Analysis of 5-year patient records from Uganda's premier cardiac center reveals stark survival disparities among children with congenital heart defects. Rural residence increased death risk by 33%, while underweight children faced 107% higher mortality compared to normal-weight peers. Delayed diagnosis emerged as another critical factor, elevating death risk by 67%. The study tracked outcomes for children diagnosed between 2014-2018, representing Uganda's estimated 16,000 annual cases of congenital heart defects. These findings illuminate the compounding disadvantages facing vulnerable populations in sub-Saharan Africa's healthcare landscape. Geographic barriers likely delay both initial diagnosis and access to specialized cardiac interventions, while malnutrition compromises children's ability to withstand complex procedures. The research underscores how social determinants of health intersect with clinical factors in pediatric cardiology. However, this preprint awaits peer review, and results may change following expert evaluation. While the findings align with broader global health inequities, the specific hazard ratios provide Uganda-specific data crucial for healthcare planning. This represents confirmatory evidence that could inform targeted interventions, particularly mobile screening programs and nutritional support initiatives in rural communities where cardiac care remains critically underserved.