A Retrospective Study on the Prevalence, Management, and Outcomes of Congenital Heart Diseases in Children at Edward Francis Small Teaching Hospital, Banjul, The Gambia.
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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.
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A Retrospective Study on the Prevalence, Management, and Outcomes of Congenital Heart Diseases in Children at Edward Francis Small Teaching Hospital, Banjul, The Gambia. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A Retrospective Study on the Prevalence, Management, and Outcomes of Congenital Heart Diseases in Children at Edward Francis Small Teaching Hospital, Banjul, The Gambia. Mariama Nyang, Lamin Makalo, Samuel Ademola Adegoke This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6383402/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 23 Jul, 2025 Read the published version in BMC Cardiovascular Disorders → Version 1 posted 11 You are reading this latest preprint version 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. Congenital Heart Disease Management Outcome Paediatrics Prevalence Figures Figure 1 Figure 2 Introduction Congenital heart defects (CHDs) are the most common major congenital anomalies, accounting for approximately one-third of all congenital malformations. They are a leading cause of morbidity, mortality, and high medical cost associated with birth defects. Ventricular septal defect (VSD) and atrial septal defect (ASD) together account for approximately 51% of all CHD cases, with an increasing trend in detection due to improved diagnostic capabilities [1]. The reported prevalence of CHDs has risen to approximately 9 per 1,000 live births, largely due to the increased detection of milder forms [2]. While the exact causes of most CHDs remain unknown, their prevalence is relatively consistent across different populations and countries. However, low-income nations with high birth rates bear a disproportionate burden. Despite a 50% reduction in overall child mortality globally over the past two decades, CHD prevalence in low- and middle-income countries (LMICs) continues to rise [3]. Studies estimate that CHDs affect approximately 0.8% of newborns worldwide, although variations exist across different studies [4]. Children with CHDs in Africa generally have worse prognosis compared to those in developed countries due to limited access to early diagnosis and specialized treatment. For instance, in Southwestern Uganda, CHDs were the leading cause of heart failure among pediatric cardiac admissions, accounting for 35% of cases [5]. Severe CHD cases are associated with a 12-fold higher risk of death within the first year of life, and thousands of children worldwide die annually from CHDs, with many never receiving a diagnosis [9,10]. In many developing countries, only a small fraction of children with CHDs receive timely diagnosis and treatment. High mortality and morbidity rates in these regions are due to multiple barriers, including limited healthcare infrastructure, insufficient trained personnel, and lack of advanced cardiac care facilities. As a result, thousands of children succumb to CHDs, and millions require urgent medical intervention [11,12,13]. The Gambian healthcare system faces significant resource constraints, affecting the diagnosis and management of CHDs. Although CHD cases are being identified at Edward Francis Small Teaching Hospital (EFSTH), many children experience poor outcomes due to a lack of specialized care. Limited access to pediatric cardiologists, diagnostic tools, and surgical interventions makes CHD management challenging. Furthermore, little is known about the true burden and impact of CHDs in The Gambia, underscoring the need for baseline data to inform policy and improve healthcare services [14] Congenital heart disease (CHD) remains a significant but understudied burden in The Gambia, with limited epidemiological data on its prevalence, incidence, and clinical patterns. Despite being a major cause of childhood morbidity and mortality, CHDs often go undiagnosed or untreated due to resource constraints, lack of specialized healthcare professionals, and inadequate diagnostic and treatment facilities. As a result, many children suffer preventable deaths or long-term complications that could have been mitigated with early diagnosis and proper management. This study aims to determine the prevalence, management strategies, and short-term outcomes of CHDs at Edward Francis Small Teaching Hospital (EFSTH). By assessing the burden of CHDs, the study will provide critical baseline data that can help healthcare policymakers and organizations allocate resources effectively, develop screening programs, and implement preventive measures. Understanding CHD trends will also support the establishment of structured referral systems and specialized pediatric cardiac care services, ultimately improving patient outcomes and survival rates. By addressing this knowledge gap, the study seeks to inform evidence-based interventions that can enhance pediatric cardiac care in The Gambia, ensuring that more children receive timely diagnosis and treatment, and reducing the overall impact of CHDs on affected families and the healthcare system. METHODOLOGY Study Design This study was a retrospective descriptive cross-sectional study conducted at Edward Francis Small Teaching Hospital (EFSTH), the main referral hospital in The Gambia and the teaching hospital of The University of The Gambia Medical School. The study involved a review of medical records of patients admitted on account of congenital heart disease (CHD) from January 2020 to December 2022. Sample Selection The study included all pediatric patients diagnosed with CHD and admitted to EFSTH between January 2020 and December 2022. Data was obtained retrospectively from patient case folders. Inclusion Criterion ✔ All pediatric patients (0–14 years) diagnosed with CHD and admitted to the pediatric ward at EFSTH from January 2020 to December 2022. Exclusion Criteria ✔ Case folders lacking the required information for the study. ✔ Patients admitted outside the study period. Data Collection Medical records of all pediatric patients diagnosed with CHD and admitted to EFSTH from January 2020 to December 2022 were reviewed. Key variables including age, sex, type of CHD (cyanotic vs. acyanotic), diagnostic methods, risk factors, management strategies, and patient outcomes were extracted from case folders. Statistical Analysis The collected data was analyzed using Microsoft Excel and SPSS (Version 20). Data was presented in the form of frequency distributions, means, and graphical representations (charts and graphs). Both qualitative and quantitative variables were analyzed separately. Ethical Considerations This study was conducted in partial fulfillment of the MBChB degree in Medicine and Surgery at the School of Medicine and Allied Health Sciences, University of The Gambia. Ethical approval was obtained from the Research Ethics Committee of EFSTH. Confidentiality was strictly maintained by ensuring that all patient data remained anonymous and was used solely for research purposes. Results 89 patients with CHD were included in the study, out of 2,668 patients who were admitted in the paediatrics department from 2020 to 2022. This gives a CHD prevalence of 3.3%. Majority of patients were female (57.3%), and the most affected age group was 1–5 years (65.2%), with a median age of 1.4 years. The most common ethnic group was Mandinka (41.6%), followed by Fula (20.2%) and Serahule (14.6%). Table.1 Diagnosis of CHD was confirmed by using 2D transthoracic echocardiography in 84.3% of cases, while 15.7% were diagnosed by physical examination with chest X-ray support. The majority of cases were acyanotic (71.9%), while 28.1% were cyanotic. The most common CHD types were ventricular septal defect (VSD) at 39.3%, atrial septal defect (ASD) at 20.2%, tetralogy of Fallot (TOF) at 16.9%, patent ductus arteriosus (PDA) at 10.1%, and atrioventricular septal defect (AVSD) at 5.6%. Table.2 Most patients (73.0%) had no identifiable risk factors. The most commonly known risk factor was Down Syndrome with maternal age greater than 35 years (18.0%), followed by maternal diabetes (2.2%) and positive family history of CHD (2.2%). Table. 3 The most frequently used drugs were furosemide (68.5%), enalapril (13.5%), and propranolol (13.5%). About 18.0% of patients received no medication. Surgical intervention was rare, only 4.5% of patients received a form of it, and these included pulmonary artery banding (2.2%) and surgical closure of defects (2.2%), while 95.5% had no surgical treatment. Table.4 Regarding outcomes, 82.0% of patients were discharged with clinic follow-up, while 6.7% died. A small number (2.2%) had spontaneous closure of small ASD or VSD, another 2.2% underwent successful surgery?? (I don’t understand this) and were discharged from follow-up, 2.2% were discharged against medical advice, and 1.1% absconded from the hospital. Figure. 1 Complications were observed in 56.2% of the patients, with the most common being heart failure (12.4%), pneumonia (10.1%), and failure to thrive (9.0%), while 43.8% had no complications. Table.5 Most patients (87.6%) had no readmission, while 11.2% were readmitted once. The majority of hospital stays lasted one or two days, with a few patients staying for five days or more. Figure. 2 The study highlights that CHD is most prevalent in young children, particularly those aged 1–5 years. Acyanotic CHD is more common than cyanotic, with VSD being the predominant defect. The majority of cases were diagnosed through echocardiography, and while medical management was common, surgical intervention was rare. Most patients were discharged for follow-up, but a small percentage experienced significant complications or mortality Discussion A total of eighty-nine (n = 89) patients were diagnosed using echocardiography, clinical presentation, and CXR in EFSTH from 2020–2022. The earliest age at diagnosis was one month. The total prevalence of CHD was 3.3%, this was found in a similar study from China.[15] The ord of increasing frequency of CHD in EFSTH was as follows: VSD, ASD, TOF, PDA, and AVSD, but there were patients with multiple CHD. In this study, VSD had the highest occurrence, 39.3%, which is similar to previous studies done in The Gambia where it was 31.5%, Nigeria where 40.6% of the patients had VSD, and other studies done in East Africa.[16,17] A study in India also showed a frequency of 31.2% of patients with VSD, making it the most common defect.[18] The rising burden of VSD globally has been attributed to the increasing availability of early diagnosis, as VSDs that would have closed spontaneously in childhood are now being detected through echocardiography in infancy.[19] This has been documented by several authors. ASD accounted for 20.2%, making it the second most common defect, showing an increasing prevalence compared to previous studies in The Gambia.[14] The highest frequency of cyanotic heart disease was TOF, which accounted for 16.9% of total CHD cases. Similar results were seen in Indonesia and studies conducted by Kumar et al (where?).[20] Mandinka was the most common ethnicity in the study, which was also observed in a similar study done in The Gambia. This can be attributed to the high Mandinka population in The Gambia. However, an interesting finding was that the Sarahule ethnic group, which constitutes less than 10% of the Gambian population, accounted for more than 14% of the study population. This overrepresentation suggests a possible genetic predisposition to CHD within the Sarahule community. Genetic susceptibility to CHD has been documented in various populations, with certain ethnic groups displaying a higher prevalence due to inherited genetic mutations or familial clustering.[21] Further research is needed to explore potential genetic factors contributing to this trend, which may warrant targeted screening and early interventions within this ethnic group. The median age at diagnosis was 1.4 years, which is similar to a study done in Korea.[22] Females were more affected, with a frequency of 57.3%, while males accounted for 42.7%, a similar gender prevalence also reported in various studies.[23] The study also observed that the prevalence of CHD decreased with age, indicating that some defects may close spontaneously over time or remain undiagnosed in older children and/or die prematurely.[24,25] This emphasizes the importance of early diagnosis and intervention to ensure timely management of CHD cases. CHD has been associated with various risk factors, with the most common in this study being Down syndrome in mothers over 35 years, occurring in 18% of cases. Advanced maternal age is a well-known risk factor for Down syndrome, and Down syndrome is associated with CHD. [26,27] The most common CHD types associated with Down syndrome in this study were VSD, followed by PDA and ASD, a similarity seen in other studies.[28–30] Maternal diabetes was identified as a risk factor in 2.2% of cases, though this low percentage may be due to insufficient documentation, as maternal diabetes has shown a significant association in other studies.[31–33] A positive family history was also identified as a risk factor as in the study by Jin and colleagues.[34] Both pharmacological and surgical therapies were used in these patients. The most commonly used drug was furosemide, but enalapril and digoxin were also prescribed which is similar to new advances as mentioned by Varela-Chinchilla CD.[34] A significant number of patients had heart failure as a complication of CHD due to delayed diagnosis and intervention, a trend also reported in other studies.[35–37] Among non-cardiac complications, pneumonia and failure to thrive were the most common, similar to findings from an Indian study.[38] Approximately 95.5% of patients did not undergo surgical intervention due to the lack of a cardiothoracic surgery center in The Gambia. Only 2.2% of patients had surgical closure of defects, while another 2.2% underwent pulmonary artery banding like in many African countries.[39] In contrast, countries with better surgical facilities have reported a higher number of successful surgical closures of defects.[40] The mortality rate for CHD patients in this study was 6.7%, with 66.7% deaths attributed to heart failure, while the remainder resulted from pneumonia and failure to thrive. Other studies too have reported higher mortality rates.[38] Most patients continue to be seen for follow-up at the paediatric cardiology clinic, with appointments scheduled based on urgency. Conclusion This study provides valuable insights into the burden, clinical spectrum, and outcomes of congenital heart disease (CHD) among children diagnosed at the Edward Francis Small Teaching Hospital (EFSTH) from 2020 to 2022. Ventricular septal defect (VSD) emerged as the most prevalent CHD, with a notable proportion of patients presenting with cyanotic defects such as tetralogy of Fallot (TOF). The findings highlight a predominance of CHD among females, a median age at diagnosis of 1.4 years, and an underrepresentation of surgical interventions due to limited local capacity. The identification of ethnic disparities, particularly the overrepresentation of the Sarahule ethnic group, suggests a potential genetic predisposition that warrants further investigation. Risk factors such as advanced maternal age, Down syndrome, and positive family history were frequently associated with CHD cases. Despite the use of pharmacological treatments, delayed diagnosis and limited surgical options contributed to significant morbidity and mortality, primarily due to heart failure. The study underscores the urgent need to strengthen early detection strategies, expand paediatric cardiology services, and establish cardiothoracic surgical facilities in The Gambia. Future research, particularly prospective and multi-centre studies, is essential to fully understand the epidemiology of CHD and guide evidence-based interventions that improve outcomes for affected children nationwide Limitations This study was limited to a review of medical records of children admitted to the hospital. One major challenge with this approach is the potential unavailability or loss of some patient folders, which may affect the completeness of the data. To address the limitation of missing or incomplete medical records, the authors have actively supported the hospital's ongoing transition to an electronic medical records (EMR) system. This has involved engaging key stakeholders, advocating for improved health information management, and contributing to institutional efforts to strengthen data collection and preservation. In addition, the authors have initiated collaborations with other healthcare facilities and academic institutions to lay the groundwork for prospective studies. These efforts aim to enhance the research findings and provide a broader, more representative picture of paediatric health outcomes in The Gambia. Abbreviations ASD Atrial Septal Defect AVSD Aterioventricular Septal Defect CHD Congenital Heart Defect EFSTH Edward Francis Small Teaching Hospital EMR electronic medical records LMICs Low- and Middle-Income Countries PDA Patent Ductus Arteriosus SPSS Statistical Package for the Social Sciences TGA Transposition of Great Arteries TOF Tetralogy of Fallot VSD Ventricular Septal Defect Declarations Ethical Declaration Ethical approval for this study was obtained from the Research Ethics Committee of Edward Francis Small Teaching Hospital (EFSTH), Banjul, The Gambia with reference number EFSTH_REC_2023_060. This retrospective study involved the review of existing medical records, and as such, informed consent was not required. All data were anonymized, and patient confidentiality was strictly maintained. The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Clinical Trial Number Not applicable. Conflict of Interest The authors declare no conflict of interest. Source of Funding This study was self-funded. Data Availability Statement The data supporting the findings of this study are held by the Medical Records Department of Edward Francis Small Teaching Hospital, Banjul, The Gambia. Due to ethical considerations and the need to protect patient confidentiality, access to the data is restricted. Interested parties may request access from the corresponding author, subject to approval by the hospital’s ethics committee. Authors’ Contributions M. Nyang; Conceptualisation, Data Collection, Writing and Data Analysis, L. Makalo; Conceptualisation, Supervision, Data Visualisation, Reviewing and Editing S.A Adegoke; Supervision, Reviewing and Editing ACKNOWLEDGMENT I express my profound gratitude to the Almighty for granting me the ability and knowledge to undertake this work. I extend my sincere appreciation to my mentors, Dr. Muhammed Dibba, Dr. Jim Jobe, and Dr. Abdou Aziz Jammeh, for their invaluable guidance and support. I am also grateful to my classmates for their encouragement throughout this journey. My deepest appreciation goes to my parents and brother for their unwavering support throughout my medical training. A special acknowledgment to Dr. Mahmoud Jallow for his continuous guidance and assistance, which have been instrumental in my academic and professional growth. References Zikarg YT, Yirdaw CT, Aragie TG. Prevalence of congenital septal defects among congenital heart defect patients in East Africa: A systematic review and meta-analysis. Plos one. 2021 Apr 22;16(4):e0250006. Zühlke L, Lawrenson J, Comitis G, De Decker R, Brooks A, Fourie B, Swanson L, Hugo-Hamman C. Congenital heart disease in low-and lower-middle–income countries: current status and new opportunities. Current cardiology reports. 2019 Dec;21:1-3. Zheleva B, Atwood JB. 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J Community Genet. 2023 Apr;14(2):189-195. doi: 10.1007/s12687-022-00627-7. Epub 2022 Dec 23. PMID: 36562914; PMCID: PMC10104982.Nijres BM, Samuel BP, Vettukattil JJ. Subclinical atherosclerosis in patients with cyanotic congenital heart disease. International journal of cardiology. 2019 May 1;282:44. Asim A, Agarwal S, Dean DD. Maternal Risk Factors Triggering Congenital Heart Defects in Down Syndrome: A Case-Control Study. Pediatr Rep. 2022 Feb 28;14(1):99-105. doi: 10.3390/pediatric14010015. PMID: 35324818; PMCID: PMC8950734.MM OG, Bhakta RT, Tarmahomed A, Mendez MD. Cyanotic Heart Disease. Sanadhya A, Meena N, Sharma P, Setia S, Study to assess incidence and type of congenital heart defect in children with dowsyndrome presenting to tertiary care teaching hospital of southern Rajasthan. Int J Contemp Pediatr2023;10:1108-12 Susan UA, Chiemerie OA. Prevalence and pattern of congenital heart disease among children with Down syndrome seen in a Federal Medical Centre in the Niger Delta Region, Nigeria. J Cardiol Cardiovasc Med. 2022; 7: 030-035. Kim MA, Lee YS, Yee NH, Choi JS, Choi JY, Seo K. Prevalence of Congenital Heart Defects Associated with Down Syndrome in Korea. J Korean Med Sci. 2014 Nov;29(11):1544-1549. Ibrahim S, Gaborit B, Lenoir M, Collod-Beroud G, Stefanovic S. Maternal Pre-Existing Diabetes: A Non-Inherited Risk Factor for Congenital Cardiopathies. Int J Mol Sci. 2023 Nov 13;24(22):16258. doi: 10.3390/ijms242216258. PMID: 38003449; PMCID: PMC10671602. Liu Y, Yue L, Chang L. Maternal Gestational Diabetes Mellitus and Congenital Heart Disease in Offspring: A Meta-Analysis. Horm Metab Res. 2024 Aug;56(8):574-584. doi: 10.1055/a-2238-1710. Epub 2024 Feb 2. PMID: 38307090. Delgado Y, Gaytan C, Perez N, Miranda E, Morales BC, Santos M. Association of congenital heart defects (CHD) with factors related to maternal health and pregnancy in newborns in Puerto Rico. Congenit Heart Dis. 2024;19(1):19-31. doi: 10.32604/chd.2024.046339. Epub 2024 Mar 20. PMID: 38912385; PMCID: PMC11192526. Varela-Chinchilla CD, Sánchez-Mejía DE, Trinidad-Calderón PA. Congenital Heart Disease: The State-of-the-Art on Its Pharmacological Therapeutics. J Cardiovasc Dev Dis. 2022 Jun 26;9(7):201. doi: 10.3390/jcdd9070201. PMID: 35877563; PMCID: PMC9316572. Liberman RF, Getz KD, Lin AE, Higgins CA, Sekhavat S, Markenson GR, Anderka M. Delayed diagnosis of critical congenital heart defects: trends and associated factors. Pediatrics. 2014 Aug;134(2):e373-81. doi: 10.1542/peds.2013-3949. PMID: 25070301; PMCID: PMC9923616. Thomford, N.E., Biney, R.P., Okai, E. et al. Clinical Spectrum of congenital heart defects (CHD) detected at the child health Clinic in a Tertiary Health Facility in Ghana: a retrospective analysis. J Congenit Heart Dis 4 , 3 (2020). https://doi.org/10.1186/s40949-020-00034-y Rashid, Usman; Qureshi, Ahmad U; Hyder, Syed N; Sadiq, Masood. Pattern of congenital heart disease in a developing country tertiary care center: Factors associated with delayed diagnosis. Annals of Pediatric Cardiology 9(3):p 210-215, Sep–Dec 2016. | DOI: 10.4103/0974-2069.189125 Jat NK, Bhagwani DK, Bhutani N, Sharma U, Sharma R, Gupta R. Assessment of the prevalence of congenital heart disease in children with pneumonia in tertiary care hospital: A cross-sectional study. Ann Med Surg (Lond). 2021 Nov 23;73:103111. doi: 10.1016/j.amsu.2021.103111. PMID: 34976377; PMCID: PMC8683668. Akintoye, O.O., Adu, B.G., Otorkpa, M.J. et al. The current state of minimally invasive cardiac surgery in Africa: a systematic review and meta-analysis. Cardiothorac Surg 32 , 15 (2024). https://doi.org/10.1186/s43057-024-00134-0 Kempny A, Dimopoulos K, Uebing A, Diller GP, Rosendahl U, Belitsis G, Gatzoulis MA, Wort SJ. Outcome of cardiac surgery in patients with congenital heart disease in England between 1997 and 2015. PLoS One. 2017 Jun 19;12(6):e0178963. doi: 10.1371/journal.pone.0178963. PMID: 28628610; PMCID: PMC5476245. Tables TABLE 1. Sociodemographic Data Demographics Frequency percentage Age 0-11months 25 28.1 12months-5years 58 65.2 >5years-10years 4 4.5 >10years 2 2.2 Gender Distribution Male 38 57.3 Female 51 42.7 Ethnicity Mandinka 37 41.6 Fula 18 20.2 Sarahule 13 14.6 Wollof 8 9.0 Others 13 14.6 Total 89 100.0 TABLE 2. SHOWING TYPES OF CHD Types Frequency Percent Atrial Septal Defect (ASD) 18 20.2% Atrioventricular Septal Defect (AVSD) 5 5.6% Patent Ductus Arteriosus (PDA) 9 10.1% Pulmonary stenosis/Atresia 5 5.6% Transposition of Great Artery (TGA) 3 3.4% Tetralogy Of Fallot (TOF) 15 16.9% Tricuspid Valve Atresia 1 1.1% Ventricular Septal Defect (VSD) 35 39.3% Not Classified (N/C) 14 15.7% TABLE 3. ASSOCIATED RISK FACTORS Risk Frequency Percent Associated osteogenesis 2 2.2% Down Syndrome with maternal age >35 16 18.0% Maternal age >35yrs 1 1.1% Maternal Diabetes 2 2.2% No identifiable factor 65 73.0% Preterm baby 1 1.1% Positive family history 2 2.2% Total 89 100 TABLE 4. SHOWING DRUGS USED AND THEIR FREQUENCIES Drugs Frequency Percent Captopril 1 1.1% Digoxin 5 5.6% Enalapril 12 13.5% Furosemide 61 68.5% No drug used 16 18.0% Not indicated 1 1.1% Propranolol 12 13.5% Spironolactone 9 10.1% TABLE 5 SHOWING COMPLICATIONS Frequency Percent Valid Percent Cumulative Percent Anemia 1 1.1 1.1 1.1 Cardiomyopathy 1 1.1 1.1 2.2 Cerebral abscess 1 1.1 1.1 3.4 Convulsion 1 1.1 1.1 4.5 Delay development 2 2.2 2.2 6.7 Delay development & Malnutrition 1 1.1 1.1 7.9 Failure to Thrive 8 9.0 9.0 16.9 Failure to Thrive, Pneumonia 5 5.6 5.6 22.5 Heart Failure 11 12.4 12.4 34.8 Heart Failure, Failure to Thrive 2 2.2 2.2 37.1 None 39 43.8 43.8 80.9 Pneumonia 9 10.1 10.1 91.0 Pneumonia, Heart Failure 6 6.7 6.7 97.8 Poor weight gain 1 1.1 1.1 98.9 Severe malnutrition 1 1.1 1.1 100.0 Total 89 100.0 100.0 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 23 Jul, 2025 Read the published version in BMC Cardiovascular Disorders → Version 1 posted Editorial decision: Revision requested 06 May, 2025 Reviews received at journal 04 May, 2025 Reviewers agreed at journal 02 May, 2025 Reviews received at journal 01 May, 2025 Reviewers agreed at journal 01 May, 2025 Reviewers agreed at journal 01 May, 2025 Reviewers invited by journal 30 Apr, 2025 Editor assigned by journal 28 Apr, 2025 Editor invited by journal 18 Apr, 2025 Submission checks completed at journal 17 Apr, 2025 First submitted to journal 17 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6383402","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":451742281,"identity":"6a9dae1a-0867-4016-94a5-5bfb93f59f3f","order_by":0,"name":"Mariama Nyang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABH0lEQVRIie2RMUvEMBiGUzK49H5Bsf0FwlcKB8LR/gvnHoVk6UFHwcFKQSdxPejgX/AQMn81Qxfl1gMdPIRuQuUmUcG0crelroJ5pjfwPvnyEUIMhj8IICHYpz2aUwITt8v4PKAc7hRqKSVjQa/EA0qE29Qr7d007w5Dyrh+WON7GoZXhXX2kgHy6yO5VlNC9yDXKPccqkuRJHNpFcEcnmaLRwZKSYIxahRkBEeCJkRa544NzWxRxp2CU6FRYNmQ6kucJp60Lj5skNwveTusrBiRIyFDUFOoUmLPSX+ZsmqI3Bd17Ktd1MOYf+OkGcag3wWWjL69ipPIrYtqY39OPK/kt217HLo6ZcvPd/SX9E0YrndEu+Tl+pbBYDD8T74BeYdsGh5xkLIAAAAASUVORK5CYII=","orcid":"","institution":"University of The","correspondingAuthor":true,"prefix":"","firstName":"Mariama","middleName":"","lastName":"Nyang","suffix":""},{"id":451742282,"identity":"e69f0237-cdaf-4c42-a1c7-f6ff6cd73f48","order_by":1,"name":"Lamin Makalo","email":"","orcid":"","institution":"University of The","correspondingAuthor":false,"prefix":"","firstName":"Lamin","middleName":"","lastName":"Makalo","suffix":""},{"id":451742283,"identity":"c9bf8023-b1ee-4c2e-a614-2611fc533b66","order_by":2,"name":"Samuel Ademola Adegoke","email":"","orcid":"","institution":"University of The","correspondingAuthor":false,"prefix":"","firstName":"Samuel","middleName":"Ademola","lastName":"Adegoke","suffix":""}],"badges":[],"createdAt":"2025-04-05 17:53:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6383402/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6383402/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12872-025-04948-6","type":"published","date":"2025-07-23T15:57:26+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":82276667,"identity":"f5baa8e5-bf7e-4df4-84bb-35565d9c7c63","added_by":"auto","created_at":"2025-05-08 14:47:07","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":27746,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6383402/v1/719cf1339bf57184477e9b3f.png"},{"id":82278315,"identity":"a35be377-1dec-4c6c-b208-2b63477c2aeb","added_by":"auto","created_at":"2025-05-08 14:55:08","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":72266,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSHOWING OUTCOME OF ADMITTED CASES\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6383402/v1/c8ca6c565214c4836eb83b1c.png"},{"id":87756671,"identity":"b33739bd-825e-4b46-9800-2a4d4729aea1","added_by":"auto","created_at":"2025-07-28 16:07:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":773569,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6383402/v1/28493763-9018-4a9d-9b49-b1ddb996df52.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A Retrospective Study on the Prevalence, Management, and Outcomes of Congenital Heart Diseases in Children at Edward Francis Small Teaching Hospital, Banjul, The Gambia.","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCongenital heart defects (CHDs) are the most common major congenital anomalies, accounting for approximately one-third of all congenital malformations. They are a leading cause of morbidity, mortality, and high medical cost associated with birth defects. Ventricular septal defect (VSD) and atrial septal defect (ASD) together account for approximately 51% of all CHD cases, with an increasing trend in detection due to improved diagnostic capabilities [1]. The reported prevalence of CHDs has risen to approximately 9 per 1,000 live births, largely due to the increased detection of milder forms [2].\u003c/p\u003e \u003cp\u003eWhile the exact causes of most CHDs remain unknown, their prevalence is relatively consistent across different populations and countries. However, low-income nations with high birth rates bear a disproportionate burden. Despite a 50% reduction in overall child mortality globally over the past two decades, CHD prevalence in low- and middle-income countries (LMICs) continues to rise [3]. Studies estimate that CHDs affect approximately 0.8% of newborns worldwide, although variations exist across different studies [4].\u003c/p\u003e \u003cp\u003eChildren with CHDs in Africa generally have worse prognosis compared to those in developed countries due to limited access to early diagnosis and specialized treatment. For instance, in Southwestern Uganda, CHDs were the leading cause of heart failure among pediatric cardiac admissions, accounting for 35% of cases [5]. Severe CHD cases are associated with a 12-fold higher risk of death within the first year of life, and thousands of children worldwide die annually from CHDs, with many never receiving a diagnosis [9,10].\u003c/p\u003e \u003cp\u003eIn many developing countries, only a small fraction of children with CHDs receive timely diagnosis and treatment. High mortality and morbidity rates in these regions are due to multiple barriers, including limited healthcare infrastructure, insufficient trained personnel, and lack of advanced cardiac care facilities. As a result, thousands of children succumb to CHDs, and millions require urgent medical intervention [11,12,13].\u003c/p\u003e \u003cp\u003eThe Gambian healthcare system faces significant resource constraints, affecting the diagnosis and management of CHDs. Although CHD cases are being identified at Edward Francis Small Teaching Hospital (EFSTH), many children experience poor outcomes due to a lack of specialized care. Limited access to pediatric cardiologists, diagnostic tools, and surgical interventions makes CHD management challenging. Furthermore, little is known about the true burden and impact of CHDs in The Gambia, underscoring the need for baseline data to inform policy and improve healthcare services [14]\u003c/p\u003e \u003cp\u003eCongenital heart disease (CHD) remains a significant but understudied burden in The Gambia, with limited epidemiological data on its prevalence, incidence, and clinical patterns. Despite being a major cause of childhood morbidity and mortality, CHDs often go undiagnosed or untreated due to resource constraints, lack of specialized healthcare professionals, and inadequate diagnostic and treatment facilities. As a result, many children suffer preventable deaths or long-term complications that could have been mitigated with early diagnosis and proper management.\u003c/p\u003e \u003cp\u003eThis study aims to determine the prevalence, management strategies, and short-term outcomes of CHDs at Edward Francis Small Teaching Hospital (EFSTH). By assessing the burden of CHDs, the study will provide critical baseline data that can help healthcare policymakers and organizations allocate resources effectively, develop screening programs, and implement preventive measures. Understanding CHD trends will also support the establishment of structured referral systems and specialized pediatric cardiac care services, ultimately improving patient outcomes and survival rates.\u003c/p\u003e \u003cp\u003e By addressing this knowledge gap, the study seeks to inform evidence-based interventions that can enhance pediatric cardiac care in The Gambia, ensuring that more children receive timely diagnosis and treatment, and reducing the overall impact of CHDs on affected families and the healthcare system.\u003c/p\u003e"},{"header":"METHODOLOGY","content":"\u003cp\u003eStudy Design\u003c/p\u003e \u003cp\u003eThis study was a retrospective descriptive cross-sectional study conducted at Edward Francis Small Teaching Hospital (EFSTH), the main referral hospital in The Gambia and the teaching hospital of The University of The Gambia Medical School. The study involved a review of medical records of patients admitted on account of congenital heart disease (CHD) from January 2020 to December 2022.\u003c/p\u003e \u003cp\u003eSample Selection\u003c/p\u003e \u003cp\u003eThe study included all pediatric patients diagnosed with CHD and admitted to EFSTH between January 2020 and December 2022. Data was obtained retrospectively from patient case folders.\u003c/p\u003e \u003cp\u003eInclusion Criterion\u003c/p\u003e \u003cp\u003e✔ All pediatric patients (0\u0026ndash;14 years) diagnosed with CHD and admitted to the pediatric ward at EFSTH from January 2020 to December 2022.\u003c/p\u003e \u003cp\u003eExclusion Criteria\u003c/p\u003e \u003cp\u003e✔ Case folders lacking the required information for the study.\u003c/p\u003e \u003cp\u003e✔ Patients admitted outside the study period.\u003c/p\u003e \u003cp\u003eData Collection\u003c/p\u003e \u003cp\u003eMedical records of all pediatric patients diagnosed with CHD and admitted to EFSTH from January 2020 to December 2022 were reviewed. Key variables including age, sex, type of CHD (cyanotic vs. acyanotic), diagnostic methods, risk factors, management strategies, and patient outcomes were extracted from case folders.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eThe collected data was analyzed using Microsoft Excel and SPSS (Version 20). Data was presented in the form of frequency distributions, means, and graphical representations (charts and graphs). Both qualitative and quantitative variables were analyzed separately.\u003c/p\u003e \u003cp\u003eEthical Considerations\u003c/p\u003e \u003cp\u003eThis study was conducted in partial fulfillment of the MBChB degree in Medicine and Surgery at the School of Medicine and Allied Health Sciences, University of The Gambia. Ethical approval was obtained from the Research Ethics Committee of EFSTH. Confidentiality was strictly maintained by ensuring that all patient data remained anonymous and was used solely for research purposes.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e89 patients with CHD were included in the study, out of 2,668 patients who were admitted in the paediatrics department from 2020 to 2022. This gives a CHD prevalence of 3.3%. Majority of patients were female (57.3%), and the most affected age group was 1\u0026ndash;5 years (65.2%), with a median age of 1.4 years. The most common ethnic group was Mandinka (41.6%), followed by Fula (20.2%) and Serahule (14.6%). \u003cb\u003eTable.1\u003c/b\u003e\u003c/p\u003e \u003cp\u003eDiagnosis of CHD was confirmed by using 2D transthoracic echocardiography in 84.3% of cases, while 15.7% were diagnosed by physical examination with chest X-ray support. The majority of cases were acyanotic (71.9%), while 28.1% were cyanotic. The most common CHD types were ventricular septal defect (VSD) at 39.3%, atrial septal defect (ASD) at 20.2%, tetralogy of Fallot (TOF) at 16.9%, patent ductus arteriosus (PDA) at 10.1%, and atrioventricular septal defect (AVSD) at 5.6%. \u003cb\u003eTable.2\u003c/b\u003e\u003c/p\u003e \u003cp\u003eMost patients (73.0%) had no identifiable risk factors. The most commonly known risk factor was Down Syndrome with maternal age greater than 35 years (18.0%), followed by maternal diabetes (2.2%) and positive family history of CHD (2.2%). \u003cb\u003eTable. 3\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe most frequently used drugs were furosemide (68.5%), enalapril (13.5%), and propranolol (13.5%). About 18.0% of patients received no medication. Surgical intervention was rare, only 4.5% of patients received a form of it, and these included pulmonary artery banding (2.2%) and surgical closure of defects (2.2%), while 95.5% had no surgical treatment. \u003cb\u003eTable.4\u003c/b\u003e\u003c/p\u003e \u003cp\u003eRegarding outcomes, 82.0% of patients were discharged with clinic follow-up, while 6.7% died. A small number (2.2%) had spontaneous closure of small ASD or VSD, another 2.2% underwent successful surgery?? (I don\u0026rsquo;t understand this) and were discharged from follow-up, 2.2% were discharged against medical advice, and 1.1% absconded from the hospital. \u003cb\u003eFigure. 1\u003c/b\u003e\u003c/p\u003e \u003cp\u003eComplications were observed in 56.2% of the patients, with the most common being heart failure (12.4%), pneumonia (10.1%), and failure to thrive (9.0%), while 43.8% had no complications. \u003cb\u003eTable.5\u003c/b\u003e\u003c/p\u003e \u003cp\u003eMost patients (87.6%) had no readmission, while 11.2% were readmitted once. The majority of hospital stays lasted one or two days, with a few patients staying for five days or more. \u003cb\u003eFigure. 2\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe study highlights that CHD is most prevalent in young children, particularly those aged 1\u0026ndash;5 years. Acyanotic CHD is more common than cyanotic, with VSD being the predominant defect. The majority of cases were diagnosed through echocardiography, and while medical management was common, surgical intervention was rare. Most patients were discharged for follow-up, but a small percentage experienced significant complications or mortality\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eA total of eighty-nine (n\u0026thinsp;=\u0026thinsp;89) patients were diagnosed using echocardiography, clinical presentation, and CXR in EFSTH from 2020\u0026ndash;2022. The earliest age at diagnosis was one month. The total prevalence of CHD was 3.3%, this was found in a similar study from China.[15] The ord of increasing frequency of CHD in EFSTH was as follows: VSD, ASD, TOF, PDA, and AVSD, but there were patients with multiple CHD.\u003c/p\u003e \u003cp\u003eIn this study, VSD had the highest occurrence, 39.3%, which is similar to previous studies done in The Gambia where it was 31.5%, Nigeria where 40.6% of the patients had VSD, and other studies done in East Africa.[16,17] A study in India also showed a frequency of 31.2% of patients with VSD, making it the most common defect.[18] The rising burden of VSD globally has been attributed to the increasing availability of early diagnosis, as VSDs that would have closed spontaneously in childhood are now being detected through echocardiography in infancy.[19] This has been documented by several authors. ASD accounted for 20.2%, making it the second most common defect, showing an increasing prevalence compared to previous studies in The Gambia.[14] The highest frequency of cyanotic heart disease was TOF, which accounted for 16.9% of total CHD cases. Similar results were seen in Indonesia and studies conducted by Kumar et al (where?).[20]\u003c/p\u003e \u003cp\u003eMandinka was the most common ethnicity in the study, which was also observed in a similar study done in The Gambia. This can be attributed to the high Mandinka population in The Gambia. However, an interesting finding was that the Sarahule ethnic group, which constitutes less than 10% of the Gambian population, accounted for more than 14% of the study population. This overrepresentation suggests a possible genetic predisposition to CHD within the Sarahule community. Genetic susceptibility to CHD has been documented in various populations, with certain ethnic groups displaying a higher prevalence due to inherited genetic mutations or familial clustering.[21] Further research is needed to explore potential genetic factors contributing to this trend, which may warrant targeted screening and early interventions within this ethnic group.\u003c/p\u003e \u003cp\u003eThe median age at diagnosis was 1.4 years, which is similar to a study done in Korea.[22] Females were more affected, with a frequency of 57.3%, while males accounted for 42.7%, a similar gender prevalence also reported in various studies.[23] The study also observed that the prevalence of CHD decreased with age, indicating that some defects may close spontaneously over time or remain undiagnosed in older children and/or die prematurely.[24,25] This emphasizes the importance of early diagnosis and intervention to ensure timely management of CHD cases.\u003c/p\u003e \u003cp\u003eCHD has been associated with various risk factors, with the most common in this study being Down syndrome in mothers over 35 years, occurring in 18% of cases. Advanced maternal age is a well-known risk factor for Down syndrome, and Down syndrome is associated with CHD. [26,27] The most common CHD types associated with Down syndrome in this study were VSD, followed by PDA and ASD, a similarity seen in other studies.[28\u0026ndash;30] Maternal diabetes was identified as a risk factor in 2.2% of cases, though this low percentage may be due to insufficient documentation, as maternal diabetes has shown a significant association in other studies.[31\u0026ndash;33] A positive family history was also identified as a risk factor as in the study by Jin and colleagues.[34]\u003c/p\u003e \u003cp\u003eBoth pharmacological and surgical therapies were used in these patients. The most commonly used drug was furosemide, but enalapril and digoxin were also prescribed which is similar to new advances as mentioned by Varela-Chinchilla CD.[34] A significant number of patients had heart failure as a complication of CHD due to delayed diagnosis and intervention, a trend also reported in other studies.[35\u0026ndash;37] Among non-cardiac complications, pneumonia and failure to thrive were the most common, similar to findings from an Indian study.[38]\u003c/p\u003e \u003cp\u003eApproximately 95.5% of patients did not undergo surgical intervention due to the lack of a cardiothoracic surgery center in The Gambia. Only 2.2% of patients had surgical closure of defects, while another 2.2% underwent pulmonary artery banding like in many African countries.[39] In contrast, countries with better surgical facilities have reported a higher number of successful surgical closures of defects.[40]\u003c/p\u003e \u003cp\u003eThe mortality rate for CHD patients in this study was 6.7%, with 66.7% deaths attributed to heart failure, while the remainder resulted from pneumonia and failure to thrive. Other studies too have reported higher mortality rates.[38] Most patients continue to be seen for follow-up at the paediatric cardiology clinic, with appointments scheduled based on urgency.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study provides valuable insights into the burden, clinical spectrum, and outcomes of congenital heart disease (CHD) among children diagnosed at the Edward Francis Small Teaching Hospital (EFSTH) from 2020 to 2022. Ventricular septal defect (VSD) emerged as the most prevalent CHD, with a notable proportion of patients presenting with cyanotic defects such as tetralogy of Fallot (TOF). The findings highlight a predominance of CHD among females, a median age at diagnosis of 1.4 years, and an underrepresentation of surgical interventions due to limited local capacity.\u003c/p\u003e \u003cp\u003eThe identification of ethnic disparities, particularly the overrepresentation of the Sarahule ethnic group, suggests a potential genetic predisposition that warrants further investigation. Risk factors such as advanced maternal age, Down syndrome, and positive family history were frequently associated with CHD cases.\u003c/p\u003e \u003cp\u003eDespite the use of pharmacological treatments, delayed diagnosis and limited surgical options contributed to significant morbidity and mortality, primarily due to heart failure. The study underscores the urgent need to strengthen early detection strategies, expand paediatric cardiology services, and establish cardiothoracic surgical facilities in The Gambia.\u003c/p\u003e \u003cp\u003eFuture research, particularly prospective and multi-centre studies, is essential to fully understand the epidemiology of CHD and guide evidence-based interventions that improve outcomes for affected children nationwide\u003c/p\u003e"},{"header":"Limitations","content":"\u003cp\u003eThis study was limited to a review of medical records of children admitted to the hospital. One major challenge with this approach is the potential unavailability or loss of some patient folders, which may affect the completeness of the data.\u003c/p\u003e \u003cp\u003eTo address the limitation of missing or incomplete medical records, the authors have actively supported the hospital's ongoing transition to an electronic medical records (EMR) system. This has involved engaging key stakeholders, advocating for improved health information management, and contributing to institutional efforts to strengthen data collection and preservation.\u003c/p\u003e \u003cp\u003eIn addition, the authors have initiated collaborations with other healthcare facilities and academic institutions to lay the groundwork for prospective studies. These efforts aim to enhance the research findings and provide a broader, more representative picture of paediatric health outcomes in The Gambia.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eASD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAtrial Septal Defect\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAVSD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAterioventricular Septal Defect\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCHD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCongenital Heart Defect\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEFSTH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEdward Francis Small Teaching Hospital\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEMR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eelectronic medical records\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLMICs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLow- and Middle-Income Countries\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePDA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePatent Ductus Arteriosus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSPSS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStatistical Package for the Social Sciences\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTGA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTransposition of Great Arteries\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTOF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTetralogy of Fallot\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eVSD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eVentricular Septal Defect\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Ethical approval for this study was obtained from the Research Ethics Committee of Edward Francis Small Teaching Hospital (EFSTH), Banjul, The Gambia with reference number EFSTH_REC_2023_060. This retrospective study involved the review of existing medical records, and as such, informed consent was not required. All data were anonymized, and patient confidentiality was strictly maintained. The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSource of Funding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;This study was self-funded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The data supporting the findings of this study are held by the Medical Records Department of Edward Francis Small Teaching Hospital, Banjul, The Gambia. Due to ethical considerations and the need to protect patient confidentiality, access to the data is restricted. Interested parties may request access from the corresponding author, subject to approval by the hospital\u0026rsquo;s ethics committee.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eM. Nyang; Conceptualisation, Data Collection, Writing and Data Analysis,\u003c/p\u003e\n\u003cp\u003eL. Makalo; Conceptualisation, Supervision, Data Visualisation, Reviewing and Editing\u003c/p\u003e\n\u003cp\u003eS.A Adegoke; Supervision, Reviewing and Editing\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eACKNOWLEDGMENT\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI express my profound gratitude to the Almighty for granting me the ability and knowledge to undertake this work. I extend my sincere appreciation to my mentors, Dr. Muhammed Dibba, Dr. Jim Jobe, and Dr. Abdou Aziz Jammeh, for their invaluable guidance and support. I am also grateful to my classmates for their encouragement throughout this journey. My deepest appreciation goes to my parents and brother for their unwavering support throughout my medical training. A special acknowledgment to Dr. Mahmoud Jallow for his continuous guidance and assistance, which have been instrumental in my academic and professional growth.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eZikarg YT, Yirdaw CT, Aragie TG. Prevalence of congenital septal defects among congenital heart defect patients in East Africa: A systematic review and meta-analysis. Plos one. 2021 Apr 22;16(4):e0250006.\u003c/li\u003e\n\u003cli\u003eZ\u0026uuml;hlke L, Lawrenson J, Comitis G, De Decker R, Brooks A, Fourie B, Swanson L, Hugo-Hamman C. Congenital heart disease in low-and lower-middle\u0026ndash;income countries: current status and new opportunities. Current cardiology reports. 2019 Dec;21:1-3.\u003c/li\u003e\n\u003cli\u003eZheleva B, Atwood JB. The invisible child: childhood heart disease in global health. The Lancet. 2017 Jan 7;389(10064):16-8.\u003c/li\u003e\n\u003cli\u003eMoons P, Sluysmans T, De Wolf D, Massin M, Suys B, Benatar A, Gewillig M. Congenital heart disease in 111 225 births in Belgium: birth prevalence, treatment and survival in the 21st century. Acta paediatrica. 2009 Mar;98(3):472-7.\u003c/li\u003e\n\u003cli\u003eZ\u0026uuml;hlke L, Mirabel M, Marijon E. Congenital heart disease and rheumatic heart disease in Africa: recent advances and current priorities. Heart. 2013 Nov 1;99(21):1554-61.\u003c/li\u003e\n\u003cli\u003eRohit M, Shrivastava S. Acyanotic and cyanotic congenital heart diseases. The Indian Journal of Pediatrics. 2018 Jun;85:454-60.\u003c/li\u003e\n\u003cli\u003eChelo D, Nguefack F, Menanga AP, Um SN, Gody JC, Tatah SA, Ndombo PO. Spectrum of heart diseases in children: an echocardiographic study of 1,666 subjects in a pediatric hospital, Yaounde, Cameroon. Cardiovascular Diagnosis and Therapy. 2016 Feb;6(1):10.\u003c/li\u003e\n\u003cli\u003eTankeu AT, Bigna JJ, Nansseu JR, Aminde LN, Danwang C, Temgoua MN, Noubiap JJ. Prevalence and patterns of congenital heart diseases in Africa: a systematic review and meta-analysis protocol. BMJ open. 2017 Feb 1;7(2):e015633.\u003c/li\u003e\n\u003cli\u003eOtaigbe BE, Tabansi PN. Congenital heart disease in the Niger Delta region of Nigeria: a four-year prospective echocardiographic analysis: cardiovascular topic. Cardiovascular journal of Africa. 2014 Nov 1;25(6):265-8.\u003c/li\u003e\n\u003cli\u003eMassoure PL, Roche NC, Lamblin G, Dehan C, Kaiser E, Fourcade L. Cardiovascular disease in children in Djibouti: a single-centre study. The Pan African Medical Journal. 2013;14.\u003c/li\u003e\n\u003cli\u003eLakhotia S, Mathur SK, Das NN, Gupta RK, Maiti D, Roy S. Surgical outcome of congenital heart disease cases: A single unit analysis in an upcoming centre in Eastern Uttar Pradesh, India. 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Front Cardiovasc Med. 2023 Sep 8;10:1131383. doi: 10.3389/fcvm.2023.1131383. PMID: 37745117; PMCID: PMC10514906.\u003c/li\u003e\n\u003cli\u003eAbdulkadir M, Abdulkadir Z. A systematic review of trends and patterns of congenital heart disease in children in Nigeria from 1964-2015. Afr Health Sci. 2016 Jun;16(2):367-77. doi: 10.4314/ahs.v16i2.5. PMID: 27605952; PMCID: PMC4994567.Rohit M, Rajan P. Approach to cyanotic congenital heart disease in children. The Indian Journal of Pediatrics. 2020 May;87:372-80.\u003c/li\u003e\n\u003cli\u003eZikarg YT, Yirdaw CT, Aragie TG. Prevalence of congenital septal defects among congenital heart defect patients in East Africa: A systematic review and meta-analysis. PLoS One. 2021 Apr 22;16(4):e0250006. doi: 10.1371/journal.pone.0250006. PMID: 33886628; PMCID: PMC8062078. \u003c/li\u003e\n\u003cli\u003eWanni, Khurshid Ahmed1; Shahzad, Naveed1; Ashraf, Mohd1,; Ahmed, Kaisar1; Jan, Muzafer1; Rasool, Shafaqat2. Prevalence and Spectrum of Congenital Heart Diseases in Children. Heart India 2(3):p 76-79, Jul\u0026ndash;Sep 2014. | DOI: 10.4103/2321-449x.140230 \u003c/li\u003e\n\u003cli\u003eLiu Y, Chen S, Z\u0026uuml;hlke L, Babu-Narayan SV, Black GC, Choy MK, Li N, Keavney BD. Global prevalence of congenital heart disease in school-age children: a meta-analysis and systematic review. BMC Cardiovasc Disord. 2020 Nov 19;20(1):488. doi: 10.1186/s12872-020-01781-x. PMID: 33213369; PMCID: PMC7678306.Bouma BJ, Mulder BJ. Changing landscape of congenital heart disease. Circulation research. 2017 Mar 17;120(6):908-22.\u003c/li\u003e\n\u003cli\u003eKumar BD, Reddy KR, Elizabeth B. Study of incidence of congenital heart diseases in children of age group 1 month to 12 yrs. Journal of Evolution of Medical and Dental Sciences. 2015 Jan 22;4(7):1151-60.\u003c/li\u003e\n\u003cli\u003eMartinez, H.R., Beasley, G.S., Jefferies, J., Towbin, J.A. (2021). Genetics and Genomics of Congenital and Acquired Cardiovascular Disease. In: da Cruz, E.M., Ivy, D., Hraska, V., Jaggers, J. (eds) Pediatric and Congenital Cardiology, Cardiac Surgery and Intensive Care. Springer, London. https://doi.org/10.1007/978-1-4471-4999-6_89-2 \u003c/li\u003e\n\u003cli\u003eHa KS, Park CM, Lee J, Shin J, Choi EK, Choi M, Kim J, Shin HJ, Choi BM, Kim SJ. Nationwide Birth Prevalence of Crucial Congenital Heart Defects From 2014 to 2018 in Korea. Korean Circ J. 2024 Dec;54(12):838-850. https://doi.org/10.4070/kcj.2024.0105Desai K, Rabinowitz EJ, Epstein S. Physiologic diagnosis of congenital heart disease in cyanotic neonates. Current opinion in pediatrics. 2019 Apr 1;31(2):274-83.\u003c/li\u003e\n\u003cli\u003ePugnaloni F, Felici A, Corno AF, Marino B, Versacci P, Putotto C. Gender differences in congenital heart defects: a narrative review. Transl Pediatr. 2023 Sep 18;12(9):1753-1764. doi: 10.21037/tp-23-260. Epub 2023 Sep 11. PMID: 37814719; PMCID: PMC10560357.\u003c/li\u003e\n\u003cli\u003eDakkak W, Alahmadi MH, Oliver TI. Ventricular Septal Defect. [Updated 2024 Oct 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470330/ \u003c/li\u003e\n\u003cli\u003eGilboa SM, Salemi JL, Nembhard WN, Fixler DE, Correa A. Mortality resulting from congenital heart disease among children and adults in the United States, 1999 to 2006. Circulation. 2010 Nov 30;122(22):2254-63. doi: 10.1161/CIRCULATIONAHA.110.947002. Epub 2010 Nov 22. PMID: 21098447; PMCID: PMC4911018.\u003c/li\u003e\n\u003cli\u003eAprigio J, de Castro CML, Lima MAC, Ribeiro MG, Orioli IM, Amorim MR. Mothers of children with Down syndrome: a clinical and epidemiological study. J Community Genet. 2023 Apr;14(2):189-195. doi: 10.1007/s12687-022-00627-7. Epub 2022 Dec 23. PMID: 36562914; PMCID: PMC10104982.Nijres BM, Samuel BP, Vettukattil JJ. Subclinical atherosclerosis in patients with cyanotic congenital heart disease. International journal of cardiology. 2019 May 1;282:44.\u003c/li\u003e\n\u003cli\u003eAsim A, Agarwal S, Dean DD. Maternal Risk Factors Triggering Congenital Heart Defects in Down Syndrome: A Case-Control Study. Pediatr Rep. 2022 Feb 28;14(1):99-105. doi: 10.3390/pediatric14010015. PMID: 35324818; PMCID: PMC8950734.MM OG, Bhakta RT, Tarmahomed A, Mendez MD. Cyanotic Heart Disease. \u003c/li\u003e\n\u003cli\u003eSanadhya A, Meena N, Sharma P, Setia S, Study to assess incidence and type of congenital heart defect in children with dowsyndrome presenting to tertiary care teaching hospital of southern Rajasthan. Int J Contemp Pediatr2023;10:1108-12 \u003c/li\u003e\n\u003cli\u003eSusan UA, Chiemerie OA. Prevalence and pattern of congenital heart disease among children with Down syndrome seen in a Federal Medical Centre in the Niger Delta Region, Nigeria. J Cardiol Cardiovasc Med. 2022; 7: 030-035.\u003c/li\u003e\n\u003cli\u003eKim MA, Lee YS, Yee NH, Choi JS, Choi JY, Seo K. Prevalence of Congenital Heart Defects Associated with Down Syndrome in Korea. J Korean Med Sci. 2014 Nov;29(11):1544-1549. \u003c/li\u003e\n\u003cli\u003eIbrahim S, Gaborit B, Lenoir M, Collod-Beroud G, Stefanovic S. Maternal Pre-Existing Diabetes: A Non-Inherited Risk Factor for Congenital Cardiopathies. Int J Mol Sci. 2023 Nov 13;24(22):16258. doi: 10.3390/ijms242216258. PMID: 38003449; PMCID: PMC10671602.\u003c/li\u003e\n\u003cli\u003eLiu Y, Yue L, Chang L. Maternal Gestational Diabetes Mellitus and Congenital Heart Disease in Offspring: A Meta-Analysis. Horm Metab Res. 2024 Aug;56(8):574-584. doi: 10.1055/a-2238-1710. Epub 2024 Feb 2. PMID: 38307090.\u003c/li\u003e\n\u003cli\u003eDelgado Y, Gaytan C, Perez N, Miranda E, Morales BC, Santos M. Association of congenital heart defects (CHD) with factors related to maternal health and pregnancy in newborns in Puerto Rico. Congenit Heart Dis. 2024;19(1):19-31. doi: 10.32604/chd.2024.046339. Epub 2024 Mar 20. PMID: 38912385; PMCID: PMC11192526.\u003c/li\u003e\n\u003cli\u003eVarela-Chinchilla CD, S\u0026aacute;nchez-Mej\u0026iacute;a DE, Trinidad-Calder\u0026oacute;n PA. Congenital Heart Disease: The State-of-the-Art on Its Pharmacological Therapeutics. J Cardiovasc Dev Dis. 2022 Jun 26;9(7):201. doi: 10.3390/jcdd9070201. PMID: 35877563; PMCID: PMC9316572.\u003c/li\u003e\n\u003cli\u003eLiberman RF, Getz KD, Lin AE, Higgins CA, Sekhavat S, Markenson GR, Anderka M. Delayed diagnosis of critical congenital heart defects: trends and associated factors. Pediatrics. 2014 Aug;134(2):e373-81. doi: 10.1542/peds.2013-3949. PMID: 25070301; PMCID: PMC9923616.\u003c/li\u003e\n\u003cli\u003eThomford, N.E., Biney, R.P., Okai, E. \u003cem\u003eet al.\u003c/em\u003e Clinical Spectrum of congenital heart defects (CHD) detected at the child health Clinic in a Tertiary Health Facility in Ghana: a retrospective analysis. \u003cem\u003eJ Congenit Heart Dis\u003c/em\u003e\u003cstrong\u003e4\u003c/strong\u003e, 3 (2020). https://doi.org/10.1186/s40949-020-00034-y\u003c/li\u003e\n\u003cli\u003eRashid, Usman; Qureshi, Ahmad U; Hyder, Syed N; Sadiq, Masood. Pattern of congenital heart disease in a developing country tertiary care center: Factors associated with delayed diagnosis. Annals of Pediatric Cardiology 9(3):p 210-215, Sep\u0026ndash;Dec 2016. | DOI: 10.4103/0974-2069.189125\u003c/li\u003e\n\u003cli\u003eJat NK, Bhagwani DK, Bhutani N, Sharma U, Sharma R, Gupta R. Assessment of the prevalence of congenital heart disease in children with pneumonia in tertiary care hospital: A cross-sectional study. Ann Med Surg (Lond). 2021 Nov 23;73:103111. doi: 10.1016/j.amsu.2021.103111. PMID: 34976377; PMCID: PMC8683668.\u003c/li\u003e\n\u003cli\u003eAkintoye, O.O., Adu, B.G., Otorkpa, M.J. \u003cem\u003eet al.\u003c/em\u003e The current state of minimally invasive cardiac surgery in Africa: a systematic review and meta-analysis. \u003cem\u003eCardiothorac Surg\u003c/em\u003e\u003cstrong\u003e32\u003c/strong\u003e, 15 (2024). https://doi.org/10.1186/s43057-024-00134-0\u003c/li\u003e\n\u003cli\u003eKempny A, Dimopoulos K, Uebing A, Diller GP, Rosendahl U, Belitsis G, Gatzoulis MA, Wort SJ. Outcome of cardiac surgery in patients with congenital heart disease in England between 1997 and 2015. PLoS One. 2017 Jun 19;12(6):e0178963. doi: 10.1371/journal.pone.0178963. PMID: 28628610; PMCID: PMC5476245.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTABLE 1. Sociodemographic Data\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"510\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eDemographics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003epercentage\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e0-11months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e28.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e12months-5years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e65.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u0026gt;5years-10years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u0026gt;10years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eGender Distribution\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e57.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e42.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eEthnicity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eMandinka\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e41.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eFula\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e20.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eSarahule\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e14.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eWollof\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e9.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e14.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTABLE 2. SHOWING TYPES OF CHD\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"638\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eTypes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003ePercent\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eAtrial Septal Defect (ASD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e20.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eAtrioventricular Septal Defect (AVSD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e5.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003ePatent Ductus Arteriosus (PDA)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e10.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003ePulmonary stenosis/Atresia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e5.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eTransposition of Great Artery (TGA)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e3.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eTetralogy Of Fallot (TOF)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e16.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eTricuspid Valve Atresia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e1.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eVentricular Septal Defect (VSD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e39.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eNot Classified (N/C)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e15.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTABLE 3. ASSOCIATED RISK FACTORS\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"638\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eRisk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003ePercent\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eAssociated osteogenesis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e2.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eDown Syndrome with maternal age \u0026gt;35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e18.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eMaternal age \u0026gt;35yrs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e1.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eMaternal Diabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e2.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eNo identifiable factor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e73.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003ePreterm baby\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e1.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003ePositive family history\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e2.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTABLE 4. SHOWING DRUGS USED AND THEIR FREQUENCIES\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"638\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eDrugs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003ePercent\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eCaptopril\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e1.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eDigoxin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e5.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eEnalapril\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e13.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eFurosemide\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e68.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eNo drug used\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e18.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eNot indicated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e1.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003ePropranolol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e13.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eSpironolactone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e10.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\u003cp\u003e\u003cstrong\u003eTABLE 5 SHOWING COMPLICATIONS\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"546\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 212px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003ePercent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003eValid Percent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eCumulative Percent\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"16\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eAnemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eCardiomyopathy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eCerebral abscess\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e3.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eConvulsion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eDelay development\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e6.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eDelay development \u0026amp; Malnutrition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e7.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eFailure to Thrive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e9.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e9.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e16.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eFailure to Thrive, Pneumonia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e22.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eHeart Failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e12.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e12.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e34.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eHeart Failure, Failure to Thrive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e37.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e43.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e43.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e80.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003ePneumonia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e10.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e10.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e91.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003ePneumonia, Heart Failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e6.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e6.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e97.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003ePoor weight gain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e98.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eSevere malnutrition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Congenital Heart Disease, Management Outcome, Paediatrics, Prevalence","lastPublishedDoi":"10.21203/rs.3.rs-6383402/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6383402/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCongenital 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo determine the prevalence, management strategies, and outcomes of CHDs in children at Edward Francis Small Teaching Hospital from January 2020 to December 2022.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA 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.\u003c/p\u003e\n\u003cp\u003eThe most common associated clinical condition was Down syndrome (%), these children were mainly born to mothers above 35 years (maternal age \u0026gt;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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eVSD was the most common CHD in this study, with a median patient age of 1.4 years. Down syndrome with maternal age \u0026gt;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.\u003c/p\u003e","manuscriptTitle":"A Retrospective Study on the Prevalence, Management, and Outcomes of Congenital Heart Diseases in Children at Edward Francis Small Teaching Hospital, Banjul, The Gambia.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-08 14:47:03","doi":"10.21203/rs.3.rs-6383402/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-06T06:21:50+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-04T21:15:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"18082734030726874114600609776870680835","date":"2025-05-03T03:56:05+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-01T16:42:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"175245907640140520560425714747417932288","date":"2025-05-01T07:39:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"273837175513296702142274623948377604522","date":"2025-05-01T04:13:36+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-01T03:43:01+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-28T10:52:27+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-04-18T10:06:27+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-17T20:14:19+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cardiovascular Disorders","date":"2025-04-17T20:13:16+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f00d5bbe-022b-4c95-9fa9-b83c837b0259","owner":[],"postedDate":"May 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-07-28T16:00:34+00:00","versionOfRecord":{"articleIdentity":"rs-6383402","link":"https://doi.org/10.1186/s12872-025-04948-6","journal":{"identity":"bmc-cardiovascular-disorders","isVorOnly":false,"title":"BMC Cardiovascular Disorders"},"publishedOn":"2025-07-23 15:57:26","publishedOnDateReadable":"July 23rd, 2025"},"versionCreatedAt":"2025-05-08 14:47:03","video":"","vorDoi":"10.1186/s12872-025-04948-6","vorDoiUrl":"https://doi.org/10.1186/s12872-025-04948-6","workflowStages":[]},"version":"v1","identity":"rs-6383402","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6383402","identity":"rs-6383402","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}
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