oa An echocardiographic screening of school children for rheumatic heart disease in Aswan, Egypt

Introduction: The global burden of rheumatic heart disease continues to be extremely high, with the main brunt being borne by developing countries. However, the prevalence and disease characteristics vary widely in different populations. Egypt hosts 80 million individuals and is known to be endemic for rheumatic heart disease. Methods: Cross sectional screening of a cohort of randomly selected 3062 school children between the ages of 5 and 15 years in Aswan, a "neglected "part of Egypt. The schools were stratified by area and age group and randomly selected using computer generated random-number. After ethical approval, the children underwent detailed physical and transthoracic echocardiographic examination. A set of rigid criteria including structural and functional changes in left sided valves, were used to determine the presence, distribution and severity of rheumatic affection. The disease was categorized into definite and possible. Findings: The mean age of the children examined was 10 (2*6) years with slight male preponderance (58.7%) which was representative of the whole school population. None of the children were on penicillin prophylaxis or were known to have cardiac disease. Definite and probable rheumatic valve affection was present in 23 and 13*4 per thousand respectively. Mitral valve affection (mainly regurgitation )was present in 96%, aortic regurgitation in 2.9% and combination of both in 1.4%. Left ventricular function was normal in all patients. Auscultation revealed a murmur in 7.1% of children with echocardiographic evidence of rheumatic heart disease showing a 14 fold increased detection rate by echocardiography. Interpretation: Asymptomatic rheumatic heart disease is common in school children in Aswan. The disease affects predominantly the mitral valve producing regurgitation in the majority, These findings are important for instituting early secondary prevention and stimulating future development of specific biomarkers and vaccine development.