Spectrum of Heart Diseases in Children in a National Cardiac Referral Center Tanzania, Eastern Africa: A Six-Year Overview.

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Global Heart Pub Date : 2024-07-29 eCollection Date: 2024-01-01 DOI:10.5334/gh.1342

Naizihijwa G Majani, Joëlle R Koster, Zawadi E Kalezi, Nuru Letara, Deogratias Nkya, Stella Mongela, Sulende Kubhoja, Godwin Sharau, Vivienne Mlawi, Diederick E Grobbee, Martijn G Slieker, Pilly Chillo, Mohamed Janabi, Peter Kisenge

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引用次数: 0

Abstract

Background: While communicable diseases have long been the primary focus of healthcare in Africa, the rising impact of paediatric and congenital heart disease (CHD) cannot be overlooked. This research aimed to estimate the frequency and pattern of heart diseases in children who underwent their first echocardiography at a national cardiac referral hospital in Tanzania.

Methods: A retrospective observational study was conducted on children aged 0 to 18 years referred for first-time cardiological evaluation from January 2017 to December 2022. Retrieval of social and echocardiogram data and descriptive analysis were performed.

Results: There were 6,058 children with complete reports. Of these, 52.8% (3,198) had heart disease, of whom 2,559 (80%) had CHD, while (340/639; 53.2%) with acquired heart disease (AHD) had rheumatic heart disease (RHD). Children with CHD had a median age 1.0 years (IQR: 0.3-3.5) and were predominantly 51.2% male. Children with RHD had a median age 9.7 years (IQR: 3.2-13.8) with equal gender distribution. Shunt lesions were common in 1,487 (58.1%), mainly VSD 19.3%, PDA 19.1%, ASD 15.1%, and atrioventricular septal defect (AVSD) 4.6%. Pulmonary valve stenosis was in 97 (3.8%). Around 35% (718) had cyanotic CHD, with TOF being most common (13.3%), followed by double outlet right ventricle (DORV) (3.6%). Compared to global average truncus arteriosus was higher in 69 (2.3%) children. In contrast, TGA and hypoplastic left heart syndrome (HLHS) were lower than the estimated global average seen in 2.3% and 0.5% of the cases, respectively. Atresia of the right-side valves was more common (174 vs. 24), and approximately 40% of the patients referred for first-time echocardiographic evaluation required hospitalization.

Conclusion: Congenital heart disease is the primary cause of heart disease in children presenting at a national referral hospital, surpassing RHD. With its distinct distribution pattern, acyanotic lesions are more frequent than cyanotic heart diseases. The observed late referral tendencies suggest improving the referral system, enhancing CHD awareness among healthcare professionals, and instituting nationwide screening programs.

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东非坦桑尼亚国家心脏病转诊中心的儿童心脏病谱：六年概述。

背景：长期以来，传染病一直是非洲医疗保健的主要重点，但儿科和先天性心脏病（CHD）的影响也不容忽视。这项研究旨在估算在坦桑尼亚一家国家心脏病转诊医院接受首次超声心动图检查的儿童患心脏病的频率和模式：该研究对2017年1月至2022年12月期间首次接受心脏病学评估的0至18岁转诊儿童进行了回顾性观察研究。检索社会和超声心动图数据并进行描述性分析：有完整报告的儿童有 6058 名。其中，52.8%（3198 名）患有心脏病，其中 2559 名（80%）患有先天性心脏病，而（340/639；53.2%）患有后天性心脏病（AHD）和风湿性心脏病（RHD）。患有先天性心脏病的儿童年龄中位数为 1.0 岁（IQR：0.3-3.5），男性占 51.2%。RHD患儿的中位年龄为9.7岁（IQR：3.2-13.8），男女比例相同。1,487名儿童（58.1%）常见分流病变，主要是VSD 19.3%、PDA 19.1%、ASD 15.1%和房室间隔缺损（AVSD）4.6%。肺动脉瓣狭窄有 97 例（3.8%）。约 35%（718 例）的儿童患有紫绀型先天性心脏病，其中以 TOF 最为常见（13.3%），其次是双出口右心室（DORV）（3.6%）。与全球平均水平相比，69 名儿童（2.3%）的动脉导管未闭率较高。相比之下，TGA 和左心发育不全综合症（HLHS）的发病率分别为 2.3% 和 0.5%，低于估计的全球平均水平。右侧瓣膜闭锁更为常见（174 例对 24 例），约 40% 首次接受超声心动图评估的患者需要住院治疗：结论：在一家国家级转诊医院就诊的儿童中，先天性心脏病是导致心脏病的主要原因，超过了RHD。先天性心脏病的分布模式各不相同，无紫绀型病变比紫绀型心脏病更为常见。观察到的晚期转诊倾向建议改善转诊系统，提高医护人员对先天性心脏病的认识，并在全国范围内开展筛查项目。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Global Heart Medicine-Cardiology and Cardiovascular Medicine

CiteScore

5.70

自引率

5.40%

发文量

审稿时长

5 weeks

期刊介绍： Global Heart offers a forum for dialogue and education on research, developments, trends, solutions and public health programs related to the prevention and control of cardiovascular diseases (CVDs) worldwide, with a special focus on low- and middle-income countries (LMICs). Manuscripts should address not only the extent or epidemiology of the problem, but also describe interventions to effectively control and prevent CVDs and the underlying factors. The emphasis should be on approaches applicable in settings with limited resources. Economic evaluations of successful interventions are particularly welcome. We will also consider negative findings if important. While reports of hospital or clinic-based treatments are not excluded, particularly if they have broad implications for cost-effective disease control or prevention, we give priority to papers addressing community-based activities. We encourage submissions on cardiovascular surveillance and health policies, professional education, ethical issues and technological innovations related to prevention. Global Heart is particularly interested in publishing data from updated national or regional demographic health surveys, World Health Organization or Global Burden of Disease data, large clinical disease databases or registries. Systematic reviews or meta-analyses on globally relevant topics are welcome. We will also consider clinical research that has special relevance to LMICs, e.g. using validated instruments to assess health-related quality-of-life in patients from LMICs, innovative diagnostic-therapeutic applications, real-world effectiveness clinical trials, research methods (innovative methodologic papers, with emphasis on low-cost research methods or novel application of methods in low resource settings), and papers pertaining to cardiovascular health promotion and policy (quantitative evaluation of health programs.