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. 2025 Jun 25;91(1):36.
doi: 10.5334/aogh.4692. eCollection 2025.

Estimating Congenital Cardiac Surgical Need in Africa Using Geographic Distribution of Surgeons

Jordan Leith  1   2 , Lamia Harik  1 , Kevin R An  1 , Taylor Brashear  2 , Robert N Peck  2   3 , Castigliano M Bhamidipati  4
Affiliations

Estimating Congenital Cardiac Surgical Need in Africa Using Geographic Distribution of Surgeons

Jordan Leith et al. Ann Glob Health. .

Abstract

Background: Access to congenital cardiac surgical care in Africa is limited and poorly characterized, with current assessments examining only the number of surgeons in individual countries compared to their respective national population. Objective: To characterize geographic catchment areas in Africa served by the nearest congenital cardiac surgeon(s), estimate patient travel distance, and map both the incidence and unmet surgical need due to congenital heart disease (CHD). Methods: Subnational population, CHD incidence, surgeon, and geographic data were collected from credible, publicly accessible sources. Quantum Geographic Information System was used to create a subnational map of Africa and conduct nearest neighbor analyses to determine the location and distance of each subnational region's nearest cardiac surgeon. Catchment areas were defined and characterized. Incident CHD cases and surgical needs due to CHD were calculated and mapped at the subnational level across Africa. Findings: There were 779 subnational regions from 54 countries included in this analysis. Africa was estimated to have 290 congenital cardiac surgeons located in 63 subnational regions corresponding to 63 catchment areas and 1,097,388 incident CHD cases annually. The average travel distance to a congenital cardiac surgeon was 324.40 km (201.57 miles). The ratio of incident CHD to total surgical case capacity was 20.79. Congenital cardiac surgical need was not limited to areas of high incidence and was compounded by distance to the nearest surgeon, with the greatest need occurring in the Congo Basin and Horn of Africa. Conclusions: Access to congenital cardiac surgery is limited in Africa with the capacity to surgically treat less than 5% of annual CHD cases. Surgical need is exacerbated by the geographic distribution of surgeons, which requires patients to travel great distances.

Keywords: access to care; congenital heart disease; global health.

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Conflict of interest statement

The authors have no competing interests to declare.

Figures

Population served in each CHD catchment area
Figure 1
Populations served by the 63 congenital cardiac surgical catchment areas across Africa.
Average patient travel distance of each CHD Catchment Area
Figure 2
Average distance a patient in each catchment area would travel to see a congenital cardiac surgeon, weighted by population.
ICCR of each CHD catchment area
Figure 3
Incident case to capacity ratio for each of the 63 congenital cardiac surgical catchment areas across Africa. ICCR: incident case to capacity ratio.
Distribution of CHD across all subnational regions of Africa
Figure 4
Choropleth map depicting incident cases of congenital heart disease across the subnational regions of Africa. CHD: congenital heart disease.
Distribution of surgical need due to CHD across subnational regions of Africa
Figure 5
Choropleth map of congenital cardiac surgical need across the subnational regions of Africa with linkages to the nearest congenital cardiac surgeon.
See this image and copyright information in PMC

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