A Retrospective Study on the Prevalence, Management, and Outcomes of Congenital Heart Diseases in Children at Edward Francis Small Teaching Hospital, Banjul, The Gambia.

Abstract Background: Congenital heart defects (CHDs) are the most common major congenital anomalies, accounting for approximately one-third of all birth defects. They significantly contribute to morbidity, mortality, and healthcare costs. This study provides insights into the prevalence, characteristics, and management challenges of CHDs in The Gambia, emphasizing the need for early diagnosis, risk factor identification, and improved cardiac care infrastructure. Objectives: To determine the prevalence, management strategies, and outcomes of CHDs in children at Edward Francis Small Teaching Hospital from January 2020 to December 2022. Method: This retrospective descriptive cross-sectional study reviewed medical records of pediatric patients admitted to Edward Francis Small Teaching Hospital, the main referral center in The Gambia and the teaching hospital for the University of The Gambia Medical School. Patient data from January 2020 to December 2022 were analyzed. Results: A total of 89 patients were included, with 57.3% (n=51) females and 42.7% (n=38) males. The median age was 1.4 years. The most common ethnic group was Mandinka, followed by Fula. Diagnosis was primarily made with standard 2D trans-thoracic echocardiography, which was performed on most of the patients (84.3%) in addition to clinical features and chest X-ray. The most prevalent CHD was ventricular septal defect (VSD) (39.3%), followed by atrial septal defect (ASD) (20.2%), tetralogy of Fallot (TOF) (16.9%), and patent ductus arteriosus (PDA) (10.1%) were also not uncommon. 15.7% of cases were unclassified. The most common associated clinical condition was Down syndrome (%), these children were mainly born to mothers above 35 years (maternal age >35 years). followed by maternal diabetes and osteogenesis imperfect?? explain. Two (2.2%) had a positive family history of congenital heart disease. However, in 65(73%) of cases, there were no associated conditions or family history of CHD. The most frequently used medication in the treatment of these children was furosemide, and heart failure was the most common complication. Surgical interventions were rare: only 2.2% of these children underwent defect closure and 2.2% had pulmonary artery banding, while 95.5% of them did not receive any form of surgical treatment. Seventy-three (82.0%) were discharged and followed up in the clinic, while 6 (6.7%) died. Conclusion: VSD was the most common CHD in this study, with a median patient age of 1.4 years. Down syndrome with maternal age >35 years was the most frequent associated condition, and heart failure was the leading complication and primary cause of death. While both pharmacological and surgical treatment mode were used, surgical intervention for treatment of these defects remains unavailable in The Gambia, highlighting the urgent need to develop local paediatric cardiac surgery services.