Cardiac Surgery to Manage Rheumatic Heart Disease in Africa Is Complex - a Geographic Perspective

Area of Science:

• Cardiology
• Public Health
• Geographic Information Systems

Background:

• Rheumatic heart disease (RHD) is the most prevalent acquired heart condition in Africa, frequently necessitating surgical intervention.
• Existing research highlights a deficit of cardiac surgeons in Africa but lacks detailed analysis of their distribution relative to population density and RHD incidence.

Purpose of the Study:

• To estimate the incidence of RHD and assess the existing cardiac surgical capacity for managing RHD in Africa.
• To characterize geographic catchment areas for cardiac surgeons, estimate patient travel distances, and quantify the unmet surgical need for RHD.

Main Methods:

• Utilized subnational population, RHD incidence, cardiac surgeon, and geographic data from accessible public sources.
• Employed Quantum Geographic Information System (QGIS) for nearest neighbor analyses to map surgeon locations, define catchment areas, and calculate distances.
• Calculated incident RHD case-to-capacity ratios (ICCR) and surgical need, incorporating the Human Development Index (HDI) to evaluate socioeconomic influences.

Main Results:

• Analysis included 779 subnational regions across 54 African countries.
• Africa has an estimated 509 cardiac surgeons serving 74 catchment areas, with 1,027,974 annual incident RHD cases.
• The average travel distance to a cardiac surgeon was 312.01 km, and the continental ICCR was 10.64.

Conclusions:

• Cardiac surgical care access for RHD is severely limited across Africa, despite the disease's high prevalence.
• Increasing cardiac surgical capacity is needed continent-wide, with a focus on strategically developing geographically accessible centers to ensure equitable RHD care.