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Treating Children With Advanced Rheumatic Heart Disease in Sub-Saharan Africa: The NGO EMERGENCY's Project at the
Rossella Miccio1, Maria Quattrociocchi1, Lorenzo Valgoi1
1Emergency ONG ONLUS, Milan, Italy.
Insights
Rheumatic heart disease care in Sub-Saharan Africa is limited by cost. The Salam Centre in Sudan provides free cardiac surgery, offering a 5-year survival rate of 85% for children with advanced rheumatic heart disease.
Area of Science:
- Cardiology
- Public Health
- Global Health
Background:
- Rheumatic heart disease (RHD) is prevalent in Sub-Saharan Africa, with limited access to affordable cardiac surgery.
- Humanitarian efforts are crucial for addressing advanced RHD in low-resource settings.
Purpose of the Study:
- To report on the establishment and outcomes of the Salam Centre for Cardiac Surgery in Sudan.
- To analyze the clinical features and outcomes of pediatric patients undergoing surgery for advanced RHD.
Main Methods:
- The Salam Centre, a humanitarian project, provides free open-heart surgery for RHD and congenital heart disease.
- Analysis of clinical data for 1,318 pediatric patients (under 15) operated on for RHD between 2007 and 2019.
Main Results:
- Over 8,000 surgeries performed since 2007, with ~20% of patients from other African countries.
- The overall 5-year survival rate for the pediatric RHD cohort was 85.0%.
- No statistically significant difference in outcomes between mitral valve repair and replacement, though repair trend suggests better outcomes.
Conclusions:
- The Salam Centre demonstrates successful delivery of high-quality, free cardiac surgery in a low-resource setting.
- Surgical intervention, coupled with long-term follow-up, can improve outcomes for RHD patients.
- Addressing RHD requires a multifaceted approach, including improved socio-economic conditions and healthcare systems.
Abstract:
Rheumatic heart disease is endemic in Sub-Saharan Africa and while efforts are under way to boost prophylaxis and early diagnosis, access to cardiac surgery is rarely affordable. In this article, we report on a humanitarian project by the NGO EMERGENCY, to build and run the Salam Centre for Cardiac Surgery in Sudan. This hospital is a center of excellence offering free-of-charge, high-quality treatment to patients needing open-heart surgery for advanced rheumatic and congenital heart disease. Since it opened in 2007, more than 8,000 patients have undergone surgery there; most of them Sudanese, but ~20% were admitted from other countries, an example of inter-African cooperation. The program is not limited to surgical procedures. It guarantees long-term follow-up and anticoagulant treatment, where necessary. By way of example, we report clinical features and outcome data for the pediatric cohort: 1,318 children under the age of 15, operated on for advanced rheumatic heart disease between 2007 and 2019. The overall 5-year survival rate was 85.0% (95% CI 82.7-87.3). The outcomes for patients with mitral valves repaired and with mitral valves replaced are not statistically different. Nevertheless, observing the trend of patients undergoing valve repair, a better outcome for this category might be assumed. RHD in children is an indicator of poor socio-economic conditions and an inadequate health system, which clearly will not be cured by cardiac surgery alone. Nevertheless, the results achieved by EMERGENCY, with the crucial involvement and participation of the Sudanese government over the years, show that building a hospital, introducing free cardiac surgery, and offering long-term post-operative care may help spread belief in positive change in the future.