“We estimate about one in 1,000 babies are born with congenital heart disease in South Africa,” states Dr Krubin Naidoo, a cardiothoracic surgeon at the Nelson Mandela Children’s Hospital in Johannesburg.
He tells Health-e News that only about a quarter of these patients receive the treatment they should be getting because the demand for these services exceeds the available skills.
Based on demographic studies, about 4,500 children should be operated on annually in South Africa for congenital heart lesions. However, less than 40% of children with congenital heart disease are receiving proper care.
This discrepancy, according to the audit of paediatric cardiac services in South Africa, may be due to service deficiencies at multiple levels: the diagnosis of congenital heart disease, particularly in newborns and infants, is being missed; paediatric and paediatric cardiac services to evaluate these patients are overwhelmed, and congenital heart surgical services are insufficient and unable to cope with the long waiting lists.
In addition to these deficiencies, Professor John Lawrenson, the Head of Paediatric Cardiology Service of the Western Cape Red Cross Children’s Hospital and Tygerberg Hospital, says other causes for the backlogs were the lack of operating time for children and ICU space because children compete with adults for surgical slots in most centres.
He says most simple, yet serious, defects can be picked up during an antenatal scan at 18-20 weeks, but there were not enough trained ultrasound practitioners in the country.
“Antenatal care needs many other improvements before ultrasound becomes routine,” he adds.
In Cape Town alone, there is a backlog of about six months, which is about 100 to 150 patients. “In Cape Town, we try to get six to seven patients operated on every week. We carefully choose which patients and their families are likely to have the best outcome,” Lawrenson explains.
Public health shortfalls
Serious deficiencies exist with the paediatric cardiac services offered in the country, particularly by the public health services.
For Naidoo, the primary concerns are that the public health care infrastructure to detect cardiac conditions in children is not in place and many children with these conditions are being overlooked.
“Patients with these problems don’t come to our attention very easily because they often need specialist referrals to be detected,” Naidoo explains.
Many of these children – and often newborns – are misdiagnosed.
“Unfortunately, without the proper treatment some of them will die,” Naidoo says, adding that if treated properly, 85% of them can return to the community as well-functioning children.
Twelve paediatric cardiologists are available in South Africa, serving a medical aid population of about 5-million as well as a small number of patients from elsewhere in Africa.
The country’s ratio of paediatric cardiologists to patients is ideal. According to international recommendations, it exceeds many developed countries. However, the situation within the public sector is very different, with an overall paediatric cardiologists/population ratio of one to 4,5-million people. In some units, such as those in Pretoria and Durban, the ratio is one to 10-million people.
In the public sector, only five major centres offer comprehensive paediatric cardiac services, namely:
- Johannesburg: Chris Hani Baragwanath, Charlotte Maxeke and Rahima Moosa;
- Pretoria: Steve Biko Academic Hospital;
- Bloemfontein: Universitas Academic Hospital;
- Durban: Inkosi Albert Luthuli Central Hospital; and
- Cape Town: Red Cross Children’s Hospital and Tygerberg Hospital.
With only a handful of hospitals providing paediatric cardiac services in South Africa, most children with cardiac diseases don’t receive the care they need. According to the audit of paediatric cardiac services in South Africa, the lack of resources should be addressed urgently to meet the needs of this vulnerable group.
In Gauteng, the Department of Health has a working partnership with the Nelson Mandela Children’s Hospital, which assists in performing surgeries that are funded by the Boikanyo Foundation.
Since November 2018, the foundation has partnered with the hospital to help with critical surgeries to children with congenital and acquired heart defects. So far, more than 30 open-heart surgeries have been funded as part of this initiative.
Dr Porai Moshesh, the Paediatric Intensivist at Nelson Mandela Children’s Hospitals, says: “If we were only to rely on the hospital budget, we will not be able to [treat] as many children as we do now.”
The hospital has started getting more referrals from outside the province. “We are trying to accommodate both elective and emergency cases,” Moshesh says. – Health-e News
An edited version of this story was published by The Star.