Beware of heart defects that go unnoticed

Many years have gone by now since I started practicing medicine, yet one thing seems to be stuck in my memory: The encounters I made with mothers or caretakers who came to hospital complaining that their children were coughing.

Well, it’s a routine reason for hospital visits at pediatrics and child health departments in many hospitals in Tanzania but the unfortunate thing is that an underlying problem is usually missed—more so, in lower level health facilities. I know cases where diagnoses such as heart disease or tuberculosis have been routinely missed by medical staff for technical reasons, leading these children to suffer further complications.

What happens is that these children are later referred to bigger medical centres when it’s already too late. More often than not, the mothers or caretakers of these children may not afford the costs of treatment.

But when I had an opportunity to meet them, I discovered that some of them suffered from congenital heart diseases, tuberculosis and at times, asthma.

For many mothers, it’s easy to blame the cough on pneumonia. Well, not every cough means pneumonia; especially when it is long standing.

You will hear a mother reporting to a doctor, “mtoto wangu anakifua cha muda mrefu, akipata nafuu kinarudi tena.” (He constantly suffers chest infections/pneumonia punctuated with periods of some improvement).

Reports show that 7 out of 1000 live births in Tanzania have heart defects. From my own observation it’s nerve-wracking that the statistics do not seem to scale down as years come and go. We need to intervene to reverse the situation.

Being born with heart defects

A heart defect occurs when there is abnormal formation of a wall or valves or of blood vessels that enter or leave the heart.

As a result of this abnormality or defect rather, blood to flows in an unusual path; sometimes bypassing the lungs where it should have picked oxygen.

Now you can understand that when this blood doesn’t pick the oxygen it needs, there could be serious consequences on the child’s growth because this oxygen is important for growth, development and activity.

Children are not miniature adults, so they will not show the same symptoms as adults with heart problems or tuberculosis.

As from my practical experience, I have encountered children presenting with a longstanding history of cough, punctuated by periods of improvement. Sometimes, caretakers may report complains of cough and difficulty in breathing only.

At times, when I picked my stethoscope to examine, I could hear a “heart murmur”—signifying the presence of a heart defect somewhere in the heart; that causes an abnormal blood flow.

Then, after a battery of tests I could arrive at a diagnosis of what heart defect I was dealing with. This is how we arrive at the diagnosis—something that lower level health facilities may miss out.

How the defects are corrected

Many heart defects can be corrected surgically but the timing of the operation depend on the severity, specific defect, and its symptoms. However, most children with such problems are reported to the hospital late.

As a medical doctor, I have usually noted that mothers or caretakers are not aware of the early signs and symptoms of such defects.

Such children are usually found to have retarded growth and mothers report poor feeding tendencies. The children can’t feed well because their hearts are not functioning properly.

Doctors have named these defects as Ventricular septal defects (VSD), Patent ductus Arteriosus (PDA) and Atrial septal defects (ASD).

What Tanzanian mothers are interested to know

Experience shows that most women in Tanzania are interested to know the causes of such heart defects.

Causes range from alcohol consumption and cigarrete smoking to certain drugs/medicines, exposure to higher than normal dozes of radiations/x-rays and infections contracted during pregnancy, such as Rubella.

One of the mothers interrupted me when I was trying to tell her the possible causes for her baby’s problem, “I have never used alcohol neither cigarettes,’’ she said.

The causes vary. According to “Merk manual,” causes of most birth defects are unknown, but certain risk factors are known including nutritional deficiencies plus others as mentioned above.

Some factors are avoidable, others are not, and even though one pregnant woman may do everything recommended on schedule- yet she gets an infant with birth defect. On stark contrast, another woman may do things that can harm the fetus, yet she doesn’t get an infant with a birth defect.

Nonetheless, my advice remains that when a woman is pregnant she should not take medicines without a doctor’s prescription, do not smoke, neither drink alcohol, eat healthy diet, get vaccinated against infections as per Tanzanian Immunization schedules and Antenatal Care guidelines.

The author is a medical doctor and public health activist based in Dar es Salaam.