Incidence of congenital heart disease in Palestinian children born in the Gaza Strip, occupied Palestinian territory: a cross-sectional study

Background Congenital heart disease is the most frequent form of congenital anomaly in newborn infants, and accounts for more than a quarter of all serious congenital anomalies worldwide. Generally, an estimated incidence of eight cases of congenital heart disease per 1000 livebirths is internationally accepted as the best approximation. The causes of most congenital heart defects are not known. This study was designed to estimate the birth incidence of children with congenital heart disease born in the Gaza Strip, occupied Palestinian territory, during 2010, and to compare this estimate with estimates from west Europe, North America, and Asia. Methods We reviewed the medical records of all children born in 2010 who were diagnosed, treated, or followed up in the four paediatric cardiology clinics in the Gaza Strip. Data were also obtained from other medical centres to which some of our patients were referred for percutaneous or surgical treatment. Patients were excluded if they had isolated patent foramen ovale; rhythm disturbances without structural defects; isolated mild peripheral pulmonary stenosis; isolated innocent patent ductus arteriosus; patent ductus arteriosus (preterm infants); hereditary disorders without cardiac consequences; or malpositioning of the heart without structural defects. Systematic echocardiographical screening of the entire population is not done, so subclinical heart defects, such as subclinical ventricular septal defect, mild pulmonary valve stenosis, or small atrial septal defect will have been missed. Babies who died perinatally or after birth before diagnosis in the Gaza Strip are not examined at post mortem. The study was approved by the human research ethics committee, Ministry of Health, Gaza Strip. Data were analysed with Microsoft Excel 2007. Because existing data were used, informed consent was required from the parents or guardians of the children. Findings Congenital heart disease was detected in 598 of 59 757 children who were born alive in the Gaza Strip during 2010, giving an incidence of ten per 1000 livebirths. 334 (56%) of 598 children were girls and 264 (44%) were boys. The most frequent anomalies were ventricular septal defects (167 [28%]), ostium secundum atrial septal defects (101 [17%]), patent ductus arteriosus (52 [9%]), and pulmonary valve abnormalities (48 [8%]). 150 children (25%) had a cardiosurgical operation and 48 (8%) had a catheter intervention. 42 (7%) children died. At ages 6 months and 1 yea