40% of children with heart diseases left to die each year

Infographic: TBS

Six-month-old Zubair was diagnosed with congenital heart failure, prompting the paediatric cardiologist of the National Heart Foundation and Research Institute to urge emergency heart surgery. 

Zubair's father Aksar Ali, a farmer by profession, rushed to gather the princely sum of Tk3 lakh needed for the surgery, selling some land in his village and borrowing from relatives.

A month into the waiting period for the surgery, Zubair is yet to receive his serial number. 

The delay stems from the Heart Foundation having only two paediatric cardiac surgeons as opposed to hundreds of patients waiting for surgery like Zubair.

The situation countrywide is even bleaker. There are currently only 12-15 cardiac surgeons in the country against a need for around 300. 

Although Bangladesh has seen breakthroughs and progress in dealing with adult heart patients, for children the situation has not improved but has rather worsened. 

In 2001, the National Institute of Cardiovascular Diseases (NICVD) launched a paediatric cardiology department. In 2002, the number of children treated for heart disease was 4,674. By 2021, the number rose to about 20,000. 

An average of 60-70 children receive NICVD's outdoor services every day. However, there are no facilities for infant and neonatal surgery. 

Zubair's family contacted NICVD, the only government hospital specialised in heart treatment in the country, but it, too, does not perform such surgeries on young children.

Even more worrying, according to the Paediatric Cardiac Society of Bangladesh (PCSB), the number of paediatric cardiologists is not more than 30 people, almost all of whom are Dhaka-based. 

Professor Dr Abdus Salam, vice president of PCSB and former head of the Department of Child Cardiology at the National Institute of Cardiovascular Diseases, told The Business Standard that child cardiology treatment in the country has not yet developed because it is not profitable. 

Many of the children suffering from heart disease come from economically-disadvantaged backgrounds, he said. 

"Doctors don't want to get into this line because it's less money. Another reason is infrastructure.  Cardiac catheterization labs and state of the art equipment are required, but there aren't enough of those. Investors aren't interested either because of the low profit margins. Furthermore, there are no dedicated skilled nurses or other staff for young children. There isn't even a dedicated ICU for children," he said.

Doctors say the reason for heart disease in children is genetic. Any kind of birth complications during birth, including environmental pollution, can cause Congenital Heart Disease (CHD) in children.  

Cardiologists also say the incidence of heart disease among the less-privileged is more prevalent as women from poor families suffer from malnutrition during pregnancy, lack proper antenatal care and suffer from various types of infections which lead to their children suffering from congenital heart disease. 

While early detection can prevent future complications, many children from lower-income families are born at home, making early detection impossible. Most approach doctors when a patient's situation worsens.

Labaid, one of the leading hospitals for heart treatment in the country, has all types of heart disease treatment for adults, but only six beds are used to treat children with the same condition. Even surgeries are done selectively. 

Dr AM Shamim, managing director of Labaid Group, told The Business Standard that the reluctance in developing treatment of children's heart disease is economic. "As most heart patients are from low-income families, we get many patients who cannot afford to pay Tk90,000 to buy the device used to treat children.

"In addition, there is a shortage of doctors specialising in paediatric heart disease. Also, the death of a child during treatment or surgeries elicits a strong reaction from parents. To avoid this trouble, investment in this area is on a reduced scale." 

He, however, said Labaid is starting a full-fledged paediatric cardiac unit with 40 beds next year with all kinds of facilities.

Dr AM Shamim said private-public partnership is essential in treating paediatric heart disease, calling for subsidies from the government in this regard, citing the example of Maharashtra in India, where heart treatment for children improved after the government subsidised private health institutions.

At present, nearly 4,00,000 children are suffering from various types of heart problems. About 50,000 children are born with congenital heart disease every year.

About 40% of children with heart disease die each year due to lack of treatment, according to the PCSB. 

Still stuck in baby steps

Only seven medical institutes in Bangladesh provide treatment for various heart ailments in children: NICVD, Bangabandhu Sheikh Mujib Medical University, Heart Foundation Hospital and Research Institute, Cardiology Department for Children at Dhaka Shishu Hospital, Ibn Sina Hospital and Combined Military Hospital (CMH) Dhaka, and Ibrahim Cardiac Hospital and Research Institute. 

Out of this, only Heart Foundation and CMH have neonatal surgeries. These two hospitals have adequate infrastructure and equipment for paediatric patients only.

The PCSB is currently working to develop manpower to treat paediatric cardiac patients. Courses in MD and FCPS in paediatric cardiology have been launched. 

Dr Abdus Salam, however, also said surgeons are not interested as there is no separate post of a Pediatric Surgeon in the government setup.

The government should give importance to paediatric cardiac treatment to reduce the child mortality rate in the country, he said. 

Last year, an initiative was taken to build a full-fledged paediatric cardiology and paediatric cardiac surgery unit at the Bangabandhu Sheikh Mujib Medical University (BSMMU). From July 2021, treatment programmes started there on a limited scale. 

Specialist surgeons from India are performing surgeries on complex paediatric heart patients at BSMMU, which has taken an initiative to bring in specialised and skilled nurses. Paediatric cardiologists feel that the suffering of paediatric heart patients will be reduced somewhat if the paediatric cardiology and paediatric cardiac surgery units of BSMMU are fully operational.

29 September is World Heart Day. This year's theme is " Use heart for every heart''.