CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
107
committee to select cardiac cases that are correctable with a good
prognosis and outcome. The researcher created a strategy to guide
the members of the selection committee in their selection of cardiac
beneficiaries. The cases selected should have predictable, good
outcomes that meet the donors’ expectations and achieve sustain-
ability for the Foundation.
Methods:
The research question is: How can donor funding be
allocated in a fair, evidence-based and sustainable way to achieve
maximum beneficial impact on indigent children requiring cardiac
surgery in Africa? I chose to do a focus group and held a question-
and-answer group interview and discussion with 15 people selected
from all of the stakeholder parties in the Foundation.
Outcomes:
The key outcomes of the focus group included the need
for surgical hubs to be developed in Africa and skills transfer to
occur, the correct diagnosis being key to the outcome of the cases
selected, the selection of complex cardiac cases directly impacting on
the costs involved, and the appropriate use of donor money being in
keeping with the avoidance of selecting cases that may have difficult
outcomes and extended length of stay in hospital.
Conclusion
We want WSPCF to make a real difference in the lives
of children with cardiac disease on the African continent. The result
of this study shows that the current selection criteria are sound and
meet the donor expectations.
1168: CHALLENGES IN IMPLEMENTING A PAEDIATRIC
CARDIOVASCULAR HOME TELEHEALTH PROJECT
Bradley Keller, Allison Keskey, Usha Sadanala, Christopher Mascio,
Carlton Hornung
1
University of Louisville, USA
Background:
Infants with single-ventricle physiology are at high
risk of sudden death following discharge (8–12%) despite palliative
management, presumably due to intravascular volume depletion,
shunt occlusion, and/or arrhythmia. Therefore, we developed a pilot
home telemedicine project to evaluate the feasibility of using web-
based daily reporting of clinical parameters to reduce unscheduled
events and death.
Methods:
Subject enrollment began following IRB approval. We
enrolled six single-ventricle subjects following palliation over a
12-month interval. Parents electronically recorded and transmitted
daily weight and peripheral oxygen saturation data, then completed
an automated 10-point phone questionnaire related to nutrition,
activity and distress. Subject enrollment in the project continued
until a second palliative surgical procedure (
n
=
4) or sudden death
(
n
=
2). All transmitted data were managed on a customised website
with hardcopy backup. We collected comprehensive clinical data in
all enrolled subjects and 12 historical controls. We analysed subject
clinical management including success in out-patient telephone
surveillance, scheduled and unscheduled office and emergency room
(ER) visits, hospitalisations, procedures and adverse events, includ-
ing death.
Results:
Subject recruitment was more difficult than expected. We
found a high success rate in transmitting subject weights but poor
correlation between oxygen saturation values measured by the study
saturation monitor and monitor provided to discharged patients
(Massimo). Success rate for out-patient telephone surveillance for
historical controls, independent of this telemedicine project to date
was approximately 30%. After technical adjustments, all enrolled
subjects (100%) were able to transmit questionnaire data. There were
14 unscheduled ER visits for controls versus two ER visits for study
subjects. Sudden death occurred in one of 12 controls and two of six
enrolled subjects.
Conclusion:
Home telemedicine monitoring for high-risk patients
with congenital heart defects is feasible, may reduce unscheduled
visits, but may not impact on the primary endpoint of preventing
sudden death.
1587: PREPARATION OF THE VISITING TEAM FOR TECH-
NOLOGY TRANSFER TO THIRD-WORLD COUNTRIES
Nazmul Hosain
1
, Farzana Amin
2
, Haroon Rasheed
3
, Md Fazle Maruf
4
,
Abdul Quiyum Chowdhury
4
, Md Kamruzzaman
5
, AKM Monzurul
Alam
6
, Sahnaz Ferdous
6
1
Cardiac Surgery, Chittagong Medical College, Bangladesh
2
University of Northern British Columbia, Canada
3
National Heart Foundation Hospital, Dhaka, Bangladesh
4
Chittagong Medical College, Bangladesh
5
Combined Military Hospital, Dhaka
6
National Institute of Cardiovascular Diasease, Dhaka, Bangladesh
Background:
The visit of a medical team for the purpose of tech-
nology transfer from the developed world is a useful tool in capac-
ity building of cardiologists and cardiac surgeons in Third-world
countries. Such visits, when taking place between two countries with
diverse socio-economic conditions, involve a number of difficult
issues. The visitors are often not aware of these facts, which reduce
the effectiveness of their dedication and effort. Between 1996 and
2012, we had the experience of hosting 15 foreign teams or individu-
als in Bangladesh for technology transfer. Various arrangements had
to be made for them. Sharing those experiences through this article
may be of interest for the future visitors.
Methods:
Hospital records served as the major source of informa-
tion. The involved doctors, nurses and other staff were interviewed.
We also contacted the visitors for their comments. After collection
of all data, we discussed our own experiences and compiled it in an
organised manner.
Results:
The important issues for the visitors, identified by our
research are addressed under the following headings:
• Selecting a suitable site for the visit
• Need assessment of the recipient institute
• Travel and immigration
• Government permission and registration issues
• Safety and security
• Arranging logistic support
• Patient selection and management
• Local hospitality and team healthcare
• Organising technology transfer
• Budget and finance
• Press and media
• Conclusion and reporting.
Conclusions:
Visiting a Third-world country for the purpose of tech-
nology transfer is often not an easy job. There are a number of issues
making it a highly specialised subject. Analysing our experience, we
have identified some key features for making such trips successful.
This may be useful for future visitors preparing for such missions.
1613: COST-EFFECTIVENESS ANALYSIS OF CONGENITAL
HEART SURGERY IN DEVELOPING COUNTRIES
Kathleen Fenton
1,2
, Sergio Hernandez Castillo
2
, Carlos Duarte Claro,
Nubia Berrios, William Novick
1
International Children’s Heart Foundation, Memphis, TN, USA
2
Asociacion Programa Corazon Abierto
Background:
Of the estimated more than one million children
born worldwide every year with congenital heart defects (CHD),
more than 95% are born in developing countries with inadequate
access to surgical repair. Since surgery for CHD seems expensive, it
may be given a lower priority in the allocation of scarce economic
resources. The World Bank uses $100 per year of life saved as the
marker for highly cost-effective interventions in poor countries. Cost-
effectiveness analysis is warranted.
Methods
: Total cost data were gathered for the first five years of a
congenital heart surgery programme in a developing country. Cost
per case included local costs plus the value of donated medical
supplies sent to support the programme. Local costs were obtained
from the business plan of the local foundation and included all costs,
including paying the hospital, the physicians, and all administrative
