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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 1, January/February 2017
56
AFRICA
Cardiac catheterisation was available in six (12.5%) of the 48
centres but was utilised for children in only three centres (6.3%)
for diagnostic and therapeutic purposes. All six centres had
single-plane equipment. The therapeutic indications included
percutaneous closure of patent ductus arteriosus (PDA) and
atrial septal defects (ASD). Surgical operations were performed
for congenital heart diseases in 13 centres.
There were 84 cardiac surgeries for congenital heart diseases
performed in 13 centres with a median (range) of six (1–20)
operations per centre over the study period. The average annual
number of surgeries for congenital heart disease was 21. The
surgeries included ligation of PDA 51 (60.7%), total repair
of tetralogy of Fallot (TOF) 16 (19.0%), ASD eight (9.5%),
ventricular septal defect (VSD) seven (8.3%), and Blalock-
Taussig shunt (B-T shunt) two (2.4%) for TOF and double-outlet
right ventricle (DORV). There were a total of 21 rheumatic
surgical cases performed in four centres during the study
period. Of the 13 centres, only six (46.2%) had facilities for and
performed open-heart surgery on children. The others did mostly
PDA ligation. Pacemakers were inserted in seven (14.6%) centres.
Of the six centres that had performed open-heart surgery on
children, four (66.7%) were located in the South-West geopolitical
zone, which also housed three (50%) of the six centres with
catheterisation laboratories. The centres with open-heart surgery
and cardiac catheterisation facilities and their distribution
according to geopolitical zone are shown in Table 4, while the
availability of echocardiography, cardiac catheterisation and
open-heart surgery by state in the country is depicted in Fig. 2.
Twenty-five (52.1%) of the 48 participating centres had
intensive care units (ICUs), with a total of 140 ICU beds
between them [median (range): 5.5 (2– 6) beds]. Only 10 (40.0%)
of the 25 centres however had a dedicated paediatric ICU with
24 beds. The median (range) number of beds in the paediatric
ICU was one (1–5). Seventeen (35.4%) of the 48 centres had a
total of 46 ventilators [median (range): one (1–7) ventilators].
The distribution of centres with open-heart surgery facilities,
catheterisation laboratories, ICU and ventilators according to
the type of hospital is shown in Table 5. All 23 private centres
except one were manned by visiting cardiologists from other
centres, while in three (50%) centres, the surgeons were visiting.
Discussion
The study found a total of 33 paediatric cardiologists serving the
country of 87.7million children, or one paediatric cardiologists to
2.6 million children. This falls far short of the ideal requirement
of a minimum of one paediatric cardiologist to serve 0.5 million
of the population.
9
Therefore Nigeria would need a minimum
of 174 paediatric cardiologists to attend to her 87.7 million
children. The available 33 paediatric cardiologists, which is about
one-fifth (33/174) of the number of personnel actually required,
speaks to the monumental challenge before Nigeria in providing
Table 1. Distribution of paediatric cardiac personnel in the centres
Personnel type
No of
centres
Total number of personnel in 48 centres
Total
Median
Range
Physicians with echo capability 26
33
1
1–4
Adult surgeons
21
31
1
1–6
Paediatric surgeons
10
12
1
1–2
Interventionists
7
5
1
1–1
Cardiac nurses
14
97
1.5
1–23
Cardiac anaesthetists
14
22
1
1–3
Perfusionists
9
13
1
1–2
Intensivists
5
7
1
1–2
Some personnel (physicians, surgeons, anaesthetiscs, perfusionists, nurses and
interventionists) were working in more than one centre. Some adult surgeons also
functioned as paediatric surgeons.
Table 2. Distribution of personnel by geopolitical zone
Type of personnel
NC
n
(%)
NE
n
(%)
NW
n
(%)
SE
n
(%)
SS
n
(%)
SW
n
(%) Total
Physicians that
can perform echo
11 (33.3) 0 (0.0) 4 (12.1) 3 (9.1) 6 (18.2) 9 (27.3) 33
Adult surgeons
7 (22.6) 0 (0.0) 3 (9.7) 7 (22.6) 6 (19.4) 8 (25.8) 31
Paediatric
surgeons
1 (8.3) 0 (0.0) 2 (16.7) 2 (16.7) 1 (8.3) 6 (50.0) 12
Interventionists 1 (20.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (20.0) 3 (60.0)
5
Nurses
11 (11.6) 0 (0.0) 4 (4.2) 25 (26.3) 8 (8.4) 47 (49.5) 95
Anaesthetists
2 (11.1) 0 (0.0) 2 (11.1) 2 (11.1) 3 (16.7) 10 (55.6) 18
Perfusionist
1 (7.7) 0 (0.0) 1 (7.7) 2 (15.4) 1 (7.7) 8 (61.5) 13
NC = North-Central, NE = North-East, NW = North-West, SE = South-East,
SS = South-South and SW = South-West.
Table 3. Availability of equipment in centres according to geopolitical zone
Type of equipment
NC
n
(%)
NE
n
(%)
NW
n
(%)
SE
n
(%)
SS
n
(%)
SW
n
(%) Total
Echo machines
15 (33.3) 2 (4.4) 2 (4.4) 3 (6.7) 4 (8.9) 19 (42.2) 45
ECG
15 (31.9) 2 (4.3) 2 (4.3) 3 (6.4) 6 (12.8) 19 (40.4) 47
Holter monitor
7 (33.3) 1 (4.8) 0 (0.0) 2 (9.5) 2 (9.5)
9 (42.9) 21
Defibrillator
7 (29.2) 1 (4.2) 1 (4.2) 2 (8.3) 4 (16.7) 9 (37.5) 24
Catheterisation lab 1 (16.7) 0 (0.0) 1 (16.7) 1 (16.7) 0 (0.0)
3 (50.0)
6
ICU
6 (24.0) 2 (8.0) 2 (8.0) 2 (8.0) 4 (16.0) 9 (36.0) 25
Ventilators
10 (21.7) 0 (0.0) 1 (2.2) 17 (40.0) 4 (8.7) 14 (30.4) 46
Echo = echocardiography, ICU = intensive care unit, ECG = electrocardiogram.
NC = North-Central, NE = North-East, NW = North-West, SE = South-East,
SS = South-South and SW = South-West.
Table 4. Centres with open-heart surgery and cardiac catheterisation
facilities by geopolitical zone
Centre according to zone
Open-heart
surgery
Catheteri-
sation lab
South-West zone
Lagos University Teaching Hospital, Lagos
✓
Lagos State University Teaching Hospital, Lagos
✓
Redington Hospital, Lagos
✓
University College Hospital, Ibadan
✓
✓
Biket Medical Centre, Osogbo
✓
✓
North-Central zone
Heart scan, Abuja
✓
Garki Hospital, Abuja
✓
South-East zone
University of Nigeria Teaching Hospital, Enugu*
✓
✓
North-West zone
Aminu Kano Teaching Hospital, Kano*
✓
*Cardiac catheterisation for children is yet to commence in these centres.
Table 5. Distribution of number of centres with some facilities
and procedures according to the type of hospital
Facilities/procedures
Public
n
(%)
Private
n
(%)
Total
n
(%)
Open-heart surgery
4 (66.7)
2 (33.3)
6 (100.0)
Catheterisation lab
3 (50.0)
3 (50.0)
6 (100.0)
Intensive care unit
21 (84.0)
4 (16.0)
25 (100.0)
Ventilators
41 (89.1)
5 (10.9)
46 (100.0)