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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 6, November/December 2014
AFRICA
265
Congenital heart disease in the Niger Delta region of
Nigeria: a four-year prospective echocardiographic
analysis
BE Otaigbe, PN Tabansi
Abstract
Introduction:
Echocardiographic evaluation remains the gold
standard for the diagnosis of structural cardiac disease. No
previous prospective studies have been done on the preva-
lence of congenital heart disease (CHD) in the Niger Delta
area. This study was done to determine the frequency and
pattern of congenital heart disease, using echocardiography
as a diagnostic tool.
Methods:
All patients presenting to the Paediatric Cardiology
clinics of two centres, the University of Port Harcourt
Teaching Hospital and the Paediatric Care Hospital between
April 2009 and March 2013, were recruited and all had echo-
cardiography performed.
Results:
Prevalence of CHD in this study was 14.4 per 1 000
children; 277 (83.4%) of the patients had acyanotic CHD
and 55 (16.6%) had cyanotic CHD. Ventricular septal defect
and tetralogy of Fallot were the commonest acyanotic and
cyanotic heart defects, respectively.
Conclusion:
The high prevalence of CHD in this study is the
highest in the country and Africa, and may be attributable
to the increased oil spillage and gas flaring from petroleum
exploitation in this region.
Keywords:
congenital heart disease, high prevalence, Niger Delta,
oil spillage
Submitted 22/10/13, accepted 18/9/14
Published online 10/11/14
Cardiovasc J Afr
2014; 25: 265–268
www.cvja.co.zaDOI: 10.5830/CVJA-2014-055
Congenital heart disease (CHD) affects approximately eight
per 1 000 live births in the general population, making it one
of the most common classes of birth defect.
1
CHD is defined as
an abnormality in the cardio-circulatory structure or function,
which is present at birth, even if it is discovered later.
2
More children die from CHD each year than are diagnosed
with cancer.
3
A large number of these children are in the
developing countries. They are often repeatedly admitted and
treated for recurrent chest infections and failure to thrive due
to ignorance of the attending health caregiver, poor diagnostic
tools, poor referral systems, and lack of skilled personnel. These
lead to late diagnosis and increased mortality rates.
CHD can be life threatening in early childhood, and children
born with severe forms are at approximately 12 times higher risk
of mortality in the first year of life, especially if they are missed
in the neonatal period.
4
About two to three in 1 000 newborns
with heart disease will be symptomatic in the first year of life,
diagnosis is established by one week in 40–50%, and by one
month of age in 50–60% of patients.
5
The incidence of CHD in Nigeria 30 years ago was 3.5 per
1 000 population.
6
This has increased in recent studies to 4.6/
1 000 in the southern,
7
and 9.3/1 000 in the northern
8
parts of
Nigeria, apparently due to increased diagnostic facilities and
more trained paediatric cardiologists in the country.
Echocardiographic evaluation remains the gold standard
for the diagnosis of structural cardiac disease.
7
Paediatric
echocardiography has not been widely available in Nigeria as
there are few paediatric cardiologists and most of the available
echocardiography machines have no paediatric probes. Prior
to the procurement of an echocardiography machine with
paediatric probes in the reporting echocardiographic centre,
history, clinical diagnosis and chest radiography were used as
tools for provisional diagnosis of CHD.
9
There has been no previous report on the incidence of
CHD in the Niger Delta region of Nigeria. Previous studies on
CHD from Nigeria have been retrospective studies and none
from the Niger Delta region of Nigeria, where there have been
claims of increasing risks to maternal and child health due to
environmental degradation and industrial pollution secondary
to petroleum mining and gas flaring in this region. This study
was done to determine the frequency and pattern of CHD, using
echocardiography as a diagnostic tool.
Methods
This was a prospective study of all patients presenting to the
paediatric cardiology clinics of two centres, the University
of Port Harcourt Teaching Hospital and the Paediatric Care
Hospital, having been referred to the clinics or seen in the wards
between April 2009 and March 2013. All the patients enrolled
were fully examined by at least one of the two paediatric
cardiologists and further evaluated with chest radiographs,
electrocardiograms (ECG) and an echocardiogram (echo).
The chest radiographs were read separately by the cardiologist
and radiologists and conflicting reports were discussed. The
ECG was performed by a technician using a Schiller AT-1
Smart Print machine, standardised at a paper speed of 25
mm/s. Echo diagnosis of all patients was done using Sonosite
Micromaxx and Sonosite Edge machines, available only at the
Paediatric Care Hospital. Each patient was recruited with a
proforma, which contained records of name, age, gender, weight,
indication for echocardiography, chest X-ray and ECG findings,
Department of Paediatrics, University of Port Harcourt
Teaching Hospital, Port Harcourt Rivers State, Nigeria
BE Otaigbe, FWACP (Paed), BM BCh,
barbiejoe64@yahoo.comPN Tabansi, BM BCh, FWACP (Paed)