title: Congenital heart disease at Laos Children's Hospital: Two year experience.
abstract: BACKGROUND
  Management of congenital heart disease (CHD) in developing countries is challenging because of limited access to health-care facilities and socioeconomic limitations. The aim of this study was to describe the recent experience with CHD at Children's Hospital, Vientiane, Laos, the only pediatric referral hospital in the country.
  
  
  METHODS
  From July 2013 to November 2015, 1009 echocardiograms were carried out in 797 individuals who visited Children's Hospital, in whom CHD was identified in 213. Demographic characteristics, echocardiography and age at first CHD diagnosis on echocardiogram were compared by residential area.
  
  
  RESULTS
  Among the 213 patients, the most frequent anomalies, in descending order, were ventricular septal defect, atrial septal defect, patent ductus arteriosus, and tetralogy of Fallot. Moderate or severe CHD requiring surgery or intervention was detected in 137 patients; median age at initial diagnosis was 6.0 months (IQR, 1.5-29.8). Among those with moderate or severe CHD, 89 patients were from rural areas and 48 from the capital area. The proportion of patients from rural areas older than 1 and 3 years at diagnosis was 46.1% and 32.6%, respectively. In contrast, patients from the capital area were diagnosed at a significantly earlier age: 16.7% at age >1 year and 6.2% at age >3 years (both P < 0.001 vs rural areas).
  
  
  CONCLUSIONS
  Diagnosis of CHD requiring surgery is delayed in Laos, especially in rural areas. Better education and training of local medical staff, and greater access to medical advice are required to improve CHD care in Laos.
authors: Cardiovascular Unit, Vientiane, Laos.|Korea International Cooperation Agency (KOICA) Laos Office, Vientiane, Laos.|Cardiovascular Center and Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
authors: In-Chang
authors: IC
authors: Hwang
authors: Cardiovascular Unit, Vientiane, Laos.|Department of Pediatrics, Children's Hospital, Vientiane, Laos.|Lee Jong-Wook Fellowship Program, JW Lee Center for Global Medicine, Seoul National University and Korea Foundation for International Healthcare (KOFIH), Seoul, Korea.
authors: Malouny
authors: M
authors: Sisavanh
authors: Department of Pediatrics, Children's Hospital, Vientiane, Laos.
authors: Somxay
authors: S
authors: Billamay
authors: Department of Pediatrics, Children's Hospital, Vientiane, Laos.
authors: Sommanikhone
authors: S
authors: Phangmanixay
authors: Department of Pediatrics, Children's Hospital, Vientiane, Laos.|University of Health Sciences, Vientiane, Laos.
authors: Bounleua
authors: B
authors: Oudavong
authors: Cardiovascular Center and Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
authors: Jeehoon
authors: J
authors: Kang
authors: Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea.|Lee Jong-Wook Fellowship Program, JW Lee Center for Global Medicine, Seoul National University and Korea Foundation for International Healthcare (KOFIH), Seoul, Korea.
authors: Bo Sang
authors: BS
authors: Kwon
authors: Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea.|Lee Jong-Wook Fellowship Program, JW Lee Center for Global Medicine, Seoul National University and Korea Foundation for International Healthcare (KOFIH), Seoul, Korea.
authors: Gi Beom
authors: GB
authors: Kim
authors: Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea.|Lee Jong-Wook Fellowship Program, JW Lee Center for Global Medicine, Seoul National University and Korea Foundation for International Healthcare (KOFIH), Seoul, Korea.
authors: Eun Jung
authors: EJ
authors: Bae
authors: Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea.|Lee Jong-Wook Fellowship Program, JW Lee Center for Global Medicine, Seoul National University and Korea Foundation for International Healthcare (KOFIH), Seoul, Korea.
authors: Chung Il
authors: CI
authors: Noh
authors: Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea.|Lee Jong-Wook Fellowship Program, JW Lee Center for Global Medicine, Seoul National University and Korea Foundation for International Healthcare (KOFIH), Seoul, Korea.|Department of Cardiology and Cardiovascular Center, Sheikh Khalifa Specialty Hospital, Ras Al Khaimah, United Arab Emirates.
authors: Jung Yun
authors: JY
authors: Choi
mesh_terms: D002648:Child; D002675:Child, Preschool; D057210:Delayed Diagnosis / Q000706:statistics & numerical data; D003906:Developing Countries; D004452:Echocardiography; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007812:Laos / Q000453:epidemiology; D008297:Male; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012111:Residence Characteristics; D012423:Rural Health / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014504:Urban Health / Q000706:statistics & numerical data
keywords: Laos; congenital heart disease; developing country; echocardiography