A retrospective study on the prevalence, management, and outcomes of congenital heart diseases in children at Edward Francis small teaching hospital, banjul, the Gambia.

backgroundCongenital heart defects (CHDs) are the most common major congenital anomalies, accounting for approximately one-third of all birth defects. They significantly contribute to morbidity, mortality, and healthcare costs. This study provides insights into the prevalence, characteristics, and management challenges of CHDs in The Gambia, emphasizing the need for early diagnosis, risk factor identification, and improved cardiac care infrastructure.

objectivesTo determine the prevalence, management strategies, and outcomes of CHDs in children at Edward Francis Small Teaching Hospital from January 2020 to December 2022.

methodThis retrospective descriptive cross-sectional study reviewed medical records of pediatric patients admitted to Edward Francis Small Teaching Hospital, the main referral center in The Gambia and the teaching hospital for the University of The Gambia Medical School. Patient data from January 2020 to December 2022 were analyzed.

resultsA total of 89 patients were included, with 57.3% (n = 51) females and 42.7% (n = 38) males. The median age was 1.4 years. The most common ethnic group was Mandinka, followed by Fula. Diagnosis was confirmed by using 2D trans-thoracic echocardiography, which was performed on most of the patients (84.3%) in addition to clinical features and chest X-ray. The most prevalent CHD was ventricular septal defect (VSD) (39.3%), followed by atrial septal defect (ASD) (20.2%), tetralogy of Fallot (TOF) (16.9%), and patent ductus arteriosus (PDA) (10.1%) were also not uncommon. 15.7% of cases were unclassified. The most commonly associated clinical condition among these children with congenital heart disease was Down syndrome (18.0%), predominantly observed in children born to mothers aged over 35 years. This finding underscores the known association between advanced maternal age and chromosomal abnormalities. Maternal diabetes (2.2%) and osteogenesis imperfecta (2.2%) were also noted as less frequent but relevant associated risk factors, highlighting the multifactorial nature of congenital heart disease. Two (2.2%) had a positive family history of congenital heart disease. However, in 65(73%) of cases, there were no associated conditions or family history of CHD. The most frequently used medication in the treatment of these children was furosemide, and heart failure was the most common complication. Surgical interventions were rare: only 2.2% of these children underwent defect closure and 2.2% had pulmonary artery banding, while 95.5% of them did not receive any form of surgical treatment. Seventy-three (82.0%) were discharged and followed up in the clinic, while 6 (6.7%) died.

conclusionVSD was the most common congenital heart disease observed in this study, with a median age at diagnosis of 1.4 years (95% Confidence Interval: within 12 to 60 months). Down syndrome with maternal age > 35 years was the most frequent associated condition, and heart failure was the leading complication and primary cause of death. While both pharmacological and surgical treatment mode were used, surgical intervention for treatment of these defects remains unavailable in The Gambia, highlighting the urgent need to develop local paediatric cardiac surgery services.