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(Circulation. 2008;118:e98.)
© 2008 American Heart Association, Inc.

Correspondence

Response to Letter Regarding Article, "Improvement in Congenital Heart Surgery in a Developing Country: The Guatemalan Experience"

Luis A. Larrazábal, MD; Kathy J. Jenkins, MD, MPH; Kimberlee Gauvreau, ScD; Vladimiro L. Vida, MD; Oscar J. Benavidez, MD, MPP

The Departments of Cardiology and Cardiac Surgery, Children’s Hospital Boston, Harvard Medical School, Boston, Mass

Guillermo A. Gaitán, MD; Flor Garcia, MD; Aldo R. Castañeda, MD, PhD

Department of Pediatric Cardiology and Cardiac Surgery of Guatemala (UNICARP), Guatemala City, Guatemala

We agree with the public health issues raised by Dr Soliman in response to our article.¹ When public health systems and policymakers in the developing world have to decide where to allocate limited resources, there is no doubt that congenital heart disease would not be a priority for a country where widespread malnutrition and communicable diseases such as malaria, tuberculosis, and HIV-AIDS are highly prevalent. In 2000, for example, HIV-positive patients occupied more than 50% of all beds in urban hospitals in Zimbabwe.²

Nevertheless, children with both congenital heart disease and who acquire rheumatic heart disease also use resources, but they can often be essentially cured with definitive surgical treatment. Surveillance and other healthcare systems that identify and provide complex treatments for these children help build important infrastructures and bring hope to many families. Agencies and individuals who invest money in these areas need data to determine the impact of funds provided. Demonstrating substantial improvement in outcomes may stimulate interest and appropriation of additional funds from external sources, as well as help internal public health agencies in making these important determinations.

	Acknowledgments

 
Disclosures

None.

	References

Top References

 
1. Larrazabal LA, Jenkins KJ, Gauvreau K, Vida VL, Benavidez O, Gaitán GA, Garcia F, Castañeda AR. Improvement in congenital heart surgery in a developing country: the Guatemalan experience. Circulation. 2007; 116: 1882–1887.[Abstract/Free Full Text]

2. Palmer DL, Mason PR, Pasi C, Tobiwa O. Value of mandatory testing for human immunodeficiency virus in a sub-Saharan hospital population. Clin Infect Dis. 2000; 31: 1258–65.[CrossRef][Medline] [Order article via Infotrieve]

This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Larrazábal, L. A. Articles by Castañeda, A. R. Search for Related Content PubMed Articles by Larrazábal, L. A. Articles by Castañeda, A. R. Related Collections Health policy and outcome research Other Ethics and Policy Pediatric and congenital heart disease, including cardiovascular surgery