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

• DOI: 10.5334/gh.1342
• Publication Date: 2024-07-29T11:05:34Z
• Authors: 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
• Keywords: Male; Heart Defects, Congenital; pediatrics; Adolescent; Heart Diseases; Epidemiology; tanzania; Tanzania; 03 medical and health sciences; 0302 clinical medicine; Diseases of the circulatory (Cardiovascular) system; Humans; Child; Referral and Consultation; Original Research; Retrospective Studies; Community and Home Care; Infant, Newborn; Infant; congenital heart defects; africa; Echocardiography; RC666-701; Child, Preschool; Africa; epidemiology; Female; Public aspects of medicine; RA1-1270; Cardiology and Cardiovascular Medicine

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.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.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.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.