30,000 born with heart defects yearly

By Esther Namirimu

At least 40 new cases of children with heart disease are registered every week. A heart disease is a defect that occurs in the structure of the heart or its vessels.

 Dr. Twalib Aliku, a paediatric cardiologist (heart expert) at the Uganda Heart Institute, says one out of every 100 babies born every day has a congenital heart problem. This translates into about 30,000 babies born with a heart problem in Uganda every year, with the majority dying before the condition is diagnosed.

Lately, Uganda is registering many cases because the technology is readily available and many people are aware of the conditions, so they endeavour to seek medical help.

“We started diagnosing heart conditions in the early 1990s. In the late 1990s, we started performing closed heart surgeries and in 2007, open heart surgeries,” he adds. Closed heart surgery is a medical procedure in which a small incision is made without opening the chest cavity, as opposed to open heart surgery where the chest cavity is opened.



Common heart conditions

There are two types of heart defects; congenital and acquired heart disease. A congenital heart defect is present at birth, while an acquired condition develops after birth.

Aliku says ventricular septal defect, which is locally referred to as “a hole in the heart”, is the commonest congenital heart defect. While some holes are small and the patients can live with them, others are so large that they require immediate medical attention to close them.

Rheumatic heart disease (caused by rheumatic fever) is the most common acquired heart disease in children in Uganda. It often starts as a fever, a sore throat and joint pains, which if not treated may damage the heart valves. Rheumatic fever is an inflammatory disease that may develop as a complication of a streptococcus infection, such as strep throat or scarlet fever.


Preventative measures

Aliku advises women in the reproductive age to start taking folic acid at least three months before pregnancy. Most women only take folic acid after realising that they are pregnant, usually about four weeks after conceiving. By this time, the baby’s heart would have already started developing.

Aliku also advises women to desist from alcohol and cigarette smoking. In addition, he recommends that women start having babies in their 20s or early 30s. “Also, guard against diseases such as HIV/AIDS, malaria, diabetes and TB, as they can trigger premature birth, where the baby is born before the organs, such as the heart, have fully developed,” he adds.

Aliku also recommends clean housing and sanitation to prevent infections like streptococcus that may result in heart diseases.


How to tell that your unborn baby is affected

Expectant mothers are advised to make use of obstetric ultra sound scans during the second trimester to observe the foetal growth. If need be, the stenographer refers the mother to a paediatric cardiologist.

 The cardiologist evaluates the condition and recommends a solution, which may include living with the defect or undergoing surgery. In addition, a pregnant woman is advised to give birth in a hospital that has the necessary equipment to do the surgery.

Cost of treatment

The cost of treatment depends on the condition as well as the requirements for the surgery because they are purchased abroad. Lubega adds that at the heart institute, one may spend about $5,000 (about sh13m), depending on the condition, while abroad, the cost depends on the complexity of the case, the price of the air ticket as well as hospital and hotel bills.

Open heart surgery is more expensive than closed heart surgery because machines take over the functions of the heart and the kidney, while the operation is being done.

Aliku says some congenital heart defects can be corrected by the local specialists, but the complex conditions like truncus arteriosus,complete atrioventricular septal defect and univentricular (single ventricle heart) disease are referred abroad for specialised attention.

The chairman and founder of the Uganda Heart Institute, Robert Ssebunya, in a recent article in New Vision said: “Mulago can now handle open heart surgery.”

Early this year, a visiting team from America carried out 13 open heart surgeries and about 16 stenting procedures. A stenting procedure involves inserting a small wire mesh tube called a stent into the heart to help prop the artery open and decrease the chance of it narrowing again.

“Last year, about 60 Ugandans benefitted from the open heart surgery and we want to assure fellow countrymen that these kind of arrangement will continue,” he adds.

Renowned Egyptian cardiac surgeon Sir Magib, says the Uganda Heart Institute surgeons are as good as any other cardiac surgeon you may find in Europe or America. “In fact, the equipment here may not be easily found in many cardiac clinics abroad. For instance, the patent ductus arteriosis condition is cheaper to treat in Uganda.

Many people cannot afford treatment for heart surgery, so the heart institute waivers some fees.