/
The Epidemiology of The Epidemiology of

The Epidemiology of - PowerPoint Presentation

luanne-stotts
luanne-stotts . @luanne-stotts
Follow
431 views
Uploaded On 2016-03-08

The Epidemiology of - PPT Presentation

Congenital Heart Disease in Saudi Arabia A Systematic Review Authors Amirah M Alenezi Nada M AlBwardi Anna Ali Mowafa Househ Ashraf ElMetwally Presenter Ashraf ID: 246631

studies chd vsd 2012 chd studies 2012 vsd prevalence children risk reported cases syndrome common saudi results incidence 1000

Share:

Link:

Embed:

Download Presentation from below link

Download Presentation The PPT/PDF document "The Epidemiology of" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.


Presentation Transcript

Slide1

The Epidemiology of Congenital Heart Disease in Saudi Arabia: A Systematic Review

Authors

Amirah M AleneziNada M AlBwardiAnna Ali Mowafa Househ Ashraf El-MetwallySlide2

Presenter: Ashraf El-Metwally

Assistant professor of Epidemiology, Collage of Public Health and Health Informatics, King Saud bin

Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia Slide3

3

CHD

CHD :“A gross structural abnormality of the heart

or intra-thoracic great vessels that is actually or potentially of functional significance

(Mitchell SC et al, 1971)Range of defects varies from a single simple defect with no symptoms to multiple complex of defects with several symptoms. (

Bernier PL et al, 2010)

Minor heart defects may not affect the quality of life of the patient.

(

Koshnood

B et al, 2010 van der

Bom

T et al, 2012)Severe heart defects would require extensive medical support. (Koshnood B et al, 2010 van der Bom T et al, 2012)

BackgroundSlide4

4

Etiology

Etiology is not known, but CHD is linked with either genetic or environmental

predisposition. (Blue GM et al, 2012)

Down’s syndrome and consanguinity are more frequently associated with CHD. (Blue GM et al, 2012)

Evidence

for the contribution of specific environmental factors to CHD causation is limited.

(

Blue GM et al, 2012

)

Folic

acid supplementation in the preconception period, ensuring rubella vaccination has been completed before pregnancy, and maintaining good glycemic control in mothers with diabetes may reduce the risk of CHD in infants

. (Blue GM et al, 2012)BackgroundSlide5

5

Global Burden

Wide variation in the incidence of CHD varying from 4/1000 to 50/1000 live

births. (Hoffman JIE et al, 2004)

International studies have reported prevalence ranging from 10-119 per 10,000 persons. (Dolk et al, 2010 Koshnood et al, 2012 Marelli et al, 2007 van der Bom T et al, 2012)

Variation is primarily due to the use of different methods to diagnose

CHD.

(

Hoffman JIE et

al,

2004)

The

relative frequency of different major forms of CHD also differs greatly between studies. (Hoffman JIE et al, 2004)The total incidence of CHD is dependent on the relative frequency of VSDs, the most common type of CHD. (Hoffman JIE et al, 2004)

BackgroundSlide6

6

Aims

No recent systematic review has examined the growing scientific evidence with respect to the epidemiology of CHD in the KingdomTo provide a comprehensive summary of CHD

Incidence

To

better understand the disease's

magnitude

Aid

in future public health

initiatives in Saudi Arabia

Burden

Impact

Prevalence

AimsSlide7

7

Methods

An electronic search was conducted in January 2014PubMed and Google

ScholarSupplementary search for articles: Cross-referencing and

Reviewing locally published journalsSlide8

8

Methods

HeartCardiac

CongenitalDefectEpidemiology

PrevalenceIncidenceRiskImpactSaudi Arabia

W

ritten

in

English

P

ublished

up to 2013

Treatment or

Interventional

studies

Keywords

Inclusion Criteria

Exclusion CriteriaSlide9

9

Flow ChartSlide10

10

Results

Prevalence Studies

Greer

W et al in 2005: Southwestern region had the highest burden of CHD with

prevalence

of

7.48

cases/

1000 persons, Central region (2.7), Northern region (2.5)

Alqurashi

et al

in 2004-05: Prevalence of CHD in children and adolescents was 2.1 cases /1000 personsAlnajjar et al in 2009: Reported 2,047 new cases of CHD, 34% of all cardiac cases in Al MadinaAlmawazini

and

Al Ghamdi

in 2011:

26.8%

of all cardiac patients were

diagnosed with

CHD in Southern Western Saudi

Al-

Mesned

et al in 2012: Incidence

of severe CHD was 5.4 per 1,000 live birth/yearSlide11

11

Results

Prevalence Studies

Most common type of defect reported by studies was

VSDJaiyesimi et al in 1993: Among prospective

cohort of 320 patients 38.5%

had

VSD

Bhat et al

in

1997: Among 1209 children

referred to the cardiology clinic 29.7% had VSDAbbag F et al in 1998: Among 608 CHD cases 32.5% had VSD

Alabdulgader

et al in

2001

:

Among 740 CHD cases 39.5% had

VSD

ASD (8.9% to 18.1%) and PS (6% to 12.4%)Slide12

12

Results

Risk Factor Studies

Risk factors that were highlighted in different studies include:

Down SyndromeConsanguineous marriage Diabetic mothers

Social

ImpactSlide13

13

Results

Risk Factor Studies

Down Syndrome(DS)

Jaiyesimi et al in 1993: Among 320 cases of CHD, trisomy-21 was found in 10%.

Alabdulgader

et al in 2001: DS was

found in 6% of all

patients.

Al-

Jarallah

et al in 2009: Among 110 down syndrome 49% had CHD.Aama et al in 2012: 130 patients with DS, CHD in 86.8%Abbag

et al in 2006: CHDs

was

found

in 61.3%

with

DS.Slide14

14

Results

Risk Factor Studies

Consanguineous

Marriage Becker and AlHalees in 1999: First cousin marriages in 41.6% of children with CHD, compared to only 28.4% in general public.

Seliem

et al

in

2007

:

62 % of CHD children were product of first cousin marriages

El

Mouzan et al in 2008: 56% of children with CHD were product of consanguineous marriages and CHD to be the only statistically significant disease associated with first cousin consanguinitySlide15

15

Results

Risk Factor Studies

Maternal Diabetes

Abu-Sulaiman et al in 2004: CHD among children of 100 diabetic mothers was determined to be higher than in the general public

;

15/1,000

live

births

Social Impact

Almesne

et

al 2013: Families of children with complex CHD had significantly higher IFS score, 62 vs. 51 (P=0.005)Slide16

16

Discussion

Cross-sectional studies found the prevalence of CHD ranging between 2.1 to

10.7/ 1,000 persons

The most prevalent type : VSD ranging from 29.5% to 39.5% of all diagnosed CHDs, followed by

ASD

(8.9% to 18.1%) and

PS

(6% to 12.4

%)

Incidence of severe CHD : 5.4/1,000 live births per year

Occurrence

of CHD in Saudi Arabia: Significantly associated with Down ’s syndrome, consanguinity and maternal

diabetes

1

2

3

4Slide17

17

Limitations

Limiting our search for articles in English

Publication bias

Limitations

of the individual studies

Very

few follow-up studies

1

2

3

4Slide18

18

Comparison with Other

Studies

International studies have reported prevalence rates ranging from 1-11.9

per 1000 persons. (Dolk et al, 2010 Koshnood et al, 2012 Marelli et al, 2007

van der

Bom

T et al,

2012

).

In KSA ranges from 2.1- 10.7 per 1000 persons

Common

cardiac congenital lesion reported in KSA was VSD ranging from 29.5% to 39.5%which is consistent with other parts of the world.(Hoffman et al, 2004Koshnood et al, 2012 Rose et al, 1964)The 2nd most common type of CHD in KSA, ASD, was also 2nd most frequent in incidence studies in the US, Canada and Bohemia while other studies found it to be less common; the 4th most common form in Hungary at 10.4%and the 5th most common type in Sweden at 4.3%.(

Carlgren

1959

Mészáros

et al, 1975Mitchell et al 1971,

Samánek

et al, 1989)Slide19

19

Comparison with Other Studies

Presence

of CHD in children with Down's syndrome ranged from

40% to 55% in international studies same as reported in KSA. (de Rubens et al, 2003 Roizen et al, 2014Vida et al, 2005 Wells et al 1994)

In KSA first cousin marriage was significantly associated with VSD, ASD, AVSD, PS, and PA. Similarly,

septal

defects (VSD and ASD) were consistently found to be associated with consanguinity especially at first cousin level, in several international

studies.

(

Al Husain

et al, 1997)Slide20

20

General

understanding of the CHD epidemiology in Saudi ArabiaCHD have prevalence higher than that in Western countries and comparable to those reported in other developing countries

Consanguineous marriages, maternal age, Diabetes and Down syndrome

were among risk factors related to CHD

1

2

3

Identified risk factors are potentially modifiable, emphasizing the importance of public health

programs

Studies that explored the prognosis and burden of these diseases on the Saudi society and healthcare services are scarce and should be the focus for future

research

4

5

Conclusion and RecommendationsSlide21

21

Thank You For

Y

our Attention