Recommendations for developing effective and safe paediatric and congenital heart disease services in low-income and middle-income countries: a public health framework

Babar S. Hasan, Division of Cardiothoracic Sciences, Sindh Institute of Urology and Transplantation, Karachi, Pakistan drbabarhasan@yahoo.com.
Areesh Bhatti, Medical College, The Aga Khan University, Karachi, Sindh, Pakistan.
Shazia Mohsin, Division of Cardiothoracic Sciences, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
Paul Barach, Department of Public Health and Anesthesiology, Thomas Jefferson School of Medicine, Philadelphia, Pennsylvania, USA.
Eltayeb Ahmed, Bristol Royal Infirmary, Bristol, UK.
Sulafa Ali, Department of Pediatrics and Child Health, University of Khartoum, Khartoum, Sudan.
Muneer Amanullah, Division of Cardiothoracic Sciences, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
Annette Ansong, Division of Cardiology, Department of Pediatrics, Children's National Hospital, The George Washington University School of Medicine & Health Sciences, Washington, District of Columbia, USA.
Tahmina Banu, Department of Pediatric Surgery, Chittagong Research Institute for Children, Chittagong, Bangladesh.
Andrea Beaton, The Heart Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Ralph Morton Bolman, University of Minnesota, Minneapolis, Minnesota, USA.
Bruna Cury Borim, Department of Pediatrics and Pediatric Surgery, Hospital da Criança e Maternidade, CardioPedBrazil, São José do Rio Preto, Brazil.
John P. Breinholt, Division Chief, Pediatric Cardiology, Penn State Health Children's Hospital, Hershey, Pennsylvania, USA.
Edward Callus, Clinical Psychology Service, IRCCS Policlinico San Danato, San Donato Milanese, Lombardia, Italy.
Massimo Caputo, Translational Health Science, University of Bristol, Bristol, UK.
Marcelo Cardarelli, Co-Founder, William Novick Cardiac Alliance, Memphis, Tennessee, USA.
Tomas Chalela Hernandez, Instituto de Cardiopatías Congénitas, Fundación Cardioinfantíl-La Cardio, Bogota, Colombia.
Ulisses Alexandre Croti, Department of Pediatrics and Pediatric Surgery, Hospital da Criança e Maternidade, CardioPedBrazil, São José do Rio Preto, Brazil.
Yayehyirad M. Ejigu, Department of Cardiothoracic Surgery, King Faisal Hospital, Kigali, Rwanda.
Kathleen Fenton, National Heart Lung and Blood Institute, Bethesda, Maryland, USA.
Anu Gomanju, Kathmandu Institute of Child Health, Kathmandu, Nepal.
Ashraf S. Harahsheh, Division of Cardiology, Department of Pediatrics, Children's National Hospital, The George Washington University School of Medicine & Health Sciences, Washington, District of Columbia, USA.
Peter Hesslein, Children's HeartLink, Minneapolis, Minnesota, USA.
Christopher Hugo-Hamman, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
Sohail Khan, Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan.
Jacques Kpodonu, Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Raman Krishna Kumar, Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
Kathy J. Jenkins, Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts, USA.
Kokila Lakhoo, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
Mahim Malik, Department of Cardiac Surgery, Rawalpindi Institute of Cardiology, Rawalpindi, Punjab, Pakistan.
Sanjiv Nichani, Leicester Children's Hospital, Leicester, East Midlands, UK.
William M. Novick, University of Tennessee Health Science Center-Global Surgery Institute, Memphis, Tennessee, USA.

Document Type

Journal Article

Publication Date

5-1-2023

Journal

BMJ global health

Volume

8

Issue

5

DOI

10.1136/bmjgh-2023-012049

Keywords

cardiovascular disease; paediatrics; public health; review; thoracic surgery

Abstract

The global of paediatric and congenital heart disease (PCHD) is substantial. We propose a novel public health framework with recommendations for developing effective and safe PCHD services in low-income and middle-income countries (LMICs). This framework was created by the Global Initiative for Children's Surgery Cardiac Surgery working group in collaboration with a group of international rexperts in providing paediatric and congenital cardiac care to patients with CHD and rheumatic heart disease (RHD) in LMICs. Effective and safe PCHD care is inaccessible to many, and there is no consensus on the best approaches to provide meaningful access in resource-limited settings, where it is often needed the most. Considering the high inequity in access to care for CHD and RHD, we aimed to create an actionable framework for health practitioners, policy makers and patients that supports treatment and prevention. It was formulated based on rigorous evaluation of available guidelines and standards of care and builds on a consensus process about the competencies needed at each step of the care continuum. We recommend a tier-based framework for PCHD care integrated within existing health systems. Each level of care is expected to meet minimum benchmarks and ensure high-quality and family centred care. We propose that cardiac surgery capabilities should only be developed at the more advanced levels on hospitals that have an established foundation of cardiology and cardiac surgery services, including screening, diagnostics, inpatient and outpatient care, postoperative care and cardiac catheterisation. This approach requires a quality control system and close collaboration between the different levels of care to facilitate the journey and care of every child with heart disease. This effort was designed to guide readers and leaders in taking action, strengthening capacity, evaluating impact, advancing policy and engaging in partnerships to guide facilities providing PCHD care in LMICs.

Department

Pediatrics

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