Conotruncal Heart Defect Repair in Sub-Saharan Africa: Remarkable Outcomes Despite Poor Access to Treatment.
Journal – World 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
Keywords – congenital heart disease; congenital heart surgery; health economics; health policy
Open access – No
Speciality – Cardiothoracic 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
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.
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.
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.
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