Cardiac Surgery Capacity in Sub—Saharan Africa: Quo Vadis?
17 April 2014
31 May 2014
23 June 2014 (online)
Background Current data on cardiac surgery capacity on which to base effective concepts for developing sustainable cardiac surgical programs in Africa are lacking or of low quality.
Methods A questionnaire concerning cardiac surgery in Africa was sent to 29 colleagues—26 cardiac surgeons and 3 cardiologists in 16 countries. Further, data on numbers of surgeons practicing in Africa were retrieved from the Cardiothoracic Surgery Network (CTSNet).
Results There were 25 respondents, yielding a response rate of 86.2%. Three models emerged: the Ghanaian/German model with a senior local consultant surgeon (Model 1); surgeons visiting for a short period to perform humanitarian surgery (Model 2); and expatriate surgeons on contract to develop cardiac programs (Model 3). The 933 cardiothoracic surgeons listed by CTSNet translated into one surgeon per 1.3 million people. In North Africa, the figure was three surgeons per 1 million and in sub-Saharan Africa (SSA), one surgeon per 3.3 million people. The identified 156 cardiac surgeons represented a surgeon to population ratio of 1:5.9 million people. In SSA, the ratio was one surgeon per 14.3 million. In North Africa, it was one surgeon per 1.1 million people. Open heart operations were approximately 12 per million in Africa, 2 per million in SSA, and 92 per million people in North Africa.
Conclusion Cardiothoracic health care delivery would worsen in SSA without the support of humanitarian surgery. Although all three models have potential for success, the Ghanaian/German model has proved to be successful in the long term and could inspire health care policy makers and senior colleagues planning to establish cardiac programs in Africa.
- 1 Christiaan Barnard. Society of cardiothoracic surgeons of South Africa. First open heart surgery in South Africa 1958. Available at: http://www.sctssa.org/index.php?option=com_content&view=article&id=15&Itemid=29 . Access: April 2, 2014
- 2 Thameur H. History of cardiac surgery in the Maghreb. Available at: http://www.authorstream.com/Presentation/thameur-1557741-history-cardiac-surgery-maghreb/ . Access April 2, 2014
- 3 Metras D, Ouezzin-Coulibaly A, Ouattara K, Chauvet J, Longechaud A, Millet P. Open-heart surgery in tropical Africa. Results and peculiar problems of the 1st 300 cases of extracorporeal circulation performed in Abidjan [in French]. Presse Med 1983; 12 (10) 621-624
- 4 Yankah AC, Marshall R, van Reken D, Boakye E, Sasraku SD. Prevalence of cardiovascualr disease in Liberia. Tropical Cardiology 1981; 7: 15-20
- 5 Edwin F, Tettey M, Aniteye E , et al. The development of cardiac surgery in West Africa—the case of Ghana. Pan Afr Med J 2011; 9: 15-21
- 6 Eze JC, Ezemba N. Open-heart surgery in Nigeria: indications and challenges. Tex Heart Inst J 2007; 34 (1) 8-10
- 7 Agyin CA. First open heart surgery in Uganda 2007. Available at: http://blog.suubitrust.org.uk/2007/07/14/uganda%E2%80%99s-first-open-heart-surgery/ . Access April 2, 2014
- 8 Yacoub MH. Establishing pediatric cardiovascular services in the developing world: a wake-up call. Circulation 2007; 116 (17) 1876-1878
- 9 Leon-Wyss JR, Veshti A, Veras O , et al. Pediatric cardiac surgery: a challenge and outcome analysis of the Guatemala effort. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2009; 12: 8-11
- 10 Unger F. Worldwide survey on cardiac interventions 1995. Cor Europeum 1999; 7: 128-146
- 11 Turina MI. European Association for Cardio-Thoracic Surgery: carrying the torch. Eur J Cardiothorac Surg 2002; 22 (6) 857-863
- 12 Population reference bureau. World population data sheet 2013. Available at: http://www.prb.org/Publications/Datasheets/2013/2013-world-population-data-sheet.aspx . Access April 2, 2014
- 13 Worldstat info. List of countries by population under 15 years . Available at: http://en.worldstat.info/Africa/List_of_countries_by_Population_under_15_years_old. Access April 2, 2014
- 14 World Bank's annual world development report (WDR) Available at: http://wdronline.worldbank.org/worldbank/a/region#africa . Access April 2, 2014
- 15 WHO. Cardiovascular diseases. Fact sheet Nr. 317. Available at: http://www.who.int/mediacentre/factsheets/fs317/en/ . Access April 2, 2014
- 16 World Bank. Health expenditure per capita (US$) in sub-Sahara Africa. Available at: http://www.tradingeconomics.com/sub-saharan-africa/health-expenditure-per-capita-us-dollar-wb-data.html . Access April 2, 2014
- 17 Beckmann A, Funkat AK, Lewandowski J , et al. Cardiac surgery in Germany during 2012: a report on behalf of the German Society for Thoracic and Cardiovascular Surgery. Thorac Cardiovasc Surg 2014; 62 (1) 5-17
- 18 Hoffman JI. Incidence of congenital heart disease: I. Postnatal incidence. Pediatr Cardiol 1995; 16 (3) 103-113
- 19 Bode CO, Nwawolo CC, Giwa-Osagie OF. Surgical education at the West African College of Surgeons. World J Surg 2008; 32 (10) 2162-2166
- 20 Tchantchaleishvili V, Mokashi SA, Rajab TK, Bolman III RM, Chen FY, Schmitto JD. Comparison of cardiothoracic surgery training in USA and Germany. J Cardiothorac Surg 2010; 5: 118-123
- 21 Yankah AC, Sievers HH, Lange PE, Regensburger D, Bernhard A. Surgical repair of tetralogy of Fallot in adolescents and adults. Thorac Cardiovasc Surg 1982; 30 (2) 69-74
- 22 Edwin F, Aniteye E, Tettey MM, Tamatey M, Frimpong-Boateng K. Outcome of left heart mechanical valve replacement in West African children—a 15-year retrospective study. J Cardiothorac Surg 2011; 6: 57-65
- 23 Antunes MJ. Repair of rheumatic mitral valve regurgitation: how far can we go?. Eur J Cardiothorac Surg 2013; 44 (4) 689-691
- 24 Geldenhuys A, Koshy JJ, Human PA, Mtwale JF, Brink JG, Zilla P. Rheumatic mitral repair versus replacement in a threshold country: the impact of commissural fusion. J Heart Valve Dis 2012; 21 (4) 424-432
- 25 Cox JL. Presidential address: changing boundaries. J Thorac Cardiovasc Surg 2001; 122 (3) 413-418
- 26 Yankah CA, Pasic M, Musci M , et al. Aortic valve replacement with the Mitroflow pericardial bioprosthesis: durability results up to 21 years. J Thorac Cardiovasc Surg 2008; 136 (3) 688-696
- 27 Valfrè C, Ius P, Minniti G , et al. The fate of Hancock II porcine valve recipients 25 years after implant. Eur J Cardiothorac Surg 2010; 38 (2) 141-146