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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 31, No 5, September/October 2020
AFRICA
257
Clinical spectrum and prevalence of congenital heart
disease in children in Botswana
Tiny Mazhani, Andrew P Steenhoff, Endale Tefera, Thuso David, Zaakir Patel, Warona Sethomo, Marek
Smieja, Loeto Mazhani
Abstract
Background:
Reliable data on congenital heart disease (CHD)
from diverse settings is important both for planning health
systems in each country and to elucidate possible aetiologies
of CHD in different settings. There is a lack of data on the
clinical spectrum and prevalence of CHD in Botswana. The
aim of this study was to describe the clinical spectrum and
prevalence of CHD in Botswana.
Methods:
This was a retrospective, descriptive, cross-sectional
study of all children from birth to 15 years who had had
an echocardiogram performed as an in- or out-patient at
Princess Marina Hospital (PMH) between 1 January 2010
and 31 December 2012.
Results:
Of 377 enrollees, 140 (40%) had normal echocardio-
graphs, 170 (45%) had CHD, and 57 (15%) had an acquired
lesion. In the CHD patients, median age was 0.9 years (Q1:
0.2, Q3: 4.1) and 85 (50%) were male. Ventricular septal
defect (VSD) (29%), patent ductus arteriosus (18%), atrio-
ventricular septal defect (AVSD) (10%) and tetralogy of
Fallot (TOF) (6%) were the predominant pathologies. VSD
was the most common acyanotic lesion and TOF the most
common cyanotic lesion. The estimated prevalence of CHD
was between 2.8 and 4.95 per 1 000 live births.
Conclusions:
The clinical spectrum of CHD in Botswana is
similar to that observed in other African countries and in the
Western world, with VSD the most common acyanotic lesion
and TOF the most common cyanotic lesion. The prevalence
of CHD was 2.8–4.95 per 1 000 live births, in keeping with
other settings. This is the first study to describe CHD in
Botswana, and it aimed to stimulate subsequent studies in
this field.
Keywords:
paediatric, cardiology, acquired heart disease, Africa
Submitted 5/5/19, accepted 1/6/20
Published online 22/6/20
Cardiovasc J Afr
2020;
31
: 257–261
www.cvja.co.zaDOI: 10.5830/CVJA-2020-021
Congenital heart disease (CHD) is defined as a gross structural
abnormality of the heart or intrathoracic great vessels.
1
Although
this abnormality is present at birth, it may initially be clinically
silent and present with symptoms only later in life.
2
The
prevalence and pattern of CHD varies within and between
countries.
3
Reported estimates vary widely and there may be
differences between low-, middle- and high-income countries.
Reliable data on CHD from diverse settings are important for
both planning health systems in each country and to elucidate
possible aetiologies of CHD in different settings.
4
In Botswana, as is the case in many low- and middle-income
countries (LMIC), the clinical spectrum and prevalence of CHD
is unknown as there are no published data on the epidemiology
of CHD. The majority of Botswana’s population receives clinical
care from the government-funded public health system. As in
many LMICs, Botswana’s public health system faces challenges
both in diagnosing and managing CHD. However, there is
some in-country expertise, including echocardiography, to both
diagnose and medically manage CHD. Additionally, for those
patients with a correctable lesion, Botswana’s middle-income
status enables Batswana citizens to be referred to other countries
for cardiac intervention and surgery. In this article we seek to
begin to address the paucity of data on CHD in Botswana. Our
objective was to describe the clinical spectrum and prevalence of
CHD in Botswana.
Methods
This was a retrospective, descriptive, cross-sectional study of
all children who had had an echocardiogram performed as an
in- or out-patient at Princess Marina Hospital (PMH). The
study period was from 1 January 2010 to 31 December 2012.
The project was reviewed and approved by ethics boards at
the Botswana Ministry of Health, PMH and the University of
Botswana.
PMH is a 525-bed tertiary hospital located in Gaborone,
Botswana’s capital city. PMH is the main tertiary referral centre
for district hospitals and clinics located in southern Botswana.
For paediatric cardiology during the study period, the PMH
paediatric cardiac clinic was the only referral centre for the
entire country. The paediatric cardiac clinic saw out-patients
three times a week and did in-patient consultations daily. It was
Department of Paediatric and Adolescent Health, Faculty
of Medicine, University of Botswana, Gaborone, Botswana
Tiny Mazhani, MMed, MD,
tinym106@yahoo.comAndrew P Steenhoff, MD
Endale Tefera, MD
Thuso David, MD
Zaakir Patel, MD
Warona Sethomo, MD
Loeto Mazhani, MD
Children’s Hospital of Philadelphia and University of
Pennsylvania, Philadelphia, USA
Andrew P Steenhoff, MD
Department of Paediatrics, Princess Marina Hospital,
Gaborone, Botswana
Loeto Mazhani, MD
McMaster University, Hamilton, Ontario, Canada
Marek Smieja, MD, PhD