Finding a link between diarrhoea and HIV infection in children

Growing up in Humansdorp in the Eastern Cape, Dr Mani Chiliwe, due to qualify as a paediatrician in 2020, vowed he would one day help his severely under-served community where child illnesses and premature mortality are ubiquitous.

“There were so few doctors where I came from. In fact, few professionals of any sort. Those that we saw were either teachers or, less often, doctors, but the few GPs I did see inspired me because they helped people so much,” Dr Chiliwe remembers.

He decided he also wanted to make such a difference. Matriculating from Lungiso High School in KwaNomzamo in Humansdorp, he enrolled to study medicine at Walter Sisulu University in Mthatha, qualifying in 2011.

After completing his internship and community service in the Port Elizabeth Hospital Complex, he settled in as a medical officer at Dora Nginza Hospital where he saw the full extent of child disease and death, much of it avoidable.

“I saw a lot of diarrhoea in HIV-positive kids, prolonged and complicated by dehydration and malnutrition. They tended to die more often than other children,” he says.

Taking action

By the time he’d begun his four years of registration towards paediatrics, he was convinced that this set of presenting symptoms, with patients often presenting tragically late, cried out for further investigation.

That is when he applied for a Discovery Foundation Rural Fellowship Award. His study, which will hopefully help him and his fellow physicians tailor more appropriate treatment to various cohorts of child patients, is entitled:

“The outcomes of children less than five years of age, admitted to Dora Nginza Hospital with diarrhoeal disease; HIV-positive versus HIV-negative children.”

“Most of the kids admitted with HIV tend to also have TB or vice versa. It seems that many of the kids with HIV or TB have prolonged diarrhoea and end up staying in hospital for longer. Children who do not have HIV seem to stay for up to half the time. But we now need to prove that with data,” he adds.

The intention, through a retrospective comparative cohort review of in-patient folders of children in the two eight-bed gastro-intestinal wards over 12 months, will hopefully uncover the causes relating to prolonged hospital stays and enable Dr Chiliwe and his colleagues to reduce deaths and improve outcomes.

“There are compounding factors like malnutrition and other co-morbidities that lengthen hospital stays, so we’ll have to take those into account,” he adds.

He emphasises that while they treat many children with diarrhoea, very few actually require admission, the specific exceptions being those who are severely dehydrated.

Childhood diarrhoea in South Africa

Existing South Africa studies confirm prolonged in-hospital stays of HIV-infected children suffering from diarrhoea and complicated by dehydration and malnutrition. Alarmingly, global literature also links diarrhoea with an eleven-fold increase in mortality.

Dr Chiliwe is married to Zikhone, a first-year medical officer at the same hospital, and they have a five-month-old son, Xhanti. He says between being on hospital call while specialising and domestic child-minding duties, he does not find much leisure time. However, he does manage to watch the occasional soccer or rugby match on television.

“I support the Kings and the Sharks, and Port Elizabeth’s Chippa United and Kaiser Chiefs in the Premier Soccer League. I’m also a former Manchester United fan,” he chuckles, alluding to the popular side’s mixed fortunes.

Most of the time, however, he works to fulfil his childhood ambition of making a difference in under-resourced communities.

Dealing with diarrhoea is vital

“Diarrhoea is a leading cause of death in children under five, especially in under-resourced communities, like most of the areas referring patients to Dora Nginza Hospital,” Dr Chiliwe emphasises. No data, however, exist to quantify the relation between diarrhoea and HIV infection in children seen at Dora Nginza Hospital.

The Discovery Foundation funding will make this specific knowledge possible through his research. He will detail demographic patient data, HIV status, length of hospital stays, mortality and contributing factors to diarrhoea, such as breastfeeding, co-morbid conditions, and nutrition and hydration status upon admission.