Aim The literature relating to paediatric cardiac disease in sub-Saharan Africa is sparse and the spectrum of paediatric cardiac disease has not been described in Malawi.
A paediatric cardiology clinic with trans-thoracic echocardiography has been established in a tertiary referral hospital in Malawi since 2008. The clinic has collected data about the paediatric cardiac pathologies seen in this part of Malawi in an effort to better understand and modify their contribution to childhood morbidity and mortality.
Methods Between January 2009 and February 2011, the age and cardiac diagnosis of every child with an abnormal echocardiogram referred to the clinic was recorded in a database. The range of diagnoses is described.
Results Of 250 children, 139 (55.6%) had congenital heart disease, and 111 (44.4%) acquired heart disease. Ventricular septal defect (VSD) (24%), Tetralogy of Fallot (10%) and patent ductus arteriousus (7.2%) were the commonest forms of congenital heart disease. Rheumatic heart disease (RHD) (22.4%) and dilated cardiomyopathy (13.6%) were the commonest acquired diseases. The mean age of presentation was 3 years 2 months for VSD and 11 years 6 months for RHD. For RHD, most present late and it is likely that untreated cardiac disease causes a large number of childhood deaths. The clinic provides secondary preventative treatment in the form of monthly benzathine penicillin injections. A total of 44 children have undergone cardiac surgery abroad in specialist centres in South Africa, India and Italy following referral from the clinic. Currently, surgical ligation of patent ductus arteriosus is offered by a specialist paediatric surgeon with 7 successful operations to date. Facilities and expertise do not allow for per-cutaneous catheterisation techniques or invasive cardiac surgery.
Conclusion In addition to the morbidity and mortality associated with congenital heart disease, children in Malawi face an additional significant burden of acquired heart disease – in particular rheumatic heart disease. Secondary prevention is an important part of ongoing treatment.
Adequate and accessible cardiothoracic surgical services should be established at a regional level to provide treatment for those amenable to surgery. Expanding charitable funding of surgery in specialist centres outside Malawi is an alternative in the meantime.