Conotruncal Heart Defect Repair in Sub-Saharan Africa: Remarkable Outcomes Despite Poor Access to Treatment.

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Conotruncal Heart Defect Repair in Sub-Saharan Africa: Remarkable Outcomes Despite Poor Access to Treatment.


JournalWorld Journal for Pediatric & Congenital Heart Surgery
Publication date – Sep – 2016
Authors – Edwin F, Entsua-Mensah K, Sereboe LA, Tettey MM, Aniteye EA, Tamatey MM2, Adzamli I, Akyaa-Yao N, Gyan KB, Ofosu-Appiah E, Kotei D
Keywordscongenital heart disease; congenital heart surgery; health economics; health policy
Open access – No
SpecialityCardiothoracic surgery, Paediatric surgery
World region South-eastern Asia, Southern Africa
Country: Democratic Republic of the Congo, Ethiopia, Kenya, Mozambique, Nigeria, Tanzania, Uganda
Language – English
Submitted to the One Surgery Index on July 1, 2018 at 1:07 am
Abstract:

Background:
The outcome of children born with conotruncal heart defects may serve as an indication of the status of pediatric cardiac care in sub-Saharan Africa (SSA). This study was undertaken to determine the outcome of children born with conotruncal anomalies in SSA, regarding access to treatment and outcomes of surgical intervention.

Methods:
From our institution in Ghana, we retrospectively analyzed the outcomes of surgery, in the two-year period from June 2013 to May 2015. The birth prevalence of congenital heart defects (CHDs) in SSA countries was derived by extrapolation using an incidence of 8 per 1,000 live births for CHDs.

Results:
The birth prevalence of CHDs for the 48 countries in SSA using 2013 country data was 258,875; 10% of these are presumed to be conotruncal anomalies. Six countries (Nigeria, Democratic Republic of the Congo, Ethiopia, Tanzania, Uganda, and Kenya) accounted for 53.5% of the birth prevalence. In Ghana, 20 patients (tetralogy of Fallot [TOF], 17; pulmonary atresia, 3) underwent palliation and 50 (TOF, 36; double-outlet right ventricle, 14) underwent repair. Hospital mortality was 0% for palliation and 4% for repair. Only 6 (0.5%) of the expected 1,234 cases of conotruncal defects underwent palliation or repair within two years of birth.

Conclusion:
Six countries in SSA account for more than 50% of the CHD burden. Access to treatment within two years of birth is probably <1%. The experience from Ghana demonstrates that remarkable surgical outcomes are achievable in low- to middle-income countries of SSA.

OSI Number – 10008
PMID – 27587494

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