ISSN 03 02 4660         AN OFFICIAL JOURNAL OF THE PAEDIATRIC ASSOCIATION OF NIGERIA


Nigerian J Paediatrics 2017 vol 44 issue 1

Nigerian J Paediatrics 2017 vol 44 issue 1

Issue
Archives
Instructions
Submit Article
Search
Contact Us
 
 
Home
Issue
Archives
Instructions
Submit Article
Search
Contact Us
Home
Quick Navigation
Pattern of cardiac diseases among children in a tertiary hospital in North Central Nigeria A three and half years retrospective cohort echocardiographic study
Niger J Paediatr 2018; 45 (1): 6 - 9
ORIGINAL
Abah RO
CC BY Pattern of cardiac diseases among
Ochoga MO
Audu OP
children in a tertiary hospital in
Idoko A
North Central, Nigeria: A three
Eseigbe EE
and half years retrospective cohort
Dabit JO
echocardiographic study
DOI:http://dx.doi.org/10.4314/njp.v45i1.2
Accepted: 7th March 2018
Abstract : Background: Cardiac
Results: Of the 8590 patients seen,
disease is an important non-
39 (0.45%) had cardiac diseases.
Abah RO
(
)
communicable disease encoun-
The mean age of the patients was
Ochoga MO, Idoko A, Eseigbe EE,
tered among paediatric popula-
60.259 months with Male: Fe-
Dabit JO
tions with varying patterns in dif-
male
of 1.1:1. Twenty-eight
Department of Paediatrics,
ferent regions. This study is aimed
(71.7%) of them had congenital
at finding the spectrum of cardiac
heart disease (CHD) with the most
Audu OP
diseases among the paediatric
prevalent type been acyanotic
Department of Community
patients seen at Benue State Uni-
CHD among 21(53.8%).
Ven-
Medicine/Epidemiology,
versity
Teaching
Hospital
tricular septal defect (VSD) ac-
Benue State University Teaching
(BSUTH), Makurdi Nigeria.
counted for 15(71.4%) of the 21
Hospital, Makurdi
Method: A retrospective review of
(53.8%) patients. Hypertensive
Email: abahplc@yahoo.com
all cardiology patients seen at
heart disease was found in one
both in- and out-patient units of
(2.6%) patient who was an obese
the paediatric department
of
adolescent.
BSUTH between June 2012 to
Conclusion: Congenital heart dis-
December 2015. Data on age,
ease (CHD) and acquired heart
gender, presenting complaints,
disease (AHD) were all repre-
final diagnosis, investigations,
sented in this cohort with CHD
intervention and treatment out-
being the most prevalent.
come were
obtained from the
case folders. The analysis of the
Keywords: Cardiac disease, Chil-
data was done with Excel spread-
dren, Pattern, Tertiary Hospital,
sheet and the results were pre-
Echocardiography
sented as frequency and percent-
ages.
Introduction
in children have not been carried out in our study loca-
tion. Our health facility is a relatively young one and it
Africa is believed to have one of the highest prevalence
would be good to know what the cardiac problems of the
of heart diseases among children with an epidemiologi-
children seen here are as it could help in determining
cal pattern that is quite different from what is obtainable
what should be priority in both manpower and infra-
in the developed countries of the world. Though the
1
structural development.
prevalence of Congenital heart disease (CHD) is re-
The objective is to assess the pattern of cardiac diseases
ported to be similar in all countries at an approximate
encountered among the paediatric patients seen in Benue
rate of 8 per 1000 live births,
[2]
Africa has been shown
State University Teaching Hospital (BSUTH), Makurdi,
to have the lowest rate due to paucity of data.
[3]
Nigeria.
In Nigeria, heart disease has been recognized as a major
contributor to childhood morbidity and mortality.
[4]
Al-
though data on national prevalence of heart disease
among children is lacking, reports of studies conducted
Materials and method
by individuals from different parts of the country
[4-7]
have documented the various type of cardiac diseases
Study Design: A retrospective cohort study of all avail-
and the prevalence encountered among children in those
able secondary data of children seen in both the in- and
areas.
out-patient units of paediatrics department in the hospi-
tal. The period under review was June 2012 to Decem-
To the best of our knowledge, study on cardiac diseases
ber 2015.
7
Study Setting: Benue State University Teaching Hospi-
Table 2: Frequency distribution of Congenital heart disease
tal (BSUTH) is a state owned tertiary health facility that
Type
Frequency
Percent
serves the State and receive referral from neighbouring
States of Taraba, Kogi, Nassarawa and other States of
Acynotic congenital heart defects
the Federation. Clinical services commenced in January
2012 in the Paediatric department and these includes
Ventricular septal defect(VSD)
15
71.4
emergency services, in- and out-patient services with an
Patent ductus arteriosus(PDA)
4
19.0
average yearly patient turnover of two thousand seven
hundred and fifty-seven.
Atrial septal defect(ASD)
2
9.5
Total
21
100.0
Data Collection
Cyanotic congenital heart defects
The records of all the children seen in both the in- and
out-patient units of the Department for cardiac problem
Tetralogy of Fallot (TOF)
3
42.9
were traced and their case folders retrieved. Data ob-
Double outlet right ventricle (DORV)
1
14.3
tained from the case folders were age, gender, present-
+VSD
ing complaints, final diagnosis, investigation results,
intervention and treatment outcome. Diagnosis was ana-
Transposition of Great arteries (d-TGA)
1
14.3
lyzed based on echocardiographic reports. Those with-
+ASD**
out echocardiographic confirmation of their diagnosis
Complex cyanotic heart defect (TOF+
2
28.6
were excluded from the final analysis.
ASD+ PDA+MR)
Ethical clearance was sought from the health research
ethics committee of BSUTH before commencement of
Total
7
100.0
the study.
The most common presenting complaint among the pa-
tients was cough in 17 (43.6%), followed by difficulty in
Data analysis
breathing in 12 (30.8%), fever in 10 (25.6%) and fast
breathing in 8 (20.5%). Table 3 gives the frequency dis-
The data were analyzed with Excel spread sheet and
tribution of the symptoms.
presented as frequencies and percentages.
Table 3: Distribution of common Symptoms presented by
patients
Results
Symptoms
Frequency
Percent
Of the total of 8590 patients seen within the study pe-
Cough
17
43.6
riod, 39 (0.45%) had cardiac diseases. This corresponds
to cardiac disease prevalence rate of 0.45%. Table 1 and
Difficulty in breathing
12
30.8
2 presents the demographic information of the 39 pa-
Fever
10
25.6
tients and the distribution of patients by the type of con-
genital cardiac disease respectively. Males were 22
Fast breathing
8
20.5
(56.4%) with a M:F 1.1:1. The age of the patients range
Leg swelling
8
20.5
from 1.5 to 180 months with a median age of 36 months.
Poor suck
6
15.4
Table 1: Age Distribution of Patients with cardiac diseases
abdominal swelling
5
12.8
(n=39)
Abdominal pain
4
10.3
Age
Frequency
Percent
(months)
Excessive cry
3
7.7
<12
13
33.3
Chest pain
2
5.1
12-59
7
17.9
Easy fatiquability
2
5.1
>60
19
48.7
Body weakness
2
5.1
Poor weight gain
2
5.1
Total
39
100
Inability to talk
2
5.1
Twenty-eight (71.7%) of the patients had congenital
poor urinary output
2
5.1
heart disease (CHD) with acyanotic congenital heart
defects (ACHD) been the most prevalent (53.8%). Ven-
Vomiting
2
5.1
tricular septal defect (VSD) was the most common type
Diarrhoea
2
5.1
(71.4%) of ACHD followed by Patent ductus arteriosus
(PDA) which accounted for 19.0%. Tetralogy of Fallot
Convulsion
1
2.6
(TOF) was the commonest type of cyanotic congenital
Scrotal swelling
1
2.6
heart defects (42.9%) among the patients.
Catarrh
1
2.6
8
8
9
One patient (2.6%) was found to have hypertensive heart
al. and Kennedy et al. gave a higher male preponder-
disease. The patient with the hypertensive heart disease
ance of 3:2 and 1.5:1 respectively.
was an obese adolescent. The five patients (12.8%) with
Majority of the patients (48.7%) were in the age group
rheumatic heart disease range in age from 84-132
of over 60 months old. This shows late presentation con-
months with one female and four males. Dilated cardio-
sidering that Congenital heart defects (CHD) accounted
myopathy was the most common form of cardiomyopa-
for over 70% of all the cases encountered, which are
thy identified among the five (12.8%) patients in this
present at birth and most cause early clinical symptoms.
category, and they were much older (96-180 months of
This portends poor outcome for such patients as even
age).
simple lesions that are easily correctable would have
developed permanent sequelae such as pulmonary hy-
Fig 1: Frequency distribution of types of cardiac diseases
pertension. In developed countries, the diagnosis of
among patients (n=39)
CHD is usually in the prenatal/neonatal period with foe-
tal echocardiography, pulse oximetry and neonatal echo-
cardiography. Delayed diagnosis often is due to limited
1
resource in terms of skilled personnel as well as diag-
nostic services which when available are restricted to
urban areas.
10
The spectrum of cardiac diseases seen among these chil-
dren in our study is similar to what has been docu-
mented in literature, with CHD been the most prevalent
cardiac disease and VSD the commonest type.
4, 5, 8, 9, 11-13
A recent review of the trends and patterns of congenital
heart disease in Nigeria over a five decades period also
showed that acyanotic CHD is the most common form
ACHD
CCHD Cardiomyopathy RHD
HHD
with VSD as the most prevalent.
13
Of the cyanotic
CHD, TOF was the most common type encountered.
ACHD: Acyanotic congenital heart defects, CCHD: Cyanotic
This is similar to what was reported from other part of
congenital heart defects, RHD: Rheumatic heart disease, HHD:
the country and Malawi.
4,5,8,9,12
Most cases of uncor-
Hypertensive heart disease
rected TGA usually die in infancy except when a shunt
Majority (61.5%) of the patients were admitted at one
that allows for survival is present as was the case in the
point or the other for congestive heart failure and were
one patient here (at 84 months) who had an associated
placed on anti failure drugs (Frusemide, Digoxin and
ASD. Similar reports in a 4 and 13 year olds had been
documented.
4
Captopril) while some received antibiotics for treatment
of pneumonia in addition. Other investigations carried
out were chest radiography, electrocardiograph and full
Of the Acquired heart disease (AHD) observed among
blood count.
this cohort, the presence of hypertensive heart disease in
The care givers were counselled about open heart sur-
one of them is surprising. It is not a common finding
among children. Nkoke et al. reported on it in their
14
gery (OHS) and device closure as available options for
definitive treatment for those patient with structural de-
series but unlike theirs which was in patients with
fects. Only two were able to access corrective surgery
chronic renal failure, here the patient was an obese ado-
(one at Garki hospital, Abuja for VSD closure and the
lescent with primary hypertension.
other in India). Majority of the patients were lost to fol-
Only two patients (5.1%) were able to accessed correc-
low-up as shown in the Table 4 below.
tive surgery. One within Nigeria while the other was in
India. Given the cost of surgery it is not surprising, as
15
Table 4: Distributions of outcome
it is well beyond the reach of the average care giver who
Outcome
Frequency
Percent
is often poor. Over 60% of the patients were lost to fol-
low-up similar to what was reported from Jos and
DAMA
2
5.1
Enugu. Most care givers are overwhelmed when con-
4,5
Died
5
12.8
On Follow-up
7
17.9
fronted with the implications of the diagnosis of cardiac
Lost to Follow-up
25
64.1
disease and often resigned to fate, resulting in them be-
Total
39
100.0
ing lost to follow-up. The contribution of cardiac disease
to childhood mortality might be more than its being
DAMA: Discharged against medical advice
reported, given that in this small cohort 12.8% death
was recorded.
Discussion
Conclusion
In our study there is no sex predilection in the occur-
rence of cardiac disease as the male to female ratio was
The spectrum of cardiac diseases observed among this
almost equal. Chinawa et al. reported similar finding
5
cohort shows that Congenital heart disease is most
among children in Enugu. However, a report by Asani et
prevalent with majority being diagnosed late. Both the
9
medical and surgical cost of care for children with car-
these children for, regional centres for cardiothoracic
diac disease is beyond the reach of the average care
services to be established to offer the needed care at
giver leading to high rate of default from treatment.
affordable rates.
There is need for more advocacy on the part of
Paediatricians who are saddled with management of
References
1. Zuhlke L, Mirabel M, Marijon
7. Sani MU, Mukhtar-Yola M,
12. Otaigbe BE, Tabansi PN.
E. Congenital heart disease and
Karaye KM. Spectrum of con-
Congenital heart disease in the
rheumatic heart disease in Af-
genital heart disease in a Tropi-
Niger Delta region of Nigeria:
rica: recent advances and cur-
cal environment: An echocar-
a four-year prospective echo-
rent priorities. Heart 2013;
diographic study. J Nat Med
cardiographic analysis. Car-
99:1554-1561
Ass 2007; 99(6): 665-669
diovasc. J Afri 2014; 25(6):
2. Hoffman J I. The global burden
8. Asani M, Aliyu I, Kabir H.
265-268
of congenital heart disease.
Profile of congenital heart de-
13. Abdulkadir M, Abdulkadir Z.
Cardiovasc J Afr 2013; 24: 141
fects among children at Aminu
A systematic review of trends
-145
Kano Teaching Hospital, Kano,
and patterns of congenital
3. van der Linde D, Konings E E
Nigeria. J Med Trop 2013; 15
heart disease in children in
M, Slager M A, et al. Birth
(2): 131-134
Nigeria from 1964-2015. Afri
prevalence of congenital heart
9. Kennedy N, Miller P. The spec-
Health Sci 2016; 16(2): 367-
disease worldwide: A system-
trum of Paediatric cardiac dis-
377. http//dx. doi.org/10.4314/
atic review and Meta-analysis.
ease presenting to an outpatient
ahs.v16i2.5
J Am Coll Cardiol 2011; 58:
clinic in Malawi. BMC Re-
14. Nkoke C, Menanga A,
2241-2247
search Notes 2013; 6: 53-58
Boombhi J, Chelo D, Kingue
4. Bode-Thomas F, Okolo SN,
10. Mocumbi AO. Lack of focus on
S. A new look at acquired
Ekediwge JE, Kwache IY,
cardiovascular disease in sub-
heart disease in a contempo-
Adewunmi O. Paediatric echo-
Saharan Africa. Cardiovasc
rary sub-Saharan African Pae-
cardiography in Jos University
Diagn There 2012; 2(1): 74-77
diatric population: The case of
Teaching Hospital; Problems,
11. Okoromah CA, Ekure EN, Ojo
Yaounde, Cameroon. Cardio-
prospects and preliminary au-
OO, Animasahun BA, Bastos
vasc Diagn There 2015; 5(6):
dit. Nig J Paediatr 2003; 30
MI. Structural heart disease in
428-434
(4): 143-149
children in Lagos: Profile,
15. Falase B, Sanusi M, Maje-
5. Chinawa JM, Eze JC, Obi I, et
problems and prospects. Niger
kodunmi A, Ajose I, Idowu A,
al. Synopsis of congenital car-
Postgrad Med J 2008; 15(2):
Oke D. The cost of open heart
diac disease among children
82-88
surgery in Nigeria. Pan Afr
attending University of Nigeria
Med J 2013; 14: 61
Teaching Hospital Ituku
doi:10.11604/
Ozalla, Enugu. BMC Research
Pamj.2013.14.16.2162
Notes 2013; 6: 475-481
6. Sadoh E W, Uzodimma C C,
Daniels Q. Childhood acquired
heart disease in Nigeria: An
echocardiographic study from
three centres. Afr Health Sci
2014; 14(3): 602-608