Pediatrics & Health Research Open Access

Pattern, Relative Frequency and morbidity of Pediatric Heart diseases at Tibebe – Ghion Specialized Teaching Hospital, Bahir Dar, North West Ethiopia

Tesfaye Taye Gelaw^1*, Habtamu Bayih Engida², Belaynew Zemed Alebachew¹, Workie Shitaw Melesse¹, Shitahun Fentie Tilahun¹ and Yaregal Kindie Workie^{1 1}Department of Paediatrics and Child Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
²Department of Internal Medicine, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
^*Correspondence: Tesfaye Taye Gelaw, Department of Paediatrics and Child Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia, Email:

Received: 11-Mar-2024, Manuscript No. IPPHR-24-19162 ; Editor assigned: 13-Mar-2024, Pre QC No. IPPHR-24-19162 (PQ); Reviewed: 27-Mar-2024, QC No. IPPHR-24-19162 ; Revised: 24-Mar-2025, Manuscript No. IPPHR-24-19162 (R); Published: 30-Mar-2025, DOI: 10.36648/2574-2817.10.1.37

Introduction

There are little reliable data concerning the spectrum and prevalence of paediatric cardiac disease in Low and Middle Income Countries (LMIC), but enough to know that the burden is considerable with patients typically presenting with advanced disease [1]. Heart diseases in children include those present at birth (congenital heart diseases) and those acquired later in life (rheumatic heart disease, cardiomyopathies, pericardial diseases, myocarditis and others) [2].

Heart diseases in paediatric population are considered to be significant contributors to mortality and morbidity as well as frequent causes of hospital admission among children [3]. The burden of heart disease is significant in comparison with other better studied and funded diseases in LMIC [4]. Estimates for prevalence of Congenital Heart Defects (CHD) in sub-Saharan Africa from Global Burden of Disease (GBD) data are also very high, with rates up to 350 per 100,000 in Niger [5].

Congenital Heart Defects (CHD) are the most common birth defects; responsible for nearly one-third of all congenital birth defects [2]. Ventricular Septal Defect (VSD) followed by Atrial Septal Defect (ASD) was the commonest acyanotic heart lesions while Tetralogy of Fallot (TOF) was the commonest cyanotic heart lesion. Studies in LMICs have characterised the spectrum of Acquired Heart Disease (AHD) of which Rheumatic Heart Disease (RHD) was the most common followed by dilated cardiomyopathy/myocarditis [3, 6-8]. Studies showed that heart failure and pulmonary hypertension associated with CHD are more common in LMICs compared to HICs [9-11]. RHD is also the most frequent cause of heart failure in sub-Saharan Africa [12,13].

The 2030 Agenda for sustainable development outlines a transformative vision. Of the goals, SDG 3.4 aims to reduce premature mortality from non-communicable diseases including cardiovascular disorders by one third [14]. Regrettably, paediatric cardiac diseases with an alarming morbidity and mortality rate and psychosocial burden have been given less due attention [15].

Although overall child mortality has decreased by half globally, death and morbidity due to heart disease has consistently increased in LMICs over the past few decades [16]. Given the increase in CHD prevalence and the consequent increase in morbidity, sustainable treatment strategy should be planned to achieve the SDGs in Africa. Failing to build this capacity, heart diseases may become a major contributor to missing the 2030 SDG target 3.4 [17,18].

Our Search of literature showed that most studies done in our country has focused mainly on relative frequencies of paediatric heart diseases without highlighting the detailed profiles and magnitude of the disease burden in terms of morbidity [19,20]. The study is therefore aimed at determining the patterns, detailed profiles and morbidities of cardiac diseases among children attending our hospital pediatric cardiology unit.

Materials and Methods

Setting and Participants

The study was conducted on clients who had attended the paediatric cardiology unit of Bahir Dar University Tibebe- Ghion Specialized Teaching Hospital, one of the referral centres in North-west Ethiopia, over a four years and nine months period from June 2019–February 2024. Four hundred fifteen children who had heart lesions confirmed by echocardiography were included.

Study Design

A descriptive cross sectional hospital based study was conducted on patients attending paediatric cardiology unit of Bahir Dar University Tibebe-Ghion specialized teaching hospital. The study period spanned from June 2019 to February 2024. Children, from birth to 15 years of age, with heart lesions on the basis of clinical evaluation and echocardiography over this time period were included.

Exclusion criteria: Children who/whose care givers are not willing to be included in the study.

• Children whose diagnosis is not supported by echocardiography.
• Patients with incomplete documentation of files and/or questionnaire.

Structured questionnaire that details demographic, socioeconomic, clinical, and echocardiographic variables was used. Descriptive analysis was performed for age, gender, clinical diagnosis, and detailed heart disease profiles. Their caregivers were informed of the study objectives and methods to be used, and consent was taken for their agreement before filling the questionnaire. Ethical clearance was obtained from the ethics and research committee of college of medicine and health sciences of Bahir Dar University.

Operational Definition

Congenital heart defect: Defect that present at birth and may occur singly or in combination.

Acyanotic congenital heart defect: Congenital heart defects that don't normally interfere with the amount of oxygen or blood that reaches the tissues of the body.

Cyanotic congenital heart defect: Heterogeneous group of cardiac abnormalities that result in deoxygenated blood being pumped to the body without first passing through the lungs.

Acquired heart disease: Conditions affecting the heart and its associated blood vessels that develop during a person's lifetime.

Rheumatic Heart Disease (RHD): Acute and chronic heart disorders caused by rheumatic fever.

Stage A/borderline rheumatic heart disease: Abnormal echocardiographic features but do not fulfil criteria for the diagnosis of RHD.

Statistical Analysis

Recorded data were cleaned, coded and analysed with IBM SPSS Statistics for windows, version 25. The Categorical variables were analysed in the form of proportions and percentages and presented in tables. Discrete variables including age were analysed and summarized as medians (IQR).

Results

Socio–Demographic Characteristics

Four hundred fifteen (415) children aged from birth to 180 months with a diagnosis of heart diseases were enrolled in to the study during the time period from June 2019- February 2024. Fifty four percent (222/415) were males. The median (IQR) age of children enrolled was 24 months (4 to 97). Table 1 demonstrates the detailed socio-demographic characteristics.

Table 1: Socio-demographic parameter of children with heart diseases: Bahir Dar University Tibebe-Ghion specialized teaching hospital, June 2019-February 2024

Relative Prevalence of Cardiac Defects and Diseases

Congenital heart defects account for 67.5% of all Pediatric heart diseases and only 30.6% exhibit acquired heart diseases. 76.4% of all children with acquired heart diseases have rheumatic heart disease. Of all the congenital heart defects, 72.5% constitute acyanotic CHDs and the remaining 23.6% were cyanotic. Twenty five percent of acyanotic CHDs had isolated ventricular septal defect followed by isolated patent ductus arteriosus, 13.8%; isolated atrioventricular septal defect atrial septal defect, 11.3%; and isolated atrial septal defect, 10.3%. TOF (36.4%) was the leading cyanotic CHD followed by d-TGA, 16.7%; tricuspid atresia, 16.7%; and DORV, 12.1%. Table 2 illustrates the relative frequency of various pediatric heart diseases.

Table 2: The relative frequency of pediatric heart diseases: Bahir Dar University Tibebe-Ghion specialized teaching hospital, June 2019-February 2024.

Presenting Complaints and Clinical Signs of Children with Heart Diseases

Respiratory distress was the most common presenting complaint (65%) followed by cough (53%), dyspnea on exertion (49%) and diaphoresis (40%). See details in Table 3.

Table 3: Presenting complaints of children with heart diseases: Bahir Dar University Tibebe-Ghion specialized teaching hospital, June 2019-February 2024.

Cardiac murmur (83%) was the most common clinical finding followed by hepatomegaly (41%), and dyspnea at rest (37%). See details in Table 4.

Table 4: Clinical signs of children with heart diseases at presentation: Bahir Dar University Tibebe-Ghion specialized teaching hospital, June 2019-January 2024.

Epidemiology of Congestive Heart Failure and Pulmonary Hypertension

Congestive heart failure was documented in 202/415(49%) of all children with heart lesions. 57% and 34% of all children with heart failure has Ross class IV and class III heart failure respectively making a cumulative of 44% all children with heart lesions. Children with acquired heart diseases have the highest proportion of heart failure in our study (70%) (Table 5).

Table 5: Profile of congestive heart failure in children with heart diseases: Bahir Dar University Tibebe-Ghion specialized teaching hospital, June 2019-February 2024

In our study, 133/415 (32%) of children with heart lesions had pulmonary hypertension of various range and type. Of all children with pulmonary hypertension, 62% had severe pulmonary hypertension (Table 6).

Table 6: Relative frequency and grading of pulmonary hypertension in children with heart diseases: Bahir Dar University Tibebe- Ghion teaching hospital, June 2019-January 2024

Discussion

Our analysis has shown a snapshot of a very important piece of information regarding the current patterns and clinical presentations of cardiac diseases in children. Among all the children with cardiac disease enrolled to the study, 67.5% had congenital cardiac defects and only 30.6% had acquired heart disease. This finding enlightens the emergence of congenital heart defects as the leading cause of pediatric heart diseases in LMICs [5].

Acyanotic congenital heart defects account for 72.5% of all congenital heart defects making the proportion of cyanotic congenital heart defects to be 23.6%. Isolated ventricular septal defect was the most common acyanotic CHD followed by isolated patent ductus arteriosus, atrioventricular septal defect and atrial septal defect respectively. Tetralogy of Fallot was the most common acyanotic CHD comprising 36.4% of all cyanotic CHDs followed by d-TGA, tricuspid atresia and DORV. Rheumatic heart disease is the most common acquired heart disease. This finding is in line with other studies elsewhere in the world.

Our study revealed respiratory distress (65%) as the most common clinical presentation and cardiac murmur (83%) as the most common clinical sign in children with heart diseases.

Congestive heart failure was found in 37.9%, 33.3% and 70 % of children with acyanotic, cyanotic and acquired heart diseases respectively. Forty four percent of all children with heart diseases had developed congestive heart failure. These findings were in line with the findings from LMICs but far higher compared to reports from High Income Countries (HICs). This is explained, in part, by the fact that children in LMICs with heart diseases have less access to medical and surgical care, sub–optimal medical care, lower family awareness on pediatric cardiac diseases, and less due attention in the national policy; all leading to delayed presentation, intervention and its consequences, congestive heart failure, pulmonary hypertension and the ultimate death.

Thirty two percent of all the studied children had pulmonary hypertension with nearly 90% of them being higher grade (moderate and severe pulmonary hypertension). Twenty seven percent, 13.6% and 36.7% of children with acyanotic, cyanotic and acquired heart diseases exhibit pulmonary hypertension respectively. This findings were consistent with reports from LMICs and far more higher than reports from HICs. This finding is substantiated by sub-optimal care, difficulty health services access and lower awareness level in the community, health care providers and beyond.

Conclusion

The proportion of congenital heart defects in the paediatric population is rising. Respiratory distress and cardiac murmur are the most common presenting complaint and clinical finding of children with heart diseases respectively. Significant proportion of children with heart diseases are presenting with congestive heart failure and pulmonary hypertension.

Limitations

This study is a descriptive cross sectional hospital based study. Hence, generalizability is limited as it is only descriptive and doesn’t represent the whole population.

Recommendations

As the challenges of providing optimal care for a child with heart disease are unparalleled; reflected by the relatively high proportion of heart failure and pulmonary hypertension, a lot more needs to be done on awareness creation, access and optimal timely management of children with heart diseases. Early diagnosis and prevention of these deadly complications requires sensitization of the community and the health work force and awareness creation to the policy makers on pediatric heart diseases.

Ethics Approval and Consent to Participate

This study was approved by the Institutional Review Board of Bahir Dar University College of Medicine and Health Sciences without comments (protocol number: 861/2023). We obtained verbal consent from the participants and/or caregivers.

Consent for Publication

Not Applicable.

Availability of Data and Materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Competing Interests

The authors declare that they have no competing interests.

Funding

No funding source to declare.

Acknowledgement

We are thankful to the Pediatric and Child health residents and nurses of Bahir Dar University Tibebe–Ghion Hospital for their relentless support of the pediatric cardiac services being provided.

References

1. Hewitson J, Zilla P (2010) Children's heart disease in sub-Saharan Africa: Challenging the burden of disease: children's heart disease. Sa Heart. 7(1):18-29.

   [Google Scholar]

2. Mamasoula C, Addor MC, Carbonell CC, Dias CM, Echevarriaâ?Gonzalezâ?deâ?Garibay LJ, et al. (2022) Prevalence of congenital heart defects in Europe, 2008–2015: A registryâ?based study. Birth Defects Res. 114(20):1404-1416.

   [Crossref] [Google Scholar] [PubMed]

3. Arshad MS, Anwar-ul-Haq HM, Adnan M, Zulqarnain A (2020) Frequency and pattern of paediatric heart diseases: Five years experience at the children’s hospital, Multan. Pak J Med Sci. 36(6):1308.

   [Crossref] [Google Scholar] [PubMed]

4. Wang H, Bhutta ZA, Coates MM, Coggeshall M, Dandona L, et al. (2016) Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980–2015: A systematic analysis for the Global Burden of Disease Study 2015. The Lancet. 388(10053):1725-1774.

   [Crossref] [Google Scholar] [PubMed]

5. Zimmerman M, Sable C (2020) Congenital heart disease in low�and�middle�income countries: focus on sub�Saharan Africa. Am J Med Genet C Semin Med Genet. 184(1):36-46.

   [Crossref] [Google Scholar] [PubMed]

6. Zuechner A, Mhada T, Majani NG, Sharau GG, Mahalu W, et al. (2019) Spectrum of heart diseases in children presenting to a paediatric cardiac echocardiography clinic in the Lake Zone of Tanzania: A 7 years overview. BMC Cardiovasc Disord. 19:1-6.

   [Crossref] [Google Scholar] [PubMed]

7. Kennedy N, Miller P (2013) The spectrum of paediatric cardiac disease presenting to an outpatient clinic in Malawi. BMC Res Notes. 6:1-4.

   [Crossref] [Google Scholar] [PubMed]

8. Sani UM, Ahmed H, Jiya NM (2015) Pattern of acquired heart diseases among children seen in Sokoto, North-Western Nigeria. Niger J Clin Pract. 18(6):718-725.

   [Crossref] [Google Scholar] [PubMed]

9. Jayaprasad N (2016) Heart failure in children. Heart Views. 17(3):92-99.

   [Crossref] [Google Scholar] [PubMed]

10. Constantine A, Dimopoulos K, Condliffe R, Clift P, Chaplin G, et al. (2021) Pulmonary arterial hypertension associated with congenital heart disease in children: Clinical characterisation, outcomes and changes in demographics over time. Eur Heart J. 42(Supplement_1):ehab724-1857.

    [Google Scholar]

11. Atwa ZT, Safar HH (2014) Outcome of congenital heart diseases in Egyptian children: Is there gender disparity?. Gaz Egypt Paediatr Assoc. 62(2):35-40.

    [Google Scholar]

12. Zhang W, Okello E, Nyakoojo W, Lwabi P, Mondo CK (2015) Proportion of patients in the Uganda rheumatic heart disease registry with advanced disease requiring urgent surgical interventions. Afr Health Sci. 15(4):1182-1188.

    [Crossref] [Google Scholar] [PubMed]

13. Nigussie B, Tadele H (2019) Heart failure in Ethiopian children: Mirroring the unmet cardiac services. Ethiop J Health Sci. 29(1).

    [Crossref] [Google Scholar] [PubMed]

14. Cepal NU (2016) The 2030 agenda and the sustainable development goals: An opportunity for Latin America and the Caribbean.

    [Google Scholar]

15. Musa NL, Hjortdal V, Zheleva B, Murni IK, Sano S, et al. (2017) The global burden of paediatric heart disease. Cardiol Young. 27(S6):S3-S8.

    [Crossref] [Google Scholar] [PubMed]

16. IfH M (2017) Evaluation. Global burden of disease collaborative network. Global burden of disease study 2016 (GBD 2016) results. Institute for Health Metrics and Evaluation Seattle.
17. Rossouw B. Congenital heart disease in Africa threatens sustainable development goals. South Afr J Crit Care. 37(1):8-9.

    [Crossref] [Google Scholar] [PubMed]

18. Desa UN (2016) Transforming our world: The 2030 agenda for sustainable development.
19. Malede T, Haileamlak A (2006) Pattern of heart disease in children over five years period in jimma university hospital: A retrospective study. Ethiop J Health Sci. 16(1).

    [Google Scholar]

20. Habtu T (2021) Pattern of heart disease in children at University of Gondar comprehensive specialized hospital, north west Ethiopia, 2021.