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IntroductionWorldwide, congenital heart disease is the principal heart disease in children and constitutes one of the major causes of infant mortality, particularly in developing countries. Infants and children with congenital heart disease exhibit a range of delays in weight gain and growth. In some instances, the delay can be relatively mild, whereas in other cases, cause the failure to thrive.ObjectivesTo determine the nutritional status and associated factors of pediatric patients with congenital heart disease.Material and methodA cross sectional analytical study conducted over a period of 6 months (Feb to Jul 2020). A total of 228 subjects with congenital heart disease who visited the cardiac center during the study period where included until the calculated sample size attained. Data is collected from patient's card and their care giver. Data was then analyzed using Statistical Package for Social Sciences (SPSS) for windows version 25.0. Odds Ratio with 95% Confidence Interval (CI) was used to determine the effect of the independent variables on the outcome variable and P-value less than 0.05 was considered statistically significant.ResultsA total of 228 children ranging from 3month to 17yrs of age with mean age of 4.7 years (SD = 3.8 years) were included in the study. Most of the subjects had acyanotic heart disease accounting for 87.7%. The overall prevalence of wasting, underweight and stunting were 41.3%, 49.1% and 43% respectively. Children with congenital heart disease and having pulmonary hypertension, were found more likely to develop wasting compared to those without pulmonary hypertension with an odds of 1.9 (95% CI: 1.0-3.4) and also have greater chance of stunting with an odds of 1.9 (95% CI: 1.0-3.4). Children 5 to 10 years of age were 2.3 times more likely to be underweight.ConclusionMalnutrition is a major problem in pediatric patients with congenital heart disease. Pulmonary hypertension and older age are associated with increased risk of undernutrition.

IntroductionIntramuscular benzathine penicillin G (BPG) injections are a cornerstone of secondary prophylaxis to prevent acute rheumatic fever (ARF) and rheumatic heart disease (RHD). Uncertainties regarding inter-ethnic and preparation variability, and target exposure profiles of BPG injection are key knowledge gaps for RHD control.MethodsTo evaluate BPG pharmacokinetics (PK) in patients receiving 4-weekly doses in Ethiopia, we conducted a prospective cohort study of ARF/RHD patients attending cardiology outpatient clinics. Serum samples were collected weekly for one month after injection and assayed with a liquid chromatography-mass spectroscopy assay. Concentration-time datasets for BPG were analyzed by nonlinear mixed effects modelling using NONMEM.ResultsA total of 190 penicillin concentration samples from 74 patients were included in the final PK model. The median age, weight, BMI was 21 years, 47 kg and 18 kg/m2, respectively. When compared with estimates derived from Indigenous Australian patients, the estimate for median (95% confidence interval) volume of distribution (V/F) was lower (54.8 [43.9-66.3] l.70kg-1) whilst the absorption half-life (t1/2-abs2) was longer (12.0 [8.75-17.7] days). The median (IQR) percentage of time where the concentrations remained above 20 ng/mL and 10 ng/mL within the 28-day treatment cycle was 42.5% (27.5-60) and 73% (58.5-99), respectively.ConclusionsThe majority of Ethiopian patients receiving BPG as secondary prophylaxis to prevent RHD do not attain target concentrations for more than two weeks during each 4-weekly injection cycle, highlighting the limitations of current BPG strategies. Between-population variation, together with PK differences between different preparations may be important considerations for ARF/RHD control programs.