Clinical Profile and Outcomes of Congenital Heart Disease Among Children Under 5 Years: A Cross-Sectional Retrospective Study from Kigali-Rwanda

Abstract

OBJECTIVE: Congenital heart disease (CHD) is the most common congenital anomaly world-wide, yet data from Rwanda remain limited. Understanding its clinical profile and outcomes is essential for improving pediatric cardiac care. This study aimed to describe the clinical characteristics, diagnostic patterns, management strategies, and outcomes of cCHD among children under 5 years of age at a tertiary hospital in Kigali, Rwanda, and to compare these parameters across different CHD subtypes. METHODS: A retrospective hospital-based cross-sectional study was conducted at the University Teaching Hospital of Kigali (CHUK), Rwanda, from June 2022 to December 2023. Medical records of children under 5 years with echocardiographically confirmed CHD were reviewed. Demographic, clinical, management, and outcome data were analyzed using descriptive statistics and comparative tests, with statistical significance set at P < .005. RESULTS: Among 361 children with CHD, the mean age was 33.3 ± 20.8 months, and 51.8% were female. Acyanotic CHD predominated (83.7%), with ventricular septal defect (VSD) (35.1%) and patent ductus arteriosus (PDA) (29.8%) most common; Tetralogy of Fallot (TOF) was most frequent among cyanotic lesions (76.3%). The most common clinical features were breathing difficulties (71.5%) and failure to thrive (53.5%). Transthoracic echocardiography was the primary diagnostic tool, preceded by cardiac ultrasound in 66.2%. Medical therapy was the mainstay (furosemide 76.5%), with cardiac interventions performed in 34.6% (most commonly VSD closure and atrial septal defect (ASD) repair). Follow-up was the most frequent outcome (acya-notic 54%, cyanotic 71%), with low mortality (3.0% vs 3.4%). Children with cyanotic CHD wereolder and had higher anthropometric measurements, while stunting was more frequent in acyanotic lesions (96% vs 78%, P < .001). Clinical features were not associated with mortality, and alldeaths occurred in children without comorbidities, suggesting an acute course of deterioration. CONCLUSION: Acyanotic CHDs were predominant among children under 5 in Rwanda, with late presentation and limited access to definitive interventions. Strengthening early screening, diagnostic capacity, and surgical services is crucial to improving outcomes. Further research on genetic and familial risk factors is warranted.