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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 1, January/February 2017
AFRICA
55
annual births and a global CHD incidence of 1%.
1,2
There are an
estimated 300 000 school-aged children afflicted with rheumatic
heart disease (RHD).
3
The prevalence of RHD in a Nigerian
community was 57/100 000 school children.
4
The burdens of
other acquired heart diseases (AHD) of childhood, although
perceived to be significant, have not been quantified. In addition,
most of the systemic diseases of childhood, especially infections
and metabolic conditions, affect the heart in one way or another.
All these constitute a huge demand for paediatric cardiac
services in the country.
The poor availability of paediatric cardiac services in
developing countries is well documented.
5
Provision of paediatric
cardiac services and uneven distribution of such services in the
most populous sub-Saharan African country presents a huge
challenge. Currently, most of the surgical paediatric cardiac
needs of Nigerian children are being met outside the country,
with only a small number of affected children receiving their
interventions in the country during periodic medical missions
undertaken by specialists from within and outside Nigeria.
6,7
It
is therefore generally perceived that the number of paediatric
cardiac practitioners and the facilities for paediatric cardiac care
in Nigeria are grossly insufficient to meet the huge demand for
such services.
Although the last half decade has witnessed efforts to train
personnel, establish new centres or upgrade the capacities of old
centres, there has been no previous attempt to formally document
the human and infrastructural resources available to provide
paediatric cardiac services in Nigeria. We therefore set out to
document the currently available services and resources as a
baseline for future comparison, with the hope that the needs gap
will be brought more sharply into focus and serve to spur more
vigorous attempts at bridging the gap. It will also help improve
access to care and ease referral decisions by informing practitioners
on the available services that are closest to their patients.
Methods
The Federal Republic of Nigeria is the most populous African
nation, with an estimated population of more than 177 million
people.
8
There are 36 states and the Federal Capital Territory,
which are grouped into six geopolitical zones. Each state
has at least one government-owned designated tertiary health
centre but not all of them have the capacity to investigate and
definitively diagnose paediatric cardiac conditions. Fewer still
have the capacity to undertake open-heart surgeries and other
cardiac interventions. A few private medical centres however,
have relatively advanced capabilities for paediatric cardiovascular
diagnostic and interventional services.
A structured questionnaire was sent to all Federal
Government-owned tertiary health facilities and to large private
medical centres in Nigeria in February 2015. The centres
known to have a paediatric cardiologist on staff were included.
This was done mainly through the platform of the Nigerian
Paediatric Cardiologists’ network, an internet platform for
disseminating information among paediatric cardiologists,
interested paediatricians and paediatric cardiac surgeons in
Nigeria. The questionnaire items included the number and type
of personnel and the range of paediatric cardiac facilities and
services available in each centre in the period between January
2010 and December 2014. Only one questionnaire was to be
returned per centre. Ethical approval was not required to use
data from the audit.
Statistical analysis
The information provided was coded and entered into SPSS
version 20.0 (Chicago, Illinois). The proportions of centres
with particular cardiac services were expressed as percentages.
Available personnel and infrastructure were analysed according
to geopolitical zone.
Results
There was a 100% response rate from the 48 centres that
participated in the study, of which 25 (52.1%) were government
owned. The majority of the participating centres (20; 41.7%) were
located in the South-West geopolitical zone. The distribution of
centres in the other zones is shown in Fig. 1.
A total of 33 paediatric cardiologists were practicing full
time in 26 of the 48 centres, providing cardiac services to the
87 million population of children in Nigeria.
1
The remaining
22 centres had only visiting cardiologists. All 33 physicians
were able to perform echocardiography. A total of 31 cardiac
surgeons were identified in this survey. In 12 centres, there were
19 (61.3%) surgeons trained in adult cardiac surgery only, while
10 centres had 12 (38.7%) surgeons trained in both adult and
paediatric cardiac surgery. The distribution of the other cadres
of personnel is shown in Table 1. Table 2 depicts the distribution
of personnel according to geopolitical zone.
Forty-seven (97.9%) centres had equipment for
electrocardiography (ECG) and pulse oximetry, while
echocardiography could be performed in 45 (93.8%) centres. In the
three centres without an echocardiography machine, the facility
had previously been available but was not functioning at the
time of the survey. The centres with functional echocardiography
machines had facilities for paediatric probe with transducer
frequency of at least 5 MHz, two-dimensional, colour and
Doppler facilities. Although defibrillators were available in
23 (47.9%) centres, paediatric paddles were only available in
11 (47.8%) of these. The distribution of the other equipment
according to geopolitical zone is shown in Table 3.
15.31%
20.42%
6.13%
2.4%
2.4%
3.6%
North-Central
North-East
North-West
South-East
South-South
South-West
Fig. 1.
Distribution of the participating centres according to
geopolitical zone.