title: Prevalence of rheumatic heart disease among school children in Ethiopia: A multisite echocardiography-based screening.
abstract: BACKGROUND
  Auscultation-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.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  A 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.
  
  
  CONCLUSIONS
  This study demonstrated a consistent pattern of high prevalence of asymptomatic RHD with definite disease predominating over borderline involvement across six regions of Ethiopia.
authors.affiliation: College of Health Sciences, Addis Ababa University, Ethiopia. Electronic address: dejuya@yahoo.com.
authors.forename: Dejuma
authors.initials: D
authors.lastname: Yadeta
authors.affiliation: School of Medicine, Mekele University, Ethiopia.
authors.forename: Abrha
authors.initials: A
authors.lastname: Hailu
authors.affiliation: School of Medicine, Jimma University, Ethiopia.
authors.forename: Abraham
authors.initials: A
authors.lastname: Haileamlak
authors.affiliation: College of Health Sciences, Addis Ababa University, Ethiopia.
authors.forename: Etsgenet
authors.initials: E
authors.lastname: Gedlu
authors.affiliation: College of Health Sciences, Addis Ababa University, Ethiopia.
authors.forename: Senbeta
authors.initials: S
authors.lastname: Guteta
authors.affiliation: College of Health Sciences, Addis Ababa University, Ethiopia.
authors.forename: Endale
authors.initials: E
authors.lastname: Tefera
authors.affiliation: School of Medicine, Gondar University, Ethiopia.
authors.forename: Zemene
authors.initials: Z
authors.lastname: Tigabu
authors.affiliation: School of Medicine, Mekele University, Ethiopia.
authors.forename: Hagazi
authors.initials: H
authors.lastname: Tesfaye
authors.affiliation: School of Medicine, Jimma University, Ethiopia.
authors.forename: Wandimu
authors.initials: W
authors.lastname: Daniel
authors.affiliation: School of Medicine, Gondar University, Ethiopia.
authors.forename: Desalew
authors.initials: D
authors.lastname: Mekonnen
authors.affiliation: School of Medicine, Gondar University, Ethiopia.
authors.forename: Meseret
authors.initials: M
authors.lastname: Zelalem
authors.affiliation: School of Medicine, Bahr Dar University, Ethiopia.
authors.forename: Yohannes
authors.initials: Y
authors.lastname: Tekleab
authors.affiliation: College of Health Sciences, Addis Ababa University, Ethiopia.
authors.forename: Bekele
authors.initials: B
authors.lastname: Alemayehu
authors.affiliation: College of Health Sciences, Addis Ababa University, Ethiopia.
authors.forename: Dufera
authors.initials: D
authors.lastname: Mekonnen
authors.affiliation: College of Health Sciences, Addis Ababa University, Ethiopia.
authors.forename: Aklilu
authors.initials: A
authors.lastname: Azazh
authors.affiliation: College of Health Sciences, Addis Ababa University, Ethiopia.
authors.forename: Tamirat
authors.initials: T
authors.lastname: Moges
authors.affiliation: School of Medicine, Mekele University, Ethiopia.
authors.forename: Tedros
authors.initials: T
authors.lastname: Hailu
authors.affiliation: School of Medicine, Haromaya University, Ethiopia.
authors.forename: Tekabe
authors.initials: T
authors.lastname: Abdosh
authors.affiliation: School of Medicine, Haromaya University, Ethiopia.
authors.forename: Nejib
authors.initials: N
authors.lastname: Yusuf
authors.affiliation: School of Medicine, Haromaya University, Ethiopia.
authors.forename: Dawit
authors.initials: D
authors.lastname: Ayele
authors.affiliation: School of Medicine, Hawassa University, Ethiopia.
authors.forename: Kindie
authors.initials: K
authors.lastname: Wuobshet
authors.affiliation: School of Medicine, Hawassa University, Ethiopia.
authors.forename: Henok
authors.initials: H
authors.lastname: Tadele
authors.affiliation: School of Medicine, Hawassa University, Ethiopia.
authors.forename: Kinfe
authors.initials: K
authors.lastname: Lemma
authors.affiliation: College of Health Sciences, Addis Ababa University, Ethiopia.
authors.forename: Solomon
authors.initials: S
authors.lastname: Shiferaw
authors.affiliation: School of Medicine, Hawassa University, Ethiopia.
authors.forename: Araya
authors.initials: A
authors.lastname: Giday
authors.affiliation: School of Medicine, Jimma University, Ethiopia.
authors.forename: Demeke
authors.initials: D
authors.lastname: Mekonnen
authors.affiliation: School of Medicine, Hawassa University, Ethiopia.
authors.forename: Getnet
authors.initials: G
authors.lastname: Alemu
authors.affiliation: Department of Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Liesl
authors.initials: L
authors.lastname: Zühlke
authors.affiliation: Mayo Clinic, Rochester, USA.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Allison
authors.affiliation: Mayo Clinic, Rochester, USA.
authors.forename: Vuisile T
authors.initials: VT
authors.lastname: Nkomo
authors.affiliation: Department of Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Engel
mesh_terms: D000293:Adolescent; D002648:Child; D003430:Cross-Sectional Studies; D004452:Echocardiography / Q000379:methods; D015150:Echocardiography, Doppler / Q000379:methods*; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D006326:Heart Auscultation / Q000379:methods*; D006801:Humans; D008297:Male; D015995:Prevalence; D012214:Rheumatic Heart Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000503:physiopathology
keywords: Echocardiographic screening; Rheumatic heart disease in Ethiopia; World heart federation criteria