Abstract
The World Health Organisation (WHO) supports pre-conception care (PCC) towards improving health and pregnancy outcomes. PPC entails a continuum of promotive, preventative and curative health and social interventions. PPC identifies current and potential medical problems of women of childbearing age towards strategising optimal pregnancy outcomes, whereas antenatal care constitutes the care provided during pregnancy. Optimised PPC and antenatal care would improve civil society and maternal, child and public health. Multiple factors bar most African women from receiving antenatal care. Additionally, PPC is rarely available as a standard of care in many African settings, despite the high maternal mortality rate throughout Africa. African women and healthcare facilitators must cooperate to strategise cost-effective and cost-efficient PPC. This should streamline their limited resources within their socio-cultural preferences, towards short- and long-term improvement of pregnancy outcomes.This review discusses the relevance of and need for PPC in resource-challenged African settings, and emphasises preventative and curative health interventions for congenital and acquired heart disease. We also consider two additional conditions, HIV/AIDS and hypertension, as these are two of the most important co-morbidities encountered in Africa, with significant burden of disease. Finally we advocate strongly for PPC to be considered as a key intervention for reducing maternal mortality rates on the African continent.
Highlights
Congenital heart diseaseThe story of congenital heart disease is one of the major successes of medicine in the last 50 years
The World Health Organisation (WHO) supports pre-conception care (PCC) towards improving health and pregnancy outcomes
The worst HIV/AIDS-affected people live in sub-Saharan Africa (SSA); 69% of all people living with HIV and 70% of all AIDS-related deaths in 2012 were from SSA,[33] which had approximately 1.6 million new HIV infections and approximately 1.2 million AIDS-related deaths
Summary
The story of congenital heart disease is one of the major successes of medicine in the last 50 years. With very few specialised cardiothoracic centres in Africa, the majority of children requiring congenital heart surgery have no access to these centres.[9] Adults with congenital heart disease in Africa fall into two categories, namely, those who are ‘postoperation’ or ‘post-intervention’, and adults with ‘previously undiagnosed’ congenital heart disease (recognised for the first time at pregnancy, or in early adulthood). The latter category is seldom encountered in the developed world. A recent review of one clinic in Cape Town, South Africa, showed that almost a third (32%, 15 with previous operations) had congenital heart disease.[11]
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