Pediatric cardiovascular care in Uganda

Aliku, Twalib; Lubega, Sulaiman; Namuyonga, Judith; Mwambu, Tom; Oketcho, Michael; Omagino, John; Sable, Craig; Lwabi, Peter

doi:10.4103/0974-2069.197069

Cited by 32 publications

(38 citation statements)

References 7 publications

(9 reference statements)

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“…It is intriguing that there is a discordance between prevalence of TA in our study and other studies. On the other hand, this finding is similar to a recent report from another sub Saharan African country, Uganda, where a high prevalence of 5% was found (Aliku et al, ). The reason for this high prevalence is not entirely understood.…”

Section: Discussionsupporting

confidence: 92%

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Clinical epidemiology of congenital heart disease in Nigerian children, 2012–2017

Ekure

Kalu²,

Sokunbi³

et al. 2018

Birth Defects Research

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Section: Discussionsupporting

confidence: 92%

“…(Kiran et al, ; Patel et al, 2016). On the contrary, Uganda recently reported a rate of 7% (Aliku et al, ). Previous epidemiological data in Nigeria seem to indicate differences between the 1960s and the 21st century.…”

Section: Discussionmentioning

confidence: 97%

Clinical epidemiology of congenital heart disease in Nigerian children, 2012–2017

Ekure

Kalu²,

Sokunbi³

et al. 2018

Birth Defects Research

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“…In 2015, through partnership with RHDAction (global movement to reduce the burden of rheumatic heart disease (RHD), RHDAction.org), an innovative pilot program of task sharing was developed to facilitate decentralized diagnosis of heart failure. A single regional referral hospital in Northern Uganda, Lira Regional Referral Hospital (LRRH), serving eight districts and approximately 2,000,000 persons [10] was selected for the program given its remote location with a large catchment area (Figure 1). No TTE was available at LRRH prior to study commencement.…”

Section: Methodsmentioning

confidence: 99%

Improving the accuracy of heart failure diagnosis in low-resource settings through task sharing and decentralization

DeWyer

Scheel

Otim

et al. 2019

Global Health Action

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Background: Task sharing of TTE may improve capacity for heart failure diagnosis and management in patients in remote, low-resource settings but the impact on diagnostic accuracy and patient outcomes has not been studied.Objectives: Determine feasibility and impact of non-expert training in transthoracic echocardiography (TTE) to improve the diagnosis and outcomes of patients with suspected heart failure in Uganda.Methods: This two-part study examined an innovative training program to develop TTE competency among non-experts and used a pre-post design to determine the impact of decentralized TTE. Four of 8 non-experts (50%) passed a three-part training course. The training comprised of distance learning through a web-based curriculum, a 2-day hands-on workshop with cardiologists, and independent practice with remote mentorship. Continuous measures were compared (pre- vs. post-TTE) using t-tests or Wilcoxon rank-sum tests as distributionally appropriate and categorical variables assessed through chi-square testing. Sensitivity and specificity were calculated according to standard methodology comparing diagnosis pre- and post-TTE during phase 2.Results: Performance in the post-training phase showed good agreement with expert categorization (κ = 0.80) with diagnostic concordance in 421 of 454 studies (92.7%). TTE changed the preliminary diagnosis in 81% of patients, showing low specificity of clinical decision-making alone (14.2%; 95% CI 10.1–19.2%). Dilated cardiomyopathy, hypertensive heart disease with preserved systolic function, and right heart failure were the most underdiagnosed conditions prior to TTE while hypertensive heart disease with decreased systolic function was the most over-diagnosed condition.Conclusions: In conclusion, non-expert providers can achieve a high level of proficiency for the categorization of heart failure using handheld TTE in low-resource settings and use of telemedicine and remote mentorship may improve performance and feasibility. The addition of TTE resulted in substantial improvement in etiological specificity. Further study is needed to understand implications of this strategy on healthcare utilization, long-term patient outcomes, and cost.

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“…In part, this is due to a predominance of hospital studies with heterogenous methodology (Tankeu et al, 2017). Reviews from Uganda (Aliku et al, 2017;Namuyonga et al, 2019) found that the distribution of CHD was similar to other parts of the world with two notable exceptions. There was an exceedingly high incidence of truncus arteriosus (5% of CHDs) and very low incidence of coarctation (less than 0.5%).…”

Section: Case Studies-africamentioning

confidence: 99%

Congenital heart disease in low‐and‐middle‐income countries: Focus on sub‐Saharan Africa

Zimmerman

Sable

2020

American J of Med Genetics Pt C

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The etiology of congenital heart disease (CHD) is multifactorial. The birth prevalence of CHD is shaped by a wide variety of maternal, fetal, and neonatal risk factors, along with the rates of prenatal diagnosis and terminations of pregnancy, all of which have geographic variability Epidemiology data availability from low‐and‐middle‐income countries (LMIC) on CHD prevalence, morbidity, and mortality are far more limited than from high income countries. Data on specific genetic, environmental, and prenatal risk associated with CHD are almost nonexistent. In this article, we will focus on defining what data are available, genetic risk factors, birth and overall prevalence, morbidity, and the impact of limited access to interventions, both surgery and cardiac catheterizations. We will highlight CHD in sub‐Saharan Africa to detail epidemiology studies in the poorest regions of the world. Existing literature as well as estimates from the Global Burden of Disease Study (http://ghdx.healthdata.org) form the basis for this review. The intersection of poverty, high fertility rates, and limited access to care results in a unique profile of CHD in LMIC. CHD is not a preventable disease (by most standards), so early detection and access are our key interventions to improve the dire outcomes for children in low‐resources settings of the world.

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Pediatric cardiovascular care in Uganda

Cited by 32 publications

References 7 publications

Clinical epidemiology of congenital heart disease in Nigerian children, 2012–2017

Clinical epidemiology of congenital heart disease in Nigerian children, 2012–2017

Improving the accuracy of heart failure diagnosis in low-resource settings through task sharing and decentralization

Congenital heart disease in low‐and‐middle‐income countries: Focus on sub‐Saharan Africa

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