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CARDIOVASCULAR JOURNAL OF AFRICA • Vol 26, No 5, October/November 2015
18
AFRICA
has achieved success in diverse studies in medicine and public
health.
Methods:
Rapid assessment is an established and robust qualita-
tive methodology that triangulates different qualitative research
methods to rapidly elicit pertinent information. Its purpose is to
attain a deep understanding of socio-economic and sociopoliti-
cal factors influencing poor health outcomes. Therefore REA
bridges the gap between empirical research and implementation
strategies whose success is dependent on direct engagement
with local communities. For RHD, we have developed an REA
protocol around two key areas of interest: health-seeking behav-
iour and adherence to secondary prophylaxis for patients with
sore throat; and ARF and RHD and mapping experiences of
patients and healthcare providers at the first point of care to
identify gatekeepers to care.
Conclusion:
We have developed REA protocols for application
in RHD, which we anticipate will ascertain the needs of diverse
communities affected by ARF and RHD by obtaining informa-
tion on patient and provider experience. The REA can now be
used as a key component of a comprehensive needs-assessment
tool. The REA protocol and instruments will be made publicly
available for use by the RHD research community.
SAVING LOST LIVES; THE NAMIBIAN CHILDREN’S
HEART PROJECT
Hugo-Hamman Christopher*, Shidhika Fenny
1
, du Toit H
2
,
Brooks A
3
, Vosloo S
4
*University of Cape Town, Christiaan Barnard Memorial
Hospital; Ministry of Health and Social Services, Namibia;
christopher.hugo@gmail.com1
University of Cape Town, South Africa; Ministry of Health
and Social Services, Namibia
2
Ministry of Health and Social Services, Namibia
3
University of Cape Town, South Africa
4
Christiaan Barnard Memorial Hospital, Cape Town, South
Africa
Introduction:
Prior to 2008, there were no services for heart
disease in Namibia. The aim of this project was to provide treat-
ment for children with heart disease. Between September 2008
and December 2014, 148 patients seen by a single cardiologist
in the Paediatric and Congenital Heart Clinic at Windhoek
Central Hospital, were referred to the Christiaan Barnard
Memorial Hospital in Cape Town, South Africa (1 500 km
away), for intervention and/or surgery. Costs were covered by
the Ministry of Health and Social Services, Namibia.
Objectives:
The primary aim of this study was to audit results
obtained through this project. We describe clinical features
and diagnosis at presentation, intervention or surgery received,
outcome and complications associated, follow up over the six-
year period and therefore, the medium-term impact of this
project.
Methods:
This was a retrospective case series. Two data sources
identified patients referred for surgery or intervention, first,
records at the Windhoek Central Hospital, and second, hospi-
tal admission records at the Christiaan Barnard Memorial
Hospital. Case notes were reviewed for diagnosis (echocardio-
gram, cardiac catheterisation), intervention or surgery, follow
up and clinical outcome.
Results:
Of 272 identified as needing surgery or intervention
148 patients with age at presentation between thrree days and
23 years were referred to Cape Town. Of these, 49 had diagnos-
tic and 13 interventional catheterisations. Four patients were
inoperable, either through complexity or irreversible pulmonary
hypertension. Cardiac surgery was performed in 112 patients, of
which 16 were palliative procedures. Complex cardiac lesions,
co-morbidities and late presentation contributed to post-oper-
ative morbidity. There were five early deaths (mortality rate
4.4%). Twenty-five have been lost to follow up.
Conclusion:
There is a heavy burden of congenital heart disease
in Namibia, a low middle-income country without the capacity
to operate on babies and small children and complex congenital
heart disease. Opinion differs on whether countries with small
populations (Namibia has 2.2 million people) should have
independent units for paediatric cardiac surgery or should refer
to larger regional centres. Nevertheless, this successful public–
private partnership reports a large cohort of patients with a
comparatively good clinical outcome.
REGISTRY’S AND RESEARCH PROVIDE A REMEDY
FOR PUBLIC POLICY; RHEUMATIC HEART DISEASE
IN NAMIBIA
Hugo-Hamman Christopher*, Sikwaya L
1
, Nzuza N
1
, Awases
A
1
, Bock A, Forster N
1
*Windhoek Central Hospital; Ministry of Health and Social
Services, Republic of Namibia; Christiaan Barnard Memorial
Hospital and the University of Cape Town, South Africa; chris-
topher.hugo@gmail.com1
Windhoek Central Hospital; Ministry of Health and Social
Services, Republic of Namibia
Background:
Although the prevalence is as high as 30/1 000
in children of seven to 17 years old, rheumatic heart disease
(RHD) is much neglected in Africa. Prior to participation in
the global registry (Remedy), the burden of RHD in Namibia
was unknown. There were no data to inform public policy and
no programme for primary or secondary prevention. We report
data which informed the development of a national programme
(ASAP) for prevention and control of RHD.
Methods:
The national registry of RHD was established at
Windhoek Central Hospital in January 2010. From January
2010 to December 2014, 463 patients were enrolled in this
prospective, national, hospital-based registry. Questionnaires
document demographics, clinical presentation, complications,
ECG and echocardiogram, and management at enrollment.
Data are presented on the first 281 patients who were entered
into Remedy.
Results:
The distribution of cases reflects regional population
density; 61% were female and 39% male. Ninety-seven (34%)
were children and 83% under 40 years. Thirty-two per cent were