Professor Heather Zar has been announced as the 2018 L’Oreal-UNESCO Women in Science Laureate for Africa and the Arab States, in recognition of her wide-ranging contributions to child health, which have improved – and saved – children’s lives across the globe, as well as helping to shape international policy. The prestigious award is given annually to five women scientists worldwide, one from each continent.

Respiratory illnesses, such as pneumonia, tuberculosis (TB) and asthma are leading causes of mortality and debilitating illness in children worldwide, but especially for children in Africa. These illnesses are also a serious complication in HIV-infected children. Zar, chair of the Department of Paediatrics and Child Health and director of the Medical Research Council Unit on Child and Adolescent Health, has devoted much of her working life to finding ways to tackle these conditions, and to developing capacity in Africa in this field. The recent award acknowledges her “outstanding contributions in the epidemiology, diagnosis, prevention and management of pulmonary illness, achieving reductions in childhood mortality globally”, as well as for “establishing a cutting-edge research programme in pneumonia, tuberculosis (TB) and asthma”.

Receiving the award was “very humbling”, says Zar, and “a really wonderful acknowledgement of the work we’ve been doing in child health over many years”.

Emphasising the role of her collaborators and study staff, she noted that “the award reflects the extraordinary teams and people I’m fortunate to work with and the strong collaborations that we’ve built”.

Zar’s work focuses on key illnesses that cause most childhood deaths and disease in Africa and globally, including childhood pneumonia, TB, HIV-associated disease and asthma.  Her work in childhood pneumonia has identified new methods for diagnosis and prevention and provided new knowledge on the causes and long-term impact. Studies in childhood TB led by Zar have fundamentally changed the way in which the disease is diagnosed, using new samples (such as induced sputum) and rapid molecular diagnostics for quick, effective diagnosis and treatment.

Zar has also conducted seminal work in improving and saving lives of in HIV-infected children, including defining the spectrum and causes of lung disease and in developing effective preventative and management strategies. She led studies to develop better preventive strategies for TB in HIV-infected children, reducing mortality by 50%. More recent research has focused on chronic diseases in HIV-infected adolescents on antiretroviral therapy.

In asthma, epidemiological studies have delineated the large burden of childhood asthma in Africa; Zar is well known for her innovation in the development of a low-cost alternative to spacers for asthma, using a simple 500ml plastic cooldrink bottle.

Possibly her most important work has been establishing the Drakenstein child health study. This unique birth cohort study is among the first in Africa to investigate comprehensively the early life determinants of child health and chronic disease. The study addresses the intersection of maternal and child health and the social and biological determinants of health; it investigates risk factors across seven areas (nutritional, environmental, psychosocial, microbiological, maternal, genetic and immunological). Childhood pneumonia and the long-term impact on health is a key focus; others include growth, nutrition, neurodevelopment and the emergence of non-communicable diseases.. The ultimate aim is to develop new interventions, not only to prevent illness in children but also chronic disease into adulthood. “This is a very important area,” says Zar, “as the origins of many adult diseases are increasingly understood to arise in childhood.”

This body of work has had a big impact on child health, improving management and prevention of childhood illnesses, and changing policy and international practice guidelines, including those produced by the World Health Organisation (WHO).

Alongside her research Zar has focused on growing research capacity, infrastructure, training postgraduates from a wide range of backgrounds, and expansion in scope and diversity of interdisciplinary work. She established the Research Centre for Child & Adolescent Health (REACH) at the Red Cross War Memorial Children’s Hospital in 2014 and an MRC unit in child health in 2015. She has developed other research sites in primary clinics and hospitals in Paarl and the Eastern Cape and is currently participating in the development of a network of African sites. Zar is credited with attracting competitive funding of more than R350 million from international grant agencies. Her mentorship of many South African and African fellows and PhD students is part of her commitment to contribute to building the next generation of African leaders in child health.

Though Africa has been a particular focus of her work, she has been a key advocate for child health globally, and her work has had important global impact. She currently serves as president of the Pan African Thoracic Society and is a past president of the Forum of International Respiratory Societies. She also serves as an advisor to the WHO and the Bill and Melinda Gates Foundation.

In a 2010 article about Zar in The Lancet, Andrew Bush, professor of paediatric respirology at Imperial College London, described her as “one of the few people who is able to cross the divide between developed and developing worlds”; her work is of “immediate relevance to the poorest children”, he said.

Expressing her gratitude to “all the staff I work with, my collaborators and mentors, our funders and the families and children I’ve been privileged to work with”, Zar says the L’Oreal award is “a wonderful opportunity to highlight the ability of clinical research to advance and transform child health.

“Working at UCT and at Red Cross War Memorial Children’s Hospital and other health facilities, we have a unique opportunity and challenge to do work that improves health, and to be strong advocates for child health,” she says.

“This work has been transformative, through advancing child health and developing much expertise and capacity in Africa.”