Community-based prevalence of rheumatic heart disease in rural Ethiopia: Five-year follow-up

Abstract

Background As little is known about the prevalence and clinical progression of subclinical (latent) rheumatic heart disease (RHD) in sub-Saharan Africa, we report the results of a 5 year follow-up of a community based, echocardiographic study of the disease, originally carried out in a rural area around Jimma, Ethiopia. Methods Individuals with evidence of RHD detected during the baseline study as well as controls and their family members were screened with a short questionnaire together with transthoracic echocardiography. Results Of 56 individuals with RHD (37 definite and 19 borderline) in the original study, 36 (26 definite and 10 borderline) were successfully located 57.3 (range 44.9–70.7) months later. At follow-up two thirds of the definite cases still had definite disease; while a third had regressed. Approximately equal numbers of the borderline cases had progressed and regressed. Features of RHD had appeared in 5 of the 60 controls. There was an increased risk of RHD in the family relatives of borderline and definite cases (3.8 and 4.0 times respectively), notably among siblings. Compliance with penicillin prophylaxis was very poor. Conclusions We show the persistence of echocardiographically demonstrable RHD in a rural sub-Saharan population. Both progression and regression of the disease were found; however, the majority of the individuals who had definite features of RHD had evidence of continuing RHD lesions five years later. There was an increased risk of RHD in the family relatives of borderline and definite cases, notably among siblings. The findings highlight the problems faced in addressing the problem of RHD in the rural areas of sub-Saharan Africa. They add to the evidence that community-based interventions for RHD will be required, together with appropriate ways of identifying active disease, achieving adequate penicillin prophylaxis and developing vaccines for primary prevention.

The Aswan Rheumatic heart disease reGIstry: rationale and preliminary results of the ARGI database

“…The ARGI database deals with late chronic disease and initiatives to diagnose earlier phases of disease including ARF ( 15 , 19 , 20 ) as well as population studies ( 21 ) are essential.…”

Descriptive Analysis of Rheumatic Heart Disease Related Complications in Pediatric Patients at Tertiary Hospital, Addis Ababa, Ethiopia

“…In a recent community-based prevalence study from south-western Ethiopia, it was reported that the prevalence of RHD was 37.5 per thousand people and this rate is almost 10-fold higher than the prevalence of RHD in schoolchildren from a rural town (Butajira) that was reported nearly 25 years ago. [9][10][11][12] Pediatric data are scarce in Ethiopia regarding complications pertaining to rheumatic heart disease, mortality rate and main cause of death in such patients. Most of the studies are in the adult population and even among them we could not find a study with a special emphasis on RHD patients to point out related complications.…”

Adherence to Secondary Prophylaxis and Risk Factors Among Patients with Rheumatic Heart Disease at Public Hospitals in Addis Ababa, Ethiopia, 2021–2022

“…People living in overcrowded and poor conditions, including in Ethiopia, are at risk of developing this disease. 2,3 The most effective treatment for preventing further infection is benzantine penicillin G (BPG), which is administered via intramuscular injection every month. Alternatively, daily oral penicillin V can be given to a selected number of patients if compliance is guaranteed.…”