Insights in Pediatric Cardiology

Prevalence and factors associated with heart failure in children admitted in a tertiary hospital in Northern Tanzania

Background: Heart failure is one of the emergency presentations among children admissions. Despite the high morbidity and mortality resulting from heart failure in children in our country from various causes, but still we have few information regarding on prevalence, etiology and factors associated with heart failure in pediatric population.

Methodology: A hospital based cross sectional study among children aged 0-12 years admitted to pediatric wards of Bugando medical centre from December 2015 to February 2016. Data regarding socio demographic, clinical, and laboratory information were collected by using structure questionnaire. Clinical diagnoses of heart failure were based on the presence of at least the first three signs which were cardinals. The signs include significant tachycardia more than standard per age, tachypnea above standards per specific age, tender hepatomegaly at least 3 cm below right costal margin, cardiomegaly with displaced apex beat above fifth intercostal space. Clinical staging of the heart failure was performed to all children with heart failure. Data analysis was done by using STATA version 13 and were considered statistically significant when the p-value was <0.05

Results: A total of 400 children were enrolled in the study. Median (IQR) age was 12 (4– 36) months. Male consisted of 61% of all participants. Heart failure prevalence was and a total of 29.8% (119/400). The most common etiology was congenital heart defect 51 (42.9%) followed by severe anemia, 42 (35.3%). Factors associated with heart failure includes difficulty breathing (OR 2.7; 95% CI; 1.04–6.98: p=0.041), hepatomegaly (OR 3.5; 95% CI 1.11– 11.3: p=0.036) and severe anemia (OR 5.6; 95% CI 2.56–12.0: p<0.001). Among children with heart failure we identified 7 (5.9%) children with heart failure clinical stage II by modified Ross classification. Children who presented with clinical stage III were 91 (76.5%) and stage IV were 21 (17.6%).

Conclusion: The high prevalence of heart failure among children observed in this study is worryingly high. Thorough clinical assessment and supported by routine echocardiogram screening for early detection of congenital heart defects and other cardiac related causes. Understanding the burden can reduce the magnitude of the problem owing to early diagnosis and prompt intervention.

Author(s): Julieth Kabirigi*, Rogatus Kabyemera, Tulla Masoza, Rwezaula Raphael, Antke Zuechner, Benson Kidenya, Neema Chami, Tumaini Mhada, Neema Kayange, Vicky Maghina, Maimuna Ahmed and Adolfine Hokororo

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