Echocardiography Screening for Rheumatic Heart Disease in Ugandan Schoolchildren
Background—Historically, sub-Saharan Africa has had the highest prevalence rates of clinically detected rheumatic heart disease. Echocardiography-based screening improves detection of rheumatic heart disease (RHD) in endemic regions. The newest screening guidelines (2006 NIH/WHO) have been tested across India and the Pacific, but application in sub-Saharan Africa has, thus far, been limited to Mozambique. We used these guidelines to determine RHD prevalence in a large cohort of Ugandan school children, identify risk factors for occult disease, and assess the value of laboratory testing.
Methods and Results—Auscultation and portable echocardiography were used to screen randomly selected schoolchildren, ages 5 to 16, in Kampala, Uganda. Disease likelihood was defined as definite, probable, or possible, in accordance with the 2006 WHO/NIH guidelines. Ninety-seven percent of eligible students received screening (4869 of 5006). 130 children (2.7%) had abnormal screening echocardiograms. Of those, secondary evaluation showed 72 (55.4%) with possible, probable, or definite RHD, 18 (13.8%) with congenital heart disease, and 40 (30.8%) with no disease. Echocardiography detected 3 times as many cases of RHD than auscultation: 72 (1.5%) vs. 23 (0.5%), p<0.001. Children with RHD were older (10.1 vs. 9.3, p: 0.002). Most cases (98%) involved only the mitral valve. Lower socioeconomic groups had more RHD (2.7% vs. 1.4%, p=0.036) and more advanced disease (64% vs. 26%, p<0.001). ASO titers were elevated in children with definite RHD.
Conclusions—This is one of the largest single-country childhood RHD prevalence studies and the first to be conducted in sub-Saharan Africa. Our data support inclusion of echo in screening protocols, even in the most resource constrained settings, and identify lower socioeconomic groups as most vulnerable. Longitudinal follow-up of children with echocardiographically diagnosed sub-clinical RHD is needed.
- Received February 16, 2012.
- Accepted April 24, 2012.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited