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Pattern of congenital heart disease in a developing country tertiary care center: Factors associated with delayed
Usman Rashid1, Ahmad U Qureshi1, Syed N Hyder1
1Department of Pediatric Cardiology, The Children's Hospital and Institute of Child Health, Lahore, Pakistan.
Insights
Delayed diagnosis of congenital heart defects (CHD) affects most children, with factors including delayed consultations and socioeconomic constraints. Improving public awareness and referral systems is crucial for early detection in developing nations.
Area of Science:
- Pediatrics
- Cardiology
- Public Health
Background:
- Congenital heart defects (CHD) are a significant global health concern.
- Early diagnosis and intervention are critical for improving outcomes in children with CHD.
- Delays in diagnosis can lead to increased morbidity and mortality.
Purpose of the Study:
- To determine the extent of diagnostic delay for various congenital heart defects in children.
- To identify factors contributing to delayed diagnosis of CHD.
- To inform strategies for improving early detection and management of CHD.
Main Methods:
- An observational study was conducted with 354 children diagnosed with CHD.
- Data collected included patient demographics and factors associated with diagnostic delay.
- The study took place at the Department of Cardiology, Children's Hospital, Lahore, Pakistan.
Main Results:
- A significant majority of children (85.1%) experienced delayed diagnosis of CHD, with a median delay of 8 months.
- Key factors contributing to delay included delayed initial medical consultation (37.2%) and delayed diagnosis by healthcare professionals (22.5%).
- Other contributing factors were delayed referral, social taboos, and financial constraints.
Conclusions:
- The majority of congenital heart defect cases are diagnosed late.
- Inadequate healthcare systems and socioeconomic challenges are primary reasons for diagnostic delays.
- Developing efficient referral systems and enhancing public awareness are essential for timely CHD diagnosis and management in developing countries.
Objective:
To determine the delay in diagnosis of various types of congenital heart defects in children and factors associated with such delay.
Patients And Methods:
For this observational study, 354 patients having congenital heart disease (CHD) presenting for the first time to the Department of Cardiology, Children's Hospital, Lahore, Pakistan, between January 1, 2015 and June 30, 2015, were enrolled after obtaining informed verbal consent from the guardian of each child. Demographical profile and various factors under observation were recorded.
Results:
Among the 354 enrolled children (M: F 1.7:1) with age ranging from 1 to 176 months (median 24 months), 301 (85.1%) had delayed diagnosis of CHD (mainly acyanotic 65.3%), with median delay (8 months). Main factors for delay were delayed first consultation to a doctor (37.2%) and delayed diagnosis by a health professional (22.5%). Other factors included delayed referral to a tertiary care hospital (13.3%), social taboos (13.0%), and financial constraints (12.3%). Most children were delivered outside hospital settings (88.7%). Children with siblings less than two (40%) were less delayed than those having two or more siblings (60%, P < 0.001).
Conclusion:
Diagnosis of congenital heart defect was delayed in majority of patients. Multiple factors such as lack of adequately trained health system and socioeconomic constraints were responsible for the delay. There is a need to develop an efficient referral system and improve public awareness in developing countries for early diagnosis and management of such children.
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