Skip to main content Accessibility help

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)...



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.


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


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.


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.


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.


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:


Hide All

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



Hide All
1. Hoffman, JI, Kaplan, S. The incidence of congenital heart disease. J Am Coll Cardiol 2002; 39: 18901900.
2. Hoffman, JI, Kaplan, S, Liberthson, RR. Prevalence of congenital heart disease. Am Heart J 2004; 147: 425439.
3. Carapetis, JR, Steer, AC, Mulholland, EK, Weber, M. The global burden of group A streptococcal diseases. Lancet Infect Dis 2005; 5: 685694.
4. Zühlke, L, Mirabel, M, Marijon, E. Congenital heart disease and rheumatic heart disease in Africa: recent advances and current priorities. Heart 2013; 99: 15541561.
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
6. The World Bank Data: Namibia. , 2017. Retrieved March 10, 2018, from
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: 549557.
8. International Statistical Classification of Diseases and Related Health Problems 10th Revision. World Health Organization, 2016. Retrieved May 10, 2018, from
9. Jenkins, KJ. Risk adjustment for congenital heart surgery: the RACHS-1 method. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2004; 7: 180184.
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: 311.
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: 18721938.
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: 268275.
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: 628632.
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: 111522a.
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: 14561466.
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.
17. Jenkins, KJ, Castaneda, AR, Cherian, KM, et al. Reducing mortality and infections after congenital heart surgery in the developing world. Pediatrics 2014; 134: e14221430.
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: 11561159.
19. Khan, A, Abdullah, A, Ahmad, H, et al. Impact of international quality improvement collaborative on congenital heart surgery in Pakistan. Heart 2017; 103: 16801686.
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: 16581659.
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: 13861394.
22. Hoffman, J. The global burden of congenital heart disease. Cardiovasc J Afr 2013; 24: 141145.
23. Namibia Humanitarian Situation Report: January–June 2017. Report by UNICEF, 2017. Retrieved July 3, 2018, from
24. Hoosen, EGM, Cilliers, AM, Hugo-Hamman, CT, et al. Audit of paediatric cardiac services in South Africa. SA Heart 2010; 7: 49.
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
26. Zheleva, B, Atwood, JB. The invisible child: childhood heart disease in global health. Lancet 2017; 389: 1618.


Type Description Title
Supplementary materials

Shidhika et al. supplementary material
Shidhika et al. supplementary material 1

 Word (33 KB)
33 KB


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed