Trends and predictors of mortality among children and adolescents with congenital heart disease in Ethiopia: A retrospective follow-up study.

Abstract

Background: Congenital heart disease (CHD) is a leading noninfectious cause of mortality during childhood and adolescence, particularly in developing countries where timely diagnosis and treatment are limited. Despite its public health significance, data on mortality trends and their predictors in resource-limited settings remain scarce. This study aimed to assess mortality trends and identify predictors among children with CHD in a resource-limited setting.

Materials and methods: We conducted a retrospective follow-up study on 6228 children and adolescents with CHD who received care at the Cardiac Center of Ethiopia, either as outpatients or inpatients, with follow-up between 2015 and 2024. Data were collected through medical record reviews and phone interviews with caregivers from January 1 to August 1, 2025. Joinpoint was used to assess trends in CHD-related mortality by calculating the annual percent change (APC), and the average APC (AAPC) was used to evaluate overall mortality trends. Predictors of CHD-related mortality were identified using a Cox proportional hazards model.

Results: The median age of patients was 0.7 years (interquartile range, 0.3-3.8 years), with a female-to-male ratio of 1.42:1. During follow-up, 827 patients (13.3%) died. The overall AAPC in mortality per 1000 CHD cases was -8.19% (95% confidence interval [CI]: -11.2--5.47, P < 0.001), indicating a statistically significant annual decline. A marked decrease occurred between 2019 and 2022 (APC: -40.94%; 95% CI: -47.41--27.50; P = 0.04). Malnutrition increased mortality risk by 2.9-fold (adjusted hazard ratio [AHR]: 2.9; 95% CI: 1.9-3.9; P < 0.001), pulmonary hypertension (PH) by 3.5-fold (AHR: 3.5; 95% CI: 2.2-6.6; P < 0.001), and the presence of syndromic associations (with or without extracardiac anomalies) by 30% (AHR: 1.3; 95% CI: 1.1-2.2; P = 0.04). Conversely, undergoing surgery or an interventional procedure reduced mortality risk by 80% (AHR: 0.2; 95% CI: 0.1-0.8; P < 0.001).

Conclusion: Mortality among children and adolescents with CHD in Ethiopia has shown a significant decline in recent years. However, malnutrition, PH, syndromic associations, and lack of surgical or interventional care remain key predictors of poor outcomes. Strengthening timely access to interventions, enhancing nutritional and multidisciplinary support, and prioritizing early identification of high-risk patients are essential to further reduce CHD-related mortality in resource-limited settings.