Abstract
Background: Cardiovascular diseases is a major health challenge in Sudan as in other African countries. Percutaneous interventions are a major cornerstone in the management of cardiovascular diseases with many African countries struggling to provide these services to their affected population. Since April 2018 a national fully-supported government cardiac catheterization program was adopted to deliver all coronary interventions and some selected valve interventions free of charge through public and affiliated centers distributed nationwide. Sudan National Cardiac Centre (NCC) is the main body overlooking this program and participating centers. In mid-April of 2023 armed conflict broke out in Sudan with major disruption in healthcare provision including cardiac service. More than four million people have been displaced and more than one million fled to neighboring countries.
Aims: To report on the data of Sudan National Cardiac Center program for cardiac catheterization since inception and the impact of armed conflict on provision of services.
Methods: Annual data from Sudan National Cardiac Center were obtained and analyzed from 2018 to 2023 as well as monthly reports for from May 2023 to June 2024. Data collected were number of operational centers, total number of procedures performed, number of individual procedures performed, and the average annual cost of the program. Pre-conflict and post-conflict data were also compared.
Results: A total of 38,694 cardiac catheterization procedures were performed under the Sudan National Program from 2018 to 2023 with average annual frequency of 6449. Coronary angiography, percutaneous coronary interventions, permanent pacemaker insertion, percutaneous mitral commissurotomy and congenital interventions constituted 64.7%, 22.8%, 9.3%,1.3 % and 1.9% of the total procedures respectively.
Ten centers participated in the program, half of them located in the capital. By end of 2023 and mid 2024 the number of operational centers were 5 and 4 respectively.
In 2022 the monthly average volume was 674 compared to 385 in May-Dec 2023 and 256 in Jan-June 2024 constituting a 52% and 62% drop in volume. The average annual cost of the program was approximately 5.4 million US dollars.
Conclusion: Armed conflicts have significant impact on provision of healthcare services. A government funded program for interventional cardiac procedure in Sudan continues to operate despite the war, however with significant limitations. Re-allocation of professional work-force, funding medical supplies availability and management, patient freedom of movement and secure access to active centers remain the main obstacles.