Browsing by Author "Vanker, Aneesa"

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    Open Access
    Cystic fibrosis in black African children in South Africa: a case control study
    (2020) Kwarteng, Owusu Sandra; Zampoli, Marco; Vanker, Aneesa; Gray, Diane
    Background Cystic fibrosis (CF) is described more commonly in Caucasian populations in whom p.Phe508del is the most common mutation. There is a paucity of data of CF in black African children. The aim of this study was to describe and compare the presentation and outcomes of black African children with CF to those with p.Phe508del genotype. Methods A retrospective case-controlled study was conducted from January 2000 – March 2018 of children with CF attending two CF centres in South Africa. Presentation, genotype, nutrition and pulmonary function outcomes of black African children were compared to matched controls with the p.Phe508del mutation. Results Thirty-four black African children (cases) with median age of diagnosis (5.5 months, IQR 2.0- 15.0) were matched to 34 controls. Among cases, 3120+1G->A CFTR mutation was most commonly identified; homozygous n=22 (64.7%) and heterozygous=7(20.5%). Compared to controls, cases at diagnosis were more malnourished and fewer presented with neonatal bowel obstruction [cases n=2 (5.9%) vs. controls n=10 (29.4%); p = 0.03]. Nutrition and pulmonary function (FEV1 in children ≥ 6 years) outcomes and changes over time from ages 3-16 years were similar in both groups; median FEV1 z-score at age 6,10 and 14 years was -0.9 (±1.5), -1.8 (±2.0) and -1.8 (±1.9) respectively for all patients. Deaths were recorded in three cases (8.8%) and one control (2.9%) (p = 0.6). Conclusion Black African children with CF were more malnourished at diagnosis, and fewer presented with neonatal bowel obstruction. Cases and controls had comparable nutritional, pulmonary function and early mortality outcomes.
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    Exogenous Lipoid Pneumonia in Children: A Systematic Review and Case Series from South Africa
    (2018) Marangu, Diana Mwendwa; Zampoli, Marco; Gray, Diane; Vanker, Aneesa
    Background and objective: To describe the clinical-radiological-pathological characteristics and treatment outcomes of childhood exogenous lipoid pneumonia (ELP) and elucidate oil administration practices. Methods: A retrospective study of children with histologically-confirmed ELP at Red Cross Children’s Hospital, South Africa. Caregivers were interviewed to understand oil administration practices. Results: Twelve children of Zimbabwean heritage aged 2.1-10.8 months were identified between 2012 and 2017. Repeated oral administration of plant-based oil for cultural reasons was reported by 10/11 caregivers. Cough (12/12), tachypnea (11/12), hypoxia (9/12) and diffuse alveolar infiltrates on chest radiography (12/12) were common at presentation. Chest computed tomography revealed ground glass opacification with lower zone predominance (9/9) and interlobular septal thickening (8/9). All bronchoalveolar lavage specimens appeared cloudy/milky, with abundant lipid laden macrophages and extracellular lipid on Oil-Red-O staining and documented polymicrobial (6/12) and Mycobacterium abscessus (2/12) co-infection. Antibiotics, systemic corticosteroids and therapeutic partial lung lavage were interventions in all, 8 and 5 patients respectively. Median time to clinical resolution was 1.1 months IQR (0.5-8.0) with radiological resolution only in 2/12 cases. Conclusions: Paediatric ELP resembles pulmonary alveolar proteinosis. Health workers should explicitly probe for a history of oil administration in children with non-resolving pneumonia and consider the diagnosis of ELP in settings where this is a common practice.
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    Indoor air pollution and environmental tobacco smoke exposure in a South African birth cohort study
    (2018) Vanker, Aneesa; Zar, Heather J; Gie, Robert P
    middleincome countries (LMIC) and a major reason for health care visits and hospitalisation. Environmental exposures to indoor air pollution (IAP) or tobacco smoke are important risk factors for childhood respiratory disease. Despite increased electrification, many communities in LMIC rely on alternate fuel sources for household cooking or heating. The impact of antenatal or postnatal exposures on early childhood respiratory disease has not been comprehensively studied in LMIC especially in Africa. The aim of this work was to investigate the impact of IAP and environmental tobacco smoke (ETS) exposure on child health and early-life respiratory disease in the Drakenstein Child Health Study (DCHS), a South African birth cohort study. The DCHS investigates the epidemiology and impact of early-life exposures on child health including lung disease. The study is set in a peri-urban poor community in the Western Cape, South Africa. Pregnant women were enrolled from two public primary healthcare clinics, Mbekweni (serving a predominantly black African population) and Newman (predominantly mixed-ancestry population) and 1000 mother-infant pairs longitudinally followed from birth through 1 year of life. The thesis chapters are presented as published manuscripts that describe IAP and ETS exposure in the 2 communities in the DCHS cohort from the antenatal period and the impact of these exposure on child health and lung diseases, LRTI and wheezing illness in the first year of life. To measure exposures comprehensively, two home visits, one in the antenatal period (third trimester) and the second postnatally (between 4 and 6 months of the infant’s life), were conducted to assess the home environment and to measure the most common indoor air pollutants and by-products of combustion. Devices placed in participants’ homes measured exposure to particulate matter (PM10), carbon monoxide (CO), nitrogen dioxide (NO2), sulphur dioxide (SO2) and volatile organic compounds (VOC). Maternal and infant urine cotinine measures were used to validate self-reported tobacco smoking and exposure. Study staff trained in recognition of LRTI or wheeze documented all episodes, which were categorised according to WHO case definition criteria. Exposure to IAP was comprehensively assessed in over 800 homes antenatally and postnatally providing important South African data on IAP and potential sources of exposure. Tobacco smoke exposure was assessed longitdunially by maternal self-report using validated scales and by measurement of urine cotinine in mothers and infants. Tobacco smoke exposure was found to be highly prevalent with a smoking prevalence of >50% in mixedancestry mothers. Alarmingly, 18% of infants were born with urine cotinine levels in keeping with active smoking, while a further 30% had levels indicating passive smoke exposure. Key findings were despite 92% of homes reporting access to electricity, there was still a reliance on cheaper alternate fuels. Tobacco smoking prevalence amongst pregnant women was high (32%), as was household exposure to tobacco smoke (44%). ETS exposure was associated with low birth weight and antenatal IAP or ETS exposure was significantly associated with increased LRTI. ETS exposure was also associated with wheezing illnesses. A novel finding was that antenatal exposure to toluene, a volatile organic compound, was associated with severe LRTI and hospitalisation. The timing of environmental exposures on the subsequent development of LRTI in infancy has not been well described. An important finding was that antenatal exposures were the main risk factors associated with LRTI, with maternal smoking in pregnancy or PM10 exposure most strongly associated with LRTI. Wheezing illness was associated with both antenatal and postnatal maternal smoking and antenatal maternal smoke exposure and postnatal household member smoking. Both IAP and ETS exposure impacted on both maternal and infant nasopharyngeal bacterial carriage which may be a precursor to the development of LRTI. Environmental exposures therefore had a substantial impact on child health and on LRTI and wheezing illness. The effect on LRTI of antenatal compared with postnatal exposure suggests an in utero developmental lung effect. This study highlights antenatal and early life as a critical period for lung development. Urgent and effective smoking cessation programmes targeting women of child bearing age as well as public health interventions to reduce IAP are required. Woman of childbearing age, pregnant women and children in poor communities represent vulnerable populations at risk for long-term health effects of these exposures.
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    The Clinical Spectrum, Aetiology and Disease Progression of Children with Post-infectious Bronchiolitis Obliterans at Tertiary Paediatric Pulmonology Service in Cape Town, South Africa
    (2021) Yassin, Aamir; Vanker, Aneesa; Gray, Diane
    Introduction: There is limited literature on chronic obstructive airway disease in the paediatric age group. Post-infectious bronchiolitis obliterans (PIBO) is a cause of obstructive airway disease children, with limited data in African children. Aim: To describe the clinical spectrum, aetiology, and disease progression of children with post-infectious bronchiolitis obliterans. Methodology: This is a cross sectional descriptive study included all patients aged 6 months to 15 years with PIBO attending a tertiary paediatric pulmonology service in Cape Town, South Africa over period of one year (November 2019 to October 2020). Results: Fifty-one patients with PIBO were enrolled, 78% were males, median age 60 months (IQR 33-107). The median age at disease presentation was 6 months (IQR 3-12), 80% initially presented with cough. Ninety-four percent of patients required hospital admission, 76% were admitted to ICU, 92% required supplemental oxygen therapy and 75% required ventilatory support. Reported cigarette smoke exposure was high (47%). Adenovirus was the most common cause of initial infection 59%. Lung hyperinflation (84%) and air trapping (78%) were the most common current chest radiographic findings; bronchiectasis in 45% of patients. Spirometry showed mixed (41.4%) or obstructive (27%) patterns, mean (SD) FEV1 z-score - 3.3(±1.4), FVC z-scores -2.4(±1.6) and FEV1/FVC z-score -3.1(±2.4). Corticosteroids were used during initial presentation in 92% of patients. Seventy six percent of patients required two or more hospital admissions. Cough (43%) and wheeze (39%) were the commonest reported current symptoms. Lung function impairment was associated with younger age at first presentation and recurrent hospital admissions. Children with higher BMI at presentation had higher FEV1/FVC z-score in later life. Improvement of symptoms over time was reported among 82% of patients. Conclusion: PIBO is a relatively common cause of chronic lung disease in South African children, with adenovirus being the commonest preceding illness. Symptoms of airway obstruction persist over time, but showed improvement with treatment, which included corticosteroids.