Heart Failure in Children in African Hospitals: Epidemiology and Management

Abstract

Introduction: Childhood heart failure is a common yet underrecognized serious condition, thus representing a major public health challenge due to its serious consequences in terms of morbidity and mortality, as well as its impact on health systems, particularly in sub-Saharan Africa, where publications remain rare. It is within this context that the authors evaluated the current state of HF in pediatric hospitals in Senegal and aimed to report its epidemiological, diagnostic, therapeutic, and evolutionary characteristics. Patients and Methods: This was a retrospective, monocentric study with both descriptive and analytical aims, including 196 cases, conducted over a period of 5 years (from January 1, 2018, to December 31, 2022) in the pediatrics department of CHD. All children aged 0 to 16 years with heart failure secondary to a cardiac disease confirmed by echocardiography were included. Statistical analysis was performed using EpiData and Excel software. Results: The hospitalization rate was 0.22%. The sex ratio (M/F) was 0.85. Infants aged 29 days to 2 years were more represented.  Dyspnea was more frequent with 77% of cases and, and heart failure was immediately global in 68.5% of cases. Congenital heart disease was the most common, accounting for 49%, followed by rheumatic heart disease at 37.2%. Left ventricular ejection fraction (LVEF) was impaired in 20.4% of patients. Pulmonary hypertension (PH) was present in 53%. Anemia was observed in 75.26% of cases, as well as acute renal failure in 54.26% of cases. The use of cardiac surgery and interventional catheterization was limited to 4%. The clinical course was marked by complications in 27.5% and mortality in 25% of cases where septic shock complicated by nosocomial infection was its most frequent cause, accounting for 26%. Conclusion: Heart failure in children is responsible for a significant mortality rate in Africa. Particular attention should be given to improving access to interventional catheterization and cardiac surgery.