title: Clinical and geographic patterns of rheumatic heart disease in outpatients attending cardiology clinic in western Kenya.
abstract: BACKGROUND
  Rheumatic heart disease (RHD) remains a leading cause of cardiovascular mortality in sub-Saharan Africa. Identifying high risk populations and geographic patterns of disease is crucial to developing RHD prevention and screening strategies in endemic areas.
  
  
  OBJECTIVE
  To identify clinical and geographical trends in RHD throughout western Kenya METHODS: We conducted a retrospective chart review of all patients <50years old attending adult cardiology clinic at a national referral hospital in western Kenya. Demographic information, residential location and cardiac history were collected. We mapped the spatial distribution of cardiac disease rates and analyzed the effect of distance from the hospital on RHD status.
  
  
  RESULTS
  Two-thirds (64%) of cardiology clinic patients <50years old (n=906) had RHD. RHD patients were younger (26 vs. 33years, p<0.001) and more often female (69% vs. 59%, p=0.001) than non-RHD patients. Global clustering of disease rates existed within 200km of the hospital with significant clustering of the RHD and non-RHD rate difference surrounding the hospital (Moran's I: 0.3, p=0.001). There was an interaction between ethnicity and distance from the hospital such that the odds of RHD decreased with further distance for Nilotes, but the odds of RHD increased with further distance for non-Nilotes CONCLUSION: Most adult cardiology patients treated at a national referral hospital in western Kenya have RHD. Young people and females are commonly affected. Ethnicity and distance to the hospital interdependently affect the odds of RHD. Future studies in this area should consider the impact of ethnic predisposition to RHD.
authors.affiliation: Department of Medicine, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710, USA. Electronic address: rebecca.lumsden@duke.edu.
authors.forename: Rebecca H
authors.initials: RH
authors.lastname: Lumsden
authors.affiliation: Division of Medicine, Moi Teaching and Referral Hospital, P.O. Box 3705-30100, Eldoret, Kenya.
authors.forename: Constantine
authors.initials: C
authors.lastname: Akwanalo
authors.affiliation: Moi University School of Medicine, Moi University College of Health Sciences, P.O. Box 3900-30100, Eldoret, Kenya.
authors.forename: Stella
authors.initials: S
authors.lastname: Chepkwony
authors.affiliation: Moi University School of Medicine, Moi University College of Health Sciences, P.O. Box 3900-30100, Eldoret, Kenya.
authors.forename: Anne
authors.initials: A
authors.lastname: Kithei
authors.affiliation: Moi University School of Medicine, Moi University College of Health Sciences, P.O. Box 3900-30100, Eldoret, Kenya.
authors.forename: Vincent
authors.initials: V
authors.lastname: Omollo
authors.affiliation: Department of Medicine, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710, USA; Duke Clinical Research Institute, Duke University, 2400 Pratt Street, Durham, NC 27705, USA.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Holland
authors.affiliation: Department of Medicine, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710, USA; Duke Clinical Research Institute, Duke University, 2400 Pratt Street, Durham, NC 27705, USA; Duke Global Health Institute, Duke University, 301 Trent Drive, Durham, NC 27710, USA.
authors.forename: Gerald S
authors.initials: GS
authors.lastname: Bloomfield
authors.affiliation: Department of Medicine, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710, USA; Duke Global Health Institute, Duke University, 301 Trent Drive, Durham, NC 27710, USA.
authors.forename: Wendy P
authors.initials: WP
authors.lastname: O'Meara
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care; D016507:Cardiology Service, Hospital; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D005260:Female; D005843:Geography; D006801:Humans; D007630:Kenya; D008297:Male; D012189:Retrospective Studies; D012214:Rheumatic Heart Disease / Q000453:epidemiology*; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Africa; Epidemiology; Kenya; RHD; Rheumatic heart disease; Valvular disease