Childhood TB remains a major health problem in South Africa while nearly half a million children under the age of 15 years live with HIV in South Africa.
into TB and HIV among children was a central focus for four PhD full-time
clinicians who recently graduated from the Department of Paediatrics and Child
Health at Stellenbosch University.
remarkable about these PhD candidates is that they are full-time clinicians,
taking care of children on a daily basis and successfully combining their
research with active service delivery,” said Professor Mariana Kruger,
executive head of Paediatrics and Child Health at Stellenbosch University.
Solomons, a paediatric neurologist at Tygerberg Children’s Hospital in Cape
Town, investigated ways of improving the early and more accurate diagnosis of
TB meningitis in children.
Read: How South Africa is combatting TB
about raising awareness about TB meningitis, he said the disease was a major
cause of death and disability in young children, yet it was completely
treatable if detected early.
The most important findings of
his study were that a research case definition based on clinical, laboratory
and radiological findings provided excellent diagnostic accuracy for detecting
TB meningitis. Cerebrospinal fluid glucose and protein detected TB meningitis
with good sensitivity.
The research revealed that newer diagnostic tests
were insufficient to rule out TB, but found that when they were positive,
unnecessary treatment delay and potential life-threatening consequences were
Solomons, who successfully defended his PhD in Amsterdam after doing a joint
PhD degree at Stellenbosch University and Vrije University of Amsterdam. It was the first joint PhD awarded by the two universities.
PhD thesis, Dr Steffi Thee from Charite Universitätsmedizin in Berlin, Germany,
investigated the safety of first- and second-line anti-tuberculosis drugs in
children. Her research through the Desmond Tutu TB Centre at Stellenbosch
University, identified critical gaps in the current knowledge in the management
of children with both drug-susceptible and drug-resistant TB.
Read: The fight against HIV is far from over for SA
her research provided essential evidence on both the dosing and safety of TB
medicines, informing international treatment guidelines for childhood TB.
However she said more studies in larger number of children with different
genetic backgrounds, HIV co-infection, nutritional status, and with higher drug
doses, novel treatment regimens and child-friendly formulations, were needed.
Mandalakas, from the Baylor College of Medicine in Texas, looked into the
impact of Preventative Therapy (PT) as a TB control strategy to reduce the
burden of childhood TB in communities. She looked at questions such as which
factors accurately predict which children are at highest risk of TB.
Mandalakas carried out her research at the Desmond Tutu TB Centre.
Health Organisation routinely recommends PT medication in children younger than
five years old as well as HIV-infected children who are in close contact with
someone with infectious TB.
thesis, Dr Ute Feucht, paediatrician and Adjunct Professor in the Department of
Paediatrics and Child Health at the University of Pretoria, focused on
improving the care of HIV-infected and –affected children during the
implementation phase of the large-scale antiretroviral therapy (ART) programme
in South Africa. She conducted her research at Kalafong Hospital in Tshwane.
Read: World first: child-friendly tuberculosis treatment will be available from 2016
interviewed caregivers and used clinical data to determine the gaps in the
system and why children were at risk of HIV-infection.
there had been improvements in HIV-diagnosis in mothers as well as infants, she
said there were some worrying gaps, such as early infant diagnosis and testing
at primary healthcare facilities, as well as ensuring prevention by educating
mothers prior to conception.
access to care is critical for HIV-infected children,” said Dr Feucht. She said
interviews with caregivers had revealed that children had good access to
routine healthcare, but that mothers weren’t getting adequate psychosocial
said South Africa was in need of a ‘clear strategy’ regarding paediatric case
finding in order to identify HIV-infected children outside of the Prevention of
mother-to-child Transmission (PMTCT) testing.
In 2012, an estimated 410,000 children aged 0 to 14
were living with HIV in South Africa, according to HIV and AIDS information
website, AVERT. From 2002 to 2012, HIV prevalence declined among children,
while the scaling up of antiretroviral treatment has reduced child mortality by
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