Congenital heart disease in low‐and‐middle‐income countries: Focus on sub‐Saharan Africa

Abstract

The etiology of congenital heart disease (CHD) is multifactorial. The birth prevalence of CHD is shaped by a wide variety of maternal, fetal, and neonatal risk factors, along with the rates of prenatal diagnosis and terminations of pregnancy, all of which have geographic variability Epidemiology data availability from low‐and‐middle‐income countries (LMIC) on CHD prevalence, morbidity, and mortality are far more limited than from high income countries. Data on specific genetic, environmental, and prenatal risk associated with CHD are almost nonexistent. In this article, we will focus on defining what data are available, genetic risk factors, birth and overall prevalence, morbidity, and the impact of limited access to interventions, both surgery and cardiac catheterizations. We will highlight CHD in sub‐Saharan Africa to detail epidemiology studies in the poorest regions of the world. Existing literature as well as estimates from the Global Burden of Disease Study (http://ghdx.healthdata.org) form the basis for this review. The intersection of poverty, high fertility rates, and limited access to care results in a unique profile of CHD in LMIC. CHD is not a preventable disease (by most standards), so early detection and access are our key interventions to improve the dire outcomes for children in low‐resources settings of the world.

Congenital heart disease in Africa threatens Sustainable Development Goals

“…[2] Pulse oximetry, an easy and inexpensive screening strategy, can help to diagnose complex CHD at birth and alert healthcare workers to direct babies timeously for further assessment before complications develop. [4,5] Access to affordable comprehensive cardiac healthcare is restricted to a handful of specialised cardiac centres on the African continent. A few lucky children receive treatment from philanthropic fly-in-fly-out medical missions sponsored by high-income countries (HICs).…”

“…[13] Without appropriate treatment, those who do survive beyond infancy will suffer debilitating complications. [4,14,15] The Sustainable Development Goals (SDGs), signed by all members of the United Nations in 2015, aim to reduce neonatal and under-5 mortality by 2030. [16] Successful programmes addressing commu nicable diseases such as HIV, TB and malaria, and childhood immunisation, are examples of what can be accomplished in Africa.…”

How do caregivers of children with congenital heart diseases access and navigate the healthcare system in Ethiopia?

“…As the World Health Organization (WHO) recognized the global burden and threat of non-communicable diseases (NCD) as one of the major challenges of the twenty-first century, increasing access to surgical care is becoming an increasingly important global health agenda due to its potential to save lives, prevent disabilities and decrease the burden of diseases [1,2]. Congenital heart disease (CHD) is the leading cause of morbidity in children, [3] and about 500,000 children are born with CHD each year in Africa [4]. In a recent study, heart failure accounted for about 11% of pediatric admissions at a referral teaching hospital in Ethiopia [5].…”

“…In a recent study, heart failure accounted for about 11% of pediatric admissions at a referral teaching hospital in Ethiopia [5]. Poverty, high fertility rates, and limited access to care add to the burden of CHD in LMICs [4]. As a result, research on cardiac surgical care capacity and demand is being actively conducted in the area [6].…”

The state of congenital heart disease

“…Although this special issue highlights recent advances in CHD, the majority of CHD treatment resources are only available to a small fraction of the world population. Zimmerman and Sable highlight the much needed status of CHD in developing countries by highlighting Dr. Sable's decades of involvement in sub‐Saharan Africa (Zimmeran, & Sable, ). Ekure adds additional data to CHD in sub‐Saharan Africa by characterizing CHD in Nigeria (Ekure et al, ).…”