Niger J Paed 2014; 41 (3):155 - 157  
Chinawa JM  
The practice of paediatric  
cardiology in Nigeria: A Review  
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  
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  
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,  
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  
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  
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  
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-  
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  
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 .  
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  
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-  
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  
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://  
content/109/3/544.full .Asseseon  
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:  
13. Pediatric Cardiothoracic Program -  
Cedars-Sinai .Obtainable at http://  
Prog..assessed on 08/12/2013.  
14. Pediatric Heart Program - Inova  
Health System . Obtainable at  
013; 17 : 101-105  
Suresh G Rao .Pediatric cardiac  
surgery in developing countries.  
Pediatric Cardiology 2007;  
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.  
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  
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.  
Magdi H. Yacoub.Establishing  
Pediatric Cardiovascular Services  
in the Developing World. Circula-  
tion. 2007; 116: 1876-1878