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Late diagnosis of CHD and its associated factors in Kenya: an analytic cross-sectional study
Mercy Ng'eno1, Del-Rossi S Quadros1, Naomi Gachara1
1Department of Paediatrics and Child Health, Aga Khan University Hospital, Nairobi, Kenya.
Insights
Late diagnosis of congenital heart disease (CHD) is high in Kenya, affecting 60.6% of pediatric patients. Parental education significantly impacts early detection, highlighting a need for improved screening initiatives.
Area of Science:
- Pediatric Cardiology
- Public Health
- Medical Diagnostics
Background:
- Congenital heart disease (CHD) burden in Africa is underestimated due to under-reporting and high fetal/neonatal mortality.
- Late diagnosis of CHD contributes to increased morbidity and mortality in pediatric populations.
Purpose of the Study:
- To determine the prevalence of late diagnosis of CHD in Kenyan children.
- To identify factors associated with the late diagnosis of congenital heart disease.
Main Methods:
- A 5-year cross-sectional study (2011-2016) included 411 pediatric patients (0-18 years) with CHD.
- Patients were categorized into early (<1 year) and late (>1 year) diagnosis groups.
- Multiple logistic regression analyzed factors associated with late CHD diagnosis.
Main Results:
- The prevalence of late CHD diagnosis was 60.6% (95% CI 55.7-65.3), with a median diagnosis age of 15 months.
- Higher parental education levels (OR=4.99) were strongly associated with decreased odds of late diagnosis.
- Cardiac murmur presence (OR=0.87) was associated with decreased odds of late diagnosis; other factors lacked statistical significance.
Conclusions:
- Late diagnosis of congenital heart disease is a significant issue in Kenya.
- Enhancing early detection and screening programs for CHD is crucial to reduce adverse outcomes.
Introduction:
Burden of CHD in Africa is generally underestimated mainly due to significant under-reporting and early-related fetal and neonatal mortality.
Objectives:
Determine the prevalence and factors associated with late diagnosis of CHD seen at three tertiary care hospitals in Kenya.
Design:
A cross-sectional study on paediatric patients with CHDs, aged 0-18 years, seen over a 5-year period, between January, 2011 and December, 2016.
Setting:
Aga Khan University Hospital Nairobi, Mater Hospital, and Kenyatta National Hospital.
Methods:
Patients were stratified into those diagnosed late (>1 year of age) and those diagnosed early (<1 year of age). Multiple logistic regression analysis was done to determine factors associated with late diagnosis.
Results:
The study enrolled 411 patients, with equal gender distribution. Prevalence of late diagnosis (>1 year of age) of CHD was 60.6% (95% CI 55.7-65.3). Median age at diagnosis was 15 (IQR 5-48) months. Presence of a cardiac murmur (OR = 0.87; 95% CI 0.72-0.92, p-value = 0.016) and level of parental education (OR = 4.99; 95% CI 2.25-11.40, p-value <0001) were associated with a decreased odds of late diagnosis. Other factors like cyanosis, an increase in the number of healthcare workers and healthcare facilities per 10,000 population showed some association with decreased odds of late diagnosis of CHD, but these were not statistically significant.
Conclusion:
Late diagnosis of CHD remains alarmingly high in our setting. Initiatives to enhance early detection and screening of CHD should be adopted to reduce related mortality and morbidity.
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