It’€™s estimated that about 180 000 children under the age of five get admitted to hospital because of pneumonia every year. HIV has had a tremendous effect on the burden of pneumonia in South Africa and it’€™s responsible for the lion’€™s share of the deaths of children under five.    

‘€œTo give you a sense of the magnitude of the problem, in a place like Soweto, less than 5% of all children that are born would be HIV-infected. But that 5% of children make up roughly about 40% – 45% of all the cases of pneumonia that are hospitalised at Baragwanath Hospital. The risk of an HIV-infected child developing pneumonia is about nine times greater than that of an HIV-uninfected child. In South Africa, almost 80% of all of the children that die of pneumonia until very recently, and I’€™m talking until about 2009, were HIV-infected children’€, says Professor Shabir Madhi, Director of the National Institutes of Communicable Diseases (NICD).  

Professor Madhi adds that what compounds the problem is that in HIV-infected children, there are more pathogens at play in addition to HIV infection itself that cause pneumonia.  

‘€œWe find multiple pathogens concurrently causing the pneumonia and what that results in is a child presenting in a much more ill state as well as the chances of that child actually dying, is much greater. In addition to which, the child obviously needs to be treated very differently compared to the HIV-uninfected child’€, he says.                

As a result, it’€™s important to know precisely what agents cause pneumonia in HIV-infected children. Furthermore, no research has been conducted since the 1980s to identify what causes pneumonia in the general child population.

‘€œMuch of our knowledge of what causes pneumonia in children in the year 2011 is actually premised on studies which were performed in the 1980s. And, obviously, much has changed since the 1980s. The important changes since the 1980s in particular, are, firstly, in 1980 we didn’€™t have anything like HIV. In addition to which, most of the antibiotics which we use today empirically to treat pneumonia were actually based and premised on what were the dominant bacterial causes of pneumonia in the 1980s’€.

‘€œAnd those two important bacteria, which still cause much of the suffering from pneumonia in children, were from the Pneumococcus and Haemophillus Influenza. Now what’€™s happened recently is that both of those bacteria against which we usually target our antibiotics when a child develops pneumonia’€¦ what we are able to do nowadays is actually prevent infections from those two bacteria through vaccination’€.

 ‘€œSo, now because of vaccination making it less likely that children will develop pneumonia from those two bacteria, together with the fact that there has been a change in terms of the profile of children that develop pneumonia, which is particularly related to HIV, we are needing to re-define or re-analyse our understanding of what are the causes of pneumonia in young children under five years of age’€, Madhi explains.                          

To fill this gap of knowledge, the National Institutes of Communicable Diseases (NICD) in South Africa has collaborated with six other countries – Bangladesh, The Gambia, Thailand, Kenya, Mali and Zambia – to investigate the causes of child-hood pneumonia. The study will involve over 12 000 children. In South Africa, it’€™s expected that child mortality due to pneumonia will decrease as a result of protective vaccination and a successful prevention of mother-to-child HIV transmission (PMTCT) programme. Prior to these, about 48 children would die daily in South Africa. It’€™s projected that the number will decrease to half.  

“Even 24 children dying each day from pneumonia is still way too much. The only way in which we can actually target and try to prevent death of all those children is, firstly, making sure that children have access to health care and when they access health care, they get the appropriate antibiotics. In addition to which, what we’€™re wanting to do is to actually try to get a better understanding of what are the most important causes of pneumonia now after all of these interventions so we can better plan as to which vaccines we need to now develop to prevent children in the future generations from developing pneumonia’€. Madhi says.

About 1 200 South African children between the ages of one month to 59 months who get admitted to Chris Hani Baragwanath Hospital, in Soweto, will participate in the Pneumonia Etiology Research for Child Health (PERCH) study over two years. About 24 pathogens will be under scrutiny. The study will also enroll an equivalent number of children who don’€™t have pneumonia to check for the existence of these pathogens. This group of children is called the control group. They will help identify the exact pathogens that cause pneumonia. If the same agents in both pneumonia-infected and uninfected children are found, researchers will deem those germs not very significant in causing pneumonia. Only pathogens found in children who have pneumonia will be taken into account.