title: Conotruncal Heart Defect Repair in Sub-Saharan Africa: Remarkable Outcomes Despite Poor Access to Treatment.
abstract: BACKGROUND
  The outcome of children born with conotruncal heart defects may serve as an indication of the status of pediatric cardiac care in sub-Saharan Africa (SSA). This study was undertaken to determine the outcome of children born with conotruncal anomalies in SSA, regarding access to treatment and outcomes of surgical intervention.
  
  
  METHODS
  From our institution in Ghana, we retrospectively analyzed the outcomes of surgery, in the two-year period from June 2013 to May 2015. The birth prevalence of congenital heart defects (CHDs) in SSA countries was derived by extrapolation using an incidence of 8 per 1,000 live births for CHDs.
  
  
  RESULTS
  The birth prevalence of CHDs for the 48 countries in SSA using 2013 country data was 258,875; 10% of these are presumed to be conotruncal anomalies. Six countries (Nigeria, Democratic Republic of the Congo, Ethiopia, Tanzania, Uganda, and Kenya) accounted for 53.5% of the birth prevalence. In Ghana, 20 patients (tetralogy of Fallot [TOF], 17; pulmonary atresia, 3) underwent palliation and 50 (TOF, 36; double-outlet right ventricle, 14) underwent repair. Hospital mortality was 0% for palliation and 4% for repair. Only 6 (0.5%) of the expected 1,234 cases of conotruncal defects underwent palliation or repair within two years of birth.
  
  
  CONCLUSIONS
  Six countries in SSA account for more than 50% of the CHD burden. Access to treatment within two years of birth is probably <1%. The experience from Ghana demonstrates that remarkable surgical outcomes are achievable in low- to middle-income countries of SSA.
authors: Department of Surgery, National Cardiothoracic Center, Korle-Bu Teaching Hospital, Accra, Ghana frankedwingh@gmail.com.
authors: Frank
authors: F
authors: Edwin
authors: Department of Surgery, National Cardiothoracic Center, Korle-Bu Teaching Hospital, Accra, Ghana.
authors: Kow
authors: K
authors: Entsua-Mensah
authors: Department of Surgery, National Cardiothoracic Center, Korle-Bu Teaching Hospital, Accra, Ghana.
authors: Lawrence A
authors: LA
authors: Sereboe
authors: Department of Surgery, National Cardiothoracic Center, Korle-Bu Teaching Hospital, Accra, Ghana.
authors: Mark M
authors: MM
authors: Tettey
authors: Department of Anesthesia, National Cardiothoracic Center, Korle-Bu Teaching Hospital, Accra, Ghana.
authors: Ernest A
authors: EA
authors: Aniteye
authors: Department of Surgery, National Cardiothoracic Center, Korle-Bu Teaching Hospital, Accra, Ghana.
authors: Martin M
authors: MM
authors: Tamatey
authors: Department of Surgery, National Cardiothoracic Center, Korle-Bu Teaching Hospital, Accra, Ghana.
authors: Innocent
authors: I
authors: Adzamli
authors: Department of Child Health, National Cardiothoracic Center, Korle-Bu Teaching Hospital, Accra, Ghana.
authors: Nana
authors: N
authors: Akyaa-Yao
authors: Department of Surgery, National Cardiothoracic Center, Korle-Bu Teaching Hospital, Accra, Ghana.
authors: Kofi B
authors: KB
authors: Gyan
authors: Department of Anesthesia, National Cardiothoracic Center, Korle-Bu Teaching Hospital, Accra, Ghana.
authors: Ernest
authors: E
authors: Ofosu-Appiah
authors: Department of Child Health, National Cardiothoracic Center, Korle-Bu Teaching Hospital, Accra, Ghana.
authors: David
authors: D
authors: Kotei
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006291:Health Policy; D006297:Health Services Accessibility; D006330:Heart Defects, Congenital / Q000191:economics / Q000453:epidemiology / Q000601:surgery*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D015996:Survival Rate / Q000639:trends; D055815:Young Adult
keywords: congenital heart disease; congenital heart surgery; health economics; health policy