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

  • Fenny F. Shidhika (a1) (a2), Christopher T. Hugo-Hamman (a1) (a2) (a3), John B. Lawrenson (a2) (a4), Henning J. Du Toit (a1), Susan M. Vosloo (a3), Andre Brooks (a3) (a5), Harold S. Pribut (a3), Susan R. Perkins (a2) and Liesl J. Zühlke (a2) (a6)...

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.

Copyright

Corresponding author

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: liesl.zuhlke@uct.ac.za

Footnotes

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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

Footnotes

References

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