Maintaining paediatric cardiac services during the COVID-19 pandemic in a developing country in sub-Saharan Africa: guidelines for a “scale up” in the face of a global “scale down”

Abstract

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.

The burden, prevention and care of infants and children with congenital anomalies in sub-Saharan Africa: A scoping review

“…Papers focused on different issues, including challenges faced by patients in accessing surgical care e.g. [ 25 , 35 , 37 ] (including due to COVID-19, [ 57 ]); and performing surgery for complex anomalies [ 37 , 38 ]; the quality of peri- and/or post-operative surgical care (e.g., [ 32 , 33 ]); outcome/survival after surgery (e.g., [ 19 , 89 , 120 ]); and developing cost-effective, local surgical management tools (e.g. management silos for gastroschisis [ 58 ]).…”

Virtual Infection Prevention and Control in Low- and Middle-Income Countries

“…This study had not yet been conducted at time of publication. Another paper from sub-Saharan Africa describes how subspecialty care, in this case pediatric cardiology, can use teleconsults and teleradiology to continue providing services (Sokunbi et al, 2020). A real-world randomized controlled trial of a web-based training module about personal protective equipment from Switzerland could be implemented in LMICs (Suppan et al, 2020).…”

Challenges to infection control in early communication intervention: A scoping review

“…This challenges the transferability of research findings in the relevant literature to settings in low- to middle-income (LMICs) countries. For example, in LMICs such as South Africa, the implementation of IPC measures may be restricted by the lack of available and affordable PPE as well as insufficient healthcare infrastructure (Blignaut, Nemutandani, & Samaranayake, 2020 ; Sokunbi et al, 2020 ). Infection prevention is essential for providing high-quality and safe healthcare services to vulnerable populations such as neonates (Dramowski et al, 2020 ).…”

“…Secondly, virtual communication or telecommunication is recommended as a practical and efficient method of providing care during the social distance restrictions of the COVID-19 pandemic (Sarma et al, 2020 ). However, virtual communication cannot fully replace in-person encounters, and individuals in LMICs may have technological constraints and/or difficulty accessing networks and the Internet (Manto et al, 2020 ; Sokunbi et al, 2020 ).…”

“…According to Dramowski, Cotton and Whitelaw ( 2017 ), previously existing environmental challenges to HAI prevention in neonates and children included overcrowding, high patient-to-staff ratios, lack of IPC provision, lack of isolation facilities, inadequate cleaning and reuse and sharing of equipment. These previous inadequacies in healthcare have most likely worsened because of the COVID-19 pandemic (Sokunbi et al, 2020 ). The purpose of this study was to describe PPE and IPC measures used in early intervention through a scoping review of existing and recent literature and consultation with South African SLTs who provide ECI.…”