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Congenital heart disease at Laos Children's Hospital: Two year experience
In-Chang Hwang1,2,3, Malouny Sisavanh1,4,5, Somxay Billamay4
1Cardiovascular Unit, Vientiane, Laos.
Insights
Diagnosis of congenital heart disease (CHD) in Laos is delayed, particularly in rural regions. Improving medical staff training and access to care is crucial for better pediatric CHD management.
Area of Science:
- Pediatric Cardiology
- Global Health
- Echocardiography
Background:
- Congenital heart disease (CHD) management in developing nations faces significant hurdles due to limited healthcare access and socioeconomic factors.
- Children's Hospital in Vientiane, Laos, serves as the sole pediatric referral center, highlighting the critical need to understand local CHD prevalence and care.
- This study examines recent experiences with CHD at this facility to identify challenges and opportunities for improvement.
Purpose of the Study:
- To describe the recent clinical experience with congenital heart disease (CHD) at the Children's Hospital in Vientiane, Laos.
- To analyze demographic characteristics and age at diagnosis for pediatric CHD patients based on their residential area.
- To identify disparities in CHD diagnosis and care between rural and urban populations within Laos.
Main Methods:
- A retrospective review of 1009 echocardiograms performed on 797 individuals between July 2013 and November 2015.
- Identification of 213 patients diagnosed with CHD, with subsequent analysis of demographic data and age at initial diagnosis.
- Comparison of CHD diagnosis timing and characteristics between patients from rural areas and the capital city.
Main Results:
- Ventricular septal defect, atrial septal defect, patent ductus arteriosus, and tetralogy of Fallot were the most common CHD types.
- Moderate to severe CHD requiring intervention was diagnosed in 137 patients, with a median age of 6.0 months.
- Patients from rural areas were diagnosed significantly later than those from the capital, with 46.1% of rural patients diagnosed after age 1 year compared to 16.7% from the capital.
Conclusions:
- Diagnosis of CHD requiring surgical or interventional treatment is substantially delayed in Laos, especially for children in rural areas.
- There is a clear need for enhanced education and training for local medical personnel.
- Improved access to medical expertise and timely diagnostic services is essential to elevate the standard of CHD care in Laos.
Background:
Management of congenital heart disease (CHD) in developing countries is challenging because of limited access to health-care facilities and socioeconomic limitations. The aim of this study was to describe the recent experience with CHD at Children's Hospital, Vientiane, Laos, the only pediatric referral hospital in the country.
Methods:
From July 2013 to November 2015, 1009 echocardiograms were carried out in 797 individuals who visited Children's Hospital, in whom CHD was identified in 213. Demographic characteristics, echocardiography and age at first CHD diagnosis on echocardiogram were compared by residential area.
Results:
Among the 213 patients, the most frequent anomalies, in descending order, were ventricular septal defect, atrial septal defect, patent ductus arteriosus, and tetralogy of Fallot. Moderate or severe CHD requiring surgery or intervention was detected in 137 patients; median age at initial diagnosis was 6.0 months (IQR, 1.5-29.8). Among those with moderate or severe CHD, 89 patients were from rural areas and 48 from the capital area. The proportion of patients from rural areas older than 1 and 3 years at diagnosis was 46.1% and 32.6%, respectively. In contrast, patients from the capital area were diagnosed at a significantly earlier age: 16.7% at age >1 year and 6.2% at age >3 years (both P < 0.001 vs rural areas).
Conclusions:
Diagnosis of CHD requiring surgery is delayed in Laos, especially in rural areas. Better education and training of local medical staff, and greater access to medical advice are required to improve CHD care in Laos.