Cardiovascular Journal of Africa: Vol 32 No 1 (JANUARY/FEBRUARY 2021)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 1, January/February 2021 AFRICA 21
Study of congenital heart defects among neonates in
Jos, Nigeria: prevalence and spectrum
Olukemi O Ige, Tolulope O Afolanranmi, Christopher S Yilgwan, Fanen Ayatse, Esin Nkereuwem, Atiene
S Sagay, Phyllis Kanki, Fidelia Bode-Thomas
Abstract
Background: There are few reports of the prevalence of CHD
in the neonatal period in sub-Saharan Africa. The only avail-
able study in Nigeria was carried out before the widespread
availability of echocardiography in the country. We sought to
determine the prevalence and spectrum of congenital heart
defects (CHD) among neonates in Jos, Nigeria.
Methods: This cross-sectional study enrolled neonates less
than one week of age from the two largest hospitals and their
immunisation centres. Relevant information was obtained
and an echocardiogram was performed on each neonate.
Results: There were 3 857 neonates recruited over a two-year
period; male-to-female ratio was 1.1:1. A total of 111 babies
had CHD, with a prevalence of 28.8 per 1 000. Sixty-four
neonates had mild CHD, with a prevalence of 16.6 per 1 000,
while moderate and severe CHD were found in 27 (7.0 per
1 000) and 20 (5.2 per 1 000), respectively.
Conclusion: CHD is prevalent in Nigerian neonates and there
is therefore a need for advocacy to improve access to its diag-
nosis at birth for appropriate management.
Keywords: congenital heart defects, neonates, prevalence, echo-
cardiography, Nigeria
Submitted 10/1/20, accepted 30/9/20
Published online 16/2/21
Cardiovasc J Afr 2021; 32: 21–27
DOI: 10.5830/CVJA-2020-044
Congenital heart defects (CHD) are common birth lesions,
defined as gross structural abnormalities of the heart or
intrathoracic great vessels that are of actual or potential
functional significance.1 One-third of deaths from birth defects
are due to CHD, with 48% of these occurring in the first year of
life. CHD therefore contribute significantly to infant mortality.2-4
The epidemiology of CHD is best studied using birth
prevalence and this has shown an increasing trend from 4.5 per
1 000 live births in the 1970s to 9.4 per 1 000 live births in the
21st century.5 Epidemiological studies have also been conducted
in children after the neonatal period and a higher prevalence of
CHD is reported in younger children.6 Since up to 25% of deaths
from CHD occur within the first month of life,7 it is critical to
detect these defects as early as possible, not only to facilitate
early intervention but also for a more accurate estimation of
the disease burden where birth prevalence data are not available.
The majority of reports on CHD in Nigerian children have
been on those being followed up in paediatric cardiology clinics
or referred for echocardiography.8,9 This limits the estimation of
the current prevalence of CHD in the country, where the only
study on the birth prevalence of CHD was reported over 50
years ago and before the era of echocardiography.10 We therefore
set out to determine the prevalence and spectrum of CHD in
neonates in Jos, Nigeria, so as to provide more accurate estimates
of the burden of CHD in the country. This will provide a better
platform for advocacy on the need to improve access to cardiac
interventions for children with CHD in the country.
Methods
The study was conducted in two tertiary heath institutions: the
Jos University Teaching Hospital (JUTH) and the Plateau State
Specialist Hospital (PSSH) in Jos, north-central Nigeria. They
are the two largest hospitals in the city, which has a population
of about 816 000 people.11 The two hospitals together handle an
average of 30 to 40 deliveries weekly.
Neonates are usually discharged 24 hours after uncomplicated
vaginal delivery unless they are sick and admitted for in-patient
care. Sick neonates born elsewhere may also be admitted for
in-patient care in these hospitals, both of which have functional
immunisation units that are equally accessible to neonates born
elsewhere. The delivery, postnatal and immunisation units of the
two hospitals served as recruitment points for the neonates in
this study.
Department of Pediatrics, University of Jos, Jos, Nigeria
Olukemi O Ige, MBBS, FWACP,
Christopher S Yilgwan, MB BS, FWACP,
Fidelia Bode-Thomas, MB BS, FWACP, MPH
Department of Pediatrics, Jos University Teaching
Hospital, Jos, Nigeria
Olukemi O Ige, MB BS, FWACP
Christopher S Yilgwan, MB BS, FWACP
Fanen Ayatse, MB BS
Fidelia Bode-Thomas, MB BS, FWACP, MPH
Department of Community Medicine, University of Jos,
Jos, Nigeria
Tolulope O Afolanranmi, MB BS, FWACP
Medical Research Council Unit, The Gambia at London
School of Hygiene and Tropical Medicine, London, UK
Esin Nkereuwem, MB BS, FWACP, MPH
Department of Obstetrics and Gynecology, University of
Jos and Jos University Teaching Hospital, Jos, Nigeria
Atiene S Sagay, MB BS, FWACS, FRCOG
Department of Immunology and Infectious Diseases,
Harvard TH Chan School of Public Health, Boston, MA, USA
Phyllis Kanki, DVM ScD