1. THE UNMET NEED FOR PAEDIATRIC AND CONGENITAL HEART SERVICES IN ACCRA Kow Entsua-Mensah 1*, Rada Bulley 1, Alfred Doku 1, Martin Adu-Adadey 1, Desrie Delsol-Gyan 1 and Frank Edwin 1. 1 National Cardiothoracic Centre, P. O. Box KB 846,Korle- Bu, Accra, Ghana. 1*Author / Presenter

2. BACKGROUND  Approximately 90% of more than 1,000,000 children who are born with congenital heart disease (CHD) around the world receive suboptimal care or have no access to care.  Approximately 50% of these children will die during their first 5 years of life before they receive any proper treatment.  In Ghana the magnitude of this problem has not been estimated. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu.2010;13(1):35-43. doi: 10.1053/j.pcsu.2010.02.001. Improving pediatric cardiac surgical care in developing countries: matching resources to needs.Dearani JA, Neirotti R, Kohnke EJ, Sinha KK, Cabalka AK, Barnes RD, Jacobs JP, Stellin G, Tchervenkov CI, Cushing JC.

3. METHODS  Retrospective search of the echocardiogram database from January 2006 to December 2010.  All patients less than 15 years diagnosed with a congenital heart disease, CHD, for the first time were selected and entered into the study.

4. RESULTS  4,823 new echocardiograms were performed  4,396 (91.2 %) met the inclusion criteria.  CHD: 60.3% of the enrolled patients.  2,175 (49.5%) were male whilst 2,221 (50.5%) were female  Male to female ratio of approx. 1:1.

5. TRIMODAL AGE DISTRIBUTION OF CHDS IN ACCRA

6. FIVE YEAR TREND IN NEW CASES SEEN IN ACCRA

7. Incidence of Acyanotic congenital heart disease 2006-2010 Acyanotic N% Ventricular Septal Defect84241.0 Atrial Septal Defect46622.7 Patent Ductus Arteriosus27713.5 Pulmonary Stenosis25611.6 Mitral valve prolapse113 5.5 Atrioventricular canal defects472.3 Tricuspid valve regurgitation291.4 Aortic Stenosis221.1 TOTAL2,052100

8. Cyanotic N% Tetralogy of Fallot43674.9 Double Outlet Ventricle498.4 Truncus Arteriosus356.0 TGA244.1 Single Atrium152.6 Single Ventricle152.6 Ebstein’s Anomaly40.7 Tricuspid valve Atresia20.3 Pulmonary valve Atresia20.3 TOTAL582100 Incidence of Cyanotic congenital heart disease - 2006-2010

9. FIVE COMMONEST CHDs IN ACCRA

10. SURGERY RATE AMONG PATIENTS WITH ASD, VSD, PDA AND TOF 2006 - 2010 YearsASDVSDPDATOF NOp% Op NOp% OpNOp% OpNOp% Op 200652713.5891719.1261869.2722636.1 2007461021.71492013.4231356.5852428.2 200868710.31781810.1521732.7762532.9 20099144.4176148.0722534.7753040.0 2010971414.42392410.01023433.31123228.6 Total3544211.98319311.227510738.942013732.6

11. INCIDENCE VRS OPERATED FRACTION YearNOperated% Operated 20062396828.5 20073036722.1 20083746717.9 20094147317.6 201055010418.9 Total188037920.2

12. DECLINE IN OPERATED FRACTION

13. DISCUSSION  The vision of the World Society for Pediatric and Congenital Heart Surgery is that every child born anywhere in the world with a CHD should have access to appropriate medical and surgical care.  Children in Ghana / Africa should be no exception to this vision. The improvement of care for paediatric and congenital cardiac disease across the World: a challenge for the World Society for Pediatric and Congenital Heart Surgery. Cardiol Young. 2008 Dec;18 Suppl 2:63-9. doi: 10.1017/S1047951108002801.

14. CHD BURDEN IN GHANA  Global incidence of CHD of 0.8% [1] of live births  Estimated population 24 million  Using CBR(31.07 per 1,000 people and IMR(40.9 deaths/1,000 live births) Ghana’s CHD burden may be obtained using the formula:  Population x (CBR–IMR) x 0.008 = number of new children born with CHD. Estimated CHD burden 5,800 per annum Jonas RA. Congenital heart surgery in developing countries. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2008:3-6. Sandoval N, Kreutzer C, Jatene M, Di Sessa T, Novick W, Jacobs JP, Pierre-Luc Bernier P-L, Tchervenkov CI. Pediatric Cardiovascular Surgery in South America : Current Status and Regional Differences. WJPCHS 2010; 1: 321-327

15. ONE PROBLEM  Our inability to comprehensively treat all the CHDs we diagnose

16. WHAT IS THE BARRIER TO ACCESSIBILITY  FINANCES!!

17. WHAT NEEDS TO BE DONE  Charities and foundations  Corporate organisations  NHIS  Special government budgetary allocation  Heart insurance  Private individuals

18. THANK YOU FOR YOUR ATTENTION