**1. Introduction**

Congenital heart disease (CHD) is the most common among all birth defects, occurring in about nine per 1000 live births globally. Fortunately, most of the CHD lesion are simple lesions, but 25% are critical lesions [1], which need urgent intervention within the first six months of age.

Each year about 1.35 million children are born with CHD; the majority of them are born in low-income countries (LICs). LICs have a higher fertility rate of 4.6 per woman compared to 1.6 per woman in high-income countries (HICs). The birth rate in LICs is 22 per 1000 population compared to 10 per 1000 population in HICs [2]. Each year around 140 million babies are born globally [3]; of these 1.4 million are born with CHD. Ninety percent of those born with CHD are born in a place with inadequate resources for pediatric cardiac care [4].

CHD is one of the main seven causes of death globally and has a significant socioeconomic impact on the community [5].

The past 50 years have witnessed massive breakthrough advances in cardiovascular care such as improvements in diagnosis, surgical treatment, catheter interventions, and Intensive care management. Survival of newborns with CHD has improved dramatically in HICs. Unfortunately, however, this is not the case in many low and low –middle-income countries where the burden is the heaviest and rates of death and disability continue to increase [6, 7].

Management of CHD requires significant resources, namely, highly developed infrastructure, equipment and highly skilled professionals who need years of training. This makes cardiovascular care in children very costly, and it needs a long time to be established. HICs have perfected the treatment of CHD over the past 50 years and are now able to provide adequate treatment to their population. LICs are only starting to build a structure to deliver such care. Even in HICs, the management of some complex CHD lesions is challenging, but in LICs the management of even simple lesions can be a challenge [8].

In LICs, 90% of children with CHD do not have access to pediatric cardiac services, even in the same country, there is a disparity in the access to the services between rural and urban, rich and poor. The challenges include poor financial and human resources and lack of infrastructure [9].

There is a huge disparity in pediatric cardiac resources between HICs and LICs, to put this difference into prospective we can compare the number of pediatric cardiac surgeons between HICs and LICs; in HICs, there are 1.67 pediatric cardiac surgeons per million population compared to 0.03 in LICs [10].

Pediatric cardiac services are expensive and need resources and large investments in the infrastructure. There is a positive correlation between the economic status of the country and the access to pediatric cardiac services [10].

The challenges and obstacles leading to suboptimal delivery of cardiac care for children with CHD in LICs, and potential solutions to improve access to cardiac care in LICs must be considered within the context of each country or region and social, economic, political and health care systems [11].

Need for greater awareness of CHD, increased education and training for incountry program clinicians, strategic health care planning at governmental and policy levels, and innovative solution for financing cardiac services in LICs are needed to help improve pediatric cardiac services [12].

As mentioned earlier, CHD is the commonest congenital anomaly, representing 28% of all congenital anomalies [13]. Studies from different parts of the world showed variation in the reported prevalence of CHD, some of the differences are due to the study methodology and setting i.e., hospital-based studies show higher prevalence compared to population studies. The prevalence figure of 8–10 per 1000 which came from HICs is generally taken as the approximate prevalence worldwide [8].

Significant geographical differences in the prevalence of CHD were reported. The lowest reported prevalence was in Africa (1.9 per 1000 live birth), the highest was in Asia (9.3 per 1000 live birth), while the prevalence in Europe was 8.2 per 1000 live birth [7].

The reported prevalence figures of CHD in Africa, especially in low-income countries, is not usually accurate and thought to be an underestimate owing to a paucity of data, poor health care system, difficulty in accessing health care system, poor health infrastructure, limited resources and early mortality [6]. CHD occur worldwide and although the incidence and prevalence may vary according to genetic *Management of Congenital Heart Disease in Low-Income Countries: The Challenges and the… DOI: http://dx.doi.org/10.5772/intechopen.104830*

and environmental factors there is no reason to think that they are lower in LICs compared to HICs [6].

In Africa, CHD is starting to become a major public health concern as the pediatric population represents 50% of the total population [14, 15] and due to the scarce availability of pediatric cardiac services, the affected population is starting to accumulate. CHD has now surpassed rheumatic heart disease (RHD) as the commonest cause of pediatric heart disease in some parts of Africa; presumably, this is related to increased awareness and better diagnostic facilities [16].

Delayed diagnosis is a major problem in LICS; this is due to low awareness of the families and medical professionals about CHD. In HICs, the diagnosis of CHD is established by 1 week of age in 40–50% of patients and by 1 month in up to 60% [7]. In addition, the fetal diagnosis is not well developed in LICs, with only 1% of cases detected antenatally [17], while in HICs prenatal diagnosis is routinely used to detect most of CHD cases before birth. Screening for CHD is not routinely practiced in LICs [1], this combined with low awareness contributes to late diagnosis. Often, late-stage presentation with complications such as pulmonary hypertension and myocardial dysfunction, few benefits from surgical treatment. Because of delayed diagnosis, lack of skilled personnel and non-availability of treatment facilities, the problem is further exacerbated [11].
