Neuro-developmental delay and associated risk factors among under-five children with congenital heart diseases attended at Jakaya Kikwete cardiac institute, Dar es Salaam, Tanzania
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Date
2025
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Kairuki University
Abstract
Background: Significant advancements in medical and surgical care for children with congenital heart diseases have resulted in increased survival. However, they have increased risk of neuro-developmental delay which poses a risk for attainment of full developmental potential. The aim is to identify neuro-developmental delay and risk factors in under-five children that were attended at JKCI. Early detection and intervention for neuro-developmental disabilities can minimize their impact and enhance attainment of full developmental potential.
Objectives: To determine the proportion of neuro-development delay and associated risk factors among under-five children with congenital heart diseases attended at Jakaya Kikwete Cardiac Institute from January to April 2025.
Methodology: A hospital-based cross-sectional study was conducted among under-five children with congenital heart diseases at Jakaya Kikwete Cardiac Institute whose diagnoses were confirmed with echocardiography. Data was collected using a structured questionnaire that inquired about sociodemographic characteristics, risk factors, anthropometric measurements and oxygen saturations. Ages and Stages Questionnaire third edition (ASQ-3) was used to determine developmental status in relation to age. Data was recorded in excel sheet and on SPSS version 25. The mean and standard deviation, or median and inter-quartile range was used for numerical variables. Chi-square and Fisher’s exact test was used to measure the association between categorical variables. Factors associated with neurodevelopmental delay were analyzed using binary logistic regression. A pvalue of ≤ 0.05 was considered statistically significant.
Results: A total of 357 under-five children that were attended at JKCI were eligible for the study and were enrolled into the study. The mean age was 25.1 months and 120 (33%) study participants were below one year, with predominance of 191 (53.3%) of males. Among the 357 study participants, 153 (42.9%) had neuro-developmental delay. Children aged between 12 to 24 months (AOR=2.45; 95% CI 1.17-5.14, p-value =0.017); malnourished children (AOR=3.01; 95%CI 1.54-5.91, p-value =0.001); those with cyanotic congenital heart disease (AOR=4.13; 95% CI 2.19-7.78, p-value <0.001); unmarried parents (AOR=2.78; 95%CI 1.18-6.55, p-value =0.02) and parity more than 1+ (AOR=2.96; 95%CI 1.44-6.09, p-value =0.003) were independently associated with neuro-developmental delay. The domain of neuro-developmental delay most affected was gross motor among 101 study participants (28.3%) and communication among 48 study participants (13.5%) was the least affected domain. Associated factors of neurodevelopment delay were age of the child below two years, malnutrition, unmarried parents and parity more than one.
Conclusions: The study demonstrates that neurodevelopmental delay is a significant public health concern among under-five children with congenital heart diseases at JKCI, with 42.8 percent affected. These delays are driven by a combination of medical and social factors, including low birth weight, young age below two years, malnutrition, cyanotic congenital heart disease, lack of pre-primary education, single-mother care, multiparity, and low parental education. The findings highlight that neurodevelopmental outcomes are shaped by an interplay of biological vulnerability and socioeconomic conditions.
Recommendations: call for a fully integrated approach to the care of children with congenital heart disease. Management should extend beyond cardiac treatment to include nutrition support, growth monitoring, developmental surveillance, early child development services, and family counseling. Routine screening for neurodevelopmental delay should be incorporated into pediatric outpatient services at JKCI, with focused attention on high-risk groups. Parents and caregivers need clear counseling on developmental challenges, therapeutic options, psychosocial support, and educational interventions. Finally, future longitudinal studies are encouraged to better understand developmental trajectories and long-term quality of life.
Key words: Congenital heart diseases, neuro-developmental delay, low birth weight, malnutrition.
Description
A dissertation report submitted in partial fulfillment of the requirements for the degree of Master of Medicine in Paediatrics and Child Health
Keywords
congenital heart diseases, under-five children, Jakaya Kikwete Cardiac Institute
Citation
Mbarak, Ahlam A., 2025. Neuro-developmental delay and associated risk factors among under-five children with congenital heart diseases attended at Jakaya Kikwete cardiac institute, Dar es Salaam, Tanzania. Dissertation. Kairuki University