Spectrum of heart diseases in children presenting to a paediatric cardiac echocardiography clinic in the Lake Zone of Tanzania: a 7 years overview

Abstract

Background: Congenital heart diseases (CHD) are among the most common congenital malformations. It is estimated that the incidence of CHD is constant worldwide, but data are rare for most African countries including Tanzania. Even less data are available on the prevalence of acquired heart diseases (AHD) in African children. Rheumatic heart disease (RHD) is the leading cause of AHD and is remaining a public health concern in Sub-Saharan Africa affecting especially the younger population. Both, CHD and AHD contribute substantially to morbidity and mortality during infancy and childhood. Methods: This hospital-based, retrospective review of the registry at the paediatric cardiac clinic of Bugando Medical Centre in the Lake Zone of Tanzania analysed the spectrum of heart diseases of paediatric patients during their first presentation by using simple descriptive statistics. Results: Between September 2009 and August 2016, a total of 3982 patients received cardiac evaluation including echocardiography studies. 1830 (46.0%) pathologic findings were described, out of these 1371 (74.9%) patients had CHD, whereas 459 (25.1%) presented with AHD. 53.9% of the patients with CHD were female and the most common associated syndrome was Down syndrome in 12.8% of patients. In 807 patients (58.9%) diagnosis of CHD was established within the first year of life. The majority of patients (60.1%) were in need of surgical or interventional therapy at time of diagnosis and 6.3% of patients were judged inoperable at the time of first presentation. Nearly 50% of cases with AHD were RHDs followed by dilated cardiomyopathy and pulmonary hypertension without underlying CHD. Conclusions: The spectrum of CHD and AHD from one centre in Tanzania is comparable to findings reported in other countries from the African continent. Echocardiography is a valuable diagnostic tool and the widespread use of it should be enhanced to diagnose heart diseases in a large number and reasonable time. Most patients present late and majority is in need of surgical or interventional treatment, which is still not readily available. Untreated heart diseases contribute substantially to morbidity and mortality during infancy and childhood. Adequate cardiac services should be established and strengthened.

Prevalence of congenital septal defects among congenital heart defect patients in East Africa: A systematic review and meta-analysis

“…Of them 8 studies were done in Ethiopia [ 11 – 17 , 30 ], 2 in Kenya [ 18 , 19 ], while 3 were in Sudan [ 22 , 23 , 31 ], 1 in Djibouti [ 10 ], 1 in Uganda [ 27 ], and 3 in Tanzania [ 24 – 26 ]. Based on the study design used 15 studies were done by cross-sectional study design [ 11 – 17 , 19 , 22 – 25 , 27 , 30 , 31 ] and other 3 studies were conducted by cohort study design [ 10 , 18 , 26 ]. 12/18 (66.6%) were published with in the year 2011–2020 and the remaining 6/18 (33.4%) were published with in the year 2000–2010.…”

“…A total of 18 studies were included in this systematic review and meta-analyses, encompassing 9109 patients [10-19, 22-27, 30, 31]. Of them 8 studies were done in Ethiopia [11][12][13][14][15][16][17]30], 2 in Kenya [18,19], while 3 were in Sudan [22,23,31], 1 in Djibouti [10], 1 in Uganda [27], and 3 in Tanzania [24][25][26]. Based on the study design used 15 studies were done by cross-sectional study design [11-17, 19, 22-25, 27, 30, 31] and other 3 studies were conducted by cohort study design [10,18,26].…”

“…Similarly, these forms of CHDs have higher proportion in different regions of Africa. For instance, ventricular and atrial septal defects in Cameroon 38.8% and 2.8% [9], Djibouti 28% and 0.13% [10] in Ethiopia 27%-62% and 6.4%-23.7% [11][12][13][14][15][16][17], in Kenya 16.1% -18.7% and 4.7%-6.2% [18,19] in Nigeria 28%-31% and 21%-29% [20,21], in Sudan 29%-34.5% and 6% -17% [22,23], in Tanzania 10%-34.6% and 3.7%-10% [24][25][26] and in Uganda 27.2% and 9.4% [27] respectively.…”

Pulmonary Hypertension in Children across Africa: The Silent Threat

“…Unrepaired congenital heart disease (CHD) is a major cause of PH. Correction of CHD in early infancy is not feasible in resource-limited settings for several reasons, including delayed detection due to limited pediatric cardiology specialists on the African continent and lack of infrastructure to perform correction of lesions such as operating theatres and catheterization laboratories [ 23 , 24 ]. In the Ugandan congenital heart disease registry, most lesions were diagnosed after infancy and kept unoperated after 5 years due to limited resources to access diagnosis and surgery [ 25 ].…”

“…Over half the children reported in the PAPUCO study in Africa had PH secondary to CHD [ 7 ]. Similarly, in a Tanzanian retrospective study, 6.3% of the children were inoperable at first diagnosis and 3% were as a result of severe pulmonary hypertension [ 24 ]. Unoperated congenital heart lesions such as persistent truncus arteriosus, VSDs, atrioventricular septal defects (AVSD), and aortopulmonary (AP) window, diagnosed after infancy, were the predominant causes [ 24 ].…”