title: Rheumatic heart disease in a developing country: Incidence and trend (Monastir; Tunisia: 2000-2013).
abstract: BACKGROUND
  The penicillin therapy of β hemolytic streptococcal pharyngitis has aided in the decrease of rheumatic heart disease (RHD) in developing countries. Tunisia is an endemic area, however, and incidence of RHD is weakly documented. We aimed at establishing the standardized incidence rate (SIR) of RHD in Monastir governorate and at determining RHD prevalence among hospitalized patients in two cardiology departments.
  
  
  METHODS
  From the regional register of Monastir Hospital morbidity, we have selected newly diagnosed patients with RHD, residents of Monastir, and hospitalized to the 2 cardiology departments between 2000 and 2013 (2001 not included).
  
  
  RESULTS
  We studied 676 newly admitted patients. We estimate 1060 to be the number of new annual RHD cases in Tunisia. The SIR per 105person-years was 10.97, being 9.3 in men and 19.1 in women, respectively. We have notified a negative trend of crude incidence rate/105Inhabitants (Inh) (CIR) (r=-0.23, p<10-3), and a strong positive correlation between age and CIR/105Inh (r=0.989, p<10-4). RHD lethality was 1%. We have registered 728 hospitalizations for RHD, representing 2.5% of all cardiology hospitalizations [95% CI: 2.3-2.7%], with a prevalence for 13.3% for women aged 15-29years. The median hospital stay was 9days (IQR: 5-15).
  
  
  CONCLUSIONS
  Our results confirm the RHD incidence decrease, consistent with epidemiological transition in Tunisia. We have also emphasized on the close trend of RHD with age and the predominance of RHD among women especially at the procreation age.
authors.affiliation: Department of Epidemiology and Preventive Medicine, University Hospital of Monastir, Tunisia. Electronic address: belguith_asma@yahoo.fr.
authors.forename: Asma
authors.initials: A
authors.lastname: Sriha Belguith
authors.affiliation: Stah Jabeur Primary Health Center, Monastir Health Group, Monastir, Tunisia. Electronic address: abdelkafiafifa@yahoo.fr.
authors.forename: Afifa
authors.initials: A
authors.lastname: Koubaa Abdelkafi
authors.affiliation: Department of Epidemiology and Preventive Medicine, University Hospital of Monastir, Tunisia. Electronic address: sanaelmhamdi@gmail.com.
authors.forename: Sana
authors.initials: S
authors.lastname: El Mhamdi
authors.affiliation: Department of Epidemiology and Preventive Medicine, University Hospital of Monastir, Tunisia. Electronic address: manel-ben-fredj@hotmail.fr.
authors.forename: Manel
authors.initials: M
authors.lastname: Ben Fredj
authors.affiliation: Department of Epidemiology and Preventive Medicine, University Hospital of Monastir, Tunisia. Electronic address: hela-abr@hotmail.com.
authors.forename: Hela
authors.initials: H
authors.lastname: Abroug
authors.affiliation: Department of Epidemiology and Preventive Medicine, University Hospital of Monastir, Tunisia. Electronic address: bensalah.arwa@yahoo.fr.
authors.forename: Arwa
authors.initials: A
authors.lastname: Ben Salah
authors.affiliation: Department of Epidemiology and Preventive Medicine, University Hospital of Monastir, Tunisia. Electronic address: bouaneneines@gmail.com.
authors.forename: Inès
authors.initials: I
authors.lastname: Bouanene
authors.affiliation: Sayada Primary Health Center, Monastir Health Group, Monastir, Tunisia. Electronic address: hassine_fahima@yahoo.fr.
authors.forename: Fahima
authors.initials: F
authors.lastname: Hassine
authors.affiliation: Department of Epidemiology and Preventive Medicine, University Hospital of Monastir, Tunisia. Electronic address: amel.amara1@yahoo.fr.
authors.forename: Amal
authors.initials: A
authors.lastname: Amara
authors.affiliation: Department of Epidemiology and Preventive Medicine, University Hospital of Monastir, Tunisia. Electronic address: bhirisana@yahoo.com.
authors.forename: Sana
authors.initials: S
authors.lastname: Bhiri
authors.affiliation: Primary Health Center, Sfax Health Group, Sfax, Tunisia. Electronic address: drderbelabdelkarim@yahoo.fr.
authors.forename: Abdelkarim
authors.initials: A
authors.lastname: Derbel
authors.affiliation: Department of Cardiology A, University Hospital of Monastir, Monastir, Tunisia. Electronic address: hgamra@rns.tn.
authors.forename: Habib
authors.initials: H
authors.lastname: Gamra
authors.affiliation: Department of Cardiology B, University Hospital of Monastir, Monastir, Tunisia. Electronic address: mf.maatouk@rns.tn.
authors.forename: Faouzi
authors.initials: F
authors.lastname: Maatouk
authors.affiliation: Department of Epidemiology and Preventive Medicine, University Hospital of Monastir, Tunisia. Electronic address: mohamed.soltani@rns.tn.
authors.forename: Mohamed Soussi
authors.initials: MS
authors.lastname: Soltani
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D003906:Developing Countries; D005260:Female; D006760:Hospitalization / Q000639:trends; D006801:Humans; D015994:Incidence; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012042:Registries; D012189:Retrospective Studies; D012214:Rheumatic Heart Disease / Q000453:epidemiology*; D012737:Sex Factors; D014416:Tunisia / Q000453:epidemiology
keywords: Age; Gender; Hospital; Incidence; Rheumatic heart disease; Trend