Pattern of congenital heart disease in a developing country tertiary care center: Factors associated with delayed diagnosis.
OBJECTIVE
To determine the delay in diagnosis of various types of congenital heart defects in children and factors associated with such delay.


METHODS
For this observational study, 354 patients having congenital heart disease (CHD) presenting for the first time to the Department of Cardiology, Children's Hospital, Lahore, Pakistan, between January 1, 2015 and June 30, 2015, were enrolled after obtaining informed verbal consent from the guardian of each child. Demographical profile and various factors under observation were recorded.


RESULTS
Among the 354 enrolled children (M: F 1.7:1) with age ranging from 1 to 176 months (median 24 months), 301 (85.1%) had delayed diagnosis of CHD (mainly acyanotic 65.3%), with median delay (8 months). Main factors for delay were delayed first consultation to a doctor (37.2%) and delayed diagnosis by a health professional (22.5%). Other factors included delayed referral to a tertiary care hospital (13.3%), social taboos (13.0%), and financial constraints (12.3%). Most children were delivered outside hospital settings (88.7%). Children with siblings less than two (40%) were less delayed than those having two or more siblings (60%, P < 0.001).


CONCLUSIONS
Diagnosis of congenital heart defect was delayed in majority of patients. Multiple factors such as lack of adequately trained health system and socioeconomic constraints were responsible for the delay. There is a need to develop an efficient referral system and improve public awareness in developing countries for early diagnosis and management of such children.
Department of Pediatric Cardiology, The Children's Hospital and Institute of Child Health, Lahore, Pakistan.
Usman
U
Rashid
Department of Pediatric Cardiology, The Children's Hospital and Institute of Child Health, Lahore, Pakistan.
Ahmad U
AU
Qureshi
Department of Pediatric Cardiology, The Children's Hospital and Institute of Child Health, Lahore, Pakistan.
Syed N
SN
Hyder
Department of Pediatric Cardiology, The Children's Hospital and Institute of Child Health, Lahore, Pakistan.
Masood
M
Sadiq
Congenital heart defect; Pakistan; delayed diagnosis