• Congenital heart disease
• paediatric cardiac function
• quality of care and outcomes

The prevalence of congenital heart disease in India has been reported as 2.25–5.2/1000 live births compared with 8–10/1000 live births in other parts of the world.1–4 This is likely to be an underestimate, however, because an unknown number of cases go unreported, particularly those delivered by unqualified personnel in rural areas where monitoring is inadequate. Specialist care of congenital heart disease in rural India is generally suboptimal due to the lack of paediatric cardiac surgical and interventional facilities. Consequently, patients have to travel long distances to metropolitan cities to avail themselves of treatment. Unlike adult cardiac care in metropolitan India, paediatric interventional and surgical care is still in a phase of development and facilities have not been prioritised in many hospitals because costs are high and return on the investment relatively low.5

Parental preference for male children exists in many sections of Indian society, where girls with congenital heart disease are not provided with the same treatment opportunities as boys. The prevalence of the male to female ratio of congenital heart disease in India has been variously reported as 1:1, 1.1:1 and 1.25:1.6–9 Given the almost equal gender prevalence, …