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The South-South partnership to provide cardiac surgery: The Namibian Children Heart Project
Introduction: Congenital and acquired heart diseases are highly prevalent in developing countries despite limited specialised care. Namibia established a paediatric cardiac service in 2009 with significant human resource and infrastructural constraints. Therefore, patients are referred for cardiac i...
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| Format: | Thesis |
| Language: | English |
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Department of Paediatrics and Child Health
2019
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| _version_ | 1867613522964250624 |
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| access_status_str | Open Access |
| author | Shidhika, Fenny Fiindje |
| author2 | Zühlke, Liesl Joanna |
| author_browse | Shidhika, Fenny Fiindje Zühlke, Liesl Joanna |
| author_facet | Zühlke, Liesl Joanna Shidhika, Fenny Fiindje |
| author_sort | Shidhika, Fenny Fiindje |
| collection | Thesis |
| description | Introduction: Congenital and acquired heart diseases are highly prevalent in developing countries despite limited specialised care. Namibia established a paediatric cardiac service in 2009 with significant human resource and infrastructural constraints. Therefore, patients are referred for cardiac interventions to South Africa. Objectives: To describe the diagnoses, clinical characteristics, interventions, post-operative morbidity and mortality and follow-up of patients referred for care. Methods: Demographics, diagnoses, interventions, intra- and postoperative morbidity and mortality as well as longitudinal follow-up data of all patients referred to South Africa were recorded and analysed. Results: The total cohort constituted 193 patients of which 179 (93%) had congenital and 7% acquired heart disease. The majority of patients (78.8%) travelled more than 400 km to Windhoek prior to transfer. There were 28 percutaneous interventions. Palliative and definitive surgery was performed in 27 and 129 patients respectively. Eighty (80/156, 51.3%) patients had postoperative complications, of which 15 (9.6%) were a direct complication of surgery. Surgical mortality was 8/156 (5.1%, 95% confidence interval 1.2.2-9.8), with a 30- day mortality of 3.2%. Prolonged ICU stay was associated with a 5% increased risk of death (Hazard Ratio 1.05, 95% confidence interval: 1.02-1.08, p=0.001). Follow-up was complete in 151 (78%) patients over seven years. Conclusions: Despite the challenges associated with a cardiac programme referring patients for intervention to a neighbouring country and the adverse characteristics of multiple lesions and complexity associated with late presentation, we report good surgical and interventional outcomes. Our goal remains to develop a comprehensive sustainable cardiac service in Namibia. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/29683 |
| institution | University of Cape Town (South Africa) |
| language | eng |
| last_indexed | 2026-06-10T12:37:29.824Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2019 |
| publishDateRange | 2019 |
| publishDateSort | 2019 |
| publisher | Department of Paediatrics and Child Health |
| publisherStr | Department of Paediatrics and Child Health |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/29683 The South-South partnership to provide cardiac surgery: The Namibian Children Heart Project Shidhika, Fenny Fiindje Zühlke, Liesl Joanna Hugo-Hamman, Christopher Paediatric Cardiology and Critical Care Introduction: Congenital and acquired heart diseases are highly prevalent in developing countries despite limited specialised care. Namibia established a paediatric cardiac service in 2009 with significant human resource and infrastructural constraints. Therefore, patients are referred for cardiac interventions to South Africa. Objectives: To describe the diagnoses, clinical characteristics, interventions, post-operative morbidity and mortality and follow-up of patients referred for care. Methods: Demographics, diagnoses, interventions, intra- and postoperative morbidity and mortality as well as longitudinal follow-up data of all patients referred to South Africa were recorded and analysed. Results: The total cohort constituted 193 patients of which 179 (93%) had congenital and 7% acquired heart disease. The majority of patients (78.8%) travelled more than 400 km to Windhoek prior to transfer. There were 28 percutaneous interventions. Palliative and definitive surgery was performed in 27 and 129 patients respectively. Eighty (80/156, 51.3%) patients had postoperative complications, of which 15 (9.6%) were a direct complication of surgery. Surgical mortality was 8/156 (5.1%, 95% confidence interval 1.2.2-9.8), with a 30- day mortality of 3.2%. Prolonged ICU stay was associated with a 5% increased risk of death (Hazard Ratio 1.05, 95% confidence interval: 1.02-1.08, p=0.001). Follow-up was complete in 151 (78%) patients over seven years. Conclusions: Despite the challenges associated with a cardiac programme referring patients for intervention to a neighbouring country and the adverse characteristics of multiple lesions and complexity associated with late presentation, we report good surgical and interventional outcomes. Our goal remains to develop a comprehensive sustainable cardiac service in Namibia. 2019-02-19T13:35:25Z 2019-02-19T13:35:25Z 2018 2019-02-19T10:46:16Z Master Thesis Masters MPhil http://hdl.handle.net/11427/29683 eng application/pdf Department of Paediatrics and Child Health Faculty of Health Sciences University of Cape Town |
| spellingShingle | Paediatric Cardiology and Critical Care Shidhika, Fenny Fiindje The South-South partnership to provide cardiac surgery: The Namibian Children Heart Project |
| thesis_degree_str | Master's |
| title | The South-South partnership to provide cardiac surgery: The Namibian Children Heart Project |
| title_full | The South-South partnership to provide cardiac surgery: The Namibian Children Heart Project |
| title_fullStr | The South-South partnership to provide cardiac surgery: The Namibian Children Heart Project |
| title_full_unstemmed | The South-South partnership to provide cardiac surgery: The Namibian Children Heart Project |
| title_short | The South-South partnership to provide cardiac surgery: The Namibian Children Heart Project |
| title_sort | south south partnership to provide cardiac surgery the namibian children heart project |
| topic | Paediatric Cardiology and Critical Care |
| url | http://hdl.handle.net/11427/29683 |
| work_keys_str_mv | AT shidhikafennyfiindje thesouthsouthpartnershiptoprovidecardiacsurgerythenamibianchildrenheartproject AT shidhikafennyfiindje southsouthpartnershiptoprovidecardiacsurgerythenamibianchildrenheartproject |