Time to diagnosis, socioeconomic and clinical features of patients with congenital heart diseases in a teaching hospital in Nigeria

Abstract

Background: Studies have shown that there is an increase in the risk of congenital heart defects (CHD) in the lower socioeconomic classes. A structured and functional referral system is key to effective health care delivery. In Nigeria, there are three tiers of health care but poor referral system has resulted in high patient burden at the tertiary hospitals. The study aimed to describe socioeconomic, clinical features, and time to diagnosis of patients with CHD in a teaching hospital in Nigeria. Methods: A cross-sectional and descriptive study, carried out at the Lagos State University Teaching Hospital (LASUTH), as part of a large study from April 2008 to March 2012. A structured questionnaire was used after obtaining an informed consent. History and physical examinations were performed in all patients with features suggestive of CHD. Echocardiography diagnosis of CHD was made by a Paediatric cardiologist. Relationship between duration of illness prior to diagnosis and social classification of the caregivers was evaluated. Analysis was done using Microsoft Excel statistical software supplemented by MegaStat statistical package. Probability values less than 0.05 were considered statistically significant. Results: A total of 300 patients with structural heart disease participated in the study. The age range was 2 days to 35 years with a mean ± SD of 32.50±48.06 months. About 15% of the subjects presented to the tertiary centre without referral. Fast breathing was the most common presenting complaints (57%) followed by cough (33%). Up to 70% presented more than a year after the onset of illness. There was no statistically significance difference in the various social groups in the duration of illness before presentation (P=0.58). Conclusions: There is a need to develop an educational program to increase awareness on the symptoms suggestive of congenital heart disease and importance of early presentation. There is also a need to develop a referral chain among health system in the region.