Rheumatic Heart Disease In Schoolchildren Research Articles

Echocardiographic screening for rheumatic heart disease in Turkish schoolchildren.

The aim of this study is to investigate the prevalence of subclinical rheumatic heart disease in schoolchildren aged 5-18 by using portable echocardiography in Ankara, Turkey. The portable echocardiography screening was performed by a paediatric cardiologist for all of the cases. The mean age of 2550 healthy students was 11.09 ± 2.91 years (1339 females, 1211 males) in three private and three public schools. Echocardiographic studies were assessed according to 2012 World Heart Federation criteria for rheumatic heart disease. After reviewing the echocardiographic images, 73 students were reevaluated by an advanced echocardiography device in the university hospital. Evidence of definite subclinical rheumatic heart disease was found in 39 students (15/1000) and borderline rheumatic heart disease in 20 students (8/1000). No children had any clinical symptoms. The mean age of children diagnosed with rheumatic heart disease and borderline rheumatic heart disease is 12.4 and 11.4 years, respectively. The risk of rheumatic heart disease was found to be increased sevenfold in girls between 14 and 18 years. We surprisingly observed that the prevalence of definite rheumatic heart disease in private schools located in high-income areas of Ankara was higher than that in public schools. This is the first and largest single-centred echocardiographic screening study for subclinical rheumatic heart disease in Turkish schoolchildren. The frequency of rheumatic heart disease has been found to be 15/1000. This finding is similar to those of recent echocardiographic screening studies performed in middle and high-risk populations. We conclude that to decrease the burden of rheumatic heart disease, echocardiographic screening studies are necessary, and long-term follow-up of children with echocardiographically diagnosed subclinical rheumatic heart disease is needed.

Handheld echocardiography for screening and control of rheumatic heart disease study in Gezira state, Sudan: a double approach model.

Rheumatic heart disease (RHD) is prevalent in Sudan's rural areas including Gezira state in central Sudan. We initiated a control program aiming at measurement of the echocardiographic (echo) prevalence of RHD, training of health workers and public awareness. This is a cross-sectional and interventional study conducted in Gezira State, Al Managil Locality from Nov 2016 to February 2018. We used handheld echo (HHE) to detect the prevalence of RHD in school children and those tested positives were referred for standard echo. In addition, training on detection of RHD for health professionals was offered using training modules for physicians and nurses. Evaluation of health facilities was carried out using a questionaire. This was coupled with educational sessions to increase public awareness about RHD using posters and pamphlets. Two thousand and one hundred twenty-nine school children were screened, 36 cases were positive by HHE, out of these 31 underwent standard echo and 5 were confirmed to have RHD, giving an echo prevalence of 2.3/1,000. All cases had mild mitral regurgitation. Knowledge, attitudes and practices of 175 health workers were assessed then a tailored training program was implemented. Practices that are not compatible with Sudan's RHD Guidelines were detected including performing skin testing prior to administration of benzathine penicillin and under-utilization of local anesthetic to decrease the pain when giving the injection. Benzathine penicillin was available in only 32% of health facilities and only 25% of their personnel received training in RHD management. RHD echo prevalence in Gezira is relatively high and the health system needs to be strengthened. A double approach, screen-to-control program that utilizes HHE screening, health workers' training, public awareness and providing medical supplies in primary health care centers is feasible.

Prevalence of rheumatic heart disease among school children in Ethiopia: A multisite echocardiography-based screening

BackgroundAuscultation-based surveys in Ethiopia conducted in the late 1990's reported a rural prevalence of 4.6/1000 and an urban prevalence of 6.4/1000 of rheumatic heart disease (RHD). With echo-based screening, we aimed to estimate the national prevalence of RHD in school children by taking school-based samples from six regions across the country using the 2012 World Heart Federation echocardiographic criteria. Patients and methodsWe conducted a cross-sectional echocardiographic screening of RHD in school children aged 6–18years from 28 randomly selected primary and secondary schools found in six different geographic regions of Ethiopia. We used the standardized WHF echocardiographic criteria. ResultsA total of 3238 children (48.5% females) were screened. The mean age was 13.2±3.2years. Of these, 44 patients (1.4%) met the WHF criteria for definite RHD, while 15 (0.5%) met the criteria for borderline disease, yielding a prevalence of 19 [13.9–23.4, 95% CI] cases per 1000 school children between the ages of 6–18years. The majority of those who tested positive were girls (26/44). The prevalence was lowest in children aged 6–9years and otherwise uniformly distributed across ages 10–18years. Definite RHD involved the mitral valve in 42 subjects, 39 of whom had mitral regurgitation and 3 with mitral stenosis. The aortic valve was affected in 6 children. The ratio of definite to borderline cases was 2.9. ConclusionThis study demonstrated a consistent pattern of high prevalence of asymptomatic RHD with definite disease predominating over borderline involvement across six regions of Ethiopia.

Rheumatic and congenital heart diseases among school children of Khon Kaen, Thailand: declining prevalence of rheumatic heart disease

Abstract Background: Rheumatic fever (RF), rheumatic heart disease (RHD), and congenital heart disease (CHD) are still major problems among Thai school children. Objective: To examine trends in the prevalence of RF/RHD and CHD along with the socioeconomic status of school children in urban Khon Kaen, northeastern Thailand. Methods: We conducted cross-sectional survey of 8,555 school children aged 5-15 years from 4 schools in urban Khon Kaen from January to March 2006. Pediatric cardiologists examined the school children and all cardiac diagnoses were confirmed by echocardiography. Socioeconomic data were also collected. Schools were divided into high and low socioeconomic status (SES) schools, based on the prevailing levels of parental education and household income. All positive cases of heart disease were followed and reviewed at a university hospital up to December 2013. Results: Of 8,555 children examined, 2 had RF/RHD, and 10 had CHD. The prevalence of RF/RHD was 0.23 per 1,000 (95% CI 0.03-0.84), and the prevalence of CHD was 1.2 per 1,000 (95% CI 0.56-2.15). Prevalence of RF/RHD among urban school children in the center of northeastern Thailand had declined from 1.13 to 0.23 per 1,000 since 1986. The indices of socioeconomic development revealed marked improvement during this 20 year interim. The prevalence of RF/RHD was higher among low SES schools (4.6 per 1,000) compared with high SES schools (0 per 1,000). Conclusion: There is a low prevalence of RHD in school children in this region compared with the period before 1986.

High prevalence of rheumatic heart disease in schoolchildren detected by echocardiography screening in New Caledonia

Despite the well-documented burden of rheumatic heart disease (RHD) in several Pacific countries, the disease is poorly understood in New Caledonia. The aim of this study was to assess the prevalence of RHD detected by echocardiographic screening in school children. An annual RHD screening programme is conducted by the Health and Social Agency of New Caledonia for school-aged children in their fourth year of primary school. For the purpose of this study, we used data collected during this echocardiographic screening between 2008 and 2010. Of 12,728 children screened, 50.2% were male and the mean age was 9.6 ± 0.6 years. Between 2008 and 2010, 114 children had RHD, corresponding to a prevalence of 8.9 cases per 1000 (95% confidence interval (CI) (7.3-10.6)). Prevalence of RHD was higher on the main island outside Greater Noumea (13.7 per 1000; 95% CI (9.8-17.5)) and in the outlying island groups (14.6 per 1000; 95% CI (8.4-20.9)) than in Greater Noumea (5.8 per 1000; 95% CI (4.1-7.5)). RHD was more prevalent in Melanesian children (13.5 per 1000; 95% CI (10.9-16.1)) than in European (1.8 per 1000; 95% CI (0.4-3.1)). This study documented a high prevalence of RHD in New Caledonia, particularly in districts located outside Noumea and in children of Melanesian heritage. These results uncover a hitherto unknown burden of disease in New Caledonia and underline the importance of delivering secondary prophylaxis to reduce the prevalence of RHD.

Screening for Cardiovascular Disease in the Young

America's youth have been screened for cardiovascular disorders for nearly a century. Initial efforts to detect rheumatic heart disease in schoolchildren have gradually shifted to the detection of congenital heart disease in the fetus and newborn, and to the prevention of sudden cardiac death in older children, especially athletes. Proposed screening programs need to consider sensitivity and specificity, cost, resource availability, and the potential for adverse effects of the screening process.

A Clinicoepidemiologic Study of Heart Disease in Schoolchildren of Menoufia, Egypt

This study was conducted to determine the prevalence of rheumatic heart disease (RHD) and congenital heart disease (CHD) in primary schoolchildren of Menoufia, Egypt and to study the relationship between these two problems and socioeconomic conditions. A total of 8000 children were screened for cardiac disease in their schools. Children with confirmed RHD and CHD in addition to 200 healthy children (controls) were visited at their homes to assess their social environment and other factors according to a designed questionnaire. We found prevalence rates of 3.4/1000 and 2.6/1000 for the RHD and CHD respectively. The most common cardiac defects were double mitral and pulmonary stenosis in the RHD and CHD groups respectively. Nineteen (39.6%) of the patients were diagnosed for the first time during the study. Penicillin prophylaxis was received by only four (14.8%) of the RHD children and none of the CHD children. The number of other affected siblings, increased multiparity, repeated abortion, and intake of contraceptives by mothers were significantly higher in families of the children with CHD. The proportion of illiterate, unskilled, and heavy smoking fathers was higher in the two patient groups. Family income was lowest in the RHD group, while increased crowding index and low whole social environment were significantly related to both RHD and CHD. Effective programs at the community and health service levels are needed in Menoufia to solve the problem of heart disease in schoolchildren in the immediate future.

Rheumatic Heart Disease in Schoolchildren from Al-Medina Al-Mounawarrah District, Saudi Arabia

The prevalence of rheumatic heart disease was assessed among schoolchildren aged 6 to 15 years. A sample size of 9,418 (10% of target population) underwent cardiac evaluation. The prevalence of rhe...

Rheumatic Heart Disease in Schoolchildren in Westren District, Saudi Arabia

Rheumatic Heart Disease in Schoolchildren in Westren District, Saudi Arabia

Rheumatic Heart Disease in Schoolchildren in Westren District, Saudi Arabia

The prevalence of rheumatic heart disease was assessed among schoolchildren aged between 6-15 years in the Western District. A sample size of 9,418 (10% of the target population) underwent cardiac evaluation. The prevalence of rheumatic heart disease was 24 per 10,000 schoolchildren (6-15 years). The prevalence was higher in rural areas and in females. This survey revealed that the carrier rate of beta-hemolytic streptococci was 34%.

Rheumatic fever and rheumatic heart disease in Japan.

Rheumatic fever (RF) is the common cause of rheumatic heart disease (RHD) in the 5-30 age group and is usually preceded by group A streptococcal pharyngitis. The annual mortality caused by RF and RHD has changed remarkably in Japan between 1960 and 1981 according to the report of the Ministry of Health and Welfare. The annual incidence of RF among schoolchildren as surveyed from pediatric clinics of 20 major hospitals between 1952 and 1980 varied year by year, and is now steadily declining. Follow-up studies of 287 patients with carditis over ten years showed that cardiac murmur disappeared in 44.9% of total patients within 4 years through use of antibiotic prophylaxis. Other patients continued to have cardiac murmur 10 years after the first attack of RF. Valvular involvement due to RF was mostly confined to mitral valve and the appearance of mitral regurgitation was particularly common in schoolchildren. Survey of RHD in schoolchildren showed that mitral regurgitation was the most common anomaly, but the prevalence rate of RHD decreased from 4.6/1000 population in 1958 to 0.14/1000 population in 1981. By contrast, mitral stenosis was predominant in adults, according to the records of patients admitted in three university hospitals. Since socio-economic conditions have improved, and penicillin has been introduced to control group A streptococcus, mortality and morbidity from RF and RHD have remarkably decreased in well developed countries. These factors may have contributed predominantly to the sharp decrease in first and recurrent attack of RF in Japan.