Nigerian Journal of Paediatrics

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-

60.2±59 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

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

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.

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)

71.4

emergency services, in- and out-patient services with an

Patent ductus arteriosus(PDA)

19.0

average yearly patient turnover of two thousand seven

hundred and fifty-seven.

Atrial septal defect(ASD)

9.5

Total

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)

42.9

were traced and their case folders retrieved. Data ob-

Double outlet right ventricle (DORV)

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)

14.3

lyzed based on echocardiographic reports. Those with-

+ASD**

out echocardiographic confirmation of their diagnosis

Complex cyanotic heart defect (TOF+

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

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

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

30.8

2 presents the demographic information of the 39 pa-

Fever

25.6

tients and the distribution of patients by the type of con-

genital cardiac disease respectively. Males were 22

Fast breathing

20.5

(56.4%) with a M:F 1.1:1. The age of the patients range

Leg swelling

20.5

from 1.5 to 180 months with a median age of 36 months.

Poor suck

15.4

Table 1: Age Distribution of Patients with cardiac diseases

abdominal swelling

12.8

(n=39)

Abdominal pain

10.3

Age

Frequency

Percent

(months)

Excessive cry

7.7

<12

33.3

Chest pain

5.1

12-59

17.9

Easy fatiquability

5.1

>60

48.7

Body weakness

5.1

Poor weight gain

5.1

Total

100

Inability to talk

5.1

Twenty-eight (71.7%) of the patients had congenital

poor urinary output

5.1

heart disease (CHD) with acyanotic congenital heart

defects (ACHD) been the most prevalent (53.8%). Ven-

Vomiting

5.1

tricular septal defect (VSD) was the most common type

Diarrhoea

5.1

(71.4%) of ACHD followed by Patent ductus arteriosus

(PDA) which accounted for 19.0%. Tetralogy of Fallot

Convulsion

2.6

(TOF) was the commonest type of cyanotic congenital

Scrotal swelling

2.6

heart defects (42.9%) among the patients.

Catarrh

2.6

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

resource in terms of skilled personnel as well as diag-

nostic services which when available are restricted to

urban areas.

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.

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.

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

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

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

5.1

Enugu. Most care givers are overwhelmed when con-

4,5

Died

12.8

On Follow-up

17.9

fronted with the implications of the diagnosis of cardiac

Lost to Follow-up

64.1

disease and often resigned to fate, resulting in them be-

Total

100.0

ing lost to follow-up. The contribution of cardiac disease

to childhood mortality might be more than it’s 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

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

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

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