African Annals of
Thoracic and Cardiovascular Surgery

OFFICIAL PUBLICATION OF THE AFRICAN ASSOCIATION OF THORACIC AND CARDIO-VASCULAR SURGEONS
  • Abbreviation: Afr. Ann. Thorac. Cardiovasc. Surg.
  • Language: English
  • ISSN: 1994-7461
  • DOI: 10.5897/AATCVS
  • Start Year: 2005
  • Published Articles: 69

Review

Current status of the pediatric congenital heart disease management pathway in low and low-middle income countries: A review

Mark Nelson Awori
  • Mark Nelson Awori
  • Department of Surgery, School of Medicine, University of Nairobi, P.O. Box 19676-00202, Nairobi, Kenya.
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Daniel Ojuka
  • Daniel Ojuka
  • Department of Surgery, School of Medicine, University of Nairobi, P.O. Box 19676-00202, Nairobi, Kenya.
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Diana Marangu
  • Diana Marangu
  • Department of Paediatrics and Child health, School of Medicine, University of Nairobi, P.O. Box 19676-00202, Nairobi, Kenya.
  • Google Scholar
Paul Bannon
  • Paul Bannon
  • Department of Cardiothoracic Surgery, University of Sydney, NSW 2006, Australia.
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  •  Received: 23 April 2023
  •  Accepted: 17 July 2023
  •  Published: 30 September 2023

Abstract

There is evidence that children with congenital heart disease (CHD) in low and low-middle income countries (LMICs) do not have access to timely intervention. The concept of the ‘Management Pathway’ (MP) for CHD has been developed to facilitate a pragmatic assessment of the quality of care. The MP is comprised three phases: diagnosis, treatment (intervention) and follow-up. Best practice recommendations regarding how each phase should be executed have been published. The fundamental tenets of these recommendations can be summarised as follows: timely diagnosis, timely treatment and robust follow-up. We aimed to examine the status of the MP in LMICs. Google Scholar and PUBMED were searched between January 1st 1966 and August 31st 2022. Twenty-nine articles, representing 43,082 patients were included: sixteen (55.2%) were from Asia; eight (27.6%) were from Africa; three (10.3%) were regional and two (6.9%) were from the Middle East. Twelve (41.4%) studies examined two phases of the MP: eleven examined diagnosis and treatment; one examined treatment and follow-up. Eight (27.6%) studies did not examine the MP at all and only one (3.4%) examined all three phases of the MP. The majority of studies found that MP phases had not been executed as recommended. No study found that all the three phases of the MP had been executed as recommended. Most papers revealed that best practice goals for the MP were not achieved; it is likely that most children with CHD in LMICs do not receive optimal surgical intervention.

Key words: Congenital heart, disease, treatment, low, middle income, countries.