The challenges of cardiothoracic surgery practice in Nigeria: a 12 years institutional experience

Abstract

Infections, malignancy and trauma currently account for the bulk of cardiothoracic surgery practice in Nigeria, with surgical activity showing a predominance of minor procedures and comparatively minimal OHS activities. Identified challenges to increasing cardiothoracic surgical activity were limitations in manpower development, infrastructure, laboratory support, local availability of consumables, cost of surgery, funding mechanisms for surgery, multiple models for development of cardiac surgery, decentralization of efforts and lack of outcome data. Data collection and reporting of results must be started to enable development of more evidence-based practice.

Status and Challenges of Care in Africa for Adults With Congenital Heart Defects

“…From published data, 9 the ACHD age profile seen in Nigeria was similar to the Ghanaian experience ( Table 2). The very low number of previously operated patients is an indication of poor access to cardiac interventions in this country, 10 which incidentally is the country with the highest CHD birth prevalence in Africa.…”

Pattern and Outcome of Cardiac Interventions Performed within and Outside Nigeria for Children with Structural Heart Diseases in Sokoto, North-western Nigeria

“…This is a common finding in many developing countries, where access to cardiac surgery remains challenging [3,6,8,9]. In a study by Falase et al [7] in Lagos-Nigeria, only 3.4% of patients including adults with structural heart diseases were able to undergo cardiac surgeries. A more recent data from the National Paediatric Cardiac Registry revealed that less than 20% of children who required cardiac interventions actually received the necessary surgery [9].…”

“…It is instructive that all the interventions undertaken at our centre were for simple lesions: PDA ligation independently performed by the local team and VSD/ ASD closure undertaken in collaboration with visiting cardiac team. While periodic cardiac mission does provide intermittent relief for a few patients and creates opportunity for some skill transfer [7], it may not adequately cater for the large volume of patients on the waiting list. Comprehensive strategy that will ensure availability of such services locally, and at regular and sustainable basis, is therefore needed.…”

“…Besides CHDs, countries in sub-Saharan Africa also suffer additional burden of preventable acquired heart diseases (AHDs), particularly rheumatic fever and Rheumatic heart diseases (RHD), which have been largely eradicated in developed nations [4,5]. Factors responsible for this include poor social and living conditions of the populace, late presentation, harmful sociocultural practices, misconceptions, and delay in making diagnosis due to lack of skill and facilities [4,6,7]. There is also limited capacity for carrying out lifesaving cardiac interventions in many developing nations, leading to a wide gap between population demand and access to these services [8,9].…”

“…A study by Ekure et al [9[ has shown that more than 80% of Nigerian children with CHD have no access to corrective surgery and only 20.5% of all the interventions were undertaken in the country. In the last decade, however, these cardiac interventions have become more frequent in the country through the support of non-governmental donor agencies (NGOs) and visiting foreign surgeons, who provide short term periodic cardiac missions [7,11].…”