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Barriers to Accessing Congenital Heart Surgery in Low- and Middle-Income Countries: A Systematic Review
Samuel P S Cheng1, Kayoung Heo1, Emilie Joos2
1Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Insights
Access to congenital heart disease (CHD) surgical care in low- and middle-income countries (LMICs) is limited by numerous factors. This review identifies key preoperative, perioperative, and postoperative barriers to improve care for children with CHD.
Area of Science:
- Global Health
- Pediatric Cardiology
- Health Services Research
Background:
- Congenital heart disease (CHD) is the most common major congenital anomaly.
- Over 90% of children with CHD in low- and middle-income countries (LMICs) lack access to essential treatments.
- Limited data exists on barriers to accessing CHD care, hindering intervention development.
Conclusions:
- Addressing barriers to healthcare access is crucial for reducing child mortality.
- This review provides a comprehensive classification of barriers to CHD care in LMICs.
- Findings can guide the development of targeted solutions to improve access to congenital cardiac surgery.
Background:
Congenital heart disease (CHD) is the most common major congenital anomaly. Ninety percent of children with CHD are born in low- and middle-income countries (LMICs), where over 90% of patients lack access to necessary treatments. Reports on barriers to accessing CHD care are limited. Accordingly, it is difficult to design evidence-based interventions to increase access to congenital cardiac surgical care in LMICs.
Objective:
We performed a qualitative systematic review to understand barriers to accessing congenital cardiac surgical care in LMICs.
Methods:
We conducted a search of Ovid MEDLINE and CINAHL databases to identify relevant articles from January 2000 to May 2021. We then used a thematic analysis to summarize qualitative data into a framework of preoperative, perioperative, and postoperative barriers.
Results:
Our search yielded 1,585 articles, of which 67 satisfied the inclusion criteria. Notable preoperative barriers included delayed diagnosis, insufficient caregiver education, financial constraints, difficulty reaching treatment centers, sociocultural stigma of CHD, sex-based discrimination of patients with CHD, and Indigeneity. Perioperative barriers included lack of hospital resources and workforce, need for prolonged hospitalization, and strained physician-patient relationships. Many patients faced barriers postoperatively and into adulthood due to a shortage of critical care resources, inadequate caregiver counseling and patient education, lack of follow-up, and debt from hospital bills and missed work.
Conclusion:
Reducing neonatal and childhood mortality begins with recognizing barriers to accessing health care. Our systematic review identifies and classifies challenges in accessing CHD in LMICs and suggests solutions to major barriers.
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