Title : The hidden burden of congenital heart disease in Afghanistan: A three-year analysis of clinical patterns and healthcare access barriers
Abstract:
Background: Congenital Heart Disease (CHD) is the most common type of birth defect and the leading cause of infant mortality related to congenital anomalies worldwide. Despite the high burden of CHD in Afghanistan, epidemiological data from the country remain extremely limited. This study aimed to characterize the spectrum of CHD in Afghanistan and discuss systemic barriers to timely diagnosis and management. The findings are intended to provide insights that can guide future research, enhance early detection efforts, and inform the development of evidence-based clinical strategies.
Methods: A retrospective observational study was conducted at Ariana Medical Complex, reviewing medical records of patients diagnosed with CHD between March 2022 and December 2024. The analysis included a total of 4,854 echocardiographically confirmed cases of Congenital Heart Disease (CHD). Data were extracted on patient age, gender, and CHD subtypes. CHD lesions were classified based on standard anatomical and physiological criteria. Cases were further categorized as simple or complex, with complex CHD defined as defects requiring advanced surgical intervention (multi-step surgical repair or palliative procedures). Descriptive statistical methods were used to analyze patterns in disease distribution, and potential gaps in timely diagnosis and care were highlighted based on professional experience and observation.
Results: Of the 4,854 cases reviewed, non-complex CHD accounted for 84.5% of the total cohort. Among these, atrial septal defect was the most frequently observed non-cyanotic lesion, representing 34.5% of all cases. Tetralogy of Fallot was the predominant cyanotic lesion, comprising 7.2% of the total CHD cases. Complex CHD constituted 13.5% of all diagnoses. Within this subgroup, complete atrioventricular canal defects accounted for 11.4%, while D-transposition of the great arteries represented 6.4%. Notably, 47.2% of complex CHD cases were diagnosed after infancy, including 3.5% that were first identified in adulthood, reflecting a significant delay in detection. Critical gaps include socioeconomic constraints; the absence of in-country pediatric cardiac surgical capacity; significant delays in diagnosis, particularly for complex lesions; a limited number of pediatric cardiologists, especially outside major cities; and a shortage of cardiac surgeons, concentrated mainly in the capital. Geopolitical and logistical barriers further limit access to timely surgical care abroad.
Conclusion: The burden of CHD in Afghanistan is exacerbated by widespread delays in diagnosis, lack of in-country surgical treatment capacity, and significant barriers to accessing care abroad. This study underscores the predominance of non-complex CHD, the late presentation of complex lesions, and the absence of systemic infrastructure to manage critical cases. Addressing these challenges requires urgent, multifaceted interventions including the establishment of local diagnostic and surgical services, targeted healthcare workforce training, and international support for medical evacuations. These findings reveal an ongoing and under-recognized public health crisis, emphasizing the need for global health equity initiatives to prioritize pediatric cardiac care in low-resource and conflict-affected settings.
This study provides a foundational overview of the Congenital Heart Disease (CHD) spectrum in Afghanistan, demonstrating a predominance of non-complex lesions alongside a significant burden of complex cases with delayed diagnosis. Beyond the descriptive findings, professional insights underscore critical systemic challenges—including limited specialist availability, the absence of in-country pediatric cardiac surgical capacity, significant access barriers, and economic constraints—that continue to impede timely diagnosis and optimal care. Addressing these issues requires not only investment in local diagnostic and treatment infrastructure but also active collaboration with international cardiology associations and healthcare institutions. Strengthened global partnerships can support capacity-building, training, and sustainable care models to improve outcomes for children with CHD in Afghanistan.
This study provides an initial overview of the CHD spectrum in Afghanistan, indicating that timely diagnosis—especially for complex cases—is hindered by limited specialist availability, shortage of in-country surgical capacity, economic constraints, severe workforce shortages, and significant access barriers. Addressing these challenges requires local investment and international collaboration to build sustainable capacity and deliver effective care.
