Trends in pediatric echocardiography and the yield for congenital heart disease in a major cardiac referral hospital in Cameroon.
BACKGROUND
Congenital heart disease (CHD) is a common condition in children in Sub-Saharan Africa (SSA), where it is associated with poor outcomes. Diagnosis of CHD in SSA depends essentially on echocardiography, which is available only in few urban referral centers. Our aim was to assess time changes in the pattern of referral for pediatric echocardiography and the subsequent diagnosis of structural CHD in a major SSA city.


METHODS
All pediatric echocardiography performed between 2004 and 2013 at the echocardiography laboratory of the Yaounde General Hospital were reviewed. The primary indication of the study and the presence of structural CHD were recorded.


RESULTS
Between 2004 and 2013, 9,390 echocardiograms were performed and 834 (8.9%) children aged 1 day to 15 years underwent echocardiography at the center, and 227 (27.2%) cases of definite structural CHD were diagnosed, with 123 (54.2%) in boys. The most frequent indications for echocardiography were heart murmurs (40%) and the suspicion of CHD (37.4%). The commonest CHD was ventricular septal defect (VSD) (30%) with tetralogy of Fallot being the most frequent cyanotic heart lesion (5.3%). The proportion of pediatric echocardiography decreased from 13.3% in 2004-2005 to 6.1% in 2012-2013 (P=0.001) but not in a linear fashion (P=0.072 for linear trend).The diagnosis of structural CHD increased from 25.1% in 2004-2005 to 27.1% in 2012-2013. This increase however was non-significant (P=0.523) and did not follow a linear trend (P=0.230).


CONCLUSIONS
The pattern of referral for pediatric echocardiography at this center has changed over time, but diagnosis of structural CHD has remained the same. Improving access to this diagnostic procedure and subsequent treatment of diagnosed CHD will help improving the outcome of the disease in this setting.
Faculty of Medicine and Biomedical Sciences, Department of Internal Medicine, University of Yaounde 1, Yaounde, Cameroon.
Clovis
C
Nkoke
Faculty of Medicine and Pharmacy, Brussels Free University-VUB, Brussels, Belgium.
Eric
E
Balti
Faculty of Medicine and Biomedical Sciences, Department of Internal Medicine, University of Yaounde 1, Yaounde, Cameroon.
Alain
A
Menanga
Department of Cardiology, Douala General Hospital, Douala, Cameroon.
Anastase
A
Dzudie
Medical University of SC, Department of Neurology, Charleston, USA.
Alain
A
Lekoubou
Faculty of Medicine and Biomedical Sciences, Department of Internal Medicine, University of Yaounde 1, Yaounde, Cameroon.
Samuel
S
Kingue
Non-Communicable Diseases Research Unit, South African Medical Research Council of South Africa, Cape Town, South Africa.
Andre Pascal
AP
Kengne
Cameroon; Echocardiography; congenital; heart disease; trends