Pediatric Cardiology and Cardiac Surgery in Developing Countries: Current Needs and Future Perspectives

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Background

Congenital heart disease (CHD) is present in nearly 1% of live births and, according to WHO, there are 1.5 million newborns affected per year. Moreover, 4 million children are estimated to be waiting for a heart operation worldwide. In the majority of CHD children (up to 90%), medical or surgical treatment may address the disease, prolong and improve quality of life, with an improvement of the clinical condition. Unfortunately, in developing countries, access to complex and expensive surgical treatments is not possible, and children are condemned to complications and even death. The number of children requiring cardiological attention is even greater if we consider the high prevalence of rheumatic heart disease. The dramatic disproportion of healthcare services between developed and developing countries makes the unequal access to medical care even more evident when it comes to pediatric cardiology and cardiac surgery. Over 70% of healthcare facilities are reachable by less than 20% of the world’s population. This leaves around 90% of children born with CHD without any access to cardiac care.

Many organizations have fought against this inequality with the overall purpose of providing care to children with CHD in developing countries. In the past decades, several programs, projects and collaborations have been developed, providing useful examples of successful and unsuccessful ideas. But nowadays, with the global economic crisis and the COVID-19 pandemic, the future of such battle against inequality is even more uncertain and difficult. The United Nations Development Program (UNDP) sustainable development goal for 2030 is to reduce mortality down to 25 per 1000 live births for children under five years of age. To achieve such a goal the care of CHD and RHD needs to be part of this strategic plan, considering that heart disease is among the most frequent causes of death in this age group, following malnutrition and infections. In consideration of the global pandemic and worldwide difficulties, we believe that this Research Topic plays a fundamental role by bringing together experts worldwide to share their experience. With the involvement of the main actors of humanitarian medicine, we aim to provide an overall picture of successful programs and evaluate possible solutions and future development.

The theme of pediatric cardiology and cardiac surgery in developing countries should be analyzed and treated with particular attention to:
1) Current results of CHD care in the developing world
2) Impact of the pandemic in international humanitarian cooperation and financial support
3) Role of scientific societies
4) Role of NGOs and large foundations
5) Sustainable socio-economic models of humanitarian medicine
6) Healthcare system organization
7) Education in pediatric cardiology / cardiac surgery for pediatricians and cardiologists / surgeons
8) Healthcare staff training models
9) Place selection, goals and team organization.

Keywords: Congenital heart disease, cardiac surgery, cardiology, humanitarian medicine, developing countries

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