పీడియాట్రిక్ న్యూరాలజీ అండ్ మెడిసిన్ జర్నల్

Challenges of Surgical Management of Childhood Cardiac Diseases in Sub-Saharan Africa, Experience of a Pediatric Cardiology Unit in Yaounde, Cameroon

Abstract

Chelo David

Background: Unlike Western countries, Africa is marked by a very high infant-juvenile mortality rate. The main causes of these deaths were previously infectious diseases and malnutrition. The early 21st century is marked by an epidemiological transition, highlighting non-communicable diseases amongst which children’s heart diseases. This raises another problem: the management of patients, including surgical treatment. We publish here the experience of our center showing the difficulties of surgical management.

Method: A retrospective and descriptive study was carried out on children younger than 16, diagnosed with cardiac condition between January 1st 2006 to June 30th 2015, at the Mother and Child Centre of the Chantal Biya Foundation in Yaounde. We collected data on socio-demographic background, the types of heart disease, clinical and therapeutical characteristics from registers, patient’s files as well as the electronic database of echocardiographic records.

Results: Out of 17280 patients consulting in our cardiac unit during the study period, 1761 (%) were diagnosed of cardiopathies. Patients were generally from poor settings. Congenital cardiopathies (cardiac diseases) concerned 1315 (74.7%) patients with ventricular septal defect as the main type, 439 (24.9%) patients suffered from acquired cardiopathies, rheumatic valvulopathies been the main figure. Both congenital and acquired cardiopathies were associated in 7 (0.4%) children. An indication for surgery was given in 1019 patients. Only 72 (7.1%) could effectively benefit from surgery. The procedure took place abroad for 46 (63.9%) patients and locally for the 26 (36.1%) others. 2/3 (76%) of management fees were paid by occidental nongovernmental organisations, 21% by families, 3% by insurances and no case by the government.

Conclusion: The treatment, especially surgery in heart diseases of children is a challenge in Africa’s poverty context. However, better organization of the health financing system could help to find a partial solution.