An Evaluation of the Management of Congestive Heart Failure in Children at Kenyatta National Hospital

Abstract

Background Congestive heart failure in the pediatric population is a significant cause of morbidity and mortality. It has a wide variety of etiologies. These causes vary widely among different geographical regions globally, ages and social classes(1). There is a paucity of data on the epidemiology, etiology, and management of congestive heart failure in children as compared to major advances in research in adult heart failure(2). Primary caregivers of children with congestive heart failure face various challenges when caring for their children. Objectives This study sought to identify the etiology of congestive heart failure as well as the types of drugs used in its management among children in Kenyatta National Hospital. It also sought to investigate the challenges faced by parents and guardians in the care of these children. Methods A cross-sectional study was done involving pediatric patients with heart failure whose medical records were reviewed. This was done to determine the etiologies and types of drugs used in the management of heart failure among children. Challenges facing parents and guardians of children with heart failure were also explored. Fifty three records of the patients were selected from the KNH records department and thirty parents and guardians of the children recruited from the pediatric wards. The data was entered into Excel 2013 and analyzed using STATA version 13.0. It was then summarized and presented in pie charts, bar graphs, and tables. Results The major etiology for heart failure among the 53 patients whose records were reviewed was infections (58.5%), this included respiratory tract and urinary tract infections. Other etiologies included; congenital heart disease (34%,) pulmonary hypertension (26%), cardiomyopathies (15.1%) and rheumatic heart disease (13.2 %.)

The most commonly prescribed drugs were furosemide (98.1%), digoxin (67.9%). Only 22.6% of the patients were on the prescribed drug combination for heart failure in children according to the Kenya national clinical guidelines. The major challenges faced by the 30 parents and guardians recruited were; financial constraint (90%), disruption of their work or business (73.3%), frequent readmissions (70%) and discrimination (53.3%). Conclusions The etiology of congestive heart failure in the pediatric patients was multifaceted and there was poor adherence to the Kenya National guidelines for the management of heart failure in children. This is in regard to the choice of drugs for heart failure as well as the dosing. Numerous challenges face parents and guardians of children with heart failure. Recommendations Prompt treatment of infections in children with underlying heart disease to prevent the development of heart failure is recommended. Further research on the lack of prescriber preference for Enalapril in the management of pediatric heart failure should be done. Strengthening of prescriber capacity in the management of congestive heart failure in children should be done.