**5. Reducing the toll of congenital heart disease in developing countries**

The huge toll of congenital heart disease in developing countries obviously calls for urgent action. Management of congenital heart disease in developing countries has hitherto however focused primarily on treatment. While treatment is very important, the huge capital investments necessary to treat affected children and those yet to be born, is clearly beyond the limited health budgets of many developing countries. The need for a paradigm shift in the management of cardiac diseases from treatment only, to prevention plus treatment and rehabilitation has been highlighted (Pezzella 2010). This has implications as well for congenital heart disease, at least those that are clearly preventable and presents the need for paediatric cardiologists to be more involved in efforts to eliminate or minimize the occurrence of congenital heart diseases of preventable cause. Furthermore, the prevention of congenital heart disease would be difficult to separate from that of other birth defects and therefore should be an integral part of prevention strategies for birth defects generally.

Even though religious and socio-cultural differences may not permit the wholesale adoption some of the methods used, there are many lessons to be learnt from the experiences of more developed countries, where the incidence of birth defects have been reduced by about 75%

Challenges in the Management of Congenital Heart Disease in Developing Countries 271

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The foregoing coupled with the realities on ground in many developing countries today, inform certain broad areas of emphasis, including the urgent need for research and accurate data, improved diagnosis and treatment and a greater emphasis on prevention than has hitherto been the case. Preventive measures in particular deserve high priority and should be integrated into primary health care. As has been suggested, achieving the millennium development goals will also help to reduce the toll of paediatric heart disease, including congenital heart disease in developing countries (Leblanc, 2009). The need for communitybased studies to generate accurate statistics on incidence, mortality and survival and the improved collection of routine data cannot be over-emphasized as such data are vital for planning intervention programmes and to justify more resource allocation. Longer term measures include the provision of more treatment facilities and the training of more specialists – obstetricians, paediatricians, cardiologists, paediatric cardiologists, cardiac surgeons, and all other allied health care professionals. This requires more resource allocation and more judicious use of available resources.
