International Journal of Community Medicine and Public Health
Balat MS et al. Int J Community Med Public Health. 2018 Oct;5(10):4437-4440
http://www.ijcmph.com pISSN 2394-6032 | eISSN 2394-6040
DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20183990
Original Research Article
Congenital heart disease: factor affecting it and role of RBSK
in dealing with situation
Martina S. Balat, Saurabh Kumar Sahu*
Department of Community Medicine, B. J. Medical College, Ahmedabad, Gujarat, India
Received: 13 July 2018
Accepted: 21 August 2018
*Correspondence:
Dr. Saurabh Kumar Sahu,
E-mail: sahu.saurabh000@gmail.com
Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
Background: Congenital heart diseases (CHD) is the second leading cause of death in infancy and childhood. So the
purpose of this study to know socio-demographic profile and the maternal risk factors affecting CHD, and the role of
RBSK in screening with respect to CHD.
Methods: A cross-sectional study was conducted during June to October 2016 in Ahmedabad city. Parents of 169
children with CHD who were beneficiaries of RBSK during the previous 3 months were interviewed.
Results: The majority of children were in the age group of 0-3 years 49.7% (mean±SD= 4.26±4). Majority of families
belonged to the lower middle class IV (41.4%). 44% of mothers had primary education. Mothers with age >30 yrs
were 55.6%. Only 30.9% of mothers had taken folic acid during the periconceptional period. Mothers with previous
adverse pregnancy outcome were 40.2%. Maternal stress and high blood pressure were present in 33.7% and 24.8%
of the mothers respectively. 48% of children were diagnosed through Rashtriya Bal Swasthya Karyakram (RBSK).
Conclusions: Lower middle class, lower maternal education, advanced maternal age, low folic acid intake, previous
adverse pregnancy outcome, maternal stress and high blood pressure were the leading risk factors for CHD. RBSK is
playing important role in screening and diagnosing of patients.
Keywords: Congenital heart disease, Risk factors, RBSK
INTRODUCTION different types of birth defects, but few studies have
included SES as a risk factor for CHD-related mortality.2
Heart defects are among the most common congenital If there is a child in the family with CHD, the chance of a
defects in neonates.1,2 The incidence of congenital heart second child being born with CHDs is 3-4 times more.7
defects is estimated at 4-8 per 1000 births.3–5 CHD is Periconceptional intake of multivitamin supplements
usually the result of the abnormal embryonic containing folic acid may reduce the risk in offspring.
development of a normal structure during the early stage Maternal lifestyle factors, including cigarette smoking,
of embryonic or fetal development.6 Lack of information passive smoking alcohol consumption, smokeless
about the risk factors, especially modifiable tobacco, drinking strong tea or coffee have also been
environmental and behavioral factors having adverse associated with risk of CHDs.1,8 Available information
effects on fetal cardiac development; act as an obstacle in about the association of maternal chronic diseases with
the prevention of CHDs.1 CHDs require medical and CHDs is limited.1 Maternal chronic diseases, including
sometimes surgical intervention early in life, and early diabetes mellitus, hypertension, connective tissue
detection and quality care can improve health outcomes.2 disorders and CHD, were associated with an increased
risk of CHDs in the offspring.1,7 The occurrence of CHD
Assessment of the potential impact of socioeconomic in developing country like ours would be much higher
status (SES) as a risk factor for the occurrence of despite the fact that most of the cases in our setup are
International Journal of Community Medicine and Public Health | October 2018 | Vol 5 | Issue 10 Page 4437
Balat MS et al. Int J Community Med Public Health. 2018 Oct;5(10):4437-4440
missed due to lack of proper facilities, detection House to house visit was done for data collection. A pre-
modalities, and diagnostic techniques.4 tested, pre-designed and semi-structural questionnaire
was used for data collection. Informed verbal consent
Rashtriya Bal Swasthya Karyakram (RBSK), a Screening was taken before asking questions. All the questions were
and Early Intervention Services Programme to all the asked orally in local language Gujarati or Hindi
children in the community. The objective RBSK is to according to the convenience of the parents and were
improve the quality of life of children through early interviewed for about 20-30 minutes. Questions regarding
detection of birth defects, diseases, deficiencies, socio-demographic characteristics; the age of children,
development delays and disability. The high burden of ethnicity, socio-economic class and education of mother
these ill health contributes significantly to child mortality, was asked. Regarding maternal risk factors; maternal age,
morbidity and out of pocket expenditure of the poor an adverse outcome in previous pregnancies, the term of
families. This initiative ensures covers of all expenditures delivery, folic acid had taken during periconceptional
of the eligible families related to child health right from period, siblings history, family history, maternal diseases
the birth.9 during pregnancy, unhealthy lifestyle, who diagnose the
disease, parents satisfaction with the treatment were
Therefore, the objectives of this study were: (1) to study checked.
the socio-demographic profile and the maternal risk
factors in children with congenital heart disease (CHD). Data were analyzed and presented in suitable tables and
(2) to study the role of RBSK in screening with respect to appropriate statistical tests were applied to test
CHD. significance where ever necessary. Data were collected
and entered in Microsoft Office Excel 2016, and Epi Info
METHODS 7 was used for statistical analysis for applying a Chi-
square test. P<0.05 was considered to be significant.
A cross-sectional study was conducted during June to
October 2016 in Ahmedabad city. The list of 196 children RESULTS
with CHD who were beneficiaries of RBSK during
March-May 2016 was obtained from the RBSK office, Socio-demographic characteristics
Gandhinagar. Parents of 169 children were interviewed
after taking consent (27 parents could not be interviewed Parents of 169 children were interviewed. A total of 27
because of various reasons like house locked, no consent parents could not be interviewed because of various
given). reasons like house locked, no consent given and were not
available during data collection; so were excluded.
Table 1: Socio-demographic characteristics of children with congenital heart disease (n=169).
Age in years Total (%) Male Female
0 to 3 84 (49.70) 40 44
3 to 6 40 (23.67) 24 16
6 to 9 17 (10.05) 9 8
9 to 12 15 (8.88) 8 7
12 to 15 13 (7.69) 7 6
Total 169 88 (52.07%) 81 (47.92%)
Mean (SD) = 4.26 (4)
Frequency Percentage (%)
Ethnicity
Hindu 140 82.84
Muslim 23 13.60
Others 6 3.55
Socio-economic class*
Upper class 12 7.10
Upper middle class 23 13.60
Middle class 39 23.08
Lower middle class 70 41.42
Lower class 25 14.79
*Modified Prasad Classification May- 2016
Maternal education level
Illiterate 23 13.60
Primary 74 43.79
Secondary 63 37.28
Graduate 9 5.32
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Balat MS et al. Int J Community Med Public Health. 2018 Oct;5(10):4437-4440
Maximum 84 (49.70%) children belong to age group 0 to Table 2: Maternal risk factors.
3 years, followed by 40 (23.67%) children from 3 to 6
years of age. The mean age of the children was 4.26±4 Frequency Percentage (%)
(SD). There were 88 (52.07%) male and 81(47.92%) Maternal age (in years)
female. The majority 140 (82.84%) of the respondents <30 75 44.38
were Hindus. CHD patients were more in Lower Middle >30 94 55.62
Class 70 (41.42%). 74 (43.79%) mothers were educated Adverse outcome in previous pregnancies*
up to primary school followed by 63 (37.28%) were up to Abortion 10 5.91
secondary school. 23 (13.60%) were illiterate (Table 1). Miscarriage 41 24.26
Stillbirth 8 4.73
Maternal risk factors Preterm delivery 16 9.47
Total 68 40.23
Majority 94 (55.62%) of the mothers were more than 30 Maternal diseases*
years of age. 68 (40.23%) of mothers gave a history of High B. P 42 24.85
previous adverse pregnancy outcome; among them, Diabetes 16 9.47
41(24.26%) had a miscarriage. 15 (8.8%) of the siblings Obesity 20 11.83
had a history of CHD. Full-term delivery was 110 Epilepsy 14 8.28
(65.08%) and pre-term delivery was 55 (32.54%). Anemia 23 13.60
Mothers drinking strong tea or coffee were 67 (39.6%), Thyroid 4 2.37
followed by mother exposed to passive smoking 33 Maternal stress 57 33.73
(19.53%). 29 (17.16%) mothers were taking smokeless Unhealthy lifestyle*
tobacco (Table 2). Drinking alcohol 3 1.76
Drinking strong tea or
Mothers taking folic acid during the periconceptional 67 39.64
coffee
period was 52 (30.76%). Our study showed a significant Smokeless tobacco 29 17.16
positive association between maternal education and Smoking 4 2.37
intake of periconceptional folic acid (X2=7.937) (Table
Passive smoking 33 19.53
3). *Multiple responses.
Table 3: Association between maternal education and periconceptional folic acid.
Periconceptional folic acid was Periconceptional folic acid not
Maternal education Total (%)
taken (%) taken (%)
Illiterate 5 (21.7) 18 (78.3) 23 (13.6)
Primary 17 (23.0) 57 (77.0) 74 (43.7)
Secondary 25 (39.7) 38 (60.3) 63 (37.2)
Graduate 5 (55.6) 4 (44.4) 9 (5.3)
Total 52 (30.8) 117 (69.2) 169 (100)
chi square =7.937; p=0.047; df=3.
Role of RBSK in screening explanation could be an early screening of mothers of
higher socio-economic class, during the antenatal period,
81 (47.9%) of the children were diagnosed through due to the utilization of fetal echocardiography during the
Rashtriya Bal Swasthya Karyakram (RBSK). 69 antenatal period can lead to early detection and
(40.82%) children were diagnosed at less than one month termination of pregnancy. In the study done by
of age. Around 151 (~90%) of parents were satisfied with Germanakis and Sifakis, it was shown that 1.4-fold
the treatment. Most common CHD seen was Ventricular increase in the probability of termination because of early
Septal Defect in 84 (49.7%) children. 89 (52.66%) diagnosis.1
children were operated while 54 (31.95%) were given
drug therapy. Treatment provided including surgical Most of the patient came to know about diagnosis during
procedures were free of cost at U.N. Mehta institute of the postnatal period and only very few were diagnosed
cardiology. during the antenatal period. Even though they were
diagnosed in the antenatal period it was after 20 weeks of
DISCUSSION pregnancy because of that termination of pregnancy
could not be done. In our study, only 5.32% mothers
In our study majority of the patient were from lower were graduate. In India, full antenatal coverage is only
middle class, one possible explanation could be the 21% (NFHS-4) which may be due to low education
affordability of government hospital. Other possible among mothers.10
International Journal of Community Medicine and Public Health | October 2018 | Vol 5 | Issue 10 Page 4439
Balat MS et al. Int J Community Med Public Health. 2018 Oct;5(10):4437-4440
In our study, more than half of mothers were above 30 Funding: No funding sources
years of age, so advance maternal age can be one of the Conflict of interest: None declared
risk factors. We should be alert when women become Ethical approval: The study was approved by the
pregnant above 30 years of age. One-third of mothers Institutional Ethics Committee of RBSK office
gave the history of adverse outcome in a previous
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ACKNOWLEDGEMENTS
We would like to thank Dr. Shailesh Sutharia, Program
Officer (School Health) Commisionerate of Health for Cite this article as: Balat MS, Sahu SK. Congenital
providing his immense support during the study and heart disease: factor affecting it and role of RBSK in
guidance throughout. We would like to thank Dr. Shikha dealing with situation. Int J Community Med Public
Jain, Assistant professor of community medicine Health 2018;5:4437-40.
department at B.J.Medical College for her guidance.
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