Pediatric Global Health Research

Dr. Lowenthal practices global health.

Global pediatric health research at CPCE aims to improve pediatric health by addressing topics of importance to the well-being of children in resource-limited settings. Currently, this area of research primarily focuses on the care and treatment of children and adolescents in sub-Saharan Africa and the Dominican Republic, where CHOP supports community-based research through its partner clinic, Niños Primeros en Salud. Global pediatric health research also supports other investigators who share CPCE’s goals in improving pediatric global health. CPCE partners with the CHOP Global Health Center.

HIV Care in sub-Saharan Africa

Infectious Disease Research in sub-Saharan Africa

Pediatric Global Health Published Research


HIV Care in sub-Saharan Africa

Human immunodeficiency virus (HIV) is the leading cause of death among adolescents in sub-Saharan Africa. Highlights of global pediatric health research results include: 

  • describing the comparative effectiveness of the two most common drug regimens used to treat children with HIV worldwide, resulting in changes to international treatment guidelines
  • identifying risk factors for poor outcomes among adolescents with HIV
  • identifying interventional targets to help improve adherence support
  • supporting a variety of trainees, including several from low-resource settings, to complete international pediatric research projects

See the Published Research

What’s Next: 

CPCE researchers have the following active global pediatric health research projects underway:

  • Adherence to HIV Treatment among Adolescents in Botswana - This Public Health Effectiveness project is clarifying the most accurate ways to monitor adherence to HIV treatments among adolescents in Botswana. Barriers and facilitators of adherence and adherence monitoring are also being described.
  • Targeted Monitoring and Determinants of Adherence in Adolescents with HIV - This Botswana-based study is exploring developmental and behavioral factors that influence HIV treatment adherence. The long-term objective of this work is to help improve adolescent HIV treatment outcomes and limit the spread of resistant virus.
  • Factors Affecting Alcohol and Drug Use among Secondary School Students in Botswana - A partnership with the Botswana Ministry of Education, this study is uncovering risk and protective factors for substance abuse, a growing problem among the youth in this country.
  • Uncovering Challenges in the HIV Care Cascade among Adolescents Hospitalized with HIV in Gaborone, Botswana - This study aims to uncover the missed opportunities for HIV diagnosis, linkage to care, initiation of treatment, and retention in care among adolescents who are at risk of HIV-related death in a high-prevalence setting.

Funding: National Institutes of Health (NIMH and NIAID); Centers for Disease Control and Prevention (CDC)

Please contact Elizabeth D. Lowenthal, MD, MSCE, CHOP Global Health Center research director, attending physician, CHOP Special Immunology Family Care Center, and assistant professor of Pediatrics and Epidemiology at the Perelman School of Medicine at the University of Pennsylvania, for more information about this line of research.  


Infectious Disease Research in sub-Saharan Africa

Nosocomial bacteremia, an infection of the bloodstream, is the most frequent infectious cause of hospital death and excess length of stay among hospitalized neonates. Rates of bloodstream infection in developing countries among neonates are 3-20 times higher than rates reported in industrialized countries. This differential burden of nosocomial infection is most notable in sub-Saharan Africa, a region with minimal healthcare-associated infection (HAI) surveillance, weak health care infrastructure, limited resources and a lack of substantive regional HAI research, particularly for nosocomial bacteremia.

Infectious disease research is underway at CPCE to estimate the burden of disease, identify risk factors associated with nosocomial bacteremia, and assess the efficacy of low-cost measures to prevent nosocomial bloodstream infection and death in hospitalized neonates in sub-Saharan Africa. Specifically, we are researching the impact of a novel package of infection control interventions on nosocomial bacteremia and mortality among hospitalized neonates at a tertiary care center in Zambia. 

This line of research is in early stages but aims to: 

  1. Determine the incidence of all-cause mortality and nosocomial bacteremia per 1000 patient days in hospitalized neonates at a large tertiary referral center in sub-Saharan Africa.
  2. Evaluate the impact of a novel bundle of infection control interventions on neonatal nosocomial bacteremia and mortality. This bundle involves low cost, simple and locally available interventions that leverage new technologies.
  3. Evaluate the risk factors associated with nosocomial bacteremia among neonates at a sub-Saharan tertiary care facility.
  4. Determine the prevalence and evolution over time in the context of strengthened infection prevention measures of nosocomial bacteremia caused by MDR-GNR infections among neonates at a sub-Saharan tertiary care facility. 

We hypothesize that the implementation of low-cost infection control interventions targeting modifiable neonatal nosocomial bacteremia risk factors will result in a clinically meaningful decrease in the incidence of nosocomial bacteremia and all-cause mortality among NICU patients in a resource-limited country. If effective, this series of interventions will serve as a model for the improvement of neonatal outcomes in health facilities in resource-poor settings.

Funding: Thrasher Research Fund

Please contact Susan Coffin, MD, MPH, CHOP Attending Physician and Clinical Director of Infectious Diseases, for more information about this line of research.

Read more about infectious disease research at CPCE.


Pediatric Global Health Published Research

Lowenthal E, Lawler K, Harari N, Moamogwe L, Masunge J, Masedi M, Matome B, Seloilwe E, Jellinek M, Murphy M, Gross R. Validation of the Pediatric Symptom Checklist in HIV-infected Batswana. Journal of Child and Adolescent Mental Health. 2011 August;23(1): 17-28. PMCID: 22685483.

Lowenthal E, Szalda D, Harari N, Finalle R, Mazhani L. Relationship of training to self-reported competency and care of adolescents in an African healthcare setting. Journal of Adolescent Health. 2011 October; 49(4): 431-3.PMCID: 21939876.

Lowenthal E, Lawler K, Harari N, Moamogwe L, Masunge J, Masedi M, Matome B, Seloilwe E, Gross R. Rapid psychosocial function screening test identified treatment failure in HIV+ African youth. AIDS Care. 2012 Jan;24(6): 722-7.PMCID: 22292411.

Hafkin J, Modongo C, Newcomb C, Lowenthal E, MacGregor R, Steenhoff AP, Friedman H, Bisson G. Impact of the human immunodeficiency virus on early multidrug-resistant tuberculosis treatment outcomes in Botswana. International Journal of Tuberculosis and Lung Disease. 2013 March; 17(3): 348-353.

Lowenthal ED, Ellenberg JH, Machine E, Sagdeo A, Boiditswe S, Steenhoff AP, Rutstein R, Anabwani G, Gross R. Association between efavirenz-based compared with nevirapine-based antiretroviral regimens and virologic failure in HIV-Infected children. JAMA. 2013 May; 309(17803-1809). PMCID: 23632724.

Ndiaye M, Nyasulu P, Nguyen H, Lowenthal ED, Gross R, Mills EJ, Nachega JB. Risk factors for suboptimal antiretroviral therapy adherence in HIV-infected adolescents in Gaborone, Botswana: a pilot cross-sectional study. Patient Preference and Adherence. 2013 Sept; Dovepress(7): 891-895.

Lowenthal E, Lawler K, Harari N, Moamogwe L, Masedi M, Masunge J, Matome B, Seloilwe E, Gross R. Use of the pediatric symptom checklist for screening for psychosocial dysfunction in Botswana. Thari Ya Bana. UNICEF and the University of Botswana. 2013 Nov;(4), 68-74.

Lowenthal E, Bakeera-Kitaka S, Marukutira T, Chapman J, Goldrath K, Ferrand R. Perinatally acquired HIV infection in adolescents from sub-Saharan Africa: a review of emerging challenges. Lancet Infectious Diseases. 2014 Jul; 14(7).

Lowenthal E, Jibril HB, Sechele ML, Mathuba K, Tshume O,  Anabwani GM. Disclosure of HIV status to HIV-infected children in a large african treatment center: Lessons learned in Botswana. Children and Youth Services Review. 2014 Sept; Elsevier(4): 143-149.

Bearden D, Steenhoff AP, Dlugos DL, Kolson K, Mehta P, Kessler K, Lowenthal E, Monokwane B, Anabwani G, Bisson GP. Early antiretroviral therapy is protective against epilepsy in children with human immunodeficiency virus infection in Botswana. J Acquir Immune Defic Syndr. 2015 Jun 1;69(2):193-9. PMID 25647527.

Gross R, Bandason T, Langhaug L, Mujuru H, Ndhlovu C, *Lowenthal E, *Ferrand R. Factors associated with self-reported adherence among adolescents on antiretroviral therapy in Zimbabwe. AIDS Care. 2015 March; 27(3): 322-6. (* Indicates equal input by two senior authors.)

Lowenthal E, Marukutira T, Tshume O, Chapman J, Nachega J, Anabwani G, Gross R. Parental absence from clinic predicts human immunodeficiency virus treatment failure in adolescents. JAMA Pediatrics. 2015 May; 169(5):498-500.