Cardiovascular Journal of Africa: Vol 32 No 5 (SEPTEMBER/OCTOBER 2021)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 5, September/October 2021 AFRICA 267 Birth prevalence of congenital heart disease among newborns in a tertiary hospital in Benin City, Nigeria Wilson E Sadoh, Ikechukwu Okonkwo, Chukwunwendu A Okonkwo, Fidelis E Eki-udoko, Ezinne Emeruwa, Promise Monday, Gold I Osueni, Jonathan Amake, Emmanuel Eyo-Ita, Barbara E Otaigbe, Gregrey A Oko-oboh Abstract Background: Congenital heart disease (CHD) is an impor- tant cause of childhood morbidity. The birth prevalence and distribution of CHD among neonates in a tertiary hospital in Nigeria was determined. Methods: This descriptive, cross-sectional study involved consecutive neonates in the neonatal and postnatal wards of the hospital. Bedside echocardiography was conducted on all neonates. Data entry and analysis was done with IBM-SPSS version 20.0. Results: A total of 2 849 neonates were recruited, consisting of 1 482 (52.0%) males. Forty-one neonates had CHD, giving a birth prevalence of 14.4/1 000 live births. Of the 41 with CHD, 21 (51.2%) were male. Thirty-six (87.8%) neonates had acyanotic CHD, of which the commonest was isolated ventricular septal defect [11 (26.8%)]. Transposition of the great arteries [3 (7.3%)] was the commonest cyanotic CHD. Conclusion: The birth prevalence of 14.4/1 000 live births in this study is high and buttresses the need for strengthening existing cardiac services in Nigeria. Keywords: congenital heart disease, neonates, echocardiography Submitted 25/9/20, accepted 2/6/21 Published online 5/8/21 Cardiovasc J Afr 2021; 32 : 267–270 www.cvja.co.za DOI: 10.5830/CVJA-2021-028 Congenital heart diseases (CHDs) are structural abnormalities of the heart and or intrathoracic vessels and are the most common and important congenital anomalies. 1 The global incidence of CHD is reported to range from 4.5 to 9.7/1 000 live births. 2,3 Birth prevalence is different from region to region. It is reported to be highest among Asians and lowest in Africans. 2,3 Most Nigerian studies on CHD are hospital-based audits of echocardiography laboratory findings. 4-7 The study on birth prevalence of CHD by Gupta and Antia 4 in 1967 found an incidence of 3.5/1 000 live births, but this study was limited by the use of only clinical screening of the newborn for the detection of CHD. There was no echocardiographic confirmation. This method would have missed out some of the minor and asymptomatic CHDs, thus giving a lower-than- expected birth prevalence value. Furthermore, this study was done over four decades ago and may not represent the current prevalence and distribution of CHDs in Nigeria. The birth prevalence of CHD is influenced by the method of recruitment. Higher figures are obtained with echocardiographic screening of children, as it picks up nearly all cases of CHD. 2 The availability of portable and mobile echocardiography machines that can be deployed by the bedside of the child makes echocardiographic screening achievable and accurate. The use of echocardiographic screening for disease conditions is known to produce a more accurate prevalence of diseases. An example is the echocardiographic screening for rheumatic heart disease compared to the use of clinical screening where a four- to 10-fold increase in prevalence was observed with echocardiographic screening over the clinical method. 8 Newborn screening captures the population of newborns with CHD, which may manifest only after discharge from hospital, and those who might die from the condition having escaped detection. This is particularly important because as many as 62% of deliveries in Nigeria occur outside healthcare facilities and are therefore unattended by skilled personnel. 9 There is a paucity of studies on the birth prevalence of CHD in Nigeria, especially that determined by echocardiographic screening. Knowledge of the current birth prevalence will assist health planners to formulate appropriate policies to address the disease. This study was therefore conducted to determine the birth prevalence of CHDs and the type in newborns in a tertiary centre in Nigeria. Methods The study was carried out in the postnatal and neonatal wards of the University of Benin Teaching Hospital (UBTH), Benin City, Edo State. Benin is the capital of Edo State. It is a cosmopolitan city located in the south-south geopolitical zone of Nigeria and Child Health, University of Benin Teaching Hospital, Benin, Nigeria Wilson E Sadoh, FWACP, ehidiamen.sadoh@uniben.edu Ikechukwu Okonkwo, FMCPaed Fidelis E Eki-udoko, FMCPaed Promise Monday, FWACP Gold I Osueni, FMCPaed Jonathan Amake, MWACP Emmanuel Eyo-Ita, MWACP Department of Obstetrics and Gynaecology, University of Benin Teaching Hospital, Benin, Nigeria Chukwunwendu A Okonkwo, FMCS Division of Pediatric Cardiology, Columbia University Irving Medical Center, NewYork, United States Ezinne Emeruwa, MD Department of Paediatrics, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria Barbara E Otaigbe, FWACP Department of Community Health, University of Benin Teaching Hospital, Benin, Nigeria Gregrey A Oko-oboh, FWACP