Drivers of Optimal Care for Congenital Heart Disease in Paediatric Patients at Kenyatta National Hospital

Abstract

Background: Congenital heart disease (CHD) is a significant cause of mortality and morbidity; ‘Evidence based practice’ (EBP) protocols improve outcome. Optimal care (OC) occurs when patients receive care as recommended by EBP protocols. In a study conducted 16 years ago, no patient received OC in Kenya. Risk factors for failure to receive OC were not examined in that study and it is not known what proportion of patients currently receive OC. Objectives: To determine the prevalence of OC and risk factors associated with failure to receive OC among paediatric in-patients with CHD at Kenyatta National Hospital (KNH). Methods: Patients less than 12 years old with CHD, admitted to the general paediatric wards at Kenya National Hospital (KNH), Nairobi, were prospectively recruited over a one-year period. Baseline data were obtained at recruitment and additional data collected through a telephone call one-year post-recruitment. Data collected included: age when CHD was first suspected/confirmed; age at intervention; attendance of follow-up visits; level of parental/guardian income/education and travel impedance. These data were compared with EBP recommendations and multivariable logistic regression was used to assess risk factors for failure to receive OC. Results: Forty-nine patients were recruited; 47 were reached via mobile phone at 1-year post-recruitment. Zero out of 47 (0%) patients received OC. The odds ratios for late diagnosis were 0.6 (0.4955, 0.8665; p-value of 0.0030) and 1.0188 (0.9967, 1.0415; p-value of 0.0965) for higher level of education and higher level of income respectively.

Conclusion: No patient received OC. A lower level of parent/guardian education is a risk factor for failure to receive OC