The 'Ironclad friendship' of China-Cambodia, lays the first step in the foundation of early diagnosis and treatment of asymptomatic congenital heart Defects- A multi-national screening and intervention project, 2017-2020

Abstract

Background: Congenital heart disease (CHD) is the leading cause of mortality in childhood worldwide. However, a large number of children with CHD are not diagnosed promptly in low- and middle-income regions, due to limited healthcare resources and lack the ability of prenatal and postnatal ultrasound examinations. The research on asymptomatic CHD in the community is still blank, resulting in a large number of children with asymptomatic CHD can not be found and treated in time. Through the China-Cambodia collaborative health care initiative, the project team conducted research, screened children's CHD through a sampling survey in China and Cambodia, collected relevant data, and retrospectively analyzed the data of all eligible patients.

Objectives: The project aimed to evaluate the prevalence of asymptomatic CHD in a sample population of 3-18years old and effects on their growth status and treatment outcomes.

Methods: We examined the prevalence of 'asymptomatic CHD' among 3-18years old children and adolescents at the township/county levels in the two participating. A total of eight provinces in China and five provinces in Cambodia were analyzed from 2017 to 2020. During 1 year follow-up after treatment, the differences in heights and weights of the treated and control groups were evaluated.

Results: Among the 3,068,075 participants screened from 2017 to 2020, 3967 patients with asymptomatic CHD requiring treatment were identified [0.130%, 95% confidence interval (CI) 0.126 -0.134%]. The prevalence rate of CHD ranged from 0.02 to 0.88%, and was negatively related to local per capita GDP (p = 0.028). The average height of 3310 treated CHD patients were 2.23% (95% CI: -2.51%~-1.9%) lower than that of the standard group and the average weight was - 6.41% (95% CI: -7.17%~-5.65%) lower, the developmental gap widening with advancing age. One year after treatment, the relative height difference remained comparable while that, in weight was reduced by 5.68% (95% CI: 4.27% ~7.09%).

Conclusions: Asymptomatic CHD now is often overlooked and is an emerging public health challenge. Early detection and treatment are essential to lower the potential burden of heart diseases in children and adolescents.

Keywords: Asymptomatic; Cambodia; Children; China; Congenital heart disease; Prevalence.

Fig. 1

Correlations of CHD prevalence across counties/districts with local per capital GDP and altitude Abbreviations: CHD: indicates congenital heart disease

Fig. 2

Proportion of CHD subtypes across age groups Abbreviations: CHD: congenital heart disease; PDA: patent ductus arteriosus, TOF: tetralogy of Fallot, ASD: atrial septal defect, VSD: ventricular septal defect

Fig. 3

Relative growth gaps across baseline age groups “Relative height or weight gap” = (height or weight of the CHD child divided by the standard height or weight of Chinese child) − 1. Therefore, a value greater than 0 indicated that the child with CHD was developing in accordance with Chinese child growth standards, otherwise the opposite is true

Fig. 4

Catching up in growth across baseline age groups “Relative height or weight gap” was both calculated at baseline and at follow-up. “Change in relative height or weight gap” = “Relative height or weight gap at baseline” - “Relative height or weight gap at follow-up”