Objectives: The ‘Management Pathway’ (MP) for congenital heart disease (CHD) is comprised of diagnostic, treatment and follow-up phases. Potential risk factors for failure to receive optimal care (OC) include a lower level of parent/guardian education/income, and poor access to healthcare facilities. The objective of the current study was to identify risk factors for failure to revive OC in paediatric patients with CHD. Method: Patients under 12 years of age with CHD, were consecutively recruited over a one year period, from the general paediatric wards at Kenyatta National Hospital (KNH), Nairobi. All patients required intervention (surgery/cardiac catheterisation) and were followed-up for 1-year post-recruitment. Data collected included: the level of parent/guardian education, income, and degree of travel-impedance. Age at diagnosis was used as the end-point for risk-factor analysis for failure to receive optimal care. Results: Forty nine patients were recruited; over 95% of parents/guardians had some level of education; almost 40% had received a tertiary level of education. Less than 10% of parents/guardians had an income level of 4 (high), the majority (over 40%) had an income level of 3 (high-middle). With respects to late diagnosis (LD), the odds ratios were 0.6 (0.4955, 0.8665; p-value of 0.0030) and 1.0188 (0.9967, 1.0415; p-value of 0.0965) for the level of education and the level of income respectively. Conclusions: A lower level of parent/guardian education was a risk factor for LD; a lower level of income was not. The level of parent/guardian education may be a risk factor for failure to receive OC.

Keywords: Congenital heart disease; diagnosis surgery follow-up; optimal care ; lower level of parent education