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Paediatric Pulmonology

Unit profile | Clinical activities | Teaching and training | Advocay | Division Highlights | Research 

Staff


Consultants Dr Marco Zampoli m.zampoli@uct.ac.za
  Dr Aneesa Vanker aneesa.vanker@uct.ac.za
  Dr Diane Gray diane.gray@uct.ac.za
     

Tracheostomy and Home ventilation
programme

Sr. Jane Booth jbooth@pgwc.gov.za
     
Admin staff Mrs. I Hector
(Pulmonology clinic)
Tel: (021) 658 5265
  Ms V Flynn (CF clinic) Tel: (021) 658 5137
     
Trainees A fellowship in paediatric pulmonology is offered. Fellows from both South Africa and other African countries are trained on a rotational basis
Respiratory Technologist Mrs Ane Visagie  


Unit Profile


The paediatric pulmonology unit is a multidisciplinary team that includes paediatric pulmonology specialists, paediatricians, medical officers, paediatric pulmonology trainees, nurse practitioners, a research pharmacist, data capturer and data manager. There is a strong working relationship with other disciplines such as paediatric radiology, paediatric allergology, ENT, neurology, intensive care unit, allied health professions, cardiothoracic surgery and nuclear medicine departments.

Clinical activities


  1. Inpatient care and consultation: A senior-registrar and consultant team is available for consultations throughout the working week. Please direct consultation requests to the duty senior registrar by paging or by telephone:
    Red Cross Hospital Switchboard: (021) 658 5111- Mrs. L Hector: (021) 658 5265.

  2. Outpatient clinics include a weekly specialised respiratory clinic, a cystic fibrosis clinic, asthma clinic and a 6 monthly neuro-respiratory clinic.

  3. After hours consultation: The on-call consultant may be contacted through the Red Cross Children’s Hospital telephone exchange.
  4. Chest radiology meetings: A multidisciplinary meeting with paediatric radiology, general paediatrics and cardiothoracic surgery is held weekly.

  5. Breatheasy Programme - tracheostomy and ventilation Home care program and inpatient unit :  a multidisciplinary unit whose activities include training caregivers in comprehensive home-based care of children with tracheotomies and/or long-term ventilation. More info on The Breatheasy programme: childrenshospitaltrust.org.za

  6. Sleep studies: Assessment of airway obstruction and sleep disorders through is overnight oximetry or basic polysomnography.
     
  7. Pulmonary function tests: Basic pulmonary function tests are performed by a qualified respiratory technologist.
     
  8. Flexible Bronchoscopy is performed on regular basis.


Teaching and Training


The unit provides education and training to undergraduate and postgraduate students, including doctors specializing in paediatrics and paediatricians specialising in paediatric pulmonology. It is HPCSA accredited for training paediatricians in paediatric pulmonology in a 2 year training program with the College of Medicine (SA), Certificate in Paediatric Pulmonology exit examination. Recent successful trainees include Drs Alexia Kappos, Naisan Samadi and Gabaza Tiva.

There is also a programme to train paediatricians from other African countries as part of the African Paediatric Fellowship Programme. These trainees spend from 6 months to up to 2 years training in the paediatric pulmonology unit. African trainees in the past 5 years include: Francis Ogara (Kenya), Hellen Aanyu (Uganda), Lisa Obimbo (Kenya), Ada Ayuk (Nigeria) and Leah Githinji (Kenya), Ann Irungu (Kenya) and Wilson Osarogiagbon (Nigeria). A post graduate diploma in paediatric pulmonology is available through the University of Cape Town. The unit also provides supervision and mentorship to a number of post graduate students undertaking Masters or PhD projects. Members of the unit have a strong involvement in continuing medical education initiatives nationally and internationally and in national, African and international professional societies. Members are actively involved in the production and dissemination of national and international guidelines on different aspects of child lung health.

There is an active national training program for the caregivers of children with tracheostomies, to enable home care of children.

Advocacy


The unit has a long history of involvement in advocacy for child health. Current contributions include guideline development and implementation, serving on national and international advisory boards for child health and involvement in initiatives concerned with raising the profile of child lung health.

Division Highlights


Members of the division are involved in a wide range of paediatric pulmonology related activities. Professor Zar is the current President of the Pan African Thoracic Society and on the Forum of International Respiratory Societies.  She was the first paediatrician to receive the World Lung Health award in 2014.

Dr Zampoli is the current chair of the SA Cystic Fibrosis Medical and Scientific Advisory Committee and treasurer of  the South African Pediatric Society (SAPA). Dr Vanker serves as the paediatric pulmonology representative on the South African Thoracic Society and Dr Gray a previous recipient of a Wellcome Trust Fellowship has been integral in developing infant lung function testing in South Africa.

Research


The division has developed one of the strongest clinical research programs in South Africa focused on childhood respiratory illnesses particularly childhood pneumonia, tuberculosis, HIV-associated lung disease and asthma. Clinical research sites have been established at Red Cross Children's Hospital, New Somerset Hospital, Paarl hospital, primary care clinics in Khayelitsha and in the Drakenstein (Paarl) area. There is strong collaboration with basic science laboratories (especially the Institute for Infectious Diseases and Molecular Medicine (IIDMM) at UCT) and with public health researchers, enabling translational programs. Prof Zar is the only member of the Paediatric Department and one of 3 women at UCT to have received an A-rating from the National Research Foundation, indicating her standing as a leading international scholar.

Research has been supported by several international funding agencies (European Developing Country Clinical Trials Partnership (EDCTP), Wellcome Trust, Gates Foundation, Rockefeller foundation, National Institute of Health, USA) and national agencies (MRC, NRF, Discovery Foundation, South African Thoracic Society, Allergy Society of SA). The MRC Unit on Child and Adolescent Health undertakes translational research focused on priority childhood diseases including  Childhood TB, childhood pneumonia and lung disease in adolescent HIV-infected children: a 5 year NIH sponsored diagnostic study on improved immunological and microbiologic strategies for childhood TB, an EDCTP funded diagnostic study focused on improved diagnosis of childhood TB in primary care settings and a Gates Foundation funded birth cohort study, the Drakenstein Child Health Study to investigate the determinants of childhood pneumonia and of chronic lung disease.

Sub-studies of the Drakenstein child lung health study include early determinants of infant lung function and its relationship to respiratory disease early in childhood; psychosocial aspects focused on maternal and child health and neurodevelopment; and the role of indoor air pollution and environmental tobacco smoke on lung health.

Other current projects include studies of the aetiology and outcome of lower respiratory tract infections in children, a study of B pertussis in hospitalised children and an extended rotavirus surveillance study.  The division was also awarded an MRC Unit on Child and Adolescent Health. 

Current studies include:

  1. Drakenstein Child Health Study (DCHS)
  2. Cape Town Adolescent Antiretroviral Cohort (CTAAC) Study
  3. MRC TB-Child

Examples of publications in the past 2 years include:

  • Muloiwa R, Dube FS, Nicol MP, Zar HJ, Hussey GD. Incidence and Diagnosis of Pertussis in South African Children Hospitalized with Lower Respiratory Tract Infection. Pediatr Infect Dis J. 2016 Mar 10. [Epub ahead of print] PubMed PMID: 26967813.

  • Suk WA, Ahanchian H, Asante KA, Carpenter DO, Diaz-Barriga F, Ha EH, Huo X, King M, Ruchirawat M, da Silva ER, Sly L, Sly PD, Stein RT, van den Berg M, Zar H, Landrigan PJ. Environmental Pollution: An Under-recognized Threat to Children's Health, Especially in Low- and Middle-Income Countries. Environ Health Perspect. 2016 Mar 1;124(3):A41-5. doi: 10.1289/ehp.1510517. PubMed PMID:26930243; PubMed Central PMCID: PMC4786991.

  • Koen N, Brittain K, Donald KA, Barnett W, Koopowitz S, Maré K, Zar HJ, Stein DJ. Psychological trauma and posttraumatic stress disorder: risk factors and associations with birth outcomes in the Drakenstein Child Health Study. Eur J Psychotraumatol. 2016 Feb 12;7:28720. doi: 10.3402/ejpt.v7.28720. eCollection 2016. PubMed PMID: 26886489; PubMed Central PMCID: PMC4756622. 

  • Tran LT, Roos A, Fouche JP, Koen N, Woods RP, Zar HJ, Narr KL, Stein DJ, Donald KA. White Matter Microstructural Integrity and Neurobehavioral Outcome of HIV-Exposed Uninfected Neonates. Medicine (Baltimore). 2016 Jan;95(4):e2577. doi:10.1097/MD.0000000000002577. PubMed PMID: 26825902.

  • Zampoli M, Pillay K, Carrara H, Zar HJ, Morrow B. Microbiological yield from induced sputum compared to oropharyngeal swab in young children with cystic fibrosis. J Cyst Fibros. 2016 Jan 26. pii: S1569-1993(16)00008-4. doi: 10.1016/j.jcf.2016.01.001. [Epub ahead of print] PubMed PMID: 26825010.

  • Zar HJ, Billo N, Ferkol T, Vestbo J. Decade of the lung--a call for action to promote lung health globally. Lancet Respir Med. 2016 Jan;4(1):e3-4. doi: 10.1016/S2213-2600(15)00505-6. PubMed PMID: 26762667.

  • Donald KA, Ipser JC, Howells FM, Roos A, Fouche JP, Riley EP, Koen N, Woods RP, Biswal B, Zar HJ, Narr KL, Stein DJ. Interhemispheric Functional Brain Connectivity in Neonates with Prenatal Alcohol Exposure: Preliminary Findings. Alcohol Clin Exp Res. 2016 Jan;40(1):113-21. doi: 10.1111/acer.12930. PubMed PMID: 26727529.

  • le Roux DM, Myer L, Nicol MP, Zar HJ. Incidence of childhood pneumonia: facility-based surveillance estimate compared to measured incidence in a South African birth cohort study. BMJ Open. 2015 Dec 18;5(12):e009111. doi: 10.1136/bmjopen-2015-009111. PubMed PMID: 26685027; PubMed Central PMCID: PMC4691755.

  • Shi T, Balsells E, Wastnedge E, Singleton R, Rasmussen ZA, Zar HJ, Rath BA, Madhi SA, Campbell S, Vaccari LC, Bulkow LR, Thomas ED, Barnett W, Hoppe C, Campbell H, Nair H. Risk factors for respiratory syncytial virus associated with acute lower respiratory infection in children under five years: Systematic review and meta-analysis. J Glob Health. 2015 Dec;5(2):020416. doi: 10.7189/jogh.05.020416. PubMed PMID: 26682048; PubMed Central PMCID: PMC4676580.

  • Wilmshurst JM, Morrow B, du Preez A, Githanga D, Kennedy N, Zar HJ. The African Pediatric Fellowship Program: Training in Africa for Africans. Pediatrics. 2016 Jan;137(1). doi: 10.1542/peds.2015-2741. Epub 2015 Dec 9. PubMed PMID: 26659458.

  • Donald KA, Fouche JP, Roos A, Koen N, Howells FM, Riley EP, Woods RP, Zar HJ, Narr KL, Stein DJ. Alcohol exposure in utero is associated with decreased gray matter volume in neonates. Metab Brain Dis. 2016 Feb;31(1):81-91. doi: 10.1007/s11011-015-9771-0. Epub 2015 Nov 29. PubMed PMID: 26616173.

  • Zar HJ, Andronikou S. Chest X-rays for screening of paediatric PTB: child selection and standardised radiological criteria are key. Int J Tuberc Lung Dis. 2015 Dec;19(12):1411. doi: 10.5588/ijtld.15.0823. PubMed PMID: 26614177.

  • Zampoli M, Kappos A, Verwey C, Mamathuba R, Zar HJ. Impact of fibrinolytics on the outcome of empyema in South African children. S Afr Med J. 2015 Sep 21;105(7):549-53. doi: 10.7196/SAMJnew.7796. PubMed PMID: 26428749.

  • Zar HJ, White DA, Morrow B, Feldman C, Risenga S, Masekela R, Lewis H, Jeena P, Madhi SA. The bronchiolitis season is upon us--recommendations for the management and prevention of acute viral bronchiolitis. S Afr Med J. 2015 Sep 21;105(7):525-6. doi: 10.7196/SAMJnew.8040. PubMed PMID: 26428741.

  • Graham SM, Cuevas LE, Jean-Philippe P, Browning R, Casenghi M, Detjen AK, Gnanashanmugam D, Hesseling AC, Kampmann B, Mandalakas A, Marais BJ, Schito M, Spiegel HM, Starke JR, Worrell C, Zar HJ. Clinical Case Definitions for Classification of Intrathoracic Tuberculosis in Children: An Update. Clin Infect Dis. 2015 Oct 15;61Suppl 3:S179-87. doi: 10.1093/cid/civ581. PubMed PMID: 26409281; PubMed Central PMCID: PMC4583568.

  • Zar HJ, Workman LJ, Little F, Nicol MP. Diagnosis of Pulmonary Tuberculosis in Children: Assessment of the 2012 National Institutes of Health Expert Consensus Criteria. Clin Infect Dis. 2015 Oct 15;61Suppl 3:S173-8. doi: 10.1093/cid/civ622. PubMed PMID: 26409280; PubMed Central PMCID: PMC4583577.

  • Nicol MP, Gnanashanmugam D, Browning R, Click ES, Cuevas LE, Detjen A, Graham SM, Levin M, Makhene M, Nahid P, Perez-Velez CM, Reither K, Song R, Spiegel HM, Worrell C, Zar HJ, Walzl G. A Blueprint to Address Research Gaps in the Development of Biomarkers for Pediatric Tuberculosis. Clin Infect Dis. 2015 Oct 15;61Suppl 3:S164-72. doi: 10.1093/cid/civ613. PubMed PMID: 26409279; PubMed Central PMCID: PMC4583573.

  • Frigati L, Maskew M, Workman L, Munro J, Andronikou S, Nicol MP, Zar HJ. Clinical Predictors of Culture-confirmed Pulmonary Tuberculosis in Children in a High Tuberculosis and HIV Prevalence Area. Pediatr Infect Dis J. 2015 Sep;34(9):e206-10. doi: 10.1097/INF.0000000000000792. PubMed PMID: 26376315.

  • Dube FS, van Mens SP, Robberts L, Wolter N, Nicol P, Mafofo J, Africa S, Zar HJ, Nicol MP. Comparison of a Real-Time Multiplex PCR and Sequetyping Assay for Pneumococcal Serotyping. PLoS One. 2015 Sep 3;10(9):e0137349. doi: 10.1371/journal.pone.0137349. eCollection 2015. PubMed PMID: 26335454; PubMed Central PMCID: PMC4559314.

  • Zar H, Green RJ, Weinberg E, Harrison VC. Max Klein, 1941-2015. S Afr Med J. 2015 Apr;105(4):254-5. PubMed PMID: 26294883.

  • Zampoli M, Kappos A, Wolter N, von Gottberg A, Verwey C, Mamathuba R, Zar HJ. Etiology and Incidence of Pleural Empyema in South African Children. Pediatr Infect Dis J. 2015 Dec;34(12):130510.  doi: 10.1097/INF.0000000000000880. PubMed PMID: 26267310.

  • Brittain K, Myer L, Koen N, Koopowitz S, Donald KA, Barnett W, Zar HJ, Stein DJ. Risk Factors for Antenatal Depression and Associations with Infant Birth Outcomes: Results From a South African Birth Cohort Study. Paediatr Perinat Epidemiol. 2015 Nov;29(6):505-14. doi: 10.1111/ppe.12216. Epub 2015 Aug 3. PubMed PMID: 26236987.

  • Vanker A, Barnett W, Nduru PM, Gie RP, Sly PD, Zar HJ. Home environment and indoor air pollution exposure in an African birth cohort study. Sci Total Environ. 2015 Dec 1;536:362-7. doi: 10.1016/j.scitotenv.2015.06.136. Epub 2015 Jul 28. PubMed PMID: 26231768.

  • Bousquet J, Schunemann HJ, Fonseca J, Samolinski B, Bachert C, Canonica GW, Casale T, Cruz AA, Demoly P, Hellings P, Valiulis A, Wickman M, Zuberbier T, Bosnic-Anticevitch S, Bedbrook A, Bergmann KC, Caimmi D, Dahl R, Fokkens WJ, Grisle I, Lodrup Carlsen K, Mullol J, Muraro A, Palkonen S, Papadopoulos N, Passalacqua G, Ryan D, Valovirta E, Yorgancioglu A, Aberer W, Agache I, Adachi M, Akdis CA, Akdis M, Annesi-Maesano I, Ansotegui IJ, Anto JM, Arnavielhe S, Arshad H, Baiardini I, Baigenzhin AK, Barbara C, Bateman ED, Beghé B, Bel EH, Ben Kheder A, Bennoor KS, Benson M, Bewick M, Bieber T, Bindslev-Jensen C, Bjermer L, Blain H, Boner AL, Boulet LP, Bonini M, Bonini S, Bosse I, Bourret R, Bousquet PJ, Braido F, Briggs AH, Brightling CE, Brozek J, Buhl R, Burney PG, Bush A, Caballero-Fonseca F, Calderon MA, Camargos PA, Camuzat T, Carlsen KH, Carr W, Cepeda Sarabia AM, Chavannes NH, Chatzi L, Chen YZ, Chiron R, Chkhartishvili E, Chuchalin AG, Ciprandi G, Cirule I, Correia de Sousa J, Cox L, Crooks G, Costa DJ, Custovic A, Dahlen SE, Darsow U, De Carlo G, De Blay F, Dedeu T, Deleanu D, Denburg JA, Devillier P, Didier A, Dinh-Xuan AT, Dokic D, Douagui H, Dray G, Dubakiene R, Durham SR, Dykewicz MS, El-Gamal Y, Emuzyte R, Fink Wagner A, Fletcher M, Fiocchi A, Forastiere F, Gamkrelidze A, Gemicioğlu B, Gereda JE, González Diaz S, Gotua M, Grouse L, Guzmán MA, Haahtela T, Hellquist-Dahl B, Heinrich J, Horak F, Hourihane JO, Howarth P, Humbert M, Hyland ME, Ivancevich JC, Jares EJ, Johnston SL, Joos G, Jonquet O, Jung KS, Just J, Kaidashev I, Kalayci O, Kalyoncu AF, Keil T, Keith PK, Khaltaev N, Klimek L, Koffi N'Goran B, Kolek V, Koppelman GH, Kowalski ML, Kull I, Kuna P, Kvedariene V, Lambrecht B, Lau S, Larenas-Linnemann D, Laune D, Le LT, Lieberman P, Lipworth B, Li J, Louis R, Magard Y, Magnan A, Mahboub B, Majer I, Makela MJ, Manning P, De Manuel Keenoy E, Marshall GD, Masjedi MR, Maurer M, Mavale-Manuel S, Melén E, Melo-Gomes E, Meltzer EO, Merk H, Miculinic N, Mihaltan F, Milenkovic B, Mohammad Y, Molimard M, Momas I, Montilla-Santana A, Morais-Almeida M, Mösges R, Namazova-Baranova L, Naclerio R, Neou A, Neffen H, Nekam K, Niggemann B, Nyembue TD, O'Hehir RE, Ohta K, Okamoto Y, Okubo K, Ouedraogo S, Paggiaro P, Pali-Schöll I, Palmer S, Panzner P, Papi A, Park HS, Pavord I, Pawankar R, Pfaar O, Picard R, Pigearias B, Pin I, Plavec D, Pohl W, Popov TA, Portejoie F, Postma D, Potter P, Price D, Rabe KF, Raciborski F, Radier Pontal F, Repka-Ramirez S, Robalo-Cordeiro C, Rolland C, Rosado-Pinto J, Reitamo S, Rodenas F, Roman Rodriguez M, Romano A, Rosario N, Rosenwasser L, Rottem M, Sanchez-Borges M, Scadding GK, Serrano E, Schmid-Grendelmeier P, Sheikh A, Simons FE, Sisul JC, Skrindo I, Smit HA, Solé D, Sooronbaev T, Spranger O, Stelmach R, Strandberg T, Sunyer J, Thijs C, Todo-Bom A, Triggiani M, Valenta R, Valero AL, van Hage M, Vandenplas O, Vezzani G, Vichyanond P, Viegi G, Wagenmann M, Walker S, Wang DY, Wahn U, Williams DM, Wright J, Yawn BP, Yiallouros PK, Yusuf OM, Zar HJ, Zernotti ME, Zhang L, Zhong N, Zidarn M, Mercier J. MACVIA-ARIA Sentinel NetworK for allergic rhinitis (MASK-rhinitis): the new generation guideline implementation. Allergy. 2015 Nov;70(11):1372-92. doi: 10.1111/all.12686. Epub 2015 Sep 13.  

  • Gray D, Willemse L, Visagie A, Smith E, Czövek D, Sly PD, Hantos Z, Hall GL, Zar HJ. Lung function and exhaled nitric oxide in healthy unsedated African infants. Respirology. 2015 Oct;20(7):1108-14. doi: 10.1111/resp.12579. Epub 2015  Jul 1. PubMed PMID: 26134556; PubMed Central PMCID: PMC4623783.

  • Balme KH, Zar H, Swift DK, Mann MD. The efficacy of prophylactic antibiotics in the management of children with kerosene-associated pneumonitis: a double-blind randomised controlled trial. Clin Toxicol (Phila). 2015;53(8):789-96. doi: 10.3109/15563650.2015.1059943. Epub 2015 Jun 26. PubMed PMID: 26114347.

  • Basera W, Botha M, Gray CL, Lunjani N, Watkins AS, Venter C, Allen KJ, Hlela C, Zar HJ, Levin ME. The South African Food Sensitisation and Food Allergy population-based study of IgE-mediated food allergy: validity, safety, and acceptability. Ann Allergy Asthma Immunol. 2015 Aug;115(2):113-9. doi: 10.1016/j.anai.2015.06.003. Epub 2015 Jun 20. PubMed PMID: 26105048.

  • Madhi SA, Groome MJ, Zar HJ, Kapongo CN, Mulligan C, Nzenze S, Moore DP, Zell ER, Whitney CG, Verani JR. Effectiveness of pneumococcal conjugate vaccine against presumed bacterial pneumonia hospitalisation in HIV-uninfected South African children: a case-control study. Thorax. 2015 Dec;70(12):1149-55. doi: 10.1136/thoraxjnl-2014-206593. Epub 2015 Jun 19. PubMed PMID: 26092924.

  • Zar HJ, Polack FP. Childhood pneumonia: the role of viruses. Thorax. 2015 Sep;70(9):811-2. doi: 10.1136/thoraxjnl-2015-207320. Epub 2015 Jun 19. PubMed PMID: 26092921. 

  • Pitcher RD, Lombard CJ, Cotton MF, Beningfield SJ, Workman L, Zar HJ. Chest radiographic abnormalities in HIV-infected African children: a longitudinal study. Thorax. 2015 Sep;70(9):840-6. doi: 10.1136/thoraxjnl-2014-206105. Epub 2015 Jun 9. PubMed PMID: 26060256.

  • Donald KA, Roos A, Fouche JP, Koen N, Howells FM, Woods RP, Zar HJ, Narr KL, Stein DJ. A study of the effects of prenatal alcohol exposure on white matter microstructural integrity at birth. Acta Neuropsychiatr. 2015 Aug;27(4):197-205. doi: 10.1017/neu.2015.35. Epub 2015 May 29. PubMed PMID: 26022619.

  • Stein DJ, Koen N, Donald KA, Adnams CM, Koopowitz S, Lund C, Marais A, Myers B, Roos A, Sorsdahl K, Stern M, Tomlinson M, van der Westhuizen C, Vythilingum B, Myer L, Barnett W, Brittain K, Zar HJ. Investigating the psychosocial (IF 1.959) determinants of child health in Africa: The Drakenstein Child Health Study. J Neurosci Methods. 2015 Aug 30;252:27-35. doi: 10.1016/j.jneumeth.2015.03.016.

  • Zar HJ, Weinberg EG. Max Klein: a great man and a great paediatrician. Thorax. 2015 Apr;70(4):396-7. doi: 10.1136/thoraxjnl-2015-206947. PubMed PMID: 25766691.

  • Pitcher RD, Beningfield SJ, Zar HJ. The chest X-ray features of chronic respiratory disease in HIV-infected children--a review. Paediatr Respir Rev. 2015 Sep;16(4):258-66. doi: 10.1016/j.prrv.2015.01.005. Epub 2015 Jan 28. Review.  PubMed PMID: 25736908.

  • Gray D, Czövek D, Smith E, Willemse L, Alberts A, Gingl Z, Hall GL, Zar HJ, Sly PD, Hantos Z. Respiratory impedance in healthy unsedated South African infants: effects of maternal smoking. Respirology. 2015 Apr;20(3):467-73. doi: 10.1111/resp.12463. Epub 2015 Jan 11. PubMed PMID: 25581268; PubMed Central PMCID: PMC4670479.

  • Zar HJ, Barnett W, Myer L, Stein DJ, Nicol MP. Investigating the early-life determinants of illness in Africa: the Drakenstein Child Health Study. Thorax. 2015 Jun;70(6):592-4. doi: 10.1136/thoraxjnl-2014-206242. Epub 2014 Sep 16. PubMed PMID: 25228292.