The COVID-19 pandemic is currently ravaging the globe and the African continent is not left out. While the direct effects of the pandemic in regard to morbidity and mortality appear to be more significant in the developed world, the indirect harmful effects on already insufficient healthcare infrastructure on the African continent would in the long term be more detrimental to the populace. Women and children form a significant vulnerable population in underserved areas such as the sub-Saharan region, and expectedly will experience the disadvantages of limited healthcare coverage which is a major fall out of the pandemic. Paediatric cardiac services that are already sparse in various sub-Saharan countries are not left out of this downsizing. Restrictions on international travel for patients out of the continent to seek medical care and for international experts into the continent for regular mission programmes leave few options for children with cardiac defects to get the much-needed care. There is a need for a region-adapted guideline to scale-up services to cater for more children with congenital heart disease (CHD) while providing a safe environment for healthcare workers, patients, and their caregivers. This article outlines measures adapted to maintain paediatric cardiac care in a sub-Saharan tertiary centre in Nigeria during the COVID-19 pandemic and will serve as a guide for other institutions in the region who will inadvertently need to provide these services as the demand increases.

Traumatic diaphragmatic rupture is not a common injury in children. It is an important cause of morbidity and mortality, though diagnosis may be missed or delayed with atypical clinical presentation and confounding radiological features. A 4-year-old male presented with periumbilical abdominal pain, bilious vomiting, fever and progressive difficulty in breathing for two days. He had complained of vague left-side chest pain on return from the swimming pool about 6 weeks earlier. An initial chest radiograph showed a non-outlined left hemidiaphragm, a left pneumothorax, rightward mediastinal shift and suspected bowel in the chest. He could not afford a CT scan, hence a repeat chest radiograph was performed, which outlined the stomach with an air-fluid level in the left hemithorax.