Professor Heather Zar, the chair of the Department of Paediatrics and Child Health and the director of the South African Medical Research Council Unit on Child and Adolescent Health at the University of Cape Town’s (UCT) Faculty of Health Sciences, is spearheading a research project that is one of 12 globally to receive a recent COVID-19 grant.

The National Institute for Health Research / United Kingdom Research and Innovation Global Effort on COVID-19 (NIHR/UKRI GECO) grant is a collaborative funding opportunity. Under Professor Zar as the project leader, the study will offer a unique opportunity to understand the determinants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and coronavirus disease (COVID-19) in children in Africa in a low-middle-income country (LMIC) context. The award will enable Zar and her team to undertake a study titled “Spectrum, determinants and long-term outcome of SARS-CoV-2 infection and disease in African children”.

The reasons children typically develop mild illness or have asymptomatic infection are poorly understood. In LMICs, where children make up a large proportion of the population, risk factors such as malnutrition, HIV exposure, tuberculosis or prior infection with endemic coronaviruses may have an impact on the risk of infection and development of COVID-19.

This project aims to investigate the spectrum of illness in African children, the risk factors for infection or disease, and the immune or inflammatory factors protecting children against SARS-CoV-2 infection or severe COVID-19 disease.

Zar is collaborating with partners at the universities of Western Australia and Southampton in the United Kingdom for this research.

COVID-19 infection in African children

“This funding provides a wonderful opportunity to better understand COVID-19 in African children in an LMIC context,” she said.

This is particularly relevant because of the high burden of pneumonia, which continues to be the major single killer of children under five years of age, due to factors such as malnutrition, smoke exposure and the high burden of infectious disease in these settings.


“Understanding why children are only mildly affected may be key to developing new strategies to prevent or ameliorate illness.”


“However, this hasn’t occurred with COVID-19,” said Zar, who is an affiliate member of the Institute of Infectious Disease and Molecular Medicine (IDM) at UCT. Surprisingly, children in LMICs and globally are predominantly only mildly affected by COVID-19, with relatively few severe cases or deaths occurring in young children. The current project will investigate whether prior infection with other organisms (including seasonal coronaviruses) protects children against severe disease through development of immunity.

“Understanding why children are only mildly affected may be key to developing new strategies to prevent or ameliorate illness,” said Zar.

Drakenstein Child Health Study

Whitney Barnett, the project’s programme manager, said that this funding will offer researchers the additional focus of investigating COVID-19 across different settings, ranging from communities to hospitals. SARS-CoV-2 infection will be investigated in children who are hospitalised with pneumonia as well as in children who are part of the population-based Drakenstein Child Health Study (DCHS), a novel African birth cohort study, which is led by Zar.

The DCHS has comprehensively investigated the early-life determinants of child health, and developmental pathways to health or disease from pregnancy through childhood – so it provides a unique platform to study COVID-19 in children, and the impact of the pandemic on child health.


“It is especially important to be able to do this study here because children make up a high proportion of the population.”


“The DCHS also bridges the intersection of infectious diseases and the emergence of non-communicable diseases,” Zar said.

“It is especially important to be able to do this study here because children make up a high proportion of the population, and risk factors such as malnutrition, pollution, poverty and a high burden of infections may contribute to their vulnerability to developing illness.”

She added that the context of the DCHS offers further understanding of COVID-19-related childhood illness, including the protective or risk factors for infection or disease that have been carefully measured from the antenatal period through childhood, and the role of inflammation.

As a child health specialist in respiratory illness, Zar said that this will inform future research and healthcare approaches and provide “a unique opportunity to generate new knowledge, identify risk factors for illness and develop novel strategies for prevention and treatment”.