Congenital heart disease, often referred to as “hole in the heart,” is a structural problem of the heart that develops before birth, usually around the sixth week of pregnancy when the baby’s heart is forming. For some reason, whether genetic, environmental, or due to maternal health factors, the heart doesn’t form properly, leading to defects in its walls, valves, or blood vessels.
Some of these conditions are detected before birth, others only weeks or months after delivery, and in some cases, not until adolescence or adulthood.
Here are some key statistics on the prevalence of congenital heart disease (CHD) in Nigeria (and some in Africa) to support your article:
Statistics
A study of neonates in a tertiary hospital in Benin City found a birth prevalence of 14.4 per 1,000 live births (i.e., about 1.44%) among 2,849 neonates. (PubMed)
A multicentre echocardiographic study across three Nigerian cities found that among children referred for echo, the most common CHD was Ventricular Septal Defect (VSD) at 46.6% of CHD cases. (PubMed)
In a systematic review of 17 studies (2,953 children) in Nigeria (1964–2015), VSD accounted for 40.6% of CHD cases, Patent Ductus Arteriosus (PDA) 18.4%, Atrial Septal Defect (ASD) 11.3%, and Tetralogy of Fallot (TOF) 11.8%. (africanhealthsciences.org)
In a study of primary school children in the Niger Delta region, the prevalence of CHD was 18.1 per 1,000 children (i.e., ~1.81%) among 1,712 pupils aged 5–14 years. (JSciMed Central)
One neonatal-period study in Jos, Nigeria (which is still Nigeria but gives a neonatal figure) found prevalence of 28.8 per 1,000 neonates (i.e., ~2.88%) among 3,857 newborns. (PubMed)
Global comparisons (not strictly Africa) indicate CHD birth prevalence ranges widely, often cited around 3 to 14 per 1,000 live births (0.3% to 1.4%) in many settings. (African Journals Online)
Common Symptoms
Babies with congenital heart disease often show signs such as:
• Bluish discoloration of the lips or skin (due to low oxygen levels)
• Fatigue or constant sleeping
• Difficulty breathing or feeding
• Poor weight gain
• Swelling in the legs or abdomen
It is heartbreaking to see these little ones, many so cute and full of life, struggling just to breathe or feed. Some cannot even suckle properly because it puts too much strain on their tiny hearts. Watching them fight for life while their mothers cry helplessly is truly one of the hardest things to witness.
What Causes Congenital Heart Disease
Several factors can contribute to a baby being born with CHD:
• Maternal infections such as rubella (German measles) during pregnancy
• Uncontrolled diabetes or gestational diabetes
• Exposure to certain medications or chemicals during pregnancy
• Alcohol use or drug exposure
• Genetic factors, where abnormal gene alignment affects the baby’s heart development
Unfortunately, in many cases, the exact cause is unknown.
Types of Congenital Heart Defects
Congenital heart defects are broadly divided into two types.
Cyanotic heart defects
These cause the skin and lips to appear bluish due to a lack of oxygen in the blood.
Examples include Tetralogy of Fallot (TOF) and Transposition of the Great Arteries (TGA).Acyanotic heart defects
In these cases, the blood is adequately oxygenated, but the heart has structural defects that affect blood flow.
Examples include Ventricular Septal Defect (VSD), Atrial Septal Defect (ASD), and Patent Ductus Arteriosus (PDA).
In Nigeria, Ventricular Septal Defect (VSD) is one of the most common types seen among infants. It is also what many people commonly refer to as a “hole in the heart.”
A VSD occurs when there is an opening in the wall, called the septum, that separates the two lower chambers of the heart known as the ventricles. Normally, this wall keeps oxygen-rich blood in the left ventricle from mixing with oxygen-poor blood in the right ventricle.
When a baby has a VSD, the opening allows blood to pass from the left side of the heart to the right side. This causes the heart to pump extra blood to the lungs, leading to increased pressure in the lung arteries and forcing the heart to work much harder than normal. Over time, if the defect is large and untreated, it can cause heart failure and other serious complications.
The symptoms depend on the size of the defect.
Small VSDs may cause no symptoms and sometimes close on their own, while larger defects can cause:
• Rapid breathing
• Difficulty feeding
• Poor weight gain
• Fatigue or sweating while feeding
• Enlargement of the heart
Treatment options depend on the size and severity of the defect. Some babies are managed with medication to control symptoms and help the heart work more efficiently, while others may need surgical repair to close the opening.
Here are some of the key reasons why congenital heart disease (CHD) appears to be more prevalent or at least more frequently diagnosed among children in Nigeria:
1. Limited prenatal diagnosis & delayed detection
In Nigeria, prenatal screening for heart defects is still very limited and not widely accessible. (CHDFNigeria)
Many children are diagnosed only after symptoms have significantly progressed. For example, one multicentre Nigerian echocardiography study found that only about 17 % of CHD cases were diagnosed in the neonatal period. (PubMed)
Because defects go undetected, they may present later, when their burden has become higher.
2. Environmental and maternal health factors
Some studies point to environmental exposures as risk-factors. For instance in the Niger Delta region, exposure to petrochemical pollution (oil spills, gas flaring) has been suggested as a contributing factor to higher congenital anomalies, including CHD. (Lippincott Journals)
Maternal illnesses such as uncontrolled diabetes or hypertension, infections during pregnancy (e.g., rubella) and poor maternal nutrition are known risk factors for CHD. A review noted that about 2–4 % of CHD cases worldwide are associated with adverse maternal conditions or teratogens. (Lippincott Journals)
In Nigeria, socioeconomic factors (limited access to prenatal care, maternal under-nutrition) add to the risk.
3. Genetic and syndromic associations
Some CHD cases are associated with chromosomal or syndromic conditions (for example, Down syndrome) which increase the risk of heart defects. (PMC)
There may also be under-explored genetic predispositions in Nigerian populations that contribute, though research is still limited.
4. Rising detection rates and improved diagnostic services
Part of the “increase” in CHD prevalence may reflect better diagnosis (e.g., more echocardiography centres) rather than a real surge in cases. For example a systematic review found that the proportion of CHD attributed to Ventricular Septal Defect (VSD) rose from ~27.5 % in the 1960s to ~55.8 % in the 2010-14 period of Nigerian studies. (PMC)
However, even with better diagnosis, access to treatment remains severely limited which makes the burden heavier.
5. Healthcare system & resource constraints
Even when CHD is detected, many children cannot access timely corrective interventions (surgery, catheter procedures). One Nigerian study noted only 6.9 % of diagnosed children had definitive intervention. (PubMed)
Poor access to nutrition, delayed referrals, lack of specialised paediatric cardiac centres exacerbate outcomes.
These system limitations mean that CHD has a larger impact (in terms of morbidity and mortality) than in settings with well-established cardiac services.
6. Data and research gaps
Precise incidence/prevalence figures are still uncertain in Nigeria. Some studies report birth prevalence of ~14.4 per 1,000 live births in one tertiary hospital in Benin City. (PubMed)
Variation in studies, under-reporting, late presentations all complicate the picture.
Because of this, more research is crucial to uncover why CHD may be more common and what specific Nigerian factors heighten risk.
The Challenge in Nigeria
Sadly, advanced care for these children remains limited in many parts of Nigeria. While open-heart surgery and other corrective procedures are performed in a few tertiary hospitals, the facilities, expertise, and equipment are not yet enough to meet the growing need.
In many cases, parents are advised to travel abroad, to India, South Africa, or other countries, for surgical correction. This is not only emotionally draining but also financially impossible for many families.
I once saw a mother break down in tears after being told that there was nothing more the hospital could do for her baby. She loved her child deeply and had done everything possible, yet she was told surgery was the only option, and it wasn’t available locally.
A Call for Further Research and Action
There is a pressing need for more research in Nigeria to understand why congenital heart disease is becoming so prevalent. Could it be environmental exposure? Poor maternal nutrition? Infections? Or genetic patterns among Nigerian populations?
Aside from the need for improved healthcare facilities, more research must also be done on why this condition is so prevalent and what Nigerian mothers can do to protect themselves and their babies. Expectant mothers need education on prenatal care, proper nutrition, vaccination, and the importance of managing health conditions such as diabetes during pregnancy.
Whatever the reason, we need more funding, data, and awareness to protect our future generations.
Takeaway
As healthcare professionals and as a nation, we must do our part:
• Educate expectant mothers about prenatal care and vaccination, especially rubella.
• Promote diabetes screening and control during pregnancy.
• Encourage research into maternal and child health.
• Advocate for improved healthcare infrastructure and cardiac surgery access in Nigeria.
We may not be able to save every baby, but we can save many more if we act early. Let us keep learning, caring, and protecting our little ones, because every heartbeat matters.
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