Management pathway for congenital heart disease at Kenyatta National Hospital, Nairobi

Abstract

BACKGROUND:

Congenital heart disease (CHD) is a significant cause of death amongst infants. The timing of treatment in relation to the natural history of the disease correlates with the treatment outcome.

OBJECTIVES:

To determine the age at first suspicion of CHD, the age at confirmation of the diagnosis of CHD and the percentage follow-up at the first post diagnosis out patient clinic and to determine the influence of patient's sex, parental income and parental education have on the MP.

DESIGN:

A five year retrospective study.

SETTING:

Kenyatta National Hospital between January 1st 2000 and December 31st 2004.

SUBJECTS:

Two hundred and fourteen patients were studied.

RESULTS:

The overall mean age at referral to a paediatric cardiologist was 16.9 +/- 24.4 months [n = 102]. The mean age at which CHD was confirmed by echocardiography was 18.6 +/- 25.6 months [n = 202]. The mean age at which CHD was first suspected in patients from the province with the highest parental income was 9.5 +/- 5.1 months [n = 6]. The mean age at which CHD was first suspected in patients from a province with a significantly lower parent income was 19.1 +/- 23.2 months [n = 22], (p = 0. 046). The mean age at which CHD was confirmed in referred male patients was 16.0 +/- 17.6 months [n=48] and the mean age at which CHD was confirmed in referred female patients was 18.8 +/- 21.7 months [n = 52] (p = 0.25).

CONCLUSION:

The mean age at referral to a paediatric cardiologist was 16.9 months. This suggests that a significant number of patients may miss the opportunity to have optimal surgical intervention. Parental income appears to influence the MP, however, the level of parental education and patient sex did not.