CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 5, May 2013
26
AFRICA
35.75 ± 21.26 years for controls. At univariate level, cases tended
to be more overcrowded than controls; 8.0 ± 23.0 versus 6.0 ± 23.0
persons per house. Controls were better spaced at 25.2 square feet
v. 16.9 for cases. More controls than cases were employed; 45.3%
v. 21.1%. Controls lived closer to health centres than the cases;
4.8 ± 23.8 versus 3.3 ± 212.9 kilometers. At multivariate level, the
odds of rheumatic heart disease was 1.7 times higher for unemploy-
ment status (odds ratio (OR) = 1.7, 95% confidence interval (CI) =
1.05–8.19) and 1.3 times higher for overcrowding (OR = 1.35, 95%
CI = 1.1–1.56). There was interaction between overcrowding and
longer distance from the nearest health centre (OR = 1.20, 95% CI
= 1.05–1.42).
Interpretation:
The major findings of this study were that there was
a trend towards increased risk of rheumatic heart disease in associa-
tion with overcrowding and unemployment. There was interaction
between overcrowding and distance from the nearest health centre,
suggesting that the effect of overcrowding on the risk of acquiring
rheumatic heart disease increases with every kilometer increase from
the nearest health centre.
DEGREE OF IMMUNOSUPPRESSION AND ECHOCARDIO-
GRAPHIC ABNORMALITIES IN HIV-TREATMENT NAÏVE
PATIENTS
Olusegun-Joseph DA*, Ajuluchukwu JNA, Okany CC, Mbakwem
AC, Oke DA, Okubadejo NU
Lagos University Teaching Hospital, Lagos, Nigeria
Introduction:
Cardiovascular abnormalities are common in
HIV-infected patients, although they are often clinically quiescent.
These abnormalities appear to be more frequent and severe with
disease progression. This study sought to evaluate the relationship
between the degree of immunosuppression and echocardiographic
abnormalities in HIV-treatment naïve patients.
Subjects and methods:
One hundred patients with no known tradi-
tional risk factors for cardiac disease were recruited for the study.
Fifty-two patients had CD4 count <200/ul, while 48 had CD4 count
>200/ul. All the participants had clinical and echocardiographic
evaluation for cardiac abnormalities, with measurement of their CD4
count.
Results:
Of the 52 patients with CD4 count <200/ul, 27 (50.94%)
had pericardial effusion compared with 21 (44.68%) in patients with
CD4 >200/ul (
p
=0.532); however, moderate to severe pericardial
effusion was significantly more common in patients with CD4 <200/
ul, compared with those with CD4 >200/ul (15.38% and 2.12%
respectively; (
p
=0.041). Dilated cardiomyopathy was found in 11.5%
of patients with CD4 <200/ul, none in patients with CD4 >200/ul
(
p
=0.032); with a mean CD4 count of 80/ul. Systolic dysfunction
was more frequent in patients with CD4 <200/ul, compared with
those >200/ul (42.30% and 17.03% respectively;
p
=0.006). Diastolic
dysfunction was also more frequent in those with CD4 <200/ul,
although this was not statistically significant (34.64% and 29.78%
respectively;
p
=0.61). Of these, however, 58% with CD4 count <200/
ul had either pseudonormalisation or restrictive diastolic dysfunction,
compared with 42% with CD4 >200/ul; with a mean CD4 of 188/ul.
Interpretation:
Echocardiographic abnormalities were more frequent
and more severe in patients with worse immunosuppression (CD4
<200/ul), compared with those with CD4 >200/ul.
CONGENITAL HEART DISEASE AFTER IN VITRO FERTI-
LISATION: A REPORT OF FOUR CASES
Otaigbe BE*, Orazulike N, Tabansi PN
University of Port Harcourt, Rivers State, Nigeria
Introduction:
In vitro fertilisation (IVF) has been available in devel-
oped countries since the 1980s. In recent times developing countries
such a Nigeria have also acquired the technology and uptake of the
service is on the increase for many infertile couples. Since its advent,
there has been concern regarding the rate of congenital malforma-
tions including congenital heart diseases (CHD) in conceived chil-
dren. Recent studies have indicated a 2- to 4-fold increase in the
rate of CHD in children conceived via IVF compared to the normal
population. Accordingly, as the number of pregnancies achieved
via IVF increases, it becomes imperative to identify the magnitude
of this association. We report four cases of CHD in IVF-conceived
babies presenting over a 6-month period.
Subjects and methods:
A case report of four infants conceived via
IVF who had CHD.
Results:
The four cases presented within 1 month of birth with age
range from 6 to 21 days. There were three term deliveries and one
preterm delivery. Birth weight ranged from 1.9 to 2.9 kg. Maternal
age ranged from 19 to 54 years. Three of the babies had complex
CHD: tetralogy of Fallot (ToF) and atrial septal defect (ASD), atrio-
ventricular canal defect (AVCD) and ventricular septal defect (VSD)/
ASD/patent ductus arteriosus (PDA) while one had a simple ASD.
All were first birth order. Two have undergone surgical correction
and are being followed up.
Interpretation:
Children conceived via IVF tend to present with
complex CHD. It is therefore important that IVF-conceived babies
have a complete cardiac evaluation for early intervention.
GERBODE DEFECTAND VENTRICULAR SEPTAL DEFECT
IN A 4-MONTH-OLD NIGERIAN: A CASE REPORT
Otaigbe BE*, Tabansi PN, Orubide D
University of Port Harcourt, Rivers State, Nigeria
Introduction:
A Gerbode defect is a rare congenital anomaly in
which there is a communication between the left ventricle and the
right atrium, either indirectly from a left-ventricular-to-right-atrial
shunt through the tricuspid valve or a true or direct left-ventricular-
to-right-atrial shunt. Rarer still is the occurrence of a Gerbode defect
with a ventricular septal defect (VSD). This has been reported only
once in the literature.
Subjects and methods:
A case report of a 4-month-old Nigerian
child with Gerbode defect and a VSD.
Results:
A 4-month-old female with complaints of poor feeding and
poor weight gain, weighing 4.5 kg (<3rd percentile) at presentation
and 2.8 kg at birth. There was no history of fast breathing, cough,
cyanosis or excessive sweating. Examination findings revealed
respiratory distress, tachypnoea, tachycardia and a left precordial
bulge. Apex beat was not displaced but she had a grade 3/6 ejec-
tion systolic murmur. Chest radiograph showed mild cardiomegaly
and pulmonary plethora. Electrocardiography showed extreme right
axis deviation and left ventricular hypertrophy. Echocardiography
revealed a dilated left atrium and a hypertrophied left ventricle with
a 6 mm defect above the tricuspid valve causing blood to shunt
from the left ventricle directly to the right atrium at a mean velocity
of 50.5 cm/s, and a 7 mm perimembranous VSD, both confirmed by
colour Doppler. A diagnosis of direct Gerbode defect and perimem-
branous VSD was made, and the patient is currently awaiting open
heart surgery which is unavailable in the country.
Interpretation:
The rare occurrence of a Gerbode defect and VSD
is highlighted. A high index of suspicion and expert echodiagnosis
is necessary for its detection. The need for a comprehensive cardiac
centre in Nigeria is imperative for prompt intervention.
CONSORTIUM FOR NCD PREVENTION AND CONTROL
IN SUB-SAHARAN AFRICA (CNCD-AFRICA): CONCEPT,
EXPERIENCE AND LESSONS
Owuor JO*, Amuyunzu-Nyamongo M
CNCD-Africa, Nairobi, Kenya 
Introduction:
CNCD-Africa was established in July 2009 as a result
of recognition that the prevalence and burden of non-communicable
disease (NCD)-related illness and injury was increasing among
low- and middle-income countries. The collective mandates of the
Secretariat, Steering Committee and Expert Group were aimed at
1...,18,19,20,21,22,23,24,25,26,27 29,30,31,32,33,34,35,36,37,38,...40