**7. Challenges incurred in establishing pediatric cardiology practice**

The practice of pediatric cardiology and pediatric cardiac services in Nigeria is faced with several challenges. The cost of pediatric cardiac services is very exorbitant and unaffordable for most developing nations. Nigeria gives priority to other disease burdens other than cardiac disease during budget allocations. The current COVID-19 pandemic, HIV/AIDS pandemic, poor health infrastructure and referral systems, malaria, pneumonias, and malnutrition have made the situation worse and dampen the importance of pediatric cardiac service.

The population of children with uncorrected congenital heart disease in Nigeria in particular and Africa in general is considerable. This is due to the fact that most pediatric services are centered on diagnosis and management of infectious diseases, shortage of trained personnel who diagnose congenital heart defects, resulting in late diagnosis and referral. Besides, the number of facilities for pediatric cardiac surgery is meager with attendant paucity of pediatric cardiac surgeons [16].

In Africa, pediatric cardiac surgery is usually performed in adults than in younger children, due to lack of manpower [17, 18]. The country no longer completely lacks facility and skills in carrying out stage procedures for cyanotic congenital cardiac disease or palliative surgery such as pulmonary artery banding or systemic-pulmonary shunt as earlier reported [19].

The challenges encountered in the establishment of pediatric surgery for cardiovascular diseases in African could be resolved through capacity building and inculcating expertise in the diagnosis and management of congenital heart diseases; training and retraining of local pediatric cardiologist and pediatric cardiac surgeon in the management of cardiac disease tailored to our sociocultural background; getting state-of-the-art equipment and facilities that will enhance the management of cardiovascular diseases in children; public enlightenment and campaign on preventive measures on emerging and reemerging cardiac disease, creating endowment funds and financial support where there will be community participation; making policies that establish pediatric cardiac training in Nigeria that will be sustainable and achievable; reinforcement of skills in terms of professional competences, exchange program, knowledge, innovative surgical techniques, new technologies, equipment, and human resources; granting financial aid to take care of the poorest of the poor by public, governmental, or private initiatives; establishment of number of centers of excellence dedicated to training, retraining, research, and clinical care in pediatric heart surgery in sub-Saharan Africa; developing international cooperation through foundations and nongovernmental organizations, and through banking firms and grants; and seeking the support of pharmaceutical industries and medical equipment [20–22].
