Advancing pediatric lung health in Africa: COVID-19 and beyond

Respiratory illnesses in children are an important cause of morbidity and mortality in Africa where poverty, food insecurity, malnutrition, and human immunodeficiency virus infection are aggravating factors in many countries. These factors, in addition to under resourced health-care infrastructure, remain important barriers to improving child lung health outcomes in Africa. However, despite these challenges, there have been significant recent advancements in understanding the epidemiology, causes, measurement tools, and treatment of childhood respiratory illnesses. In this review, we highlight some advances in childhood pneumonia, tuberculosis, asthma, and other important non-communicable lung diseases common in children. Furthermore, we discuss the role of environmental influences on children's lung health in Africa and highlight novel methods of measuring lung function in children. Although children contribute a small role in the global epidemiology of COVID-19 pandemic, socioeconomic and health-care delivery disruptions caused by government responses to contain the pandemic have resulted in significant indirect setbacks to child health. We further highlight how the COVID-19 pandemic has impacted areas of pediatric lung health and discuss ways to mitigate effects of COVID-19 in Africa

Melhoras na função pulmonar de uma população com fibrose cística em um país em desenvolvimento / Improvements in lung function of a pediatric cystic fibrosis population in a developing country

OBJETIVO: Documentar a alteração em função pulmonar de uma população pediátrica com fibrose cística tratada no Red Cross War Memorial Children's Hospital, Cidade do Cabo, África do Sul, entre janeiro de 1999 e dezembro de 2006. MÉTODOS: Revisão retrospectiva dos prontuários médicos e melhores resultados de espirometria em intervalos de 3 meses. RESULTADOS: Um total de 1.139 testes de função pulmonar de 79 pacientes mostrou melhora significativa ao longo dos 8 anos estudados. Ao comparar o primeiro trimestre de 1999 com o último trimestre de 2006, 78 testes de função pulmonar foram realizados em 65 pacientes com números iguais de pacientes em ambos os grupos e semelhante em termos de gênero, idade, idade ao diagnóstico, etnia, genótipo da fibrose cística e número de pacientes colonizados com Staphylococcus aureus ou Pseudomonas aeruginosa.Em 2006, 15 pacientes (38,5 por cento) estavam em tratamento com azitromicina, comparados com um (2,6 por cento) paciente em 1999 (p = 0,0003). Volume expiratório forçado no primeiro segundo mediano (intervalo interquartil), capacidade vital forçada e fluxo expiratório médio entre 25 e 75 por cento da capacidade vital forçada aumentaram de 61 por cento (51-73), 63 por cento (52-89) e 40 por cento (27-57) previstos no primeiro trimestre de 1999 para 81 por cento (69-100, p = 0,004), 82 por cento (70-98, p = 0,007) e 62 por cento (41-87, p = 0,01) previstos durante o último trimestre de 2006, respectivamente. CONCLUSÕES: Testes de função pulmonar aumentaram em 20 por cento ao longo de 8 anos em grupos comparáveis de pacientes. Isso provavelmente reflete a melhora na prestação de cuidados a crianças sul-africanas com fibrose cística.

OBJECTIVE: To document the change in pulmonary function of a pediatric cystic fibrosis population managed at the Red Cross War Memorial Children's Hospital, Cape Town, South Africa, between January 1999 and December 2006. METHODS: Retrospective review of the medical records and best spirometry results within 3-monthly intervals. RESULTS: A total of 1,139 pulmonary function tests from 79 patients showed a significant improvement over the 8 years studied. When comparing the first quarter of 1999 with the last quarter of 2006, 78 pulmonary function tests were performed on 65 patients with equal patient numbers in both groups and similar in terms of gender, age, age at diagnosis, ethnicity, cystic fibrosis genotype and number of patients colonized with either Staphylococcus aureus or Pseudomonas aeruginosa. In 2006, 15 patients (38.5 percent) were on azithromycin treatment compared to one (2.6 percent) patient in 1999 (p = 0.0003). Median (interquartile range) forced expiratory volume in 1 second, forced vital capacity, and average expiratory flow between 25 and 75 percent of forced vital capacity increased from 61 percent (51-73), 63 percent (52-89), and 40 percent (27-57), predicted in the first quarter of 1999, to 81 percent (69-100, p = 0.004), 82 percent (70-98, p = 0.007), and 62 percent (41-87, p = 0.01), predicted during the last quarter of 2006, respectively. CONCLUSIONS: Pulmonary function tests increased by 20 percent over 8 years in comparable patient groups. This likely reflects improved care of South African children with cystic fibrosis.