41 / 64
CARDIOVASCULAR JOURNAL OF AFRICA • Volume 31, No 5, September/October 2020
AFRICA
261
group was 4.95 per 1 000 live births, which is comparable to
studies done in the Western world, with an incidence of CHD
between three and 12 per 1 000 live births.
10
This study had some limitations. The spectrum of CHD
described is of symptomatic children presenting to a national
referral centre paediatric cardiology clinic. Hence patients
with asymptomatic or milder lesions such as ASDs are likely
under-represented. VSD type was documented in 46% of
our patients, likely because many patients had their initial
echocardiograph prior to the study period, and subsequent
follow-up echocardiographs were less detailed. The mean age
of patients with a VSD was 3.3 years; this was the age when the
echocardiograph was performed and not necessarily the age of
presentation. From our study, we were unable to determine the
number of VSDs that closed spontaneously. Similarly, future
studies should also document type and size of ASD and AVSD.
Our approach to estimating the national prevalence of CHD
has both advantages and disadvantages. The advantage is that
PMHwastheonlycentreperformingechocardiographsinchildren
in the country during the study period. The disadvantages are
mainly due to the possible referral bias. Patients from peripheral
parts of the country may never have arrived at the PMH cardiac
centre. Additionally, patients who had asymptomatic or small
ASDs, VSDs that closed spontaneously or silent PDAs, or those
who died before coming to medical attention would have been
missed. This figure would therefore be an underestimation.
Additionally the inadvertent inclusion of non-citizens with CHD
who reside in but were born outside Botswana may lead to an
overestimation of CHD. Future studies are required to give us a
more accurate reflection of the prevalence of CHD in Botswana.
Conclusions
The clinical spectrum of CHD 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 in Botswana 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. Findings will also assist national
policies in prioritising non-communicable diseases such as CHD.
References
1.
Mitchell S, Korones S, Berendes H. Congenital heart disease in 56,109
births incidence and natural history.
Circulation
1971;
43
(3): 323–332.
2.
Brickner ME, Hillis LD, Lange RA. Congenital heart disease in adults.
N Engl J Med
2000;
342
(4): 256–263.
3.
Tchoumi JT, Butera G, Giamberti A, Ambassa J, Sadeu J. Occurrence
and pattern of congenital heart diseases in a rural area of sub-Saharan
Africa: cardiovascular topics.
Cardiovasc J Afr
2011;
22
(2): 63–66.
4.
Van der Linde D, Konings EE, Slager MA, Witsenburg M, Helbing
WA, Takkenberg JJ,
et al
. Birth prevalence of congenital heart disease
worldwide: a systematic review and meta-analysis.
J Am Coll Cardiol
2011;
58
(21): 2241–2247.
5.
Sani MU, Mukhtar-Yola M, Karaye KM. Spectrum of congenital heart
disease in a tropical environment: an echocardiography study.
J Nat Med
Assoc
2007;
99
(6): 665.
6.
Bassili A, Mokhtar SA, Dabous NI, Zaher SR, Mokhtar MM, Zaki A.
Congenital heart disease among school children in Alexandria, Egypt:
an overview on prevalence and relative frequencies.
J Trop Pediatr
2000;
46
(6): 357–362.
7.
Bannerman C, Mahalu W. Congenital heart disease in Zimbabwean
children.
Ann Trop Paediatr
1998;
18
(1): 5.
8.
El Hag A. Pattern of congenital heart disease in Sudanese children.
East
Afr Med J
1994;
71
(9): 580–586.
9.
Ould ZH, Ould LD, Ould JM, Ould KI, Bourlon F, Mechmeche R.
[Consultation of congenital heart diseases in pediatric cardiology in
Mauritania].
La Tunisie Medicale
2006;
84
(8): 477–479.
10. Hoffman J. Incidence of congenital heart disease: I. Postnatal incidence.
Pediatr Cardiol
1995;
16
(3): 103–113.
11. Park MK.
Pediatric Cardiology for Practitioners
. Elsevier Health
Sciences, 2007.
12. Tchoumi JT, Ambassa J, Chelo D, Djimegne FK, Giamberti A, Cirri
S,
et al.
Pattern and clinical aspects of congenital heart diseases and
their management in Cameroon.
Bull Société Pathologie Exotique
2011;
104
(1): 25–28.
13. Damasceno A, Mayosi BM, Sani M, Ogah OS, Mondo C, Ojji D,
et
al.
The causes, treatment, and outcome of acute heart failure in 1006
Africans from 9 countries: results of the sub-Saharan Africa Survey of
Heart Failure.
Arch Int Med
2012;
172
(18): 1386–1394.
14. Cilliers AM. Rheumatic fever and rheumatic heart disease in Gauteng on
the decline: experience at Chris Hani Baragwanath Academic Hospital,
Johannesburg, South Africa.
S Afr Med J
2014;
104
(9): 632–634.
15. Otaigbe B, Tabansi P. Congenital heart disease in the Niger Delta region
of Nigeria: a four-year prospective echocardiographic analysis: cardio-
vascular topic.
Cardiovasc J Afr
2014;
25
(6): 265–268.
16. Zühlke L, Mirabel M, Marijon E. Congenital heart disease and rheu-
matic heart disease in Africa: recent advances and current priorities.
Heart
2013;
99
(21): 1554–1561.
17. Kennedy N, Miller P. The spectrum of paediatric cardiac disease
presenting to an outpatient clinic in Malawi.
BMC Res Notes
2013;
6
(1): 53.
18. Sawant SP, Amin AS, Bhat M. Prevalence, pattern and outcome of
congenital heart disease in Bhabha Atomic Research Centre Hospital,
Mumbai.
Indian J Pediatr
2013;
80
(4): 286–291.