From Early detection to Outcome: Transforming Congenital Heart Disease Care in Tanzania
Notice bibliographique
Résumé
This thesis investigates the burden, diagnosis, and management of congenital heart disease (CHD) in Tanzania, emphasising the critical importance of early detection through pulse oximetry (POX) screening. The findings are presented in three thematic parts that collectively offer a comprehensive understanding of the CHD landscape and practical strategies to improve outcomes. Part 1: Global Perspective and Burden of CHD in Tanzania (Chapters 1–3) The first section explores global and regional CHD burden, noting CHD affects 1 in 100 live births globally, with CCHD accounting for 2.5–3 per 1,000 and contributing to nearly 10% of neonatal deaths. In Tanzania, an estimated 13,600 children are born annually with CHD, around 4,000 of whom have CCHD. Chapter 2 analyzes echocardiographic data from over 6,000 children referred to JKCI, revealing that 80% of diagnosed heart defects were CHDs, mostly detected late (median age: 1 year). Ventricular septal defects (VSD), patent ductus arteriosus (PDA), and Tetralogy of Fallot (TOF) were predominant. Challenges include late referrals, a 40% hospitalization rate, and poor referral systems. Chapter 3 details the Tanzanian POX Study, which screened over 10,000 newborns and found a CCHD birth prevalence of 3.27 per 1,000—higher than previously reported. Surgical intervention significantly improved survival (88% vs. 40%). These chapters advocate for integrating POX screening and strengthening referral pathways. Part 2: Surgical Outcomes and Quality of Life (Chapters 4–6) This section highlights Tanzania’s growing surgical capacity at JKCI, where annual pediatric surgeries rose from 34 in 2015 to 350 in 2023, with 70% performed by local teams. Chapter 4 focuses on TOF repairs, showing most surgeries occur after age 1, with underweight status and severe cyanosis linked to poorer outcomes. In-hospital mortality was 5.9%, but no deaths occurred in children operated on before one year. Chapter 5 shows significant improvement in children’s health-related quality of life (HRQoL) after surgery, with financial hardship as a major barrier. Chapter 6 examines caregiver QoL using the Swahili PedsQL Family Impact Module, revealing improved emotional well-being post-surgery but persistent family stress, underscoring the need for psychosocial support. Part 3: Feasibility and Impact of POX Screening (Chapters 7–12) This section assesses POX screening’s feasibility and cost-effectiveness. Chapter 7 describes a prospective cohort study enrolling 30,000 newborns at two hospitals. Chapter 8 reports high specificity (99.5%) and moderate sensitivity (50%), improving with dual screening and mandatory physical exams. Chapter 9’s systematic review confirms that combining POX and physical exams increases sensitivity to 93%. Chapter 10 shows POX also detects non-cardiac neonatal conditions like sepsis and PPHN. Chapter 11 shares healthcare workers’ positive views on scalability. Chapter 12 confirms POX’s affordability (USD 6–8 per newborn) and cost-effectiveness (USD 264.87 per QALY), with a return of USD 20 for every USD 1 invested. Altogether, this thesis demonstrates that early CHD detection via POX is feasible, life-saving, and economically sound, offering a scalable strategy to improve child survival in Tanzania and similar settings.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,010 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,003 | 0,002 |
| Science ouverte | 0,001 | 0,004 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».