Status of Pediatric Cardiac Care in Developing Countries

Round 1

Reviewer 1 Report

The manuscript focuses on the current burden pediatric disease, specifically the current state of Congenital Heart Disease and Rheumatic Heart Disease, and the future challenges to face up to improve early diagnosis and prevent deaths through the attainment of factors such as the training of specialized personnel and increase of funds to hospitals and cardiac centers. The article is generally well written and provides an important cue of reflection for administrators of public health, stakeholders, charitable non-governmental organizations and multinational companies. I highlight only two minor revisions.

At line 45 please correct as 9.3/1000.

At line 139 please reconsider to rephrase the statement, since it appears incorrect in English

Author Response

Line 45: Corrected as 9.3/1000

Line 139: Sentence re written

Reviewer 2 Report

This is a very well-written, brief discussion of the unmet needs related to CHD in communities and countries that lack medical and financial resources to provide care.

Page 2, line 44.  The author should include a comment that CHD incidence is related to altitude and is CHD incidence may be increased by up to 5 fold in regions such as Machiu Pichu, Peru or the Tibet Autonomous Region of the PRC.

Page 3, line 127.  The author does not mentioned or reference the continued dependence of some communities on compassionate medical and surgical teams that travel from established centers to provide CHD screening and treatments in developing countries.  These programs directly contribute to the establishment of local referral patterns and the training of permanent in-country providers.

Page 4, line 164.   This brief review manuscript would be strengthened by some discussion regarding the rapid miniaturization and reduction in cost for cardiac imaging equipment as well as the rapid expansion of telemedicine strategies using remote specialists for interpretation.   

Author Response

Page 2, line 44: added "Birth prevalence is also related to altitude and may be increased by up to 5 fold in high altitude regions such as Machiu Pichu, Peru etc."

Page 3, line 127.  Please see lines 148-153 already in text. "Transporting children with CHD or RHD to centres in affluent countries for surgery is not only very expensive, but a non-sustainable model. Similarly visit of expert operating team to developing countries can also work for short time, but it has the advantage of capacity building of the home centre. The pediatric cardiac unit in Guatemala city is an excellent example of a program that was established through a collaboration between the Aldo Castaneda Foundation and the government of Guatemala."

Page 4, line 164.   Please see lines 130-131 and 156-158, already in text

Line 130-131 "In addition, the internet and telemedicine are being successfully used to transfer knowledge and skills"

Lines 156-158 "Encouraging home grown technology, and exclusion of the “middle man” for importing equipment and consumables cuts down the cost significantly." 

Reviewer 3 Report

The author provided an overview of the current challenges facing management of pediatric heart diseases, specifically congenital heart diseases (CHD) and rheumatic heart diseases (RHD) and proposed means to address the challenges.

Below are my comments and suggestions.

1.     Provide a brief overview of pediatric heart diseases, including the main categories and the disease burden, before delving into CHD and RHD.

2.     More explicitly state the rationale of focusing on CHD and RHD, especially for RHD.

3.     Change title for 3.1 to Delay in Diagnosis and Referral

4.     Provide more references for the first paragraph of 3.1.

5.     For the first paragraph of 3.3, be more specific about which geographic region each statement applies to (e.g. India or developing countries).

6.     Change title of 3.4 to Inadequate Preventive Measures and Screening

Author Response

1. Added "Heart diseases in children include those present at birth (congenital heart diseases) and those acquired later in life (rheumatic heart disease, cardiomyopathies, pericardial diseases and others)."

2. CHd and RHD included as these are the two more common pediatric herat diseases in developing countries.

3. Title changed "Delay in diagnosis and referral" 

4. Not available

5. Already mentioned "most low income countries"

6. Changed to "Inadequate Preventive Measures and Screening"