CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 4, May 2013
AFRICA
117
Pattern of congestive heart failure in a Kenyan paediatric
population
JULIUS A OGENG’O, PATRICK M GATONGA, BEDA O OLABU, DIANA K NYAMWEYA, DENNIS ONG’ERA
Abstract
Background:
Heart failure in children is a common cause of
morbidity and mortality, with high socio-economic burden.
Its pattern varies between countries but reports from Africa
are few. The data are important to inform management and
prevention strategies.
Objective:
To describe the pattern of congestive heart failure
in a Kenyan paediatric population.
Methods:
This was a retrospective study done at Kenyatta
National Hospital, Nairobi Kenya. Records of patients aged
12 years and younger admitted with a diagnosis of heart
failure between January 2006 and December 2010 were
examined for mode of diagnosis, age, gender, cause, treat-
ment and outcome. Data were analysed using the Statistical
Programme for Social Scientists version 16.0 for windows,
and presented in tables, bar and pie charts.
Results:
One hundred and fifty-eight cases (91 male, 67
female) patients’ records were analysed. The mean age was
4.7 years, with a peak at 1–3 years. The male:female ratio
was 1.4:1. All the cases were in New York Heart Association
(NYHA) class II–IV. Evaluation of infants was based on the
classification proposed by Ross
et
al
. (1992). Diagnosis was
made based on symptoms and signs combined with echo-
cardiography (echo) and electrocardiography (ECG) (38%);
echo alone (12.7%); ECG, echo and chest X-ray (CXR)
(11.4%); and ECG alone (10.8%). The underlying cause
was established on the basis of symptoms, signs, blood tests,
CXR, echo and ECG results. Common causes were infection
(22.8%), anaemia (17.1%), rheumatic heart disease (14.6%),
congenital heart disease (13.3%), cardiomyopathy (7.6%),
tuberculosis and human immunodeficiency virus (6.9%
each); 77.9% of patients recovered, 13.9% after successful
surgery, and 7.6% died.
Conclusion:
Congestive heart failure is not uncommon in the
Kenyan paediatric population. It occurs mainly before five
years of age, and affects boys more than girls. The majority
are due to infection, anaemia, and rheumatic and congenital
heart diseases. This differs from those in developed coun-
tries, where congenital heart disease and cardiomyopathy
predominate. The majority of children usually recover.
Prudent control of infection and correction of anaemia are
recommended.
Keywords:
heart failure, infections, paediatric, Kenya
Submitted 27/6/11, accepted 18/3/13
Cardiovasc
J Afr
2013;
24
: 117–120
DOI: 10.5830/CVJA-2013-015
Congestive heart failure in a paediatric population is a common
cause of morbidity and mortality and is a serious public health
concern, with tremendous socio-economic impact.
1,2
Its pattern
varies between and within countries.
3-5
In sub-Saharan Africa,
studies mainly from Nigeria reveal that it accounts for 5.8–9.0%
of emergency admissions to paediatric units.
2,4,5
These causes
vary between developed and developing countries, age and
geographical location.
6,7
These data are important in diagnosis,
treatment, prognosis, control and prevention. Reports from
eastern Africa are, however, scarce and altogether absent for
Kenya. This study therefore investigated the pattern of congestive
heart failure in a black Kenyan paediatric population.
Methods
This was a retrospective study at Kenyatta National Hospital
(KNH), Nairobi, Kenya, which is a 1 800-bed capacity teaching
and eastern African regional referral centre. It receives about 30
000 paediatric in-patients a year, mainly from black Kenyans
of middle to lower socio-economic class. This hospital has
four paediatric cardiologists and 40 paediatric cardiology beds.
Ethical approval for the study was granted by KNH/University of
Nairobi Ethics and Research committee.
Records of patients aged 12 years and younger who were
admitted to the hospital with heart failure according to New
York Heart Association (NYHA) classification II–IV between
January 2006 and December 2010 were retrieved from the
hospital registry. In infants, diagnosis and classification was
based on criteria proposed by Ross
et
al
. (1992).
8
Patients were
divided into male and female gender. Each gender category was
subsequently divided into infants (one year and below), and four
age groups of three years each, starting at one year.
Subsequently, the records were examined for cause and
sub-cause of heart failure based on clinical, echo, ECG, CXR
and laboratory findings. The causes were divided into six
categories, namely congenital heart disease (CHD), rheumatic
heart disease (RHD), anaemia, infections, cardiomyopathy, and
other. In the categories where there were more than 25 patients,
they were further subdivided according to specific cause. Those
cases in whom some data on the parameters above were missing
were excluded from the study.
Data obtained were analysed using Statistical Programme
for Social Scientists (SPSS) version 16.0 for windows, and
presented in tables, bar and pie charts.
Results
One hundred and sixty-five cases were retrieved. Seven were
excluded from the study: four in whom age, and three in whom
Department of Human Anatomy, University of Nairobi,
Nairobi, Kenya
JULIUS A OGENG’O, BSc, MB ChB, PhD
PATRICK M GATONGA, BSc
BEDA O OLABU, BSc, MB ChB,
DIANA K NYAMWEYA, MB ChB
DENNIS ONG’ERA, BSc, MB ChB
