Prevalence of Rheumatic Heart Disease Detected by Echocardiographic Screening Among School Children in the Niger Delta Region of Nigeria
Rheumatic heart disease (RHD) is an important public health problem in developing countries. Community-based studies using portable echocardiography have enhanced detection of RHD for early intervention. The aim of this study was to determine the prevalence of RHD among school children in Port Harcourt, the pattern of valvular involvement (s), the relationship of RHD with certain risk factors (such as overcrowding and socioeconomic status) and to ascertain the sensitivity, specificity and positive predictive value of cardiac auscultation in detecting RHD. A total of 461 students aged 5-15 years were selected by multi-staged sampling from thirteen schools in Port Harcourt. Questionnaires were used to obtain relevant information on history suggestive of rheumatic fever or RHD and parents’ occupation and level of education. Subsequently, all the selected students had cardiac auscultation and echocardiographic examination. Ethical clearance was obtained from the Research and Ethics Committee of the University of Port Harcourt Teaching Hospital and from Rivers State Ethical Committee. The study revealed an RHD prevalence rate of 4.3 per 1,000 students using cardiac auscultation and 6.5 per 1,000 students using echocardiography only. All (100%) of the affected students with RHD were within the age category of 11-15 years and were females. Mitral regurgitation (66.7%) was the commonest valvular lesion seen. There was significant association between RHD and overcrowding (p = 0.04), while 66.7% belonged to the middle socioeconomic class (SEC) and 33.3% to the low SEC. Cardiac auscultation is 66.7% sensitive and 98.7% specific in detecting RHD with a positive predictive value of 25% when compared with echocardiography. This study shows that RHD is a problem among school children within the study area. It is recommended that community screening of children for RHD using echocardiography for early detection and treatment should be undertaken to advert complications and improve the quality of life of the affected individuals.
Rheumatic Heart Disease, Prevalence, Echocardiography, Screening
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