OBJECTIVE: To evaluate paediatric cardiac services in South
Africa with respect to referral base, services provided and
STUDY DESIGN: A descriptive study design was used. An audit
of the referral base, personnel and activity of paediatric
cardiac units throughout South Africa was conducted by
means of a questionnaire. A specialist from each centre was
asked to provide the relevant data. Where accurate data
was not available, estimates were provided by practitioners
within each centre.
RESULTS: All identified units participated in the audit. Three
were private sector units while the other five were primarily
public sector units. Twenty four paediatric cardiologists,
equally distributed between public and private sector units,
were practicing in the country as at end 2008, with a further
eight paediatricians undergoing training in paediatric
cardiology. This is significantly less than the 88 paediatric
cardiologists required for the population of South Africa.
Eight paediatric cardiac surgeons were operating predominantly
on children in public hospitals and five in private
An estimated 1370 operations for congenital heart disease
were performed over a one year period, with 800 of these in
the public sector. Extrapolating from accepted estimates of
congenital heart disease incidence, this represents conservatively,
less that 40% of operations required for the
population. Additionally, only 26% of the estimated 114
simple transposition of great arteries born annually were
operated on, indicating serious deficiencies in the ability to
adequately detect and intervene in serious congenital heart
disease presenting in the neonatal period.
CONCLUSION: The infrastructure and resources to detect and
manage heart disease in children in South Africa, particularly
within the public sector, are grossly inadequate.