REVIEW

Niger J Paed 2014; 41 (3):155 - 157

Chinawa JM

The practice of paediatric

cardiology in Nigeria: A Review

DOI:http://dx.doi.org/10.4314/njp.v41i3,1

Accepted: 11th February 2014

Abstract Background: The

works on practice of paediatrc

cardiology in Nigeria was per-

formed using Google and Pub

Med. The Cochrane Database of

Systematic Reviews was also

searched.

The areas of focus were historical

facts, burden of the problem, or-

ganization, factors militating Pae-

diatric cardiology practice in Nige-

ria and the way forward.

Results and Conclusions: Con-

trary to what is widely believed in

many quarters, though errone-

ously, there is overwhelming evi-

dence that the practice of paediat-

ric cardiology has left much to be

desired.

practice of Paediatric cardiology in

Nigeria is at its early phase and it is

being choked in an environment

overwhelmed with economic,

(

)

Chinawa JM

Department of Paediatrics, University

of Nigeria/Teaching Hospital,

PMB 01129,Enugu,

Enugu State,

Nigeria.

Postal Code 400001

ethnic and political issues. Paediat-

ric cardiology covers a broad area

of medicine. This includes diagno-

sis, medical treatment, interven-

tional cardiology, prenatal diagno-

sis and surgery. It will also not

thrive without a high level of infra-

structure manned by personnel

with advanced training and exper-

tise. Regretably, the manpower and

infrastructure that are needed is

grossly inadequate in Nigeria.

For the practice of paediatric cardi-

ology to gain ground, a well knit-

ted corroborative mechanism

Keywords: paediatric cardiology;

involving the government and hos-

pital authorities must be endorsed

Methods: A search for published

Nigeria; manpower; infrastructure

Introduction

Univers₅ity of Nigeria Teaching Hospital (UNTH) in

Enugu. The team of surgeons included F.A. Udekwu

and his colleagues. By the year 2000, a total of 102 such

operations had been carried out at the center by different

A student who wanted to read medicine has several ex-

aminations to write and about six to twelve years of ma-

jor examinations in order to become a consultant paedia-

trician. Paediatrics is a major course which needs to be

Nigerian teams led by Professor Martin Aghaji . In

Ghana, open heart surgery began in 1964 when Profes-

sor C.O Easmon’s team successfully performed closure

of an atrial septal defect using surface cooling to achieve

passed before qualifying as a doctor . To be a pediatric

cardiologist, someone need to at least spend an addi-

tional two years to qualify after becoming a consultant

pediatrician. Pediatric cardiology in developing country

is tasking. It is difficult to procure all the necessary in-

gredients to fend for the surgical needs of a very large

number of children with congenital heart defects while

dealing with severe financial constraints, poor funding

from the government, lack of sustainability and main-

taining quality in the backdrop of constant turnover of

trained medical, nursing, and other paramedical person-

hypothermia . In Senegal, the Surgery Department of

Dakar´s Fann University Teaching Hospital began her

first open heart program in 1990 .

In 1983, a group in Cote D’Ivoire reported their results

of the fir₈st 300 cases of open heart surgery performed in

Abidjan.

Burden of the topic

nel .

It is pertinent to note that lack of facilities for sustain-

able paediatric cardiac services in the developing world

Historical background

results in preventable deaths and suffering . It is esti-

mated that 15 million children die or are crippled annu-

ally by potentially treatable or preventable cardiac dis-

eases. Ignored for a long time, this issue is starting to be

a cause of major concern to individuals, governments,

and, most importantly, cardiovascular specialists who

It is has been documented that four of the sixteen na-

tions in the West Af_,r₄ican sub-region have accounts of

open heart surgery . The first open-heart surgery in

Nigeria was performed on 1st February 1974 At the

can appreciate the gravity of the problem and that the

current situation is unacceptable . In parts of western

ponents that must be on ground should include a paedi-

atric cardiac catheterization laboratory equipped for

interventional cardiology and transcatheter radiofre-

quency ablations, a cardiac operating suite suitable for

surgical treatment of all paediatric cardiovascular pa-

tients, an extracorporeal membrane oxygenator

Africa, only 20% of the parents of children less than 15

years old requiring surgery for congenital heart disease

are able to finance the operation within 12 months of

diagnosis .

(

ECMO), and a cardiac intensive care unit (ICU) or pae-

A study in Nigeria revealed that only a handful (6.2%)

of children with congenital heart disease had surgery

diatric ICU and/or neonatal ICU equipped and staffed to

care for paediatric cardiovascular patients

6,17

and a good number defaulted follow up . Treatment of

children with CHD are limited to larger cities and it is

While we are battling with these standards above, devel-

oped countries have even moved a step ahead by the use

of mechanical assist devices as a bridge to heart trans-

plantation in children.

quite expensive and beyond the reach of the poor . So

many parents could not afford this cost and they will

either abandon routine ho₀spital visits or leave their chil-

dren in the hands of fate .

Another vital area that militates cardiology practice in

Nigeria is the area of funding, research training and sus-

tainability. To ensure sustainability, trained staff should

be retained. This can be done by creating good working

conditions, inclusion of programs for postgraduate train-

ing and facilities for research to enhance professional

To improve the survival of children with cardiac disease,

there is need to diagnose and treat them at earliest age

through provision of affordable human resources, diag-

nostic and surgical as well as other interventional facili-

ties₁₀at each of the six geo-political zones of the coun-

try.

and academic satisfaction .

In developed countries, the need to create and fund pae-

diatric units is related to national need. A survey con-

ducted by the WHO on resources for paediatric cardiac

services concluded that a center able to perform 300 to

Factors militating Paediatric cardiology practice in

Nigeria

Paediatric cardiac service is too expensive for most de-

veloping nations like ours. Though cardiac disease is the

leading cause of morbidity and mortality in the United

00 paediatric operations annually is needed in devel-

oped countries for populations of two million people .

No accurate statistics are available about the need for

paediatric services in the developing world in general

and Nigeria in particular. The painful and lamentable

part is that many developing countries like ours with

populations of about 250 million people are without a

single specialized paediatric cardiac center able to offer

States for the past 80 years , it may not be the same in

developing countries, where malaria and malnutrition

are major culprits that take priority when it comes to

budge allocation .

The state of our health infrastructure ,referral systems,

overemphasis on malnutrition, and the HIV/AIDS pan-

demic made development of a good paediatric cardiac

modern preventive and therapeutic procedures .

practice inconceivable .

Organization

The way out

For paediatric cardiology to take root in Nigeria, it can-

not exist alone. A program must be enacted that will

The practice of paediatric cardiology in Nigeria can gain

ground, if the teaching of Dearani et al is upheld . He

rotate around it . This will comprise of both personnel

and instruments. They include board certified physi-

cians and expert nursing and ancillary team members:

Cardiothoracic Surgery, Paediatric Anesthesiology, Pae-

diatric Cardiology and Interventional Cardiology, Paedi-

atric Intensive Care Medicine Neonatology, Paediatric

Medicine, Maternal-Fetal Medicine , Adult Congenital

Cardiology, Advanced Practice Nursing, Genetics Nurs-

ing, Perfusionist, Respiratory Therapy, Nutrition Ther-

apy, Social W₃ orkers, Occupational Therapy, and Physi-

opined that a comprehensive education strategy from the

paediatrician to the allied health care provider is the

mainstay for successful paediatric cardiology program.

He also noted that the road to successful advancement of

paediatric cardiology depends on many factors, such as

government support, hospital administration support,

medical staff leadership, and a committed and motivated

faculty with requisite skills, incentives, and resources .

Medical and health staff and personnel support is a very

vital tool in the promotion of paediatric cardiology prac-

tice. For instance, in 2001, there were 1609 certified

cal Therapy .

The Pediatric Cardiac team is in a unique position to

provide optimum, individualized care for each patient.

paediatric cardiologists in the United States . The ratio

Diagnosing and treatment of children’s heart diseases

require specialized knowledge and dedication.

was approximately 45,000 children younger than 18

years per paediatric cardiologist. It is estimated that

more than 19,000 cardiac surgeries are performed in

children younger than 18 years in the United States each

year . The case for Nigeria is far fetched It is therefore

pertinent for all concerned to join hands together to

make the practice of paediatric cardiology worthwhile in

Nigeria

Diagnostic facilities should include a fully equipped

paediatric echocardiography laboratory, a paediatric

cardiac catheterization and electrophysiology laboratory,

and appropriate additional facilities and capabilities for

comprehensive laboratory and non-i₅nvasive diagnostic

evaluations of critically ill children Therapeutic com-

Conclusion

Acknowledgements

The practice of paediatric cardiology in Nigeria is still at

a primordial stage. Much is needed to be done to make

the practice worthwhile. A good and formidable paediat-

ric cardiology program will curb economic and brain

drain we are experiencing in our country

We acknowledge the Almighty God whose assistance

and ideas throughout the course of this work were price-

less. Also being appreciated is Prof. Ezechukwu whose

idea in the writing of this manuscript is priceless

Conflict of Interest: None

Funding: None

References

Chinawa JM, Chinawa AT , Obu

HA, Chukwu BF, Eke CB. Per-

formance of medical students in

paediatric examinations and asso-

ciated factors. Curr Pediatr Res

10. Chinawa JM, Eze JC, Obi

17. American academy of pediatrics.

Guidelines for Pediatric Cardiovas-

cular Centers. Pediatrics 200;. 10:

544 -549 .Obtainable from http://

pediatrics.aappublications.org/

content/109/3/544.full .Asseseon

08/12/2013

18. Kettler HE, Modi R. Building local

research and development capacity

for the prevention and cure of ne-

glected diseases: the case of India.

Bull World Health Organ. 2001;

79: 742–747.

19. Greenlund KJ, Giles WH, Keenan

NL. Heart disease and stroke mor-

tality in the 20th century. In: Ward

J, Warren C, eds. Silent victories:

the history and practice of public

health in twentieth century Amer-

ica. Oxford, England: Oxford Uni-

versity Press; 2006.

20. Hewitson J, Brink J, Zilla P.The

challenge of pediatric cardiac ser-

vices in the developing world.

Semin Thorasc Cardiovasc

I ,Arodiwe I,Ujunwa F, Adiele

KB,Obu HA. Synopsis of congeni-

tal cardiac disease among children

attending University of Nigeria

Teaching Hospital Ituku Ozalla,

Enugu. BMC Research Notes

2013, 6:475

11. World Health Organization. Ne-

glected Diseases That Disable

Millions. Global Defense Against

the Infectious Disease Threat.

Geneva, Switzerland: World

Health Organization; 2003.

12. Larrazabal LA, Jenkins KJ, Gau-

vreau K, Vida VL, Benavidez OJ,

Gaitán GA, Garcia F, Castañeda

AR. Improvement in congenital

heart surgery in a developing

country: the Guatemalan experi-

ence. Circulation. 2007; 116:

1882–1887.

13. Pediatric Cardiothoracic Program -

Cedars-Sinai .Obtainable at http://

www.cedars-sinai.edu/Patients/

Programs-and-Services/Heart-

Institute/Centers-and-

Prog..assessed on 08/12/2013.

14. Pediatric Heart Program - Inova

Health System . Obtainable at

http://www.inova.org/healthcare-

services/pediatrics/types-of-

services/pediatric-

013; 17 : 101-105

Suresh G Rao .Pediatric cardiac

surgery in developing countries.

Pediatric Cardiology 2007;

8:144-8

Budzee A, Tantchou Tchoumi JC,

Ambassa JC, Gimberti A, Cirri S,

Frigiola A, Butera G. The Cardiac

Center of Shisong Hospital, the

first cardio-surgical center in West

and Central Africa is Inaugurated

in Cameroon. Pan Afr Med J.

010 ;4:4.

. Budzee A, Ghidoni I, Giamberti A,

Cirri S, Tantchou Tchoumi JC,

Ambassa JC, Butera G. The first

coronary by-pass grafting surgery

done in western and central Africa.

Pan Afr Med J. 2011;8:46

Eze JC, Ezemba N. Open-heart

surgery in Nigeria: indications and

challenges. Tex Heart Inst J.

2002 ;14:340-5.

21. Shakuntala A Singh, Ajai R

Singh.Diseases of Poverty and

Lifestyle, Well-Being and Human

Development. Ajai R Singh. Pov-

erty and human development

2008;6: 187-225

22. Dearani JA, Neirotti R, Kohnke

EJ, Sinha KK, Cabalka AK, Bar-

nes RD et al.Improving pediatric

cardiac surgical care in developing

countries: matching resources to

needs. Semin Thorac Cardiovasc

Surg Pediatr Card Surg Annu.

2010;13:35-43

007;34:8-10.

Frimpong-Boateng K. The begin-

nings of cardiothoracic surgery in

Ghana. In Deep down my heart.

First edition. Edited by Woeli

Publishing Services, Accra: 2000:

cardiovascu.Assessed on

08/12/2013.

15. Fyfe DA, Ritter SB, Snider AR,

etal. Guidelines for transesophag-

eal echocardiography in children.

J Am Soc Echocar-

Frank Edwin, Mark Tettey, Ernest

Aniteye, Lawrence Sereboe, Mar-

tin Tamatey, Kow Entsua-Mensah,

David Kotei, Kofi Baffoe-Gyan.

The development of cardiac sur-

gery in West Africa - the case of

Ghana. Pan Afr Med J. 2011;9:15

Coulibaly AO, Ouattara K, Kan-

gah KM, Yangni-Angate H,

Tanauh Y, Longechaud A, Millet

P, Yapobi Y, Ake E, Brunet A.

Reflections on 851 open heart

operations at the Institute of Cardi-

ology in Abidjan. Chirurgie.

diogr.1992;5 :640– 644

16. Meyer RA, Hagler D, Huhta J, et

al. Guidelines for physician train-

ing in fetal echocardiography:

recommendations of the Society of

Pediatric Echocardiography, Com-

mittee on Physician Training. J

Am Soc Echocardiogr.1990;3 :1–

23. Chang RK, Klitzner TS.Resources,

use, and regionalization of pediat-

ric cardiac services. Curr opin

cardiol.2003 Mar;18(2):98-101.

987;113(5):470-475.

Magdi H. Yacoub.Establishing

Pediatric Cardiovascular Services

in the Developing World. Circula-

tion. 2007; 116: 1876-1878