Prevalence, and factors associated with mortality among children with congenital heart diseases at a Tertiary Health Centre in the Gambia

Abstract

Background: The burden, morbidities and determinants of mortality associated with congenital heart diseases (CHDs)- an important cardiovascular problem in children, is poorly defined in the Gambia. This study sets out to assess the prevalence, spectrum, treatment outcome, and determinants of mortality in children with CHDs admitted to the main referral hospital in the Gambia..

Methods: The medical records of 4336 admitted children aged <15 years were consecutively reviewed over a two-year period. Those with CHDs confirmed with 2-D Echocardiography were further analyzed for socio-demographic and clinical features, including associated complications. The outcomes of hospitalization of the children with CHDs were assessed, and factors associated with mortality were determined using binary logistic regression analysis.

Results: CHDs were diagnosed in 111 (2.4%) of the 4336 total admissions during the study period. Ventricular septal defects (29.7%) were the most common CHDs, while tetralogy of Fallot (23.4%) was the most common cyanotic heart lesion. About 20.0% of the children with CHDs had features of Down syndrome. Breathlessness and abnormal heart sounds were the most common clinical manifestations, and pneumonia, failure to thrive/undernutrition were the most common associated complications. In-hospital care mortality was 10.8% and male sex (p=0.049), school age (p = 0.013), chest pain (p = 0.004), pallor (p < 0.001) and FTT/undernutrition (0.018) were significantly associated with mortality on bivariate analysis and only pallor at presentation with AOR=14.73; 95% CI 2.35 – 92.37 independently associated with mortality with regression model.

Conclusion: CHDs occur in 24 of 1000 childhood admissions at the only tertiary health facility in the Gambia, and VSD was the most common lesion. One in ten of these children died, and the presence of pallor predicted mortality. Making definitive interventions accessible and affordable for these children will reduce the burden of CHDs.