Access to pediatric cardiac care in Tanzania

• Published in: Canadian Journal of Surgery 2022-08, Vol.65, p.S15-S15
• Main Authors: Sasson, Lior, Dekel, Hagi, Sternfeld, Alona Raucher, Assa, Sagi, Sarid, Racheli Sion, Mnong'one, Naizihijwa Joel, Sharau, Godwin Godfrey, Mongella, Stella Mihayo, Caryl, William Goldstein, Goldman, Bernard
• Format: Article
• Language: English
• Subjects: Pediatrics
• ISSN: 0008-428X; 1488-2310

Background: Pediatric cardiac care resources are inadequate in most countries. Children with congenital or acquired heart disease are either referred to Western centres or depend on intermittent visits (missions) to local hospitals. Save a Child's Heart (SACH) has brought more than 6000 children from 63 countries to Israel for surgery since 1995; of these, 735 came from Tanzania and Zanzibar. Since 2011, SACH has conducted 13 surgical and interventional missions in Tanzania (total of 197 children treated), with 17 screening (diagnostic) missions in Tanzania and 8 in adjacent Zanzibar. Our study objective was to assist in the development of an independent, sustainable pediatric cardiac centre of competence in Tanzania. Methods: SACH embarked on a stand-alone pediatric cardiac service in Tanzania after the central government expressed support for a cardiac institute (Jakaya Kikwete Cardiac Institute [JKCI]) in the capital. Over a 12-year interval, SACH trained the core persons needed: surgeons, anesthetists, cardiologists, intensivists, interventionalists, technicians, perfusionists and operating room and intensive care unit nurses (24 in total). Performance reviews were routinely conducted. Trainees spent 3 months to 5 years in Israel, depending on previous experience. SACH missions to JKCI continued during the training period. SACH Canada assumed responsibility for salary support, new equipment and disposables plus mission costs; board members attended 2 missions as observers. Results: Surgical volumes for 2020 (121 patients) and 2021 (240 patients) reflected increased capacity with satisfactory outcomes. A JKCI screening mission to Zanzibar resulted in children referred to both Israel and JKCI. There is a significant backlog of patients in a Tanzanian population of more than 61 million. Conclusion: The goal of a functional, stand-alone, sustainable pediatric cardiac care service is possible in a low- to middle-income country. Government and other support from an expert Western centre for training and ongoing oversight is essential. Transition to a fully independent centre is in process.