigator in the global study of asthma in childhood as part of the African network.

"There was a misconception that asthma is rare in African children. The study showed that it's common, with prevalence rates that are often higher than global rates," says Zar. Asthma is now recognised as one of the most common chronic diseases in African children.

Also in the realm of asthma research is Zar's development of a low-cost alternative to asthma spacers­ that use a modified common 500ml plastic drinks bottle. This has empowered caregivers, enabling optimal asthma therapy to be given to children even in the poorest of circumstances.

Zar recently set up a birth cohort study (the Drakenstein child lung-health study), the first on the African continent, which is funded by the Gates Foundation. It will investigate the determinants of pneumonia and of child health with focus areas that include nutrition, infectious diseases, environmental exposure, psychosocial factors, maternal health, as well as genetic and immunological factors.

Interventions
"The study will hopefully provide valuable information to identify new interventions for improving child health," she says.  

Zar has led the development of a clinical translational research programme focused on child health. "Translational research is the bridge between clinical and basic science research, and the implementation of findings into practice and public health including policy and guidelines," Zar says.

She has led an initiative to develop an expanded paediatric clinical research unit at Red Cross Hospital, with satellite sites in community ­settings. This will enable the growth of clinical research and build capacity.

"Despite children being a third of the population, child health is ­relatively underfunded and under­resourced," says Zar.

"Yet child health has been worsening over the past 20 years in South Africa." More funding and capacity development are needed to strengthen child-health programmes, she says.

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