Compendium of cardiac diseases among children presenting in tertiary institutions in southern Nigeria: a rising trend

Prevalence of undernutrition and associated factors among children with congenital heart disease in Africa: a systemic review and meta-analysis

BACKGROUND

Undernutrition is a major public health issue in children with congenital heart disease in Africa. In this continent, the degree of undernutrition also varies from country to country. Therefore, summarizing data concerning undernutrition in children with congenital heart disease is essential to refine treatment guidelines and policies. This meta-analysis aims to deliver pooled data concerning undernutrition among African children with congenital heart disease.

METHODS

In this review, relevant studies were searched via PubMed/MEDLINE online, Science Direct, Hinari, Web of Science, CINHAL, EMBASE, WHO database, Google, and Google Scholar. To conduct this review, PRISMA guidelines were used. STATA 17 was used to estimate the pooled prevalence of undernutrition in children. A random effect meta-analysis model was used to conduct this meta-analysis. The heterogeneity of the studies was evaluated by the I2 test. Publication bias was assessed via funnel plots supplemented with Egger's weighted regression test. Finally, for all analyses, p < 0.05 was considered statistically significant.

RESULT

In this review, a total of 5898 studies were found. Among these, 5878 were excluded using PRISMA, and the remaining 20 studies were included in the final analysis. The prevalence of undernutrition, underweight, wasting, and stunting in children with congenital heart disease was 65.14% (95% CI 51.32-78.95, I2 = 97.4%, p = 0.0001), 45.76% (95% CI 35.83-55.69, I2 = 96.7, p < 0.0001), 39.37% (95% CI 29.55-49.19, I2 = 97.4, p < 0.0001), and 39.38% (95% CI 33.02-45.72, I2 = 92.4%, p < 0.0001), respectively. Anemia (OR = 4.5, 95% CI 1.60-12.68), CHF (OR = 5.98, 95% CI 3.09-11.57), pulmonary hypertension (OR = 2.76, 95% CI 1.89-4.04), and age (OR = 2.78, 95% CI 1.79-4.31) were associated with undernutrition in children with CHD.

CONCLUSION

In this meta-analysis, the pooled prevalence of undernutrition and its indicators in children with CHD were high. As a result, there is still a need to improve early screening and treatment of undernutrition in children with congenital heart disease concomitant with early screening and treatment of congenital heart disease and its common complications in Africa.

Pooled prevalence and subgroup variations of Tetralogy of Fallot among children and adolescents with congenital heart defect in Sub-Saharan Africa: A systematic review and meta-analysis

BACKGROUND

Tetralogy of Fallot is one of the critical congenital heart defects needing intervention within the first year of life.

OBJECTIVE

This review aims to systematically assess the prevalence of Tetralogy of Fallot among children and adolescents with congenital heart defects in Sub-Saharan Africa from January 2000 to January 2024.

METHODS

All original observational studies focused on children and adolescent population diagnosed with congenital heart defects within Sub-Saharan Africa; reported the primary outcome of interest were included. Prisma guidelines were utilized to perform this systematic review and meta-analysis. Electronic databases including Medline (PubMed), Scopus, Google Scholar, and African Index Medicus were searched. A weighted inverse variance random-effects model was employed to estimate the pooled prevalence of Tetralogy of Fallot.

RESULTS

Thirty-one studies included encompassing a total of 11,265 participants from 15 Sub-Saharan African countries with representation from Southern (4 studies, 619 participants), Central (5 studies, 2,220 participants), Eastern (11 studies, 3,384 participants), and Western (11 studies, 5,042 participants). Cross-sectional studies comprised (25 studies, 8,909 participants), and cohort design (6 studies, 2,356 participants). The analysis revealed a pooled prevalence of 10% (95% CI: 9%; 12%) with I2 (77%, p-value < 0.01). The subgroup analysis based on geographic regions revealed statistically significant difference.

CONCLUSIONS AND FUTURE IMPLICATIONS

The prevalence of Tetralogy of Fallot observed was found considerably higher compared to global estimate and reports of developed countries. In a subgroup analysis based on the geographic region, a surprisingly high prevalence was reported across all regions of Sub-Saharan Africa. The substantial disparities and high prevalence observed underscores the complex interplay of factors influencing occurrence of Tetralogy of Fallot. Identifying the true scope of Tetralogy of Fallot burden may help policymakers and healthcare providers to prioritize interventions, optimize resource allocation, and potentially improve its outcomes in Sub-Saharan Africa.

The Prevalence of Associated Congenital Cardiac Anomalies (Shunt-Dependent Lesions) in Children with Transposition of Great Artery

BACKGROUND

Transposition of the great arteries (TGA) is a rare cyanotic heart disease associated with congenital cardiac anomalies; often called shunt-dependent lesions. Transposition of the great arteries is also linked to syndromic correlates.

AIM

This study was to document the prevalence of TGA and various forms of shunt-dependent lesions in children with TGA.

METHODS

This was a descriptive study where one thousand and five echocardiography were carried out in two health institutions over 9 years.

RESULTS

Data were analyzed with IBM statistical software version 20. The prevalence of children with TGA was 1.7%. The majority of the infants, 73.3%, had ASD as shunt-dependent lesion. All the infants, 100.0%, presented with cyanosis, breathlessness, and poor weight gain. Less than one-tenth of the infants, 6.7%, had an intact septum. The highest proportion of the infants, 80.0%, has more than one congenital cardiac anomaly (shunt-dependent lesions). Infants with TGA have lower left ventricular mass (LVM) of 119.1 ± 116.5 compared with control (18.8 ± 12.6). This was statistically significant, Mann-Whitney U test (11.024), P < 0.001. The under-filled left ventricular mass was found in 73.3% of the infants. Infants with TGA co-existing with Teratology of Fallot (TOF) was (1/15) 6.7%; large Ostium secundum atrial septal defect was (OS ASD) (1/15) 6.7% and cases of ventricular septal defect (VSD) with associated ASD were (1/15) 6.7%. All infants had left aortic arch, which is a normal variant. None (0/15) had any surgical intervention as most were lost to follow-up.

CONCLUSION

The prevalence of TGA was low in this setting. There were several shunt-dependent lesions associated with TGA. Atrial septal defect is the commonest. Poor management outcome was due to late presentation.

Echocardiographic Comparison of Left Ventricular Systolic Function and Aortic Blood Flow Velocimetry in Children with Ventricular Septal Defect

BACKGROUND

The assessments of left ventricular (LV) longitudinal systolic dynamics in children with ventricular septal defect (VSD) have achieved a major milestone in the evaluation of LV systolic function.

OBJECTIVES

This study aims to evaluate the LV function, LV mass (LVM), and the descending aorta blood flow in children with VSD compared to that obtained in age and sex-matched controls.

RESULTS

The mean LVM of the control, 113.5 ± 123.9 was higher than that of those who had VSD, 75.8 ± 83.9, and the difference in mean was found to be statistically significant (Mann-Whitney U = 2.322, P = 0.022). The mean EF of the control, 67.9 ± 10.3 was comparable to that of those with VSD, 65.6 ± 13.9, (Student's t = 1.223, P = 0.223). Similarly, the mean descending aorta blood flow of control, 1.6 ± 2.2 was comparable to that of those with VSD, 3.9 ± 16.1, (Mann-Whitney U = 1.002, P = 0.321). There was a very weak positive correlation between LVM and descending aorta blood flow among the subjects (n = 85, r = 0.117, P = 0.425). There was a very weak negative correlation between LVM and descending aorta blood flow among control. (n = 85, r = -0.065, P = 0.609).

CONCLUSION

The LVM among children with VSD is lower than controls but there is no difference between LV function in subjects and controls. There is a linear increase of LVM with descending aorta blood flow.