STUDY OVERVIEW

The Drakenstein Child Health Study (DCHS) is an African birth cohort study in a peri-urban area outside Cape Town, South Africa. The overall aim is to investigate the impact of early life exposures on development of health or disease. Key health outcomes measured in childhood include infectious disease, with a focus on lower respiratory tract illness, lung health, growth/nutrition, and neurodevelopment/mental health with careful phenotyping longitudinally done. Comprehensive longitudinal collection of risk factors in 7 areas (environmental, infectious, nutritional, genetic, psychosocial, maternal and immunological risk factors) is ongoing from the antenatal period. 
  
The DCHS is one of the largest African birth cohorts with comprehensive collection of clinical, microbiological and biologic samples in a low- and middle-income (LMIC) setting. We have a biorepository and linked comprehensive database with over 500,000 samples which serves as a platform for cross-disciplinary research, linking metadata and samples to different databases (demographic, clinical, radiological, microbiological, genetic, transcriptomic, environmental, immunological, psychosocial). There is a large network of postgraduate students and collaborators globally.  

ABOUT THE STUDY

The Drakenstein Child Health Study (DHCS) aims to investigate the association between early life risk factors on the development of disease in a low- and middle-income setting and to identify new strategies that may prevent or ameliorate the burden of disease. 

The DCHS enrolled 1143 pregnant women in public sector clinics from 2012 to 2015 and has followed mother-child pairs through childbirth, childhood and adolescence, with very high cohort retention. The study is located in the peri-urban Drakenstein district, Western Cape, South Africa. The community is characterised by low socioeconomic status and a high prevalence of infectious diseases, adverse exposures, and psychosocial stressors.
 

Drakenstein Child Health Schema

SITES

Clinical Research Sites:

Participants live in two communities – Mbekweni and Paarl East – located in Paarl in the Cape Winelands, home to 300 000 people. Both communities have high rates of poverty, unemployment, violence and associated health problems. 

Primary health care clinics in the public sector provide free services to children and families. Clinical sites are at Paarl Hospital and 2 primary care clinics, TC Newman and Mbekweni clinics within a short distance of the homes of the population that they serve. These clinics are well-established primary health care clinics providing routine care including antenatal care, and childhood immunizations and are the first health facility that sick children from this geographical area attend. There are well-established referral pathways for children to Paarl hospital. 

Administrative and Data Hub: 

The DCHS administrative, project management and data teams are based in the South Africa Medical Research Unit (SAMRC) on Child & Adolescent Health at Red Cross Children’s Hospital in Cape Town. This Unit has a long history in undertaking research in child and adolescent health, provides a strong clinical research infrastructure, and is in close proximity to our research laboratory. The Unit has conducted a range of clinical research at the site in the past 10 years. More than 5,000 children have been enrolled and followed in clinical research studies during this period, including cohort studies, observational studies and clinical trials. 

Institute of Child Health Research Laboratory and Biorepository: 

Longitudinally collected maternal and child specimens from the DCHS are stored in the University of Cape Town Department of Paediatrics and Child Health Institute of Child Health (ICH) laboratory at Red Cross Children’s Hospital. The Wellcome Trust funded Biorepository links samples and metadata across three large SAMRC Child & Adolescent health studies with over 500,000 specimens from the DCHS.  

Detailed data include comprehensive measures of epidemiological and biological measures, including sociodemographic, clinical, radiological, microbiological, genetic, environmental, immunological and psychosocial data encompassing child, maternal, and environmental health measures. The biorepository supports numerous African and international researchers, promoting interdisciplinary and capacity building research in Africa. It provides a rich and comprehensive data resource enabling novel, collaborative research focused on improving African child and adolescent health. 

COMMUNITY ENGAGEMENT

We have strong engagement with the local school in Mbekweni to support initiatives to improve child and adolescent health and strengthen educational capacity. We have established a school library with a full-time librarian, have assisted with skills training for teachers, and have built a soccer field at Langabuya Primary for further community upliftment. During COVID, the study undertook educational and poverty alleviation projects.  Subsequently the study has partnered with the school to paint classrooms and brightly coloured murals, and to further provide training to upskill teachers in areas of need.

The study regularly engages with local health authorities, policy makers, the local community and the national Department of Health on study outcomes that can be utilised to promote interventions that strengthen health and inform policy. These partnerships have also been key to building strong referral pathways for our mothers and children within the local health and education systems as well as with NGOs. Our referrals are made to local partners when participants need additional care or support in the areas of physical and mental/neurodevelopmental health. As the participants enter adolescence, an adolescent advisory board will be established comprising adolescents from the study and from local communities. 

HIGHLIGHTED PUBLICATIONS

  1. van Biljon N, Lake MT, Goddard L, Botha M, Zar HJ, Little F. Latent classes of anthropometric growth in early childhood using uni- and multivariate approaches in a South African birth cohort. PLoS One. 2025 Mar 25;20(3):e0319237. doi: 10.1371/journal.pone.0319237. 
  2. Zar HJ, Workman L, MacGinty R, Botha M, Johnson M, Hunt A, Burd T, Nicol MP, Flasche S, Quilty BJ, Goldblatt D. Natural immunity and protection against variants in South African children through five COVID-19 waves: A prospective study. Int J Infect Dis. 2025 Jan;150:107300. doi: 10.1016/j.ijid.2024.107300.
  3. Wedderburn CJ, Bondar J, Lake MT, Nhapi R, Barnett W, Nicol MP, Goddard L, Zar HJ. Risk and rates of hospitalisation in young children: A prospective study of a South African birth cohort. PLOS Glob Public Health. 2024 Jan 17;4(1):e0002754.
  4. Martinez L, Gray DM, Botha M, Nel M, Chaya S, Jacobs C, Workman L, Nicol MP, Zar HJ. The Long-Term Impact of Early-Life Tuberculosis Disease on Child Health: A Prospective Birth Cohort Study. Am J Respir Crit Care Med. 2023 Apr 15;207(8):1080-1088. doi: 10.1164/rccm.202208-1543OC. 
  5. Chaya S, Vanker A, Brittain K, MacGinty R, Jacobs C, Hantos Z, Zar HJ, Gray DM. The impact of antenatal and postnatal indoor air pollution or tobacco smoke exposure on lung function at 3 years in an African birth cohort. Respirology. 2023 Aug 17. doi: 10.1111. 
  6. McCready C, Haider S, Little F, Nicol MP, Workman L, Gray DM, Granell R, Stein DJ, Custovic A, Zar HJ. Early childhood wheezing phenotypes and determinants in a South African birth cohort: longitudinal analysis of the Drakenstein Child Health Study. Lancet Child Adolesc Health. 2023 Feb;7(2):127-135. doi: 10.1016/S2352-4642(22)00304-2. 
  7. Martinez L, Nicol MP, Wedderburn CJ, Stadler A, Botha M, Workman L, le Roux DM, Zar HJ. Cytomegalovirus acquisition in infancy and the risk of tuberculosis disease in childhood: a longitudinal birth cohort study in Cape Town, South Africa. Lancet Glob Health. 2021 Dec;9(12):e1740-e1749. doi: 10.1016/S2214-109X(21)00407-1.
  8. Zar HJ, Nduru P, Stadler JAM, Gray D, Barnett W, Lesosky M, Myer L, Nicol MP. Early-life respiratory syncytial virus lower respiratory tract infection in a South African birth cohort: epidemiology and effect on lung health. Lancet Glob Health. 2020 Oct;8(10):e1316-e1325. doi: 10.1016/S2214-109X(20)30251-5.
  9. Gray, Wedderburn CJ, MacGinty RP, McMillan L, Jacobs C, Stadler JA, Hall GL, Zar HJ. Impact of HIV and antiretroviral drug exposure on lung growth and function over 2 years in an African Birth Cohort. AIDS. 2019 Nov 11. PMID: 31714357. 
  10. Zar HJ, Pellowski JA, Cohen S, Barnett W, Vanker A, Koen N, Stein DJ. Maternal health and birth outcomes in a South African birth cohort study. PLoS One. 2019 Nov 21;14(11):e0222399. PMID: 31751344.
  11. Wedderburn CJ, Yeung S, Rehman AM, Stadler JAM, Nhapi RT, Barnett W, Myer L, Gibb DM, Zar HJ, Stein DJ, Donald KA. Neurodevelopment of HIV-exposed uninfected children in South Africa: outcomes from an observational birth cohort study. Lancet Child & Adolescent Health. 2019 November; 3(11): 803-813. doi: 10.1016/S2352-4642(19)30250-0.
  12. Martinez L, le Roux DM, Barnett W, Stadler At, Nicol MP, Zar HJ. Tuberculin Skin test conversion and primary progressive tuberculosis disease in the first 5 years of life: a birth cohort study from Cape Town, South Africa. Lancet Child Adolescent Health. 2018 Jan;2(1):46-55 PMCID: PMC5810304.
  13. Donald KA, Hoogenhout M, du Plooy CP, Wedderburn CJ, Nhapi RT, Barnett W, Hoffman N, Malcolm-Smith S, Zar HJ, Stein DJ. Drakenstein Child Health Study (DCHS): investigating determinants of early child development and cognition. BMJ Paediatrics Open. 2018 June; 2(1):e000282.
  14. Vanker A, Barnett W, Workman L, Nduru PM, Sly PD, Gie RP, Zar HJ. Early-life exposure to indoor air pollution or tobacco smoke and lower respiratory tract illness and wheezing in African infants: a longitudinal birth cohort study. Lancet Planet Health. 2017 Nov;1(8):e328-e336
  15. Koen N, Brittain K, Donald KA, Barnett W, Koopowitz S, Mare K, Zar HJ, Stein DJ. Psychological trauma and posttraumatic stress disorder: risk factors and associations with birth outcomes in the Drakenstein Child Health Study.  European Jourmal of Psychotraumatology. 2016 December 1; 7(1): 28720.
  16. Gray DM, Willemse L, Alberts A, et al. Determinants of early life lung function in African infants. Thorax. 2016 October; 72(5): 445-450. doi: http://dx.doi.org/10.1136/thoraxjnl-2015-207401.
  17. Zar HJ, Barnett W, Stadler A, Gardner-Lubbe S, Myer L, Nicol MP. Aetiology of childhood pneumonia in a well vaccinated South African birth cohort: a nested case-control study of the Drakenstein Child Health Study. Lancet Respir Med. 2016 Jun;4(6):463-72. doi: 10.1016/S2213-2600(16)00096-5. Epub 2016 Apr 21.
  18. Zar HJ, Barnett W, Myer L, Stein DJ, Nicol MP. Investigating the early-life determinants of illness in Africa: the Drakenstein Child Health Study. Thorax. 2015;70(6):592-4. PMCID: PMC5107608.
  19. Gray DM, Willemse L, Alberts A, Simpson S, Sly PD, Hall GL, Zar HJ. Lung function in African infants: A pilot study. Pediatric Pulmonology. 2015 January; 50: 49-54.
  20. Stein DJ, Koen N, Donald KA, Adnams CM, Koopowitz S, Lund C, Marais A, Myers B, Roos A, Sorsdahl K, Stern M, Tomlinson M, ver der Westhuizen C, Vythilingum B, Myer L, Barnett W, Brittain K, Zar HJ. Investigating the psychosocial determinants of child health in Africa: The Drakenstein Child Health Study. Journal of Neuroscience Methods. 2015 March 30; 252:27-35. doi: 10.1016/j.jneumeth.2015.03.016.

STUDY MANAGEMENT TEAM

The Drakenstein Child Health Study is structured to allow for collective ownership of the project across partners while ensuring a functional management system. The co-investigators and expert advisory group members are amongst the leading experts in their respective fields and will ensure a multi-disciplinary collaborative approach to the proposed study.

Heather J. Zar, MBChB, FCPaeds, PhD is the Principal Investigator, providing oversight and direction to the overall project. Prof Zar is located in the Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, UCT.

Mark Nicol, MMed, PhD leads the microbiological and laboratory aspects of the project. Mark Nicol is a medical microbiologist who holds the Wernher and Beit Chair of Medical Microbiology at the University of Cape Town and the National Health Laboratory Service (NHLS) of South Africa.

Landon Myer, MBChB, PhD is the epidemiologist for the project, providing guidance on study design and analyses. Prof Myer is Head of the Division of Epidemiology & Biostatistics, UCT.

Dan Stein, MBChB, PhD leads the psychosocial aspects of the study.  He is currently the Head of the Department of Psychiatry and Mental Health, UCT.