Table of Contents  
ORIGINAL ARTICLE
Year : 2013  |  Volume : 15  |  Issue : 2  |  Page : 131-134

Profile of congenital heart defects among children at Aminu Kano Teaching Hospital, Kano, Nigeria


Department of Paediatrics, Aminu Kano Teaching Hospital, Kano, Nigeria

Date of Web Publication24-Dec-2013

Correspondence Address:
Mustafa Asani
Department of Paediatrics, Aminu Kano Teaching Hospital, Kano
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2276-7096.123598

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  Abstract 

Background: The pattern of congenital heart diseases (CHD) varies from region to region even in the same country. Echocardiography has been available in Aminu Kano Teaching Hospitalfor about 10 years now but problems then were non-available of appropriate probes for children making it difficult to make some specific diagnosis. This study was undertaken to determine the types and the relative frequencies of congenital heart defects seen among children at the Aminu Kano Teaching Hospital, Kano, Nigeria.
Materials and Methods: This is a retrospective study of the echocardiographic data collected over 24 month's period, between October 2009 and September 2011. Information obtained from the records included age, gender, clinical diagnosis, and echocardiographic findings. Data was analyzed and expressed in frequency tables and percentages.
Results: A total of 506 children were seen. The age range was between 5 days and 15 years with a mean age of 3.29 ΁ 2.56. A total of 173 (34.2%) had CHD. There were 104 boys and 69 girls giving a M: F ratio of 3:2. 48.6% of the children were 1 year and younger. In order of frequencies, the common CHD are ventricular septal defect (30.6%), tetralogy of fallot (16.7%), atrial septal defect (12.1%), patent ductus arteriosus (10.9%), endocardial cushion defect (8.8%), tricuspid atresia (4.6%) and truncus arteriosus (2.3%).
Conclusions: Echocardiographic screening of the children revealed a wide variety of CHDs. VSD and TOF are the most common, accounting for about half of the cases with CHDs. There is an urgent need for government and non-government organizations to establish well-equipped cardiothoracic surgical centes across the country to cater for children with CHDs.

Keywords: Congenital heart defects, children, echocardiography


How to cite this article:
Asani M, Aliyu I, Kabir H. Profile of congenital heart defects among children at Aminu Kano Teaching Hospital, Kano, Nigeria. J Med Trop 2013;15:131-4

How to cite this URL:
Asani M, Aliyu I, Kabir H. Profile of congenital heart defects among children at Aminu Kano Teaching Hospital, Kano, Nigeria. J Med Trop [serial online] 2013 [cited 2019 Jun 18];15:131-4. Available from: http://www.jmedtropics.org/text.asp?2013/15/2/131/123598


  Introduction Top


Cardiovascular diseases are no longer diseases of the developed world but have become a cause of growing concern in the developing countries as well. [1] Mitchell et al. [2] defined congenital heart disease CHD as the structural heart disease or intrathoracic great vessels that is actually or potentially of functional significance present at the time of birth even if there was a delay in detection. Hoosen et al. [3] noted that CHDs are commonly missed, misdiagnosed, or identified in less developed countries due to limited facilities and lack of skilled human resources. Only a minority of these cases is detected and most are at late stages of the disease, this is mostly due to inadequate diagnostic facilities. The overall incidence in the developing world is largely unknown. Gupta and Antia estimated the incidence of congenital heart defects in Nigeria to be 3.5 per thousand live births. [4]

The pattern of structural heart diseases varies from region to region and from country to country. Echocardiography has been available in Aminu Kano Teaching Hospital (AKTH) for about 10 years now but problems then were non-availability of appropriate probes for children and earlier equipments lacked Doppler capabilities thus making it difficult to make some specific diagnosis. An earlier study done in the cente was done by the physicians and included adults with CHDs. [5] The recent acquisition of ALOKA cardiac ultrasound machine with appropriate pediatric probe by the hospital and the establishment of a Paediatric Cardiology unit will no doubt help to better define the pattern of CHDs seen hence the need for this study.


  Materials and Methods Top


This is a retrospective study of the echocardiographic data collected over a 24 month period, between October 2009 and September 2011. The subjects were seen in AKTH. AKTH is located in Tarauni LGA of Kano state. It is the only tertiary health facility in Kano. Kano city is in northern Nigeria, capital of Kano State. It is in the North-western geopolitical zone of Nigeria and is located in the Sudan Savanna belt of Nigeria. In addition to the hospital's tertiary function, AKTH offers secondary services to the populace and its services extend to the neighboring states of Jigawa, Katsina, Bauchi, Gombe, Yobe, and Zamfara.

Information obtained from the records included age, gender, and clinical diagnosis. Transthoracic echocardiography was done by the two consultant Paediatricians in the cardiology unit. M - mode and two-dimensional pictures were taken in the standard echo windows with Doppler interrogations for the presence of congenital heart defects. All the studies were carried out using ALOKA cardiac ultrasound system, manufactured in October 2007. Data was analyzed and expressed in frequency tables and percentages.


  Results Top


A total of 506 children were referred for echocardiographic studies in the 2 year study period. The age range was between 5 days and 15 years with a mean age of 3.29 ± 2.56 years. A total of 173 (34.2%) out of the referred cases had CHDs. There were 104 boys and 73 girls giving a male to female ratio of 3:2. 48.6% of the children were 1 year and younger while 81.5% of the children were 5 years and below as illustrated in [Table 1]. The acyanotic lesions are the predominant lesions accounting for 68.3% while the cyanotic types account for 31.7%. Ventricular septal defect (VSD) accounts for 30.6% of the total cases, making it the most common type of CHD. Tetralogy of fallot (TOF) is next in frequency and is the most common type of cyanotic heart disease seen in this study as illustrated in [Table 2]. The frequency of boys are higher than the girls in the common CHD [VSD, TOF, atrial septal defect (ASD), patent ductus arteriosus (PDA), endocardial cushion defect (ECD), and tricuspid atresia] while the rare lesions are more frequently seen in girls. Seven children (4.1%) have 2 left to right shunts (VSD ± PDA ± ASD).
Table 1: Age and sex distribution of patients with CHD


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Table 2: Sex and percentage distribution of CHD


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[Table 3] shows the relative comparison of some CHDs in some centes. [6],[7],[8] VSD is the most common lesion in these centes while TOF is the most common cyanotic type in these centes as well.
Table 3: Relative comparison of some congenital heart diseases in other centes


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  Discussion Top


This study highlights the distribution of CHDs seen in AKTH from Kano and neighboring states like Jigawa, Katsina, Bauchi, and Kaduna from which referrals are received. These neighboring states either do not have echocardiographic services or pediatric cardiologists hence the referral. This may partly account for the large number of requests, 506 within 2 years. In addition, the growing awareness among health professionals of the availability of this diagnostic tool and the improvement of diagnosis contributes to its patronage whenever there are indications for screening for the presence of heart diseases. This will explain the dramatic increase in the diagnosis of CHDs, 173 cases seen over 24 months, when compared to a similar study carried out in this cente, from 2002 to 2006 when a total of 122 cases were seen among children and adult over a longer period of 48 months. [5] About half of the children were diagnosed in infancy [Table 1] similar to the finding by Ibadin et al. from Benin, Nigeria, [9] this is a far cry from what is obtainable in developed countries where neonatal diagnosis is the norm and there is a trend toward fetal diagnosis and management. [10] Early diagnosis is highly desirable because about 1 in 13 children born with CHD will die within the first month of life without appropriate treatment. [11]

General male preponderance of 3:2 is similar to what was obtained in studies by Bannerman et al. in Zimbabwe [12] but in contrast to the study by Ibadin et al. [9] who found a slight female preponderance. The male preponderance in this study may be a reflection of the higher number of boys referred for echocardiographic studies, but the reasons why more boys are referred still remains unclear. The acyanotic lesions account for about two third of the total CHDs, this is consistent with studies done in other countries. [13],[14]

In this study, VSD accounted for 30.6% of the cardiac lesions making it the most common CHD. The finding of this study is in agreement with studies carried out elsewhere in the world with an incidence between 25% and 35%. [6],[7],[8] In this study, seven children (4.1%) have two left to right shunts; similar cases were reported elsewhere, this necessitates thorough evaluations during echocardiographic studies since the presence of a shunt does not rule out the presence of others in the same patient. This may explain the report of different findings on the same subject by different echocardiographers and the incompatible clinical presentations of patients with small shunts since the hemodynamic effects of these multiple lesions are addictive.

[Table 3] illustrated the differences in frequencies of some CHD in different centers; [6],[7],[8] this may reflect the multifactorial etiological causes of CHD. The primary causes of CHD is mostly unknown but are thought to be a combination of genetic predisposition and environmental factors hence the value of genetic counseling to families with patients with CHD cannot be overemphasized. [15]

In conclusion, with the availability of non-invasive diagnostic facilities such as echocardiography and skilled human resources, the burden of CHDs will be better appreciated in the subregion. The establishment of specialist health facilities with pediatric cardiology units with early referral will no doubt lead to early diagnosis. The management of confirmed cases of CHDs remains a major challenge to managing pediatricians who share the burden of lack of access to definitive treatment with the primary care givers since the cost of surgery remains out of reach to the majority of the patients. The few patients who have had open heart surgery were sponsored by state governments and very recently by a non-governmental organization, Murtala Mohammed Foundation. Hence, there is an urgent need for government and non-government organizations to establish well-equipped cardiothoracic surgical centes across the country to cater for these patients either for free or at highly subsidized rate since by adolescence 85-95% of all untreated CHD cases will be dead. [16] In the interim, pediatricians, cardiac surgeons, and other stake holders are encouraged to persevere in their efforts to save lives, improve the quality of life of affected children and to step up their level of advocacy. [17]

 
  References Top

1.Hewiston J, Zilla P. Children's heart disease in sub-Saharan Africa: Challenging the burden of disease. Sa Heart J 2010;7:18-29.  Back to cited text no. 1
    
2.Mitchell S, Korones S, Berendes S. Congenital Heart Disease in 56,109 births, incidence and natural history. Circulation 1971;43:323-32.  Back to cited text no. 2
    
3.Hoosen EG, Cilliers AM, Hugo-Hamman CT, Brown SC, Lawrenson JB, Zuhlke L. Paediatric cardiac services in South Africa. S Afr Med J 2011;101:106-7.  Back to cited text no. 3
    
4.Gupta B, Antia AU. The incidence of congenital heart disease in Nigerian children. Br Heart J 1967;29:906-9.  Back to cited text no. 4
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5.Sani U, Mukhtar-Yola M, Karaye KM. Spectrum of congenital heart disease in a tropical environment: An echocardiographic study. JNatl Med Assoc 2007;99:665- 9.  Back to cited text no. 5
    
6.Okoromah CA, Ekure EN, Ojo OO, Animasahun BA, Bastos MI. Structural heart disease in children in Lagos: Profile, Problems and Prospects. Niger Postgrad Med J 2008;15: 82-8.  Back to cited text no. 6
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7.Jaiyesimi F, Ruberu DK, Misra VK. Pattern of congenital Heart Disease in King fahd specialist Hospital, Buraidah. Ann Saudi Med 1993;13:407-11.  Back to cited text no. 7
    
8.Ashraf M, Chowdhary J, Khajuria K, Reyaz AM. Spectrum of congenital Heart Diseases in Kashmir, India. Indian Paediatr 2009;46:1107-8.  Back to cited text no. 8
    
9.Ibadin MO, Sadoh WE, Osarogiagbo W. Congenital heart diseases at the University of Benin Teaching Hospital. Niger J Paediatr 2005;32:29-32.  Back to cited text no. 9
    
10.Rychnik J. Frontiers in fetal cardiovascular disease. Pediatr Clin N Am 2004;51:1489-502.  Back to cited text no. 10
    
11.Thaur JS, Negi PC. Ahluwalia SK, Sharma R. Integrated community based screening for cardiovascular diseases of childhood. World Health Forum 1997;18:24 -7.  Back to cited text no. 11
    
12.Bannerman CH, Mahalu W. Congenital Heart Diseases in Zimbawean children. Ann Trop Paediatr 1998;18:5-12.  Back to cited text no. 12
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13.Fyler DC. Report of the New England Regional Infant Cardiac Program. Paediatrics 1980;65:375-461.  Back to cited text no. 13
    
14.Sadiq M, Roshan B, Khan A, Farhan L, Irfan B, Seryar S. Pattern of Paediatric heart disease in Pakistan. J Coll Physicians Surg Pak 2002;12:149-53.  Back to cited text no. 14
    
15.Bernstein D. Epidemiology and genetic basis of congenital heart diseases. In: Behrman RE, Kliegman RM, Jenson HB, editors. Nelson textbook of Paediatrics. Philadelphia, Pennsylvania: Saunders; 2007. p. 1878-81.  Back to cited text no. 15
    
16.Adams FH. Congenital heart disease; comments regarding incidence and natural history. Calif Med 1959;90:2136.  Back to cited text no. 16
    
17.Bode-Thomas F. Overcoming challenges in the management of structural Heart Diseases in Nigerian Children. J Med Trop 2011;13:54-6.  Back to cited text no. 17
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]


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