Community-based prevalence study of rheumatic heart disease in rural Ethiopia

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.