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Leke AZ, Malherbe H, Kalk E, Mehta U, Kisa P, Botto LD, Ayede I, Fairlie L, Maboh NM, Orioli I, Zash R, Kusolo R, Mumpe-Mwanja D, Serujogi R, Bongomin B, Osoro C, Dah C, Sentumbwe–Mugisha O, Shabani HK, Musoke P, Dolk H, Barlow-Mosha L. The burden, prevention and care of infants and children with congenital anomalies in sub-Saharan Africa: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001850. [PMID: 37379291 PMCID: PMC10306220 DOI: 10.1371/journal.pgph.0001850] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/17/2023] [Indexed: 06/30/2023]
Abstract
The aim of this scoping review was to determine the scope, objectives and methodology of contemporary published research on congenital anomalies (CAs) in sub-Saharan Africa (SSA), to inform activities of the newly established sub-Saharan African Congenital Anomaly Network (sSCAN). MEDLINE was searched for CA-related articles published between January 2016 and June 2021. Articles were classified into four main areas (public health burden, surveillance, prevention, care) and their objectives and methodologies summarized. Of the 532 articles identified, 255 were included. The articles originated from 22 of the 49 SSA countries, with four countries contributing 60% of the articles: Nigeria (22.0%), Ethiopia (14.1%), Uganda (11.7%) and South Africa (11.7%). Only 5.5% of studies involved multiple countries within the region. Most articles included CA as their primary focus (85%), investigated a single CA (88%), focused on CA burden (56.9%) and care (54.1%), with less coverage of surveillance (3.5%) and prevention (13.3%). The most common study designs were case studies/case series (26.6%), followed by cross-sectional surveys (17.6%), retrospective record reviews (17.3%), and cohort studies (17.2%). Studies were mainly derived from single hospitals (60.4%), with only 9% being population-based studies. Most data were obtained from retrospective review of clinical records (56.1%) or via caregiver interviews (34.9%). Few papers included stillbirths (7.5%), prenatally diagnosed CAs (3.5%) or terminations of pregnancy for CA (2.4%).This first-of-a-kind-scoping review on CA in SSA demonstrated an increasing level of awareness and recognition among researchers in SSA of the contribution of CAs to under-5 mortality and morbidity in the region. The review also highlighted the need to address diagnosis, prevention, surveillance and care to meet Sustainable Development Goals 3.2 and 3.8. The SSA sub-region faces unique challenges, including fragmentation of efforts that we hope to surmount through sSCAN via a multidisciplinary and multi-stakeholder approach.
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Affiliation(s)
- Aminkeng Zawuo Leke
- Institute for Nursing and Health Research, Centre for Maternal, Fetal and Infant Research, Ulster University, Newtownabbey, United Kingdom
- Centre for Infant and Maternal Health Research, Health Research Foundation, Buea, Cameroon
| | - Helen Malherbe
- Research & Epidemiology, Rare Diseases South Africa NPC, Bryanston, Sandton, South Africa
| | - Emma Kalk
- Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Ushma Mehta
- Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Phylis Kisa
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Lorenzo D. Botto
- Division of Medical Genetics, University of Utah, Salt Lake City, Utah, United States of America
- International Center on Birth Defects, University of Utah, Salt Lake City, Utah, United States of America
| | - Idowu Ayede
- Department of Paediatrics, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | - Lee Fairlie
- Faculty of Health Sciences, Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Nkwati Michel Maboh
- Centre for Infant and Maternal Health Research, Health Research Foundation, Buea, Cameroon
| | - Ieda Orioli
- Genetics Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- ReLAMC: Latin American Network for Congenital Malformation Surveillance, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rebecca Zash
- The Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana and Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Ronald Kusolo
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Daniel Mumpe-Mwanja
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Robert Serujogi
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Bodo Bongomin
- Gulu University Faculty of Medicine: Gulu, Gulu, UG/ World Health Organization, Kampala, Uganda
| | - Caroline Osoro
- Kenya Medical Research Institute, Centre for Global Health Research, Nairobi, Kenya
| | - Clarisse Dah
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | | | | | - Philippa Musoke
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Helen Dolk
- Institute for Nursing and Health Research, Centre for Maternal, Fetal and Infant Research, Ulster University, Newtownabbey, United Kingdom
| | - Linda Barlow-Mosha
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
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Woods A, Shofner C, Hodge B. International pediatric surgery partnerships in sub-Saharan Africa: a scoping literature review. Glob Health Action 2022; 15:2111780. [PMID: 36047712 PMCID: PMC9448389 DOI: 10.1080/16549716.2022.2111780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Sub-Saharan Africa (SSA) faces a critical shortage of pediatric surgical providers. International partnerships can play an important role in pediatric surgical capacity building but must be ethical and sustainable. Objective The purpose of this study is to perform a scoping literature review of international pediatric surgery partnerships in SSA from 2009 to 2019. We aim to categorize and critically assess past partnerships to aid in future capacity-building efforts. Methods We performed a scoping literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) guidelines. We searched the PubMed and Embase databases for articles published from 2009 to 2019 using 24 keywords. Articles were selected according to inclusion criteria and assessed by two readers. Descriptive analyses of the data collected were conducted in Excel. Results A total of 2376 articles were identified. After duplicates were removed, 405 articles were screened. In total, 83 articles were assessed for eligibility, and 62 were included in the review. The most common partnership category was short-term surgical trip (28 articles, 45%). A total of 35 articles (56%) included education of host country providers as part of the partnership. Only 45% of partnerships included follow-up care, and 50% included postoperative outcomes when applicable. Conclusions To increase sustainability, more partnerships must include education of local health-care providers, and short-term surgical trips must be integrated into long-term partnerships. More partnerships need to report postoperative outcomes and ensure follow-up care. Educating peri-operative providers, training general surgeons in common pediatric procedures, and increasing telehealth use are other goals for future partnerships.
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Affiliation(s)
- Alison Woods
- Department of Pediatrics, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Charles Shofner
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Bethany Hodge
- Department of Pediatrics, Division of Pediatric Hospital Medicine, Global Education Office, University of Louisville School of Medicine, Louisville, KY, USA
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Voss M, Swart O, Abel L, Mahtani K. Capacity-building partnerships for surgical post-graduate training in low- and middle-income countries: a scoping review of the literature with exploratory thematic synthesis. Health Policy Plan 2021; 35:1385-1412. [PMID: 33159525 DOI: 10.1093/heapol/czaa075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2020] [Indexed: 11/14/2022] Open
Abstract
In recent years, international surgical programmes have moved away from vertical service delivery and towards collaborative, capacity-building partnerships. The aim of this review was to provide a map of the current literature on international surgical training partnerships together with an exploration of factors influencing their implementation. Three bibliographic databases were searched for peer-reviewed reports of surgical training partnerships between organizations in high- and low or middle-income countries to July 2018. Reports were sorted in an iterative fashion into groups of similar programmes, and data were extracted to record the intervention strategies, context, financing, reported results and themes around implementation. Eighty-six reports were grouped into five types of programme: full residency training, bi-institutional twinning partnerships, diagonal/sub-specialist programmes, focused interventions or courses and programmes using remote support. Few articles were written from the perspective of the low-middle income partner. Full residency programmes and some diagonal/sub-specialist programmes report numbers trained while twinning partnerships and focused interventions tend to focus on process, partners' reactions to the programme and learning metrics. Two thematic networks emerged from the thematic synthesis. The first made explicit the mechanisms by which partnerships are expected to contribute to improved access to surgical care and a second identified the importance of in-country leadership in determining programme results. Training partnerships are assumed to improve access to surgical care by a number of routes. A candidate programme theory is proposed together with some more focused theories that could inform future research. Supporting the development of the surgical leadership in low- and middle-income countries is key.
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Affiliation(s)
- Miranda Voss
- Harris Manchester College, Savile Road Oxford, Oxford OX1 3TZ, UK
| | - Oostewalt Swart
- Department of Surgery, Worcester Hospital, Murray Street, Worcester 6840, South Africa
| | - Lucy Abel
- Nuffield Department of Primary Healthcare Sciences, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK
| | - Kamal Mahtani
- Nuffield Department of Primary Healthcare Sciences, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK
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Tchervenkov CI, Herbst C, Jacobs JP, Al-Halees Z, Edwin F, Dearani JA, Finucane K, Sandoval N, Sarris GE, Fragata J, Abdulgani HB, Arboleda M, Bacha EA, Barron DJ, Becker P, Boumzebra D, Cervantes J, Elgamal A, Helvind MH, Iyer KS, Jatene MB, Jun TG, Kirklin JK, Kreutzer C, Lee C, Lotto AA, Manuel V, Maruszewski B, Najm H, Overman D, Rahmat B, Reddy D, Sakamoto K, Samankatiwat P, Sivalingam S, St Louis JD, Stellin G, Stephens EH, Tretter JT, Truong NLT, Tweddell JS, Vida V, Vosloo S, Zhang H, Zheleva B, Jonas RA. Current Status of Training and Certification for Congenital Heart Surgery Around the World: Proceedings of the Meetings of the Global Council on Education for Congenital Heart Surgery of the World Society for Pediatric and Congenital Heart Surgery. World J Pediatr Congenit Heart Surg 2021; 12:394-405. [PMID: 33942697 DOI: 10.1177/21501351211003520] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The optimal training of the highly specialized congenital heart surgeon is a long and complex process, which is a significant challenge in most parts of the world. The World Society for Pediatric and Congenital Heart Surgery (WSPCHS) has established the Global Council on Education for Congenital Heart Surgery as a nonprofit organization with the goal of assessing current training and certification and ultimately establishing standardized criteria for the training, evaluation, and certification of congenital heart surgeons around the world. The Global Council and the WSPCHS have reviewed the present status of training and certification for congenital cardiac surgery around the world. There is currently lack of consensus and standardized criteria for training in congenital heart surgery, with significant disparity between continents and countries. This represents significant obstacles to international job mobility of competent congenital heart surgeons and to the efforts to improve the quality of care for patients with Congenital Heart Disease worldwide. The purpose of this article is to summarize and document the present state of training and certification in congenital heart surgery around the world.
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Affiliation(s)
- Christo I Tchervenkov
- Division of Cardiovascular Surgery, 10040The Montreal Children's Hospital of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Claudia Herbst
- Department of Cardiac Surgery, Pediatric Cardiac Surgery, 27271Medical University of Vienna, Austria
| | - Jeffrey P Jacobs
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, USA
| | - Zohair Al-Halees
- Heart Center, 37852King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Frank Edwin
- National Cardiothoracic Centre, Accra, Ghana.,University of Health and Allied Sciences, Ho, Ghana
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Nestor Sandoval
- Department of Cardiac Surgery, Fundacion Cardioinfantil-Instituto de Cardiologia, Bogota, Colombia
| | | | - Jose Fragata
- Cardiothoracic Surgery, Santa Marta Hospital, NOVA Medical School, Lisbon, Portugal
| | | | - Miguel Arboleda
- Pediatric Cardiovascular Surgery, Instituto Nacional Cardiovascular (INCOR), Lima, Peru
| | - Emile A Bacha
- Department of Surgery, Section of Pediatric and Congenital Heart Surgery, Columbia University New York-Presbyterian/Morgan Stanley Children's Hospital, New York, NY, USA
| | - David J Barron
- Pediatric Cardiac Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Pedro Becker
- Cardiovascular Surgery, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Drissi Boumzebra
- Cardiovascular Surgery Unit, Mohamed VI University Hospital, Marrakech, Morocco
| | - Jorge Cervantes
- Department of Pediatric Cardiac and Congenital Heart Surgery, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico
| | - Adel Elgamal
- Congenital and Pediatric Cardiac Surgery, Mansoura University Children's Hospital, Mansoura, Egypt
| | - Morten H Helvind
- Department of Congenital Heart Surgery, Rigshospitalet, University Hospital of Copenhagen, Denmark
| | - Krishna S Iyer
- Pediatric & Congenital Heart Surgery, Fortis-Escorts Heart Institute, New Delhi, India
| | | | | | - James K Kirklin
- Division of Cardiothoracic Surgery, University of Alabama at Birmingham, AL, USA
| | - Christian Kreutzer
- Division of Pediatric Cardiovascular Surgery, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Cheul Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Attilio A Lotto
- Pediatric Cardiac Surgery, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Valdano Manuel
- Cardiovascular Surgery, Clinica Girassol, Luanda, Angola
| | - Bohdan Maruszewski
- Pediatric Cardiothoracic Surgery Department, Children's Memorial Health Institute, Warsaw, Poland
| | - Hani Najm
- Division of Cardiovascular Surgery, Pediatric and Congenital Heart Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - David Overman
- Division of Cardiovascular Surgery, Children's Minnesota, Minneapolis, MN, USA
| | - Budi Rahmat
- Pediatric and Congenital Heart Surgery Division, National Cardiovascular Center, Harapan Kita, Jakarta, Indonesia
| | - Darshan Reddy
- Lenmed Ethekwini Hospital and Heart Centre, Nelson R. Mandela School of Medicine, Durban, South Africa
| | - Kisaburo Sakamoto
- Department of Cardiovascular Surgery, Mount Fuji Shizuoka Children's Hospital, Shizuoka, Japan
| | - Piya Samankatiwat
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sivakumar Sivalingam
- Department of Cardiothoracic Surgery, National Heart Institute, Kuala Lumpur, Malaysia
| | - James D St Louis
- Departments of Surgery and Pediatrics, Children's Hospital of Georgia, Augusta University, Augusta, GA, USA
| | - Giovanni Stellin
- Pediatric and Congenital Cardiac Surgery Unit, University of Padova, Padova, Italy
| | | | - Justin T Tretter
- Department of Pediatrics, University of Cincinnati College of Medicine, Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Nguyen Ly Thinh Truong
- Department of Cardiovascular Surgery, Children's Heart Center, National Children's Hospital, Hanoi, Vietnam
| | - James S Tweddell
- Cardiothoracic Surgery, Heart Institute, Cincinnati Children's Hospital Medical, Cincinnati, OH, USA
| | - Vladimiro Vida
- Pediatric and Congenital Cardiac Surgery Unit, University of Padova, Padova, Italy
| | - Susan Vosloo
- Christiaan Barnard Memorial Hospital, Cape Town, South Africa
| | - Hao Zhang
- Shanghai Children's Medical Center and National Medical Center, Shanghai, China
| | | | - Richard A Jonas
- Cardiac Surgery, Center for Neuroscience Research, Children's National Hospital, Washington, DC, USA
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Edwin F, Elgamal MA, Dorra A, Reddy D, Entsua-Mensah K, Adzamli I, Yao NA, Tettey M, Tamatey M, Vosloo S, Kinsley R. Challenges of Caring for Functionally Single Ventricle Patients in Africa. World J Pediatr Congenit Heart Surg 2019; 10:338-342. [PMID: 31084309 DOI: 10.1177/2150135118817769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Surgical palliation has remarkably improved survival of functionally single ventricle (FSV) patients born in developed nations but such outcomes have not occurred in Africa. The poor care coverage for FSV patients in Africa exists within the larger sphere of deficient health care for children born with congenital heart defects (CHDs) in Africa generally. This review takes the position that to improve health-care coverage for CHD patients on the continent, political priority is paramount. This can be attained with cohesive leadership for the CHD agenda, a guiding institution, and the mobilization of civil society to drive advocacy at national and international levels.
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Affiliation(s)
- Frank Edwin
- 1 Department of Surgery, University of Health and Allied Sciences, Ho, Ghana.,2 National Cardiothoracic Centre, Korle Bu Teaching Hospital, Accra, Ghana
| | | | - Abid Dorra
- 4 Cardiology Department, Hedi Chaker Hospital, Sfax, Tunisia
| | - Darshan Reddy
- 5 Department of Cardiothoracic Surgery, University of Kwa-Zulu Natal, Durban, South Africa.,6 Lenmed Ethekwini Hospital and Heart Centre, Durban, South Africa
| | - Kow Entsua-Mensah
- 2 National Cardiothoracic Centre, Korle Bu Teaching Hospital, Accra, Ghana
| | - Innocent Adzamli
- 2 National Cardiothoracic Centre, Korle Bu Teaching Hospital, Accra, Ghana
| | - Nana-Akyaa Yao
- 2 National Cardiothoracic Centre, Korle Bu Teaching Hospital, Accra, Ghana
| | - Mark Tettey
- 2 National Cardiothoracic Centre, Korle Bu Teaching Hospital, Accra, Ghana.,7 School of Medicine and Dentistry, University of Ghana, Accra, Ghana
| | - Martin Tamatey
- 1 Department of Surgery, University of Health and Allied Sciences, Ho, Ghana.,2 National Cardiothoracic Centre, Korle Bu Teaching Hospital, Accra, Ghana
| | - Susan Vosloo
- 8 Christiaan Barnard Memorial Hospital, Cape Town, South Africa
| | - Rob Kinsley
- 6 Lenmed Ethekwini Hospital and Heart Centre, Durban, South Africa
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6
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Kontchou NAT, McCrary AW, Schulman KA. Workforce Cost Model for Expanding Congenital and Rheumatic Heart Disease Services in Kenya. World J Pediatr Congenit Heart Surg 2019; 10:321-327. [PMID: 31084310 DOI: 10.1177/2150135119837201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cardiovascular disease is the number one global killer, with over three quarters of these deaths arising from the populations of low- and middle-income countries (LMICs). Addressing the burden of cardiovascular disease in LMICs must include medical and surgical services for these patients. In this article, we model the needs and costs to scale up the cardiac provider workforce in Kenya, which can be adapted to other LMICs based on country-specific workforce hours and workforce salaries. METHODS Using published epidemiological reports from sub-Saharan Africa, we structured the model based on the expected disease burden of congenital and rheumatic disease in a simulated 1,000-person population. Services modeled include clinic visits, echocardiograms, diagnostic cardiac catheterizations, interventional catheterizations, and heart surgery. Costs were modeled based on Kenyan public sector salaries. After scaling the model, we created a sensitivity analysis of change in service duration and salaries. RESULTS Based on a 1,000-person Kenyan population, we estimate that 2.5 heart surgeries will be needed every year, with a corresponding annual workforce cost of US$526. Including accompanying services of clinic visits, echocardiograms, and both diagnostic and interventional cardiac catheterizations, the total annual workforce cost is US$899. Based on estimated productive hours for public sector workforce, 196 full-time equivalent cardiac surgeons will be needed for the entire population of Kenya (2017 figure). CONCLUSIONS We present a model for appropriate cardiovascular service staffing based on disease burden and workforce costs. This model can be scaled up as needed to plan for local capacity building.
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Affiliation(s)
| | - Andrew W McCrary
- 2 Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Kevin A Schulman
- 3 Department of Medicine and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
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7
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Nguyen NW. Micro-Costing Estimation of Workforce Needs: Will That Work for Cardiac Services in Kenya? World J Pediatr Congenit Heart Surg 2019; 10:328-329. [PMID: 31084300 DOI: 10.1177/2150135119843067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Nguyenvu W Nguyen
- 1 Division of Pediatric Cardiology, Cardon Children's Medical Center, Mesa, AZ, USA
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8
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Edwin F. Palliation of Functionally Single Ventricle Patients in Sub-Saharan Africa-Is It Justifiable? World J Pediatr Congenit Heart Surg 2019; 10:171-173. [PMID: 30841827 DOI: 10.1177/2150135119830006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Resource constraints in many sub-Saharan African countries undermine efforts to provide the full spectrum of pediatric cardiology and cardiac surgery. Palliation of the child born with functionally single ventricle is the lowest priority for policymakers when viewed from the perspective of cost-effectiveness. This commentary focuses on the relative importance of different criteria that policymakers and the general public consider important in setting health-care priorities as it relates to palliation of the patient with functionally single ventricle in sub-Saharan Africa. It argues the position that cost-effectiveness analysis tends to exclude those with high cost-to-treat illness, and decisions made on that basis alone are not acceptable to the general population on whose behalf those decisions are made.
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Affiliation(s)
- Frank Edwin
- 1 Department of Surgery, University of Health and Allied Sciences, Ho, Ghana.,2 National Cardiothoracic Centre, Korle Bu Teaching Hospital, Accra, Ghana
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Manuel V, Morais H, Turquetto ALR, Miguel G, Miana LA, Pedro A, Nunes MAS, Leon G, Magalhães MP, Martins T, Júnior APF. Single Ventricle Palliation in a Developing Sub-Saharan African Country: What Should be Improved? World J Pediatr Congenit Heart Surg 2019; 10:164-170. [DOI: 10.1177/2150135118822671] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Single ventricle physiology management is challenging, especially in low-income countries. Objective: To report the palliation outcomes of single ventricle patients in a developing African country. Methods: We retrospectively studied 83 consecutive patients subjected to single ventricle palliation in a single center between March 2011 and December 2017. Preoperative data, surgical factors, postoperative results, and survival outcomes were analyzed. The patients were divided by palliation stage: I (pulmonary artery banding [PAB] or Blalock–Taussig shunt [BTS]), II (Glenn procedure), or III (Fontan procedure). Results: Of the 83 patients who underwent palliation (stages I-III), 38 deaths were observed (31 after stage I, six after stage II, and one after stage III) for an overall mortality of 45.7%. The main causes of operative mortality were multiple organ dysfunction due to sepsis, shunt occlusion, and cardiogenic shock. Twenty-eight survivors were lost to follow-up (22 after stage I, six after stage II). Thirteen stage II survivors are still waiting for stage III. The mean follow-up was 366 ± 369 days. Five-year survival was 28.4 % for PAB and 30.1% for BTS, while that for stage II and III was 49.8% and 57.1%, respectively. Age (hazard ratio, 0.61; 95% confidence interval: 0.47-0.7; P = .000) and weight at surgery (hazard ratio, 0.45; 95% confidence interval: 0.31-0.64; P = .002) impacted survival. Conclusion: A high-mortality rate was observed in this initial experience, mainly in stage I patients. A large number of patients were lost to follow-up. A task force to improve outcomes is urgently required.
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Affiliation(s)
- Valdano Manuel
- Cardio-Thoracic Center, Clínica Girassol, Luanda, Angola
- Division of Cardiovascular Surgery, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Humberto Morais
- Cardiology Department, Hospital Militar Principal/Instituto Superior, Luanda, Angola
| | - Aida L. R. Turquetto
- Division of Cardiovascular Surgery, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Gade Miguel
- Cardio-Thoracic Center, Clínica Girassol, Luanda, Angola
| | - Leonardo A. Miana
- Division of Cardiovascular Surgery, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Albino Pedro
- Cardio-Thoracic Center, Clínica Girassol, Luanda, Angola
- Pediatric Cardiology Department, Cardiac Surgery Department, Portuguese Red Cross Hospital, Lisbon, Portugal
| | - Maria A. S. Nunes
- Cardio-Thoracic Center, Clínica Girassol, Luanda, Angola
- Pediatric Cardiology Department, Cardiac Surgery Department, Portuguese Red Cross Hospital, Lisbon, Portugal
| | - Gilberto Leon
- Cardio-Thoracic Center, Clínica Girassol, Luanda, Angola
| | - Manuel Pedro Magalhães
- Cardio-Thoracic Center, Clínica Girassol, Luanda, Angola
- Pediatric Cardiology Department, Cardiac Surgery Department, Portuguese Red Cross Hospital, Lisbon, Portugal
| | - Telmo Martins
- Cardio-Thoracic Center, Clínica Girassol, Luanda, Angola
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Thomford NE, Dzobo K, Yao NA, Chimusa E, Evans J, Okai E, Kruszka P, Muenke M, Awandare G, Wonkam A, Dandara C. Genomics and Epigenomics of Congenital Heart Defects: Expert Review and Lessons Learned in Africa. OMICS : A JOURNAL OF INTEGRATIVE BIOLOGY 2018; 22:301-321. [PMID: 29762087 PMCID: PMC6016577 DOI: 10.1089/omi.2018.0033] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Congenital heart defects (CHD) are structural malformations found at birth with a prevalence of 1%. The clinical trajectory of CHD is highly variable and thus in need of robust diagnostics and therapeutics. Major surgical interventions are often required for most CHDs. In Africa, despite advances in life sciences infrastructure and improving education of medical scholars, the limited clinical data suggest that CHD detection and correction are still not at par with the rest of the world. But the toll and genetics of CHDs in Africa has seldom been systematically investigated. We present an expert review on CHD with lessons learned on Africa. We found variable CHD phenotype prevalence in Africa across countries and populations. There are important gaps and paucity in genomic studies of CHD in African populations. Among the available genomic studies, the key findings in Africa were variants in GATA4 (P193H), MTHFR 677TT, and MTHFR 1298CC that were associated with atrial septal defect, ventricular septal defect (VSD), Tetralogy of Fallot (TOF), and patent ductus arteriosus phenotypes and 22q.11 deletion, which is associated with TOF. There were no data on epigenomic association of CHD in Africa, however, other studies have shown an altered expression of miR-421 and miR-1233-3p to be associated with TOF and hypermethylation of CpG islands in the promoter of SCO2 gene also been associated with TOF and VSD in children with non-syndromic CHD. These findings signal the urgent need to develop and implement genetic and genomic research on CHD to identify the hereditary and genome-environment interactions contributing to CHD. These projected studies would also offer comparisons on CHD pathophysiology between African and other populations worldwide. Genomic research on CHD in Africa should be developed in parallel with next generation technology policy research and responsible innovation frameworks that examine the social and political factors that shape the emergence and societal embedding of new technologies.
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Affiliation(s)
- Nicholas Ekow Thomford
- 1 Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, Institute for Infectious Disease and Molecular Medicine, University of Cape Town , Cape Town, South Africa
- 2 School of Medical Sciences, University of Cape Coast , Cape Coast, Ghana
| | - Kevin Dzobo
- 3 ICGEB, Cape Town Component, University of Cape Town , Cape Town, South Africa
- 4 Division of Medical Biochemistry, IIDMM, Department of IBM, Faculty of Health Sciences, University of Cape Town , Cape Town, South Africa
| | - Nana Akyaa Yao
- 5 National Cardiothoracic Centre, Korle Bu Teaching Hospital , Accra, Ghana
- 6 University of Ghana Medical School, University of Ghana , Accra, Ghana
| | - Emile Chimusa
- 1 Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, Institute for Infectious Disease and Molecular Medicine, University of Cape Town , Cape Town, South Africa
| | - Jonathan Evans
- 1 Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, Institute for Infectious Disease and Molecular Medicine, University of Cape Town , Cape Town, South Africa
| | - Emmanuel Okai
- 2 School of Medical Sciences, University of Cape Coast , Cape Coast, Ghana
- 7 Cape Coast Teaching Hospital , Cape Coast, Ghana
| | - Paul Kruszka
- 8 National Human Genome Research Institute, Medical Genetics Branch, National Institutes of Health , Bethesda, Maryland, USA
| | - Maximilian Muenke
- 8 National Human Genome Research Institute, Medical Genetics Branch, National Institutes of Health , Bethesda, Maryland, USA
| | - Gordon Awandare
- 9 Department of Biochemistry, WACCBIP, University of Ghana , Legon, Accra, Ghana
| | - Ambroise Wonkam
- 1 Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, Institute for Infectious Disease and Molecular Medicine, University of Cape Town , Cape Town, South Africa
| | - Collet Dandara
- 1 Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, Institute for Infectious Disease and Molecular Medicine, University of Cape Town , Cape Town, South Africa
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