Challenges in the Management of Congenital Heart Disease in Developing Countries

The 2011 World Bank classification of nations and their economies based on 2010 per capita Gross National Incomes (GNI) lists 35 countries as low income (GNI 1005 US Dollars or less), 56 as lower middle income (1006 – 3975 USD), 54 upper middle income (3976 – 12275 USD) and 70 as high income (12,276 USD or more). Low and middle income countries are often conveniently referred to as developing countries (World Bank, 2011) but vary greatly in their levels of economic, infra-structural and health care development. The challenges of managing congenital heart disease in many low income and lower middle income countries are overwhelming, with very few or in some cases no treatment and prevention strategies in place at all. On the other hand, many upper middle income countries and a few lower middle income ones having been able to establish successful programmes for the treatment of congenital heart disease, albeit not without challenges, are striving to extend these services to the under-served parts of their populations while still confronted with challenges of prevention. Congenital heart disease (CHD) refers to the presence of a structural abnormality of the heart and / or great vessels that is present at birth and is of actual or potential functional significance. The term usually excludes congenital arrhythmias and cardiomyopathies even though these may be based on genetic or other abnormalities that are present at birth (Hoffman & Kaplan, 2002). In recent decades, the management of congenital malformations of the heart has improved remarkably in the developed world such that even very complicated lesions are now amenable to treatment. The situation in many of the least developed countries / regions is the direct opposite – only very few children born with congenital heart disease ever receive the appropriate treatment or care. This is the result of several factors that may be considered obstacles or challenges to congenital heart disease management in these regions. Thus, hundreds of thousands of children die each year from congenital heart disease, while millions more remain in desperate need of treatment in the developing world. Alleviating the sufferings of such children is a major challenge to practitioners and perhaps even more so to the families of affected children. Several strategies have been advocated and used in attempts to help some of the affected children access the necessary care. These strategies vary from transporting a few affected children to other countries for treatment, to short-term visits by teams of experts from advanced countries to perform surgical procedures on a few children, to establishing regional centres