Birth prevalence of congenital heart disease: A cross-sectional observational study from North India.

Sir,

I read with interest the study by Saxena et al. on the birth prevalence of congenital heart diseases (CHDs) in India.[1] Based on routine clinical examination and pulse oximetry, followed by screening echocardiography for diagnosing CHDs, the authors estimated 8.07/1000 live births the prevalence of CHDs in their studied cohort. I presume that the actual prevalence of CHDs might be underrated. This is based on the following five points.

First, the aforementioned prevalence was extracted from hospital-based data. Community-based data could better elucidate the true prevalence of CHDs.

Second, the estimated prevalence was related only to live births and did not include macerated or malformed babies who might have CHDs.

Third, in spite of making significant progress in increasing institutional births in India, the rate of home delivery is still substantial (37.7%).[2] Therefore, a good number of babies with CHDs born at home are expected to abscond medical registration.

Fourth, consanguineous marriages (CMs) is still culturally preferred in India with an estimated prevalence of 12.3%.[3] Parental consanguinity, in particular, first-cousin marriage between parents, has been noticed to be one of the important risk factors for the occurrence of CHDs in India.[4] Interestingly, only 18.7% of people surveyed in India were aware of various health hazards associated with CMs.[3]

Fifth, due to the limited diagnostic precision of echocardiography, cardiovascular magnetic resonance (CMR) has recently expanded its role in the diagnosis and management of CHDs and acquired heart diseases in the pediatric patients. It provides much diagnostic information to guide decisions.[5] I presume that conducting large-scale studies in India employing CMR could better delineate the true prevalence and pattern of CHDs in the pediatric population.

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Conflicts of interest

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