About CHD
C
ongenital Heart Disease (CHD) is an enormous problem in Low-Middle-Income Countries and particularly in sub-Saharan Africa. There are an estimated 500,000 children born in Africa with CHD each year with a major proportion of this in sub-Saharan Africa. The vast majority of these children receive sub-optimal or no care at all.
The Global Burden of Disease Study estimated that 80% of deaths from non-communicable diseases, including CHD, now occur in LMICs (Low-to-Middle-Income Countries). Additionally, the World Health Organization (WHO) estimates that 1% of live births have CHD accounting for 1.5 million per year.
There have been estimates by the WHO to suggest that 90% of these children have suboptimal or no access to care at all with most of these children concentrated in LMICs, particularly sub-Saharan Africa.
What you should know about Congenital Heart Disease (CHD)
There is much to be said and many studies available about the incidences of CHD in children in Africa and throughout the world. These reports however generally only deal in raw fact and do not look at the emotional and social burden that infant disability and death places on the families and their communities.
The biggest sadness is that 85% of these mortalities could be prevented if the funding were available to help these little babies, most of which are under 1 year old.
Congenital Heart Disease is a large, rapidly emerging global problem in child health. Without the ability to substantially alter the prevalence of congenital heart disease, interventions and resources must be used to improve survival and quality of life, but who funds these interventions?
The incidence of congenital heart disease (CHD) ranges from 19 to 75 per 1,000 births. It is also the leading cause of birth defects and the second leading cause of death in the first year of life after infectious diseases.
A significant number of South African children, however, die from conditions that can be successfully managed only at specialised centres. An estimated 11 000 are born annually in South Africa with this condition.
Each year approximately 4 500 of this total require surgical intervention. With appropriate care, the prognosis for most of these children is excellent, with at least 85% expected to survive to adulthood.
South Africa has been steadily falling behind internationally accepted levels of care for children with congenital and acquired heart disease.
In 2006, approximately 1 300 patients were operated on for CHD in South Africa, only 800 of them in the public service hospitals, which serve close to 85% of the population.
This means that less than 25% of the children in South Africa with CHD who rely on the public health services receive the care they need. Every year over 3 000 children die or remain disabled from their congenital heart condition.
COSTS RELATED TO CHD
The estimated cost of one paediatric open-heart surgery is:
R250 000
Health Care Considerations
Factors that impact healthcare delivery include affordability, access, and awareness. All three of these elements must exist for successful healthcare delivery. In CHD, particularly in sub-Saharan Africa, each of these three factors contributes to numerous children being unable to obtain appropriate care.
Affordability
Without governmental (or humanitarian) support, the treatment of CHD is unaffordable for the vast majority of the population in sub-Saharan Africa. The costs are prohibitive even though the treatment can sometimes be curative or often have a strikingly positive impact on the individual’s clinical status. The current setup, particularly in East Africa, is self-funding for the vast majority of patients with CHD.
Those who cannot afford the treatment will either accept their fate or attempt to raise some money, often with the help of their families or local village communities. However, the money raised frequently falls short or is too late. In the rare instance where they are able to pay for treatment, the financial impact to the family and their village is considerable, not only in their existing state of affairs, but also for their future planning.
Public hospitals (where the care is free or for a nominal cost) attempt to bridge the cost of the care, but are congested and overwhelmed.
Around 20% of children with congenital heart disease also have a genetic disorder like Down syndrome, trisomy 18 or CHARGE syndrome.
Types of heart defects
There are many different types of congenital heart defects, falling mainly into these categories:
- Holes in the heart. Holes can form in the walls between heart chambers or between major blood vessels leaving the heart. In certain situations, these holes allow oxygen-poor blood to mix with oxygen-rich blood, resulting in less oxygen being carried to your child’s body.
- Obstructed blood flow. When blood vessels or heart valves are narrow because of a heart defect, the heart must work harder to pump blood through them. Eventually, this leads to enlarging of the heart and thickening of the heart muscle. Examples of this type of defect are pulmonary stenosis or aortic stenosis.
- Abnormal blood vessels. Several congenital heart defects happen when blood vessels going to and from the heart don’t form correctly, or they’re not positioned the way they’re supposed to be.A defect called transposition of the great arteries occurs when the pulmonary artery and the aorta are on the wrong sides of the heart.
A condition called coarctation of the aorta happens when the main blood vessel supplying blood to the body is too narrow. Total anomalous pulmonary venous connection is a defect that occurs when blood vessels from the lungs attach to wrong area of the heart.
- Heart valve abnormalities. If the heart valves can’t open and close correctly, blood can’t flow smoothly.One example of this type of defect is called Ebstein’s anomaly. In Ebstein’s anomaly, the tricuspid valve — which is located between the right atrium and the right ventricle — is malformed and often leaks.
- An underdeveloped heart. Sometimes, a major portion of the heart fails to develop properly. For example, in hypoplastic left heart syndrome, the left side of the heart hasn’t developed enough to effectively pump enough blood to the body.
- A combination of defects. Some infants are born with several heart defects. Tetralogy of Fallot is a combination of four defects: a hole in the wall between the heart’s ventricles, a narrowed passage between the right ventricle and pulmonary artery, a shift in the connection of the aorta to the heart, and thickened muscle in the right ventricle.
OUR
BENEFICIARIES
All donations we collect get allocated to the great initiatives run by our worthy beneficiaries:
- The Red Cross War Memorial Children’s Hospital
- Weekend Waiting List Project
- The Christiaan Barnard Division of Cardiothoracic Surgery
- 1000 Hearts initiative
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