Late diagnosis of CHD and its associated factors in Kenya: an analytic cross-sectional study

Abstract

Abstract Introduction: Burden of CHD in Africa is generally underestimated mainly due to significant under-reporting and early-related fetal and neonatal mortality. Objectives: Determine the prevalence and factors associated with late diagnosis of CHD seen at three tertiary care hospitals in Kenya. Design: A cross-sectional study on paediatric patients with CHDs, aged 0–18 years, seen over a 5-year period, between January, 2011 and December, 2016. Setting: Aga Khan University Hospital Nairobi, Mater Hospital, and Kenyatta National Hospital. Methods: Patients were stratified into those diagnosed late (>1 year of age) and those diagnosed early (<1 year of age). Multiple logistic regression analysis was done to determine factors associated with late diagnosis. Results: The study enrolled 411 patients, with equal gender distribution. Prevalence of late diagnosis (>1 year of age) of CHD was 60.6% (95% CI 55.7–65.3). Median age at diagnosis was 15 (IQR 5–48) months. Presence of a cardiac murmur (OR = 0.87; 95% CI 0.72–0.92, p-value = 0.016) and level of parental education (OR = 4.99; 95% CI 2.25–11.40, p-value <0001) were associated with a decreased odds of late diagnosis. Other factors like cyanosis, an increase in the number of healthcare workers and healthcare facilities per 10,000 population showed some association with decreased odds of late diagnosis of CHD, but these were not statistically significant. Conclusion: Late diagnosis of CHD remains alarmingly high in our setting. Initiatives to enhance early detection and screening of CHD should be adopted to reduce related mortality and morbidity.