Structure of Morbidity and Prevalence of Congenital Malformations among Children of the Osh Region in 2018-2020

Aizhan Tashbolotovna Matkasymova*, Aida Abdisaminovna Anarbaeva, Baktygul Turdalievna Janturaeva, Kursanbek Tashbolotovich Turdubaev, Roman Kalmatovich Kalmatov

Abstract

Analysis of the structure of morbidity and prevalence of congenital malformations among children in the Osh region in 2018-2020. The database was compiled based on the results of the analysis of 950 medical records of children with congenital heart defects (aged 0 to 15 years 11 months) filled in during 2018-2020. Results: the authors have noted an increase in the number of boys and a decrease in the number of girls with congenital heart defects in 2020 compared to 2019 and 2018 (66.4% and 33.6%; 61.3% and 38.7%; 47.3% and 52.7%, respectively). There was a significant decrease (p <0.05) in the number of children aged 0 to 1 year (38.8% in 2020 versus 50.2% in 2018) and a significant (p <0.05) increase in the number of children in the age range 6 to 15 years old (21.1% in 2020 compared to 12.5% in 2018). Significantly more often (p <0.05) in 2018, 2019 and 2020, ventricular septal defect was registered (39.60%; 45.29% and 34.12% of cases, respectively). Conclusion: the study of the peculiarities of the dynamics of registered congenital heart defects among children of the Osh region in 2018-2020 taking into account gender and age characteristics is important for the development of organizational measures for diagnosis and treatment and will make it possible to create a congenital heart defects register in this region, the presence of which will ensure the monitoring of patients with congenital heart defects at every stage from registration to deregistration.

Keywords: Congenital heart defects, Morbidity, Ventricular septal defect, Osh region

Introduction

Congenital heart defects (CHDs) and cardiovascular system defects account for 47% (12.2 per 10 thousand live births) of all causes of death from malformations (Alanazi et al., 2020; Permadi et al., 2020). Analysis of the total mortality data increased during the first week of life, accounting for 1/3 of newborns (Bokeriya & Shatalova, 2016).

In the Kyrgyz Republic, 1,700,000 — 2,000,000 children are born annually, and 20,000 of those children have heart defects at birth. The share of critical defects, where the surgical correction is necessary for the first days and even hours of life, amounts to approximately 25% (Kirillov et al., 2014; Bokeriya & Gudkova, 2016).

There are many classifications of congenital malformations (CMs) (Kirillov et al., 2014; Flocco et al., 2018).

Pathophysiological classification is considered one of the main kinds of classification. The malformations are divided into the following:

1. White (left-right shunt: no mixing of arterial and venous blood).

• With an enrichment of the pulmonary circulation (patent ductus arteriosus (PDA), atrial septal defect (ASD), ventricular septal defect (VSD), AV communication, etc.);
• With the depletion of the pulmonary circulation (isolated pulmonary stenosis, etc.);
• With the depletion of the systemic circulation (isolated aortic stenosis, coarctation of the aorta, etc.);
• Without a significant disturbance of systemic hemodynamics (disposition of the heart: dextro-, sinistro-, mesocardia; heart dystopias, such as cervical, thoracic, abdominal).

2. Blue (right-left blood discharge, mixing of arterial and venous blood occurs):

• with enrichment of the pulmonary circulation (complete transposition of the great vessels (TGV), Eisenmenger complex, etc.);
• with the impoverishment of the pulmonary circulation (tetrad of Fallot, Ebstein's anomaly, etc.).

According to other researchers, defects can be isolated (VSD, ASD, pulmonary artery stenosis) and complex (combined), namely, defects of the atrioventricular septum, tetralogy of Fallot, and transposition of the great arteries (Ekenze et al., 2009; Lobzov, 2010; Flocco et al., 2018).

According to domestic researchers, it is important to classify CHD according to the criticality of the situation during the neonatal period (ductus-dependent and foramen-dependent) (Manuilenko et al., 2000; Bokeriya, 2019).

It is noted that the prevalence of CHDs in certain regions is characterized by significant variability. There are regional differences in prevalence and incidence due to genomic, clinical, and environmental factors (Papova, 2006; Lobzov, 2008; Federal clinical guidelines for medical care for children with congenital heart defects, 2015).

Clarification of the structural features and the prevalence rate of CHDs among children in each of the regions is a necessary step for creating a regional register of CHD patients. This will allow for dynamic monitoring of such patients and timely determination of the tactics of their management in the postpartum period.

In our work, we analyzed the structure of the incidence and prevalence of CHDs among children in the Osh region for 2018-2020.

Purpose of the study: analysis of the structure of morbidity and prevalence of CMs among children in the Osh region in 2018-2020.

Materials and Methods

This retrospective clinical study was conducted at the Osh Interregional Children's Clinical Hospital.

To compile the database, we used the results of the analysis of 950 medical records of children with CHDs (aged 0 to 15 years 11 months) filled in during 2018-2020. The accumulation of the initial data into the database was carried out using the Microsoft® Excel software.

Registration of CHDs was carried out following the nomenclature headings Q20-Q28 "Congenital anomalies of the circulatory system", class XVII "Congenital anomalies (malformations), deformities and chromosomal abnormalities" of the International Statistical Classification of Diseases and Problems Associated with Health (10th revision) (ICD‑10). The following CHDs were taken into account: VSD/ASD (ventricular/atrial septal defect), VSD + ASD, atrioventricular canal (AVC), PDA, TGV, double vascular discharge from the right ventricle (DOS from the right ventricle) severe CHD, Fallot's disease, Epstein's disease.

The following were used as primary documentation: inpatient report forms (form No. 010u, order No. 1030 of the Ministry of Health of the USSR dated 04.10.1980); inpatient statistical cards (form No. 066/u‑02, order No. 413 of the Ministry of Health of the Russian Federation dated 30.12.2002). The analysis of the prevalence of CHDs in the Osh region was carried out by territorial zones.

The analysis of the results is presented as M ± σ. Differences were considered significant when the significance level of the analyzed data was less than 0.05.

Results and Discussion  

The gender/age characteristics of the respondents, according to a certain time interval in absolute and percentage terms, are presented in Tables 1 and 2 and Figures 1 and 2.

Table 1. Gender characteristics of the subjects with CHDs according to the defined time interval.

The presented data characterize the trend of an increase in the number of boys and a decrease in the number of girls with CHDs in 2020 compared to 2019 and 2018 (66.4% and 33.6%; 61.3% and 38.7%; 47.3% and 52.7%, respectively).

The age characteristics of the subjects, according to a certain time interval, are presented in Table 2.

Table 2. Comparative characteristics of the age-specific data of patients with CHDs according to the defined time interval (abs.).

Analysis of age-specific data for the presented period (2018, 2019, and 2020) indicates a significant decrease (p <0.05) in the number of children aged 0 to 1 year (38.8% in 2020 versus 50.2% in 2018) and a significant (p <0.05) increase in the number of children in the age range from 6 to 15 years (21.1% in 2020 compared to 12.5% in 2018).

The structure of CHD morbidity for 2018-20 is presented in Table 3.

Table 3. Comparative characteristics of the structure of the CHD incidence in 2018-20.

Note: * p <0.05 is the reliability of the difference in the trait within the groups.

VSD was registered significantly more often (p <0.05) in 2018, 2019 and 2020 (39.60%; 45.29% and 34.12% of cases, respectively). The second place in the frequency of occurrence was held by ASD (24.89%; 22.17% and 22.84%, respectively).

An analysis of the prevalence of CHDs in the districts of Osh oblast is presented in Table 4.

Table 4. Comparative characteristics of the CHD prevalence in the districts of the Osh region.

Note: * p <0.05 is the reliability of the difference in the trait within the groups.

The presented data indicate that the largest number of cases (p <0.05) of registration of children with CHD was recorded in Osh in 2018, 2019, and 2020.

CHDs are one of the main problems in pediatric cardiac surgery. This is since timely verification of one or another defect determines the further tactics of managing the child with the determination of the volume of surgery and the timing.

Some authors associate the increase in the incidence rate among children in the age range from 6 to 15 years, which was demonstrated in our study, with delayed diagnosis and, accordingly, later surgical intervention for this pathology, etc. (Nelunova et al., 2018).

When analyzing the gender characteristics of registered CHDs for the period 2018-2020, we noted an increase in the number of male children (p <0.05) (66.4% in 2020 compared to 47.3% in 2018) and a decrease in the number of female children with CHDs (52.7% and 33.6% in 2018 and 2020 respectively).

The study of the prevalence of CHD patient groups according to the districts of Osh oblast showed that most often they were registered (2018-2020) in Osh, Kara-Suu, and Nookat (26.70%; 24.89%; 13.58% in 2018., 2019 and 2020, respectively; 27.59%, 24.53%; 13.44% in 2018, 2019 and 2020, respectively; 27.56%, 25.45% and 13.65% in 2018, 2019, and 2020 respectively).

Conclusion

1. The study of the peculiarities of the dynamics of registered CHDs among children of the Osh region in 2018-2020 taking into account gender and age characteristics is important for the development of organizational measures for diagnosis and treatment.
2. The study of the prevalence of CHD groups in the districts of Osh oblast will make it possible to create a CHD register in this region, the presence of which will ensure the monitoring of CHD patients at every stage from registration to deregistration.

Acknowledgments: None

Conflict of interest: None

Financial support: None

Ethics statement: None

Alanazi, A., Alghanim, M. H., Alamer, A. J., Alshaqaqiq, M. A., Al Busaeed, M. M., Alahmed, A. H., Alali, A. I., Almazyadi, H., Alharbi, W. F., Nasser, I. A. et al. (2020). Acute Myocardial Infarction Patients’ Knowledge Regarding the Modifiable Risk Factors of Heart Disease. International Journal of Pharmaceutical Research & Allied Sciences, 9(2), 210-216.

Bokeriya, E. L. (2019). Perinatal cardiology: present and future. Part I: congenital heart defects. Rossijskij Vestnik Perinatologii i Pediatrii, 64(3), 5-10. doi:10.21508/1027–4065–2019–64–3–5–10

Bokeriya, L. A., & Gudkova, R. G. (2016). Cardiovascular surgery. Diseases and congenital anomalies of the circulatory syste. Moscow: NTsSSKh im. A.N. Bakuleva. 228 p. (in Russ).

Bokeriya, L. A., & Shatalova, K. V. (eds). (2016). Pediatric heart surgery: a guide for doctors. Moscow: NTsSSKh im. A.N. Bakuleva, pp. 24-40 (in Russ).

Ekenze, S. O., Jac-Okereke, C. A., & Nwankwo, E. P. (2019). Funding paediatric surgery procedures in sub-Saharan Africa. Malawi Medical Journal, 31(3), 233-240.

Federal clinical guidelines for medical care for children with congenital heart defects. (2015). Union of pediatricians of Russia, Association of pediatric cardiologists of Russia. 2015. Available at: http://www.pediatr-russia.ru (in Russ).

Flocco, S. F., Lillo, A., Dellafiore, F., & Goossens, E. (Eds.). (2018). Congenital Heart Disease: The Nursing Care Handbook. Springer.

Kirillov, K. O., Nachinkin, V. V., Kim, A. I., & Yurlov, I. A. (2014). Epidemiology of congenital heart defects and ways to optimize cardiac surgery in the Volgograd region. Children's diseases of the heart and blood vessels.

Lobzov, A. V. (2008). The role of environmental factors in the formation of congenital malformations: author's abstract of a Cand. med. sci. thesis. Bishkek, 121 p.

Lobzov, A. V. (2010). The assessment of risk factors for congenital malformations. Pediatriya, 89(1).

Manuilenko, Yu. I., Abdyldaev, T. T., & Sadyrbekov, K. K. (2000). Radiation situation and health indicators of the population in some regions of Kyrgyzstan. edited by K. A. Karimov. Ekologiya Kyrgyzstana: problemy, prognozy, rekomendatsii. pp. 3-9.

Nelunova, T. I., Burtseva, T. E., Gogolev, N. M., Chasnyk, V. G., Orel, V. I., & Guryeva, N. A. (2018). Prevalence and structure of congenital heart defects in newborns of the Republic of Sakha (Yakutia). Pediatrician (St. Petersburg), 9(5), 53-58. doi:10.17816/PED9553-58 Submitted for publication on 29.08.2018.

Papova, O. V. (2006). The features of the clinical course and treatment of cerebral disorders in children with persistent viral infections: author's abstract of a Cand. med. sci. thesis. Bishkek.

Permadi, A. W., Hartono, S., Wahjuni, E. S., & Lestari, N. K. D. (2020). The Combination of Physical Exercise Programs in Patients with Heart Failure. International Journal of Pharmaceutical and Phytopharmacological Research, 10(1), 22-28.