Time of first echocardiographic diagnosis of Congenital Heart Disease and its associated factors among children attending the Uganda Heart Institute

Abstract

Background: CHD accounts for one third of all congenital anomalies. When undiagnosed and untreated, it is a major cause of death in the first year of life and major morbidity and mortality later in childhood. Definitive diagnosis by echocardiography is often a challenge in low-and-middle income countries. This leads to missed opportunity for timely corrective surgery, before onset of complications. Timing of treatment in relation to the natural history of the disease correlates with the treatment outcome. Objectives: To determine the time of first echocardiographic diagnosis of Congenital Heart Disease and its associated factors among children attending the Uganda Heart Institute (UHI). Methodology: This was a quantitative cross-sectional study, 412 children aged <18 years who had a first-time echocardiographic diagnosis of CHD at the UHI were enrolled consecutively after informed consent of the caregiver and/or assent of children aged ≥8 years. A questionnaire was administered to elicit the factors associated with time of first echocardiographic diagnosis of CHD. The dependent variable was time of first echocardiographic diagnosis. Time of diagnosis for each participant was dichotomised into delayed diagnosis and not delayed diagnosis using the revised and updated consensus statement of the Working group on management of congenital heart diseases by two consultant paediatric cardiologists. The independent variables were demographics and other associated factors (child, disease, maternal and perinatal, family, health system and community factors. Modified Poisson regression analysis was used for bivariate and multivariate analysis to obtain the crude and adjusted prevalence ratios. Results: The median time of first echocardiographic diagnosis of CHD in UHI was 6 (IQR 2 - 16.5) months. Out of 412 children, 198 of them (48.1%) were found to have delayed first echocardiographic diagnosis. Maternal tertiary education, APR:0.60 (95% CI:0.42 – 0.85, p value 0.004; delivery at a public health facility, APR 1.35 (95% CI:1.03 - 1.76), p value 0.032; absence of a physical abnormality or defect, APR 1.61 (95% CI:1.09 – 2.39), p value 0.018; alternative treatment sought before visiting a health facility, APR 1.37 (95% CI:1.07 – 1.77) p value 0.014; and residence outside the central region, APR 1.27 (95% CI:1.03 – 1.57) p value 0.025 were associated with a higher likelihood of delayed diagnosis. Conclusion and Recommendations: The median time of CHD diagnosis was 6 months (IQR 2 - 16.5 months) with almost half of participants having a delayed diagnosis. Maternal education below tertiary level, delivery at a public health facility, absence of dysmorphic features, alternative mode of care sought before visiting a health facility and residence outside the central region were associated with a higher likelihood of delayed diagnosis. There is need for cardiac screening for newborns before discharge from the birth facility, health education on signs and symptoms of CHD for the general public and mothers during the perinatal period and a subsequent study should assess facilitators and barriers to early diagnosis of CHD by health-workers.