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The Namibian Children’s Heart Project: a South–South partnership to provide cardiac care

Published online by Cambridge University Press:  20 February 2019

Fenny F. Shidhika ,
Christopher T. Hugo-Hamman ,
John B. Lawrenson ,
Henning J. Du Toit ,
Susan M. Vosloo ,
Andre Brooks ,
Harold S. Pribut ,
Susan R. Perkins  and
Liesl J. Zühlke Open the ORCID record for Liesl J. Zühlke [Opens in a new window]
Fenny F. Shidhika
Affiliation:
Windhoek Central Hospital, Ministry of Health and Social Services, Windhoek, Namibia Division of Paediatric Cardiology, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
Christopher T. Hugo-Hamman
Affiliation:
Windhoek Central Hospital, Ministry of Health and Social Services, Windhoek, Namibia Division of Paediatric Cardiology, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa Christiaan Barnard Memorial Hospital, Cape Town, South Africa
John B. Lawrenson
Affiliation:
Division of Paediatric Cardiology, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa Department of Paediatrics, Child Health Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
Henning J. Du Toit
Affiliation:
Windhoek Central Hospital, Ministry of Health and Social Services, Windhoek, Namibia
Susan M. Vosloo
Affiliation:
Christiaan Barnard Memorial Hospital, Cape Town, South Africa
Andre Brooks
Affiliation:
Christiaan Barnard Memorial Hospital, Cape Town, South Africa Chris Barnard Division of Cardiac Surgery, University of Cape Town, Cape Town, South Africa
Harold S. Pribut
Affiliation:
Christiaan Barnard Memorial Hospital, Cape Town, South Africa
Susan R. Perkins
Affiliation:
Division of Paediatric Cardiology, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
Liesl J. Zühlke*
Affiliation:
Division of Paediatric Cardiology, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa Division of Cardiology, Groote Schuur Hospital,University of Cape Town, Cape Town, South Africa
*
Author for correspondence: Associate Professor L. Zühlke, 2.17 Institute of Child Health, Red Cross War Memorial Children’s Hospital, Klipfontein Road, Rondebosch, Cape Town 7700, South Africa. Tel: +27216502373; E-mail: [email protected]
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Abstract

Introduction

Congenital and acquired heart diseases are highly prevalent in developing countries despite limited specialised care. Namibia established a paediatric cardiac service in 2009 with significant human resource and infrastructural constraints. Therefore, patients are referred for cardiac interventions to South Africa.

Objectives

To describe the diagnoses, clinical characteristics, interventions, post-operative morbidity and mortality, and follow-up of patients referred for care.

Methods

Demographics, diagnoses, interventions, intra- and post-operative morbidity and mortality, as well as longitudinal follow-up data of all patients referred to South Africa, were recorded and analysed.

Results

The total cohort constituted 193 patients of which 179 (93%) had CHD and 7% acquired heart disease. The majority of patients (78.8%) travelled more than 400 km to Windhoek before transfer. There were 28 percutaneous interventions. Palliative and definitive surgery was performed in 27 and 129 patients, respectively. Out of 156 patients, 80 (51.3%) had post-operative complications, of which 15 (9.6%) were a direct complication of surgery. Surgical mortality was 8/156 (5.1%, 95% confidence interval 2.2–9.8), with a 30-day mortality of 3.2%. Prolonged ICU stay was associated with a 5% increased risk of death with hazard ratio 1.05, 95% confidence interval 1.02–1.08, p=0.001. Follow-up was complete in 151 (78%) patients for more than 7 years.

Conclusions

Despite the challenges associated with a cardiac programme for referring patients seeking intervention in a neighbouring country and the adverse characteristics of multiple lesions and complexity associated with late presentation, we report good surgical and interventional outcomes. Our goal remains to develop a comprehensive sustainable cardiac service in Namibia.

Keywords

CHDNamibiaPublic–private partnershipssurgical outreachsustainable cardiac service
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 2 , February 2019 , pp. 206 - 213
Copyright
© Cambridge University Press 2019 

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Footnotes

Cite this article: Shidhika FF, Hugo-Hamman, CT, Lawrenson JB, Du Toit HJ, Vosloo SM, Brooks A, Pribut HS, Perkins SR, Zühlke LJ. (2019) The Namibian Children’s Heart Project: a South–South partnership to provide cardiac care. Cardiology in the Young29: 206–213. doi: 10.1017/S1047951118002172

References

1. Hoffman, JI, Kaplan, S. The incidence of congenital heart disease. J Am Coll Cardiol 2002; 39: 1890–1900.Google Scholar
2. Hoffman, JI, Kaplan, S, Liberthson, RR. Prevalence of congenital heart disease. Am Heart J 2004; 147: 425–439.Google Scholar
3. Carapetis, JR, Steer, AC, Mulholland, EK, Weber, M. The global burden of group A streptococcal diseases. Lancet Infect Dis 2005; 5: 685–694.Google Scholar
4. Zühlke, L, Mirabel, M, Marijon, E. Congenital heart disease and rheumatic heart disease in Africa: recent advances and current priorities. Heart 2013; 99: 1554–1561.Google Scholar
5. The State of the World’s Children 2017. Statistical Tables by UNICEF Data: Monitoring the Situation of Children and Women, 2017. Retrieved May 10, 2018, from https://data.unicef.org/resources/state-worlds-children-2017-statistical-tables/.Google Scholar
6. The World Bank Data: Namibia. , 2017. Retrieved March 10, 2018, from https://data.worldbank.org/country/Namibia.Google Scholar
7. van der Velde, ET, Vriend, JW, Mannens, MM, Uiterwaal, CS, Brand, R, Mulder, BJ. CONCOR, an initiative towards a national registry and DNA-bank of patients with congenital heart disease in the Netherlands: rationale, design, and first results. Eur J Epidemiol 2005; 20: 549–557.Google Scholar
8. International Statistical Classification of Diseases and Related Health Problems 10th Revision. World Health Organization, 2016. Retrieved May 10, 2018, from http://apps.who.int/classifications/icd10/browse/2016/en.Google Scholar
9. Jenkins, KJ. Risk adjustment for congenital heart surgery: the RACHS-1 method. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2004; 7: 180–184.Google Scholar
10. Kang, N, Cole, T, Tsang, V, Elliott, M, de Leval, M. Risk stratification in paediatric open-heart surgery. Eur J Cardiothorac Surg 2004; 26: 3–11.Google Scholar
11. Franklin, RCG, Beland, MJ, Colan, SD, et al. Nomenclature for congenital and paediatric cardiac disease: the International Paediatric and Congenital Cardiac Code (IPCCC) and the Eleventh Iteration of the International Classification of Diseases (ICD-11). Cardiol Young 2017; 27: 1872–1938.Google Scholar
12. Wren, C. The epidemiology of cardiovascular malformations. In: Moller JH, Hoffman JIE, Benson DW, van Hare GF, Wren C, (eds.) Pediatric Cardiovascular Medicine. Wiley-Blackwell, Oxford, England, 2012: 268–275.Google Scholar
13. Malviya, S, Voepel-Lewis, T, Siewert, M, et al. Risk factors for adverse postoperative outcomes in children presenting for cardiac surgery with upper respiratory tract infections. Anesthesiology 2003; 98: 628–632.Google Scholar
14. Zühlke, L, Engel, ME, Karthikeyan, G, et al. Characteristics, complications, and gaps in evidence-based interventions in rheumatic heart disease: the Global Rheumatic Heart Disease Registry (the REMEDY study). Eur Heart J 2015; 36: 1115–22a.Google Scholar
15. Zühlke, L, Karthikeyan, G, Engel, ME, et al. Clinical outcomes in 3343 children and adults with rheumatic heart disease from 14 low- and middle-income countries: 2-year follow-up of the Global Rheumatic Heart Disease Registry (the REMEDY study). Circulation 2016; 134: 1456–1466.Google Scholar
16. Tangeni Auala, NA, Henning du Toit, J, Nghaamwa, CH-H. Surgery for rheumatic heart disease a 5-year (2010–2015) review from Namibia. Cardiol Young 2017; 27: P1373.Google Scholar
17. Jenkins, KJ, Castaneda, AR, Cherian, KM, et al. Reducing mortality and infections after congenital heart surgery in the developing world. Pediatrics 2014; 134: e1422–1430.Google Scholar
18. Nguyen, N, Leon-Wyss, J, Iyer, KS, Pezzella, AT. Paediatric cardiac surgery in low-income and middle-income countries: a continuing challenge. Arch Dis Child 2015; 100: 1156–1159.Google Scholar
19. Khan, A, Abdullah, A, Ahmad, H, et al. Impact of international quality improvement collaborative on congenital heart surgery in Pakistan. Heart 2017; 103: 1680–1686.Google Scholar
20. Yacoub, M, Hosny, H, Afifi, A. Improving postoperative outcome of congenital heart surgery in low/middle-income countries: climbing mount excellence. Heart 2017; 103: 1658–1659.Google Scholar
21. Damasceno, A, Mayosi, BM, Sani, M, et al. The causes, treatment, and outcome of acute heart failure in 1006 Africans from 9 countries: results of the sub-Saharan Africa survey of heart failure. Arch Intern Med 2012; 172: 1386–1394.Google Scholar
22. Hoffman, J. The global burden of congenital heart disease. Cardiovasc J Afr 2013; 24: 141–145.Google Scholar
23. Namibia Humanitarian Situation Report: January–June 2017. Report by UNICEF, 2017. Retrieved July 3, 2018, from https://www.unicef.org/appeals/files/UNICEF_Namibia_Humanitarian_Situation_Report_June_2017.pdf.Google Scholar
24. Hoosen, EGM, Cilliers, AM, Hugo-Hamman, CT, et al. Audit of paediatric cardiac services in South Africa. SA Heart 2010; 7: 4–9.Google Scholar
25. A Case for the Invisible Child: Childhood Heart Disease and the Global Health Agenda. Brief 1 by Children’s HeartLink 2015. Retrieved July 3, 2018, from https://childrensheartlink.org/wp-content/uploads/2017/06/The-Invisible-Child-Brief-1.pdf.Google Scholar
26. Zheleva, B, Atwood, JB. The invisible child: childhood heart disease in global health. Lancet 2017; 389: 16–18.Google Scholar
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