Long-Term Mortality of Children with Congenital Heart Disease Admitted to the Departmental University Hospital of Borgou/Alibori from 2011 to 2022

Background: Congenital heart disease is a public health issue due to its incidence and mortality rate. The aim of this study was to investigate the long-term mortality of children with congenital heart disease admitted to the Departmental University Hospital of Borgou/Alibori (CHUD-B/A) from 2011 to 2022. Methods: This descriptive longitudinal study with analytical aims covered 11 years (April 1, 2011 to December 31, 2022). It consisted of a review of the records of children under 15 years of age with echocardiographically confirmed congenital heart disease. This was followed by an interview with the parents to assess the children’s current condition. Data were entered using Kobocollect software and analyzed using R Studio 4.2.2. software. Results: A total of 143 complete files were retained. The median age at diagnosis was 14 months (IIQ: Q1 = 4;Q3 = 60) with a range of 2 days and 175 months, and the sex-ratio (M/F) was 0.96. Left-to-right shunts were the most frequent cardiopathy group (62.9%). Only 35 children (24.5%) benefited from restorative treatment. The mortality rate was 31.5%. Median survival under the maximum bias assumption was 114 months and 216 months under the assumption of minimum bias. Survival was significantly better in children with right-to-left shunts (p = 0.0049) under the assumption of minimum bias. The death risk factors were: age at diagnosis less than 12 months (aHR = 7.58;95% CI = 3.36 - 17.24;p Conclusion: The long-term mortality of congenital heart disease is high and favoured by the absence of restorative treatment. Local correction of congenital heart disease and medical follow-up will help to reduce this mortality.

Complications of Peripartum Cardiomyopathy at the Departmental University Hospital Teaching of Borgou (Benin) in 2022: About 3 Cases

Introduction: Peripartum cardiomyopathy (PPCM) is a dilated cardiomyopathy occurring in the last month of pregnancy or the first five months postpartum without pre-existing cardiovascular pathology. It is a major cause of pregnancy-related heart failure with high morbidity and mortality. In severe forms (10% to 15% of cases), thrombo-embolic complications are the main cause. The initial hemodynamic evolution is totally unpredictable and sometimes extremely brutal and fatal. The objective of this work was to show the often pejorative evolution of PPCM in our country. Methods: We report in this work three serious clinical cases revealing the complications of this PPCM among patients admitted to the cardiology department of the CHUD-B/A in 2022 for heart failure. The data were collected according to the Declaration of Helsinki. Patients and Observations: The first case was a PPCM with severe left ventricular (LV) systolic dysfunction complicated by spontaneous left intraventricular contrast and right superficial sylvian ischemic stroke. The second case reports a global cardiac decompensation of a PPCM with severe LV systolic dysfunction complicated by an apical thrombus. The third case is that of a state of cardiogenic shock complicating a PPCM with severe LV systolic dysfunction. Among our 03 patients presenting these severe forms of PPCM, the evolution, in spite of the symptomatic and prognostic treatments of the heart failure, and even of the complications, was unfavourable with death in two of them. Conclusion: Complications of PPCM are frequent and fatal in Benin.

Quality of Management of Severe Malaria Cases in Children under Five: A Case of Four Health Facilities in the Littoral Department in Benin

Background: Benin republic is a sub-Saharan African country endemic to malaria caused by Plasmodium falciparum. To reduce the death rate due to this scourge, it is essential to ensure quality care, especially for children under five years who are the most vulnerable. The main objective of this study is to assess the quality of severe malaria case management in patients under five years. Methods: Descriptive and analytical cross-sectional study was performed in health facilities in Cotonou city, the economic capital of Benin Republic. Study sample included 205 suspected cases of severe malaria among children aged under five years, in four health facilities. In each of hospitals, all children under five years with severe malaria presumption were enrolled in the study. Quality was assessed through five components: diagnosis, treatment, patient monitoring, counselling/advice, and patient’s follow-up. Based on the Benin Republic’s malaria case management standard protocol, the assessment criteria of each component were defined. Results: The sex ratio was 1.25 boys to a girl. The median of hospitalisation duration was 3 days with first quartile (Q1) = 2 and third quartile (Q3) = 5. Among 205 severe malaria cases included, 157 (76.59%) were not managed in accordance with the requirements of the national protocol of malaria case management. The different components of cases management are not all implemented during the care of patients. Conclusion: There is a need for training to health workers on implementation of severe malaria in children under 5 years protocol. Also, there is a need for investigation about factors associated with malaria protocol implementation.