TY - JOUR
T1 - Recommendations for developing effective and safe paediatric and congenital heart disease services in low-income and middle-income countries
T2 - A public health framework
AU - Hasan, Babar S.
AU - Bhatti, Areesh
AU - Mohsin, Shazia
AU - Barach, Paul
AU - Ahmed, Eltayeb
AU - Ali, Sulafa
AU - Amanullah, Muneer
AU - Ansong, Annette
AU - Banu, Tahmina
AU - Beaton, Andrea
AU - Bolman, Ralph Morton
AU - Borim, Bruna Cury
AU - Breinholt, John P.
AU - Callus, Edward
AU - Caputo, Massimo
AU - Cardarelli, Marcelo
AU - Hernandez, Tomas Chalela
AU - Croti, Ulisses Alexandre
AU - Ejigu, Yayehyirad M.
AU - Fenton, Kathleen
AU - Gomanju, Anu
AU - Harahsheh, Ashraf S.
AU - Hesslein, Peter
AU - Hugo-Hamman, Christopher
AU - Khan, Sohail
AU - Kpodonu, Jacques
AU - Kumar, Raman Krishna
AU - Jenkins, Kathy J.
AU - Lakhoo, Kokila
AU - Malik, Mahim
AU - Nichani, Sanjiv
AU - Novick, William M.
AU - Overman, David
AU - Quenot, Alexis Palacios Macedo
AU - Patton Bolman, Ceeya
AU - Pearson, Dorothy
AU - Raju, Vijayakumar
AU - Ross, Shelagh
AU - Sandoval, Nestor F.
AU - Sholler, Gary
AU - Sharma, Rajesh
AU - Shidhika, Fenny
AU - Sivalingam, Sivakumar
AU - Verstappen, Amy
AU - Vervoort, Dominique
AU - Zühlke, Liesl J.
AU - Zheleva, Bistra
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2023/5/4
Y1 - 2023/5/4
N2 - The global burden of paediatric and congenital heart disease (PCHD) is substantial. We propose a novel public health framework with recommendations for developing effective and safe PCHD services in low-income and middle-income countries (LMICs). This framework was created by the Global Initiative for Children's Surgery Cardiac Surgery working group in collaboration with a group of international rexperts in providing paediatric and congenital cardiac care to patients with CHD and rheumatic heart disease (RHD) in LMICs. Effective and safe PCHD care is inaccessible to many, and there is no consensus on the best approaches to provide meaningful access in resource-limited settings, where it is often needed the most. Considering the high inequity in access to care for CHD and RHD, we aimed to create an actionable framework for health practitioners, policy makers and patients that supports treatment and prevention. It was formulated based on rigorous evaluation of available guidelines and standards of care and builds on a consensus process about the competencies needed at each step of the care continuum. We recommend a tier-based framework for PCHD care integrated within existing health systems. Each level of care is expected to meet minimum benchmarks and ensure high-quality and family centred care. We propose that cardiac surgery capabilities should only be developed at the more advanced levels on hospitals that have an established foundation of cardiology and cardiac surgery services, including screening, diagnostics, inpatient and outpatient care, postoperative care and cardiac catheterisation. This approach requires a quality control system and close collaboration between the different levels of care to facilitate the journey and care of every child with heart disease. This effort was designed to guide readers and leaders in taking action, strengthening capacity, evaluating impact, advancing policy and engaging in partnerships to guide facilities providing PCHD care in LMICs.
AB - The global burden of paediatric and congenital heart disease (PCHD) is substantial. We propose a novel public health framework with recommendations for developing effective and safe PCHD services in low-income and middle-income countries (LMICs). This framework was created by the Global Initiative for Children's Surgery Cardiac Surgery working group in collaboration with a group of international rexperts in providing paediatric and congenital cardiac care to patients with CHD and rheumatic heart disease (RHD) in LMICs. Effective and safe PCHD care is inaccessible to many, and there is no consensus on the best approaches to provide meaningful access in resource-limited settings, where it is often needed the most. Considering the high inequity in access to care for CHD and RHD, we aimed to create an actionable framework for health practitioners, policy makers and patients that supports treatment and prevention. It was formulated based on rigorous evaluation of available guidelines and standards of care and builds on a consensus process about the competencies needed at each step of the care continuum. We recommend a tier-based framework for PCHD care integrated within existing health systems. Each level of care is expected to meet minimum benchmarks and ensure high-quality and family centred care. We propose that cardiac surgery capabilities should only be developed at the more advanced levels on hospitals that have an established foundation of cardiology and cardiac surgery services, including screening, diagnostics, inpatient and outpatient care, postoperative care and cardiac catheterisation. This approach requires a quality control system and close collaboration between the different levels of care to facilitate the journey and care of every child with heart disease. This effort was designed to guide readers and leaders in taking action, strengthening capacity, evaluating impact, advancing policy and engaging in partnerships to guide facilities providing PCHD care in LMICs.
KW - cardiovascular disease
KW - paediatrics
KW - public health
KW - review
KW - thoracic surgery
UR - http://www.scopus.com/inward/record.url?scp=85159413519&partnerID=8YFLogxK
U2 - 10.1136/bmjgh-2023-012049
DO - 10.1136/bmjgh-2023-012049
M3 - Article
AN - SCOPUS:85159413519
SN - 2059-7908
VL - 8
JO - BMJ Global Health
JF - BMJ Global Health
IS - 5
M1 - bmjgh-2023-012049
ER -