New global report on pediatric cardiac health released: Pediatric heart disease kills and weakens the growth and future performance potential of millions of children.
The second global report of Pediatric Heart Disease has been published by Children’s HeartLink. The report, entitled “Linked by a common purpose: Global efforts for improving pediatric heart health,” discusses in depth factors influencing the difficulty of diagnosis and treatment of congenital heart disease outside of developed countries. It builds on the past investigation of the incidence and prevalence of congenital and acquired heart disease in children, but also highlights trends and issues in the attraction and retention of specially trained nurses and physicians into the pediatric heart health arena.
In 2005 Children’s HeartLink published the first edition of what we envisioned to be a series of reports on pediatric cardiac disease and meeting the challenge of increasing access and quality of services for children around the world. As was noted in the first publication, the needs of children at risk from heart disease in the developing world are both understudied and un-responded to. We have tried in the second publication to again gather some of the latest thinking on pediatric heart disease and the challenges in addressing it in underserved regions of the world.
The first section of the report discusses factors and potential obstacles in the detection and treatment of congenital heart disease (CHD) in the developing world, which affects one in one hundred live births the world over and is the most common birth defect. The review of literature revealed the main factors preventing diagnosis and treatment of CHD in the developing world are: 1) Lack of Access to Cardiac Care; 2) Few Facilities to Treat Pediatric Heart Disease; 3) Shortage of Training for Pediatric Cardiac Specialists; 4) Prohibitive Expense of Pediatric Cardiac Treatment; 5) Lack of Basic Health Care; 6) Shortage of Health Care Workers; 7) Migration of Health Care Workers to Developed Countries; 8) Competing Priorities in Health Care; 9) Lack of Investment in Public Health Sectors.
Because of the pervasive challenge of funding tertiary health services, many countries are forced to severely limit the amount of treatment for children with CHD and depend on international NGOs to support additional treatment for these cases. Equally important is the international support for building sustainable programs through training, technical assistance, donated resources and building on going collegial relationships.
While advocating for continued assistance to cardiac programs around the world the report’s two other main recommendations for international organizations assisting children with heart disease are:1) to coordinate and consolidate efforts between organizations, individuals, facilities, and partner hospitals around the world to continue to build awareness of heart disease as a major health burden effecting millions of children and 2) to increase efforts to build sustainable centers of excellence for assisting children at risk of developing and suffering from cardiac disease.
The Report also notes that acquired heart disease (AHD) in children is still a significant burden for many families in the developing world. Most often caused by complication of Rheumatic Fever or Chagas disease this type of heart disease is preventable. Further, the report found that the majority of Rheumatic Fever cases are still found in developing countries with incidence figures as high as 6 cases per 1,000 in a population, compared to less than one case per 1,000 people in the developed world. In 2003, it was estimated that 12 million individuals suffered from Rheumatic Fever and Rheumatic Heart Disease worldwide and at least 3 million of these individuals had subsequent congestive heart failure, requiring repeated hospitalization. Of all cases, nearly two-thirds are children between the age of 5 and 15, with the highest estimated number of cases in Sub-Saharan Africa.
In the discussion of the relevance of the United Nations Millennium Development Goals (MDGs) to children’s heart disease in the developing world it was found that while pediatric heart diseases are not explicitly included in the MDGs (non communicable disease were not included), accomplishing the health-related goals will have a direct impact on children with heart disease in poor countries. Many of the health goals, such as lowering maternal and child mortality rates, improving child vaccinations, and increasing the number of skilled health personnel, can only be achieved by the creation or improvement of health care infrastructures in poor countries. While it is unrealistic to imagine that most countries can develop health care systems that can offer advanced pediatric cardiac treatments, it is possible to imagine that basic, functioning health care programs in poor countries would be able to prevent, detect, and diagnose both acquired and congenital heart diseases more effectively. Further, as resources are available, programs would refer patients to regional health care centers for treatment of most types of heart disease. Investment in the prevention and treatment of heart disease is certainly of benefit and can be addressed within the primary health care and health infrastructure existing in most countries.
The report also examines the effects the Health Worker Migration Crisis on pediatric cardiac care in the developing world. When cardiac programs lose and cannot replace experienced team members in a timely manner, patient care is compromised. In the developing world, where hospitals are often under-resourced and staff is overworked and poorly paid, maintaining quality personnel is exponentially more difficult. According to the WHO, there are 57 countries with health care systems on the verge of collapse due to staff shortages. More than four million additional health workers are needed to fill personnel gaps. More than half of these additional workers are needed in Sub-Saharan Africa, an area of the world that shoulders 24 percent of the world’s disease burden, 11 percent of the world’s population, and only 3 percent of the world’s health workers.
For international medical organizations, such as Children’s HeartLink, the migration of health workers has a significant impact on the sustainability of partner site programs and the impact of Children’s HeartLink efforts. This problem gains more recognition as organizations like the WHO are establishing The Global Health Workforce Alliance in 2006 to “...tackle global shortages of health-care workers”, countries like the UK are restricting international recruitment practices, and professional organizations are calling for more self-reliance in meeting health worker needs by each developed country. Based on the knowledge that salary alone is only part of the retention problem, Children’s HeartLink is working with the Red Cross Children’s Hospital in
In conclusion CHD and AHD affect millions of children around the world, but the majority of them will never receive the treatment they need. These children have little to no access to treatment, not only because of a lack of access to cardiac care, but also because of an overall lack of socioeconomic development and health care investment in their countries. These factors combine to create poor public health systems, a lack of adequate resources, a lack of health information for the public and a shortage of health care workers that prevent children from receiving corrective treatment. Pediatric heart disease is not a problem created in a vacuum. The international community will be able to make real strides towards reducing the prevalence of AHD and improving the diagnosis and management of CHD only when it is placed within the global context of economic and health care disparities.
For the last 40 years Children's HeartLink has been dedicated to the mobilization of global resources to prevent, treat, and cure children’s heart disease. We hope that this report contributes to the knowledge and understanding of pediatric heart disease and the efforts to offer greater access to its prevention and treatment in underserved regions of the world. We also hope to further the knowledge of the field and come closer to preventing and curing cardiac heart disease for all children of the world.
Editorial Advisory Committee: Dr. Philipp Bonhoeffer, Great Ormond Street Hospital for Children; Dr.
To receive a copy of the full report and full list of references please go to http://www.childrensheartlink.org or contact Bistra Zheleva at bistra@childrensheartlink.org.
