Background: Multisystem inflammatory syndrome in children (MIS-C) following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been infrequently described in Africa. Objective: To describe the clinical characteristics, outcomes and associations of severe disease in children hospitalized with MIS-C in KwaZulu-Natal. Methods: Retrospective multicenter study of children (0–13 years) who met the Centers for Disease Control and Prevention criteria for MIS-C. Children with shock were compared with children without shock to determine the characteristics of severe MIS-C. Results: Twenty-nine children with MIS-C were identified, the mean age was 55 (SD ±45) months, 25 (86%) were Black-African, and 8 (28%) had pre-existing comorbidities. The predominant presenting symptoms included fever 29 (100%), gastrointestinal symptoms 25 (83%), skin rash 19 (65%), and shock 17 (59%). Children with shock had significantly increased CRP ( P = 0.01), ferritin ( P < 0.001), troponin-T ( P = 0.02), B-type natriuretic peptide (BNP) ( P = 0.01), and lower platelets ( P = 0.01). Acute kidney injury ( P = 0.01), cardiac involvement ( P = 0.02), and altered levels of consciousness ( P = 0.03) were more common in children with shock. The median length of hospital stay was 11 (IQR 7–19) days, with a mortality of 20.6%. Children who did not survive had significantly higher ferritin levels 1593 (IQR 1069–1650) ng/mL versus 540 (IQR 181–1156) ng/mL; P = 0.03) and significantly more required mechanical ventilation (OR 18; confidence interval 1.7–191.5; P = 0.005). Conclusions: Hospitalized children with MIS-C in KwaZulu-Natal had more aggressive disease and higher mortality than children in better-resourced settings. Markedly elevated biomarkers and critical organ involvement were associated with severe disease. Risk factors for poor outcomes include higher ferritin levels and the need for mechanical ventilation.

confirmation of congenital heart lesions in the foetus, the care of children with acquired heart disease and the investigation of innocent murmurs of childhood. There is a local perception that the demand for these services far exceeds the available skills in South Africa. In addition to the cardiological needs of our population, the need for surgery for children with heart lesions appears

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Optimal paediatric cardiac services in South Africa-what do we need? Providing comprehensive care for children with heart disease requires an integrated team of interdependent health practitioners.The team members include cardiologists, cardiothoracic surgeons, anaesthetists, intensivists, cardiac technologists, perfusionists,nurses,socialworkersandphysiotherapists.Theseteam members provide special, very specific skills in dealing with this groupofpatients.Thecareofthesepatientsoftenneedstocontinue into adulthood and adult cardiologists with the necessary training to care for congenital heart disease in adults are essential. Weaknesses or a deficiency at any level, or the inability of the team to function together seamlessly, seriously compromises patientcare.

Purpose of Review The paper outlines the current status of health care and pediatric cardiac services in South Africa and the challenges faced in providing pediatric cardiac care in the country. Recent Findings As infant and child mortality rates in South Africa and most of Sub-Saharan Africa continue to decline, establishing and improving the infrastructure to manage congenital heart disease increases in importance. Summary South Africa has well-established pediatric cardiac units in most major centers in the country. These have been able to train sufficient numbers of pediatric cardiologists to double the number in the country in just over a decade as well as train fellows from surrounding countries. A significant proportion of funding for this training comes from non-government sources. The number of pediatric cardiologists is however still far less than required with services spread unevenly throughout the country. Pediatric cardiac surgical services remain severely constrained with an urgent need to train more pediatric cardiac surgeons. Further progress depends not only on focussing resources on cardiac disease but also improvements in the health care systems and socioeconomic conditions in general.