THE UNMET NEED FOR PAEDIATRIC AND CONGENITAL HEART SERVICES IN ACCRA Kow Entsua-Mensah 1*, Rada Bulley 1, Alfred Doku 1, Martin Adu-Adadey 1, Desrie Delsol-Gyan 1 and Frank Edwin 1. 1 National Cardiothoracic Centre, P. O. Box KB 846,Korle- Bu, Accra, Ghana. 1*Author / Presenter

BACKGROUND  Approximately 90% of more than 1,000,000 children who are born with congenital heart disease (CHD) around the world receive suboptimal care or have no access to care.  Approximately 50% of these children will die during their first 5 years of life before they receive any proper treatment.  In Ghana the magnitude of this problem has not been estimated. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu.2010;13(1): doi: /j.pcsu Improving pediatric cardiac surgical care in developing countries: matching resources to needs.Dearani JA, Neirotti R, Kohnke EJ, Sinha KK, Cabalka AK, Barnes RD, Jacobs JP, Stellin G, Tchervenkov CI, Cushing JC.

METHODS  Retrospective search of the echocardiogram database from January 2006 to December  All patients less than 15 years diagnosed with a congenital heart disease, CHD, for the first time were selected and entered into the study.

RESULTS  4,823 new echocardiograms were performed  4,396 (91.2 %) met the inclusion criteria.  CHD: 60.3% of the enrolled patients.  2,175 (49.5%) were male whilst 2,221 (50.5%) were female  Male to female ratio of approx. 1:1.

TRIMODAL AGE DISTRIBUTION OF CHDS IN ACCRA

FIVE YEAR TREND IN NEW CASES SEEN IN ACCRA

Incidence of Acyanotic congenital heart disease Acyanotic N% Ventricular Septal Defect Atrial Septal Defect Patent Ductus Arteriosus Pulmonary Stenosis Mitral valve prolapse Atrioventricular canal defects472.3 Tricuspid valve regurgitation291.4 Aortic Stenosis221.1 TOTAL2,052100

Cyanotic N% Tetralogy of Fallot Double Outlet Ventricle498.4 Truncus Arteriosus356.0 TGA244.1 Single Atrium152.6 Single Ventricle152.6 Ebstein’s Anomaly40.7 Tricuspid valve Atresia20.3 Pulmonary valve Atresia20.3 TOTAL Incidence of Cyanotic congenital heart disease

FIVE COMMONEST CHDs IN ACCRA

SURGERY RATE AMONG PATIENTS WITH ASD, VSD, PDA AND TOF YearsASDVSDPDATOF NOp% Op NOp% OpNOp% OpNOp% Op Total

INCIDENCE VRS OPERATED FRACTION YearNOperated% Operated Total

DECLINE IN OPERATED FRACTION

DISCUSSION  The vision of the World Society for Pediatric and Congenital Heart Surgery is that every child born anywhere in the world with a CHD should have access to appropriate medical and surgical care.  Children in Ghana / Africa should be no exception to this vision. The improvement of care for paediatric and congenital cardiac disease across the World: a challenge for the World Society for Pediatric and Congenital Heart Surgery. Cardiol Young Dec;18 Suppl 2:63-9. doi: /S

CHD BURDEN IN GHANA  Global incidence of CHD of 0.8% [1] of live births  Estimated population 24 million  Using CBR(31.07 per 1,000 people and IMR(40.9 deaths/1,000 live births) Ghana’s CHD burden may be obtained using the formula:  Population x (CBR–IMR) x = number of new children born with CHD. Estimated CHD burden 5,800 per annum Jonas RA. Congenital heart surgery in developing countries. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2008:3-6. Sandoval N, Kreutzer C, Jatene M, Di Sessa T, Novick W, Jacobs JP, Pierre-Luc Bernier P-L, Tchervenkov CI. Pediatric Cardiovascular Surgery in South America : Current Status and Regional Differences. WJPCHS 2010; 1:

ONE PROBLEM  Our inability to comprehensively treat all the CHDs we diagnose

WHAT IS THE BARRIER TO ACCESSIBILITY  FINANCES!!

WHAT NEEDS TO BE DONE  Charities and foundations  Corporate organisations  NHIS  Special government budgetary allocation  Heart insurance  Private individuals

THANK YOU FOR YOUR ATTENTION