Matthew Kelly, MD, MPH, first began studying pneumonia among children in Botswana in 2011, when he was a Children’s Hospital of Philadelphia (CHOP) David N. Pincus Global Health Fellow. Although Dr. Kelly had done clinical work in several other African countries during his medical training, nothing had prepared him for the poor pneumonia outcomes of children in Botswana. In particular, he was struck by the high mortality of a specific group — the HIV-negative children of HIV-infected mothers, referred to as “HIV-exposed, uninfected.” Dr. Kelly’s research team observed that these children had longer illness courses and worse outcomes than the children of HIV-negative mothers.
Dr. Kelly received a Thrasher Early Career Award to study the pneumonia outcomes of HIV-exposed, uninfected children in Botswana. Between April 2012 and August 2016, he and the study’s research nurse recruited 400 children under 24 months of age with severe pneumonia at Princess Marina Hospital in Botswana’s capital city, Gaborone. The main aim of his study was to compare the pneumonia outcomes of HIV-exposed, uninfected children to those of children whose mothers were HIV-negative.
The research team, which included researchers from the Botswana Ministry of Health, the University of Botswana’s School of Medicine, McMaster University, Duke University Medical Center, Cincinnati Children’s Hospital, Children’s Hospital of Philadelphia, and the Botswana-UPenn Partnership, assessed children at hospital presentation, conducted interviews with each child’s caregiver, and reviewed hospital charts daily until hospital discharge.
Discoveries that are making a difference
Dr. Kelly’s research found that HIV-exposed, uninfected children were four times more likely to die from pneumonia than the children of HIV-negative mothers, and that formula feeding (as opposed to breastfeeding) was a major factor in the higher risk of death for these children. The groundbreaking results have been presented at a number of international research conferences, published in the Journal of The Pediatric Infectious Disease Society, and informed development of new departmental pneumonia treatment guidelines at Princess Marina Hospital. To continue this important area of research and find new ways to help children with pneumonia in low- and middle-income countries, Dr. Kelly has also used results from this research in successful grant applications to the International AIDS Society and the Duke University Center for AIDS Research.
Dr. Kelly’s current research is looking at the impact of normal bacteria in the nose, or upper respiratory tract, on the risk of pneumonia in infants. This study will identify the normal “healthy” bacteria that protect against the “harmful” bacteria that cause pneumonia. The ultimate goal of this work is to develop a therapy containing these bacteria —a probiotic cocktail — that effectively prevents pneumonia in children.
What started as a fellowship opportunity for a CHOP pediatric fellow has gone on to change the delivery of care in Botswana, and has contributed to capacity building and training of Botswana’s own clinicians and researchers. For example, four University of Botswana pediatric residents and one master’s degree candidate have worked on Dr. Kelly’s research over the past six years, and one of the pediatric residents recently completed his Botswana-based pediatric training and used data from Dr. Kelly’s research for his residency thesis.
Pneumonia is closely linked to poverty and is one of the main childhood illnesses that accounts for the health gap that exists between children in rich and poor countries. --Matthew Kelly, MD, MPH, pediatric infectious diseases specialist
This article was originally published on the Children's Hospital of Philadelphia Global Health Update.