Treating Children With Advanced Rheumatic Heart Disease in Sub-Saharan Africa: The NGO EMERGENCY's Project at the Salam Centre for Cardiac Surgery in Sudan

Rossella Miccio,Luca Rolla,Gina Portella,Nicoletta Erba,Alessandro Salvati,Elena Giovanella,Salvatore Lentini,Maria Quattrociocchi,Liliane Chatenoud,Gino Strada,Martin Langer,Manahel Badr Saad,Sofia Gatti,Daniela Rocchi,Lorenzo Valgoi

doi:10.3389/fped.2021.704729

Abstract

Rheumatic heart disease is endemic in Sub-Saharan Africa and while efforts are under way to boost prophylaxis and early diagnosis, access to cardiac surgery is rarely affordable. In this article, we report on a humanitarian project by the NGO EMERGENCY, to build and run the Salam Centre for Cardiac Surgery in Sudan. This hospital is a center of excellence offering free-of-charge, high-quality treatment to patients needing open-heart surgery for advanced rheumatic and congenital heart disease. Since it opened in 2007, more than 8,000 patients have undergone surgery there; most of them Sudanese, but ~20% were admitted from other countries, an example of inter-African cooperation. The program is not limited to surgical procedures. It guarantees long-term follow-up and anticoagulant treatment, where necessary. By way of example, we report clinical features and outcome data for the pediatric cohort: 1,318 children under the age of 15, operated on for advanced rheumatic heart disease between 2007 and 2019. The overall 5-year survival rate was 85.0% (95% CI 82.7–87.3). The outcomes for patients with mitral valves repaired and with mitral valves replaced are not statistically different. Nevertheless, observing the trend of patients undergoing valve repair, a better outcome for this category might be assumed. RHD in children is an indicator of poor socio-economic conditions and an inadequate health system, which clearly will not be cured by cardiac surgery alone. Nevertheless, the results achieved by EMERGENCY, with the crucial involvement and participation of the Sudanese government over the years, show that building a hospital, introducing free cardiac surgery, and offering long-term post-operative care may help spread belief in positive change in the future.

Highlights

Rheumatic heart disease (RHD) is a disease connected to poverty: group A streptococcal infection is the first event, which may be followed in sequence by acute rheumatic fever (ARF) and RHD
The majority (1,318, 56%) of these children suffered from RHD, while 1,025 (43.5%) underwent surgery for CHD and 11 (0.5%) for other reasons (Supplementary Figure 2)
Mortality rates were comparable over time, with values of 4.4% (n = 22/499), 2.7% (n = 11/405) and 3.3% (n = 14/414), in the periods 2007–2011, 2012–2015, and 2016–2019, respectively

Summary

INTRODUCTION

Rheumatic heart disease (RHD) is a disease connected to poverty: group A streptococcal infection is the first event, which may be followed in sequence by acute rheumatic fever (ARF) and RHD. The estimated need for cardiac surgery for RHD in endemic countries in Sub-Saharan Africa (SSA) is around 150 per year per million people [9] This number is far from manageable, and only about 5% of patients with severe RHD had access to heart surgery [10]. Valve surgery with implantation of mechanical heart valves is by far the most frequent procedure at the Salam Centre, and the resulting need for adequate anticoagulant treatment led to the establishment of the OAC This activity is run in cooperation with Federazione Centri per la Diagnosi della Trombosi e la Sorveglianza delle Terapie Antitrombotiche (FCSA) and is based on education of patients, free tests, drug supply, and counseling whenever necessary.

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Strengths and Limitations of This Article

DATA AVAILABILITY STATEMENT

ETHICS STATEMENT