Open Access

ARTICLE

Pattern of inpatient pediatric cardiology consultations in sub-Saharan Africa

Kriti Puri¹, Peter Kazembe², Treasure Mkaliainga³, Msandeni Chiume³, Antonio G. Cabrera¹, Amy Sims Sanyahumbi¹

1 Lillie Frank Abercrombie Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas, USA
2 Baylor College of Medicine, Children’s Foundation Malawi, Lilongwe, Malawi
3 Department of Pediatrics, Kamuzu Central Hospital, Lilongwe, Malawi

* Corresponding Author: Kriti Puri, Pediatric Cardiology Fellow, Baylor College of Medicine, Section of Pediatric Cardiology, Texas Children’s Hospital, 6621 Fannin St, MC 19345C, Houston, TX 77030. Email:

Congenital Heart Disease 2018, 13(2), 334-341. https://doi.org/10.1111/chd.12573

Abstract

Malawi is one of the poorest nations in the world, ranked 151st among 195 countries by the World Bank, with an under-5-year mortality rate of 63 per 1000 live births. There are no previous studies describing the spectrum of inpatient pediatric cardiology consultations in sub-Saharan Africa. A descriptive cohort study was performed at Kamuzu Central Hospital (KCH), a tertiary care hospital in Lilongwe, Malawi. Demographic, anthropometric, and clinical information for all cardiology consults patients aged 0–18 years admitted to the children’s wards over a period of 1 month was reviewed. Seventy-three consults and 69 echocardiograms were performed on 71 patients (35 males, 38 females). The median (IQR) age was 3.1 years (9 months–10.5 years). About 53% (39/73) had failure to thrive, 4.1% (3/73) were sero-reactive for HIV and 100% (73/73) were fully immunized for age per the Expanded Program on Immunization schedule. Seventy-four percent of the echocardiograms were abnormal, with 34.8% (24/69) having congenital heart disease (CHD) and 18.8% (13/69) having acquired heart disease (AHD) with preserved cardiac function. Among CHD, 10.1% (7/69) had cyanotic CHD and 24.6% (17/769 had acyanotic CHD. Among AHD, 10.1% (7/69) had rheumatic heart disease with preserved cardiac function. Symptomatic systolic heart failure (HF) with ejection fraction <50%, was found in 20.3% (14/69), and pulmonary hypertension was diagnosed in 10.1% (7/69). Overall admission mortality was 5.5% (4/73). Three patients left the hospital against medical advice. None of the patients with systolic HF had CHD. There was no significant association of HIV, gender, or failure to thrive on presence of systolic HF. This is the first report describing the spectrum of pediatric cardiology consults in an inpatient setting in Malawi. There was an unexpectedly high proportion of CHD and systolic HF. Further studies should be conducted to explore the implications and potential causes of these findings.

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