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India lacks a complete paediatric cardio-care service
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INDIA LACKS A COMPLETE PAEDIATRIC CARDIO-CARE SERVICE

Soma Basu
September 30, 2022 00:08 IST
Updated: September 30, 2022 02:00 IST
Soma Basu
September 30, 2022 00:08 IST
Updated: September 30, 2022 02:00 IST


A DEARTH OF SPECIALISTS AND INFRASTRUCTURE IN INDIA, IN THE GOVERNMENT AND
PRIVATE SECTORS, IS HAMPERING THE FUTURE OF CHILDREN WITH CONGENITAL HEART
DISEASE

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‘We need to act fast as many of India’s children need help’ | Photo Credit:
Getty Images


A DEARTH OF SPECIALISTS AND INFRASTRUCTURE IN INDIA, IN THE GOVERNMENT AND
PRIVATE SECTORS, IS HAMPERING THE FUTURE OF CHILDREN WITH CONGENITAL HEART
DISEASE



It is overwhelming for parents to be told that their child may have heart
defects. It is worse when the child does not get treated in time due to lack of
paediatric cardiac care in the vicinity of his/her home.

Congenital Heart Disease (CHD), which the Centers for Disease Control and
Prevention (CDC), Atlanta, U.S., acknowledges to be the most common congenital
disorder, is responsible for 28% of all congenital birth defects, and accounts
for 6%-10 % of all the infant deaths in India.


Also Read


CHILDREN WITH HEART DEFECTS HAVE POOR QUALITY OF LIFE, FINDS STUDY

Paediatricians say timely medical intervention can save 75% of these children
and give them normal lives. The lack of a national policy for the treatment of
cardiovascular diseases in children keeps a huge number outside the ambit of
treatment. It is estimated that over 1,00,000 children keep getting added to the
existing pool of children awaiting surgery.

According to the Pediatric Cardiac Society of India (PCSI), the prevalence of
congenital cardiac anomalies is one in every 100 live births; or an estimated
2,00,000 children are born with CHD every year. Only 15,000 of them receive
treatment. At least 30% of infants who have complex defects require surgical
intervention to survive their first birthday but only 2,500 operations can be
performed each year. A case in point is the premier All India Institute of
Medical Sciences (AIIMS), where infants are waitlisted till 2026 for cardiac
surgery.


A DISTRESSING PERCEPTION, GROUND REALITIES

A retired health bureaucrat says that there has been more neglect and little
improvement in child health care because creating a comprehensive paediatric
cardiology care service is usually considered economically unviable — it is
resource intensive and requires infrastructure investment that politicians and
policymakers choose to evade.



There are 22 hospitals and less than 50 centres in India with infant and
neonatal cardiac services. Geographically, these centres are not well
distributed either. A 2018 cardiology department report of AIIMS, highlighted
how South India accounted for 70% of these centres; most centres are located in
regions with a lower burden of CHD. For instance, Kerala has eight centres
offering neonatal cardiac surgeries for an estimated 4.5 lakh annual
childbirths. Populous Uttar Pradesh and Bihar, with an estimated annual
childbirth of 48 and 27 lakh births per annum, respectively (Census of India,
2012), do not have a centre capable of performing neonatal cardiac surgery.


IT TAXES THE VULNERABLE AND THE MARGINALISED

For 600 districts with a 1.4 billion population, there are only 250 paediatric
cardiologists available. The doctor to patient ratio is an abysmal one for
half-a-crore population. According to the Annals of Pediatric Cardiology
journal, the United States had 2,966 paediatric cardiologists in 2019 — a ratio
of one per 29,196 population. Jammu and Kashmir, Himachal Pradesh, Jharkhand,
Punjab, Odisha (besides U.P. and Bihar) have a higher CHD burden but do not have
paediatric cardiologists in the government sector. There are four paediatric
cardiologists for 38 Delhi government hospitals. Now, Jaipur (Rajasthan), Raipur
(Chhattisgarh), Coimbatore (Tamil Nadu), Madurai (Tamil Nadu), Bhubaneshwar
(Odisha), Palwal (Haryana), Indore (Madhya Pradesh), are on the map of
paediatric cardiac care, but largely in the private sector.

Apart from the low number of paediatric cardiologists and cardiac surgeons, and
critical care centres, poverty is another barrier before treatment. Transporting
sick neonates from States with little or no cardiac care facilities to faraway
centres for accurate diagnosis and treatment burdens parents financially.

It is not just unaffordability but also inaccessibility that constraints
paediatric services. In addition, there is the non-availability of crucial
equipment that is essential for diagnosis of heart diseases in the unborn.
Accentuating the problem is the general lack of awareness about early symptoms
of CHD among parents.


ANTENATAL CHECKS ARE CRUCIAL

The Child Heart Foundation, a non-governmental organisation working in Siliguri
(West Bengal), Jalandhar (Punjab) and Delhi, with underprivileged children with
CHD, has been flagging the need for fetal echocardiography.

Paediatricians say antenatal detection of congenital anomalies is crucial for
neonatal care and management. But certain congenital defects such as accurate
heart health assessment are not visible in a normal ultrasonography of an unborn
baby. Fetal echocardiography done in a pregnant woman of 18 to 24 weeks allows
better visualisation of the structure and function of the heart. There are
programmes worth emulating such as Kerala’s ‘Hridayam (for little hearts)’,
aimed at early detection, management and support to children with CHD or the
Tamil Nadu Chief Minister’s Comprehensive Health Insurance Scheme offering free
specialised surgeries.

The National Health Protection Scheme (Ayushman Bharat), is expected to
financially assist 10 crore poor families but has still to take off. So far,
Maharashtra, Karnataka, Gujarat and Andhra Pradesh have apparently got going.

A 2018 article by the Department of Cardiothoracic Cardiology, AIIMS, states,
“paediatric cardiology is not a priority area in the face of competing demands
for the resources”.

Nothing seems to have changed, and as another World Heart Day (September 29) has
passed by, we need to act fast to help India’s many children in need.

soma.basu@thehindu. co.in




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India
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Printable version | Sep 30, 2022 2:08:27 am |
https://www.thehindu.com/opinion/op-ed/india-lacks-a-complete-paediatric-cardio-care-service/article65951374.ece

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