title: Rheumatic heart disease in rural south India: A clinico-observational study.
abstract: BACKGROUND
  Rheumatic heart disease (RHD) is still a public health issue in many countries in the world, and particularly in Southeast Asia. India, for example, contributes 25%-50% of the global burden of RHD. Clinic-based and epidemiological studies on RHD in India have used different methodologies and clinical criteria to estimate RHD burden in India. The present study employs strict clinical criteria, including echocardiography, to estimate RHD prevalence and associated clinical complications in a large unique rural population in southern India covered through a governmental health insurance scheme.
  
  
  METHODS
  Total 44,164 eligible patients were screened from 238 primary care health centers in rural southern India between October 2007 and March 2012 using strict clinical criteria and objective ascertainment. A total of 403 patients aged 15 years or above were finally analyzed based on both the inclusion and exclusion criteria. Detailed information on both demographic and clinical characteristics was obtained through personal interviews and clinical examinations. Descriptive analyses were performed, including age standardization.
  
  
  RESULTS
  The age-standardized RHD prevalence rate was 9.7/1000 populations-more common in younger age groups (<44 years) and relatively high among females. Pulmonary hypertension was the most common clinical complication followed by CHF, tricuspid regurgitation, as well as infective endocarditis. More than two-thirds had no past history of RHD or penicillin prophylaxis.
  
  
  CONCLUSIONS
  RHD rates are still high in rural India among populations covered through governmental health insurance scheme. Both primary and secondary preventive measures, including widespread coverage of penicillin prophylaxis, must be considered mainstay tools to both prevent and reduce RHD burden in endemic populations, including rural India.
authors.affiliation: Department of Medicine, GSL Medical College and General Hospital, N.H 216 Rajahmundry, East Godavari District, Andhra Pradesh 534296, India.
authors.forename: Manne
authors.initials: M
authors.lastname: Sriharibabu
authors.forename: Yalamanchali
authors.initials: Y
authors.lastname: Himabindu
authors.forename: Zubair
authors.initials: Z
authors.lastname: Kabir
keywords: Prevalence; RHD; South India
references.citation: N Engl J Med. 2007 Aug 2;357(5):470-6
references.pmid: 17671255
references.citation: J Assoc Physicians India. 2006 Apr;54:279-82
references.pmid: 16944609
references.citation: J Epidemiol Community Health. 1996 Feb;50(1):62-7
references.pmid: 8762356
references.citation: J Cardiovasc Dis Res. 2012 Jul;3(3):204-11
references.pmid: 22923938
references.citation: J R Soc Health. 1995 Oct;115(5):303-4, 309
references.pmid: 7473501
references.citation: Heart. 2004 Apr;90(4):394-9
references.pmid: 15020513
references.citation: J Indian Med Assoc. 1992 Mar;90(3):57-9
references.pmid: 1634785
references.citation: Indian Heart J. 2007 Jan-Feb;59(1):9-10
references.pmid: 19098328
references.citation: Indian Heart J. 2002 Jan-Feb;54(1):54-8
references.pmid: 11999089
references.citation: Heart. 2001 Apr;85(4):407-10
references.pmid: 11250966
references.citation: Circulation. 2008 Dec 16;118(25):2748-53
references.pmid: 19106399
references.citation: Bull World Health Organ. 1993;71(1):59-66
references.pmid: 8440039
references.citation: Heart. 2011 Dec;97(24):2018-22
references.pmid: 22076022
references.citation: Heart. 2001 Aug;86(2):127
references.pmid: 11454820
references.citation: Natl Med J India. 2009 Mar-Apr;22(2):72-4
references.pmid: 19852341
references.citation: Sichuan Da Xue Xue Bao Yi Xue Ban. 2003 Jul;34(3):533-5
references.pmid: 12910712
references.citation: Indian Heart J. 2003 Mar-Apr;55(2):152-7
references.pmid: 12921330
references.citation: Echocardiography. 2010 Apr;27(4):448-53
references.pmid: 20345448
references.citation: J Heart Valve Dis. 2009 May;18(3):327-35; discussion 336
references.pmid: 19557993
references.citation: N Engl J Med. 2007 Aug 2;357(5):439-41
references.pmid: 17671252
references.citation: Heart. 2005 Sep;91(9):1131-3
references.pmid: 16103536