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.