title: Community-based prevalence study of rheumatic heart disease in rural Ethiopia.
abstract: Background Chronic Rheumatic Heart disease (RHD) continues to be a health problem in many low and middle income countries and especially in sub-Saharan Africa. Echocardiography has shown that the disease is far more widespread than may be detected by clinical assessment, but data are lacking on the prevalence and epidemiological features in rural Africa. Design Community-based prevalence survey Methods We used transthoracic echocardiography to carry out a population-based study of RHD in a rural area of Ethiopia. A total of 987 participants aged 6 to 25 were selected by cluster sampling. The prevalence of RHD was assessed by the current consensus World Heart Federation criteria. Results There were 37 definite cases of RHD and a further 19 borderline cases giving an overall prevalence of 37.5 cases per 1000 population (95% CI 26.9-51.8) rising to 56.7 (95% CI 43.9-73.5) if the borderline cases are included. The prevalence of definite disease rose to a peak of 60 cases per 1000 in those aged 16-20 years before falling to 11 cases per 1000 in subjects aged 21-25 years. Of the 37 with definite disease, 36 had evidence of mitral valve and seven evidence of aortic valve disease. Conclusions RHD has a high prevalence in rural Ethiopia. Although follow-up is needed to determine how the disease develops with advancing age, the data provide evidence that the disease is an important health problem in rural sub-Saharan Africa requiring urgent concerted action.
authors.affiliation: 1 Jimma University Hospital, Ethiopia.
authors.forename: Tadesse
authors.initials: T
authors.lastname: Gemechu
authors.affiliation: 2 Aswan Heart Centre, Aswan, Egypt.
authors.forename: Hani
authors.initials: H
authors.lastname: Mahmoud
authors.affiliation: 3 London School of Hygiene and Tropical Medicine, UK.
authors.forename: Eldryd Ho
authors.initials: EH
authors.lastname: Parry
authors.affiliation: 4 MRC Lifecourse Epidemiology Unit, University of Southampton, UK.
authors.forename: David Iw
authors.initials: DI
authors.lastname: Phillips
authors.affiliation: 2 Aswan Heart Centre, Aswan, Egypt.|5 NHLI, Heart Science Centre, Imperial College London, UK.
authors.forename: Magdi H
authors.initials: MH
authors.lastname: Yacoub
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002648:Child; D016000:Cluster Analysis; D003906:Developing Countries; D004452:Echocardiography / Q000379:methods*; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D020380:Needs Assessment; D015995:Prevalence; D011379:Prognosis; D012214:Rheumatic Heart Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000503:physiopathology; D018570:Risk Assessment; D012424:Rural Population / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D017678:Sex Distribution; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D015996:Survival Rate; D055815:Young Adult
keywords: Chronic rheumatic heart disease; Ethiopia; echocardiography; prevalence; rural communities