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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 5, September/October 2017
AFRICA
285
Prevalence of rheumatic valvular heart disease in
Rwandan school children: echocardiographic evaluation
using the World Heart Federation criteria
J Mucumbitsi, B Bulwer, L Mutesa, V Ndahindwa, M Semakula, E Rusingiza, P Arya, S Breakey,
C Patton-Bolman, E L Kaplan
Abstract
Background:
Rheumatic fever (RF) and rheumatic valvular
heart disease (RHD) remain important medical, surgical and
public health concerns in many parts of the world, especially
in sub-Saharan Africa. However, there are no published data
from Rwanda. We performed a RHD prevalence study in a
randomly selected sample of Rwandan school children using
the 2012 World Heart Federation (WHF) criteria.
Methods:
Echocardiographic assessment of 2 501 Rwandan
school children from 10 schools in the Gasabo district near
Kigali was carried out. Resulting data were evaluated by four
experienced echocardiographers. Statistical analyses were
carried out by statisticians.
Results:
RHD prevalence was 6.8/1 000 children examined
(95% CI: 4.2/1 000–10.9/1 000). Seventeen met WHF criteria
for RHD, 13 fulfilled criteria for ‘borderline’ RHD and four
were ‘definite’ RHD. None of these 17 had been previously
identified.
Conclusion:
These data indicate a significant burden of RHD
in Rwanda and support a need for defined public health RF
control programmes in children there.
Keywords:
rheumatic heart disease, rheumatic fever, echocardiog-
raphy, prevalence, epidemiology
Submitted 21/7/16, accepted 11/1/17
Published online 1/3/17
Cardiovasc J Afr
2017;
28
: 285–292
www.cvja.co.zaDOI: 10.5830/CVJA-2017-007
The incidence of acute rheumatic fever (RF) and the prevalence
of rheumatic heart disease (RHD) have decreased remarkably
in industrialised countries during recent decades.
1-3
Yet this
disease process remains a significant health issue among
socio-economically disadvantaged populations, especially in
developing countries.
To effectively allocate limited health resources for medical
and public health planning in low- and middle-income countries,
accurate assessment of the current status of RF and RHD is
necessary. Echocardiography has emerged as an effective diagnostic
tool for assessing cardiac pathology in patients with RHD. Recent
studies have reported a wide variation in RF incidence and RHD
prevalence across countries, even within different socio-economic
strata and geographic regions within the same country.
4-7
Several guidelines for diagnosing RHD have been published
in recent years.
8-12
Although some differences exist among these
guidelines, they are useful in supporting rapid, non-invasive
assessment of RHD status for both clinical care and
epidemiological studies. Compared with clinical auscultation,
echocardiography has been reported to be advantageous for
demonstrating very mild (borderline) pathology or ‘silent
carditis/valvulitis’ in RHD.
13-15
The purpose of this project was to determine the prevalence
of RHD in a sample of Rwandan school children using the 2012
World Heart Federation (WHF) echocardiographic criteria.
10
There are no previously published RHD prevalence data from
this sub-Saharan African country. Such determinations are
important for country-based medical and public health efforts.
The findings from our echocardiographic study in Rwanda are
described and discussed in this report.
Rwandan Heart Foundation and Department of Pediatrics,
King Faisal Hospital, Kigali, Rwanda
J Mucumbitsi, MD
Noninvasive Cardiovascular Research, Cardiovascular
Division, Brigham and Women’s Hospital, Boston,
Massachusetts, USA
B Bulwer, MD
College of Medicine and Health Sciences, University of
Rwanda, Kigali, Rwanda
L Mutesa, MD, PhD
School of Public Health, College of Medicine and Health
Sciences, University of Rwanda, Kigali, Rwanda
V Ndahindwa, MD, MSc
Rwanda Biomedical Centre, Kigali, Rwanda; Interuniversity
Institute for Biostatistical and Statistical Bioinformatics,
University of Hasselt, Belgium
M Semakula, PhD
School of Medicine and Pharmacy, University of Rwanda,
Kigali, Rwanda
E Rusingiza, MD
Department of Pediatric Cardiology, Massachusetts
General Hospital, Boston, Massachusetts, USA
P Arya, MD
Massachusetts General Hospital, Institute of Health
Professions, Boston, Massachusetts, USA
S Breakey, RN, PhD
Team Heart Inc, Boston, Massachusetts, USA
C Patton-Bolman, RN, MSN
Department of Pediatrics, University of Minnesota Medical
School, Minneapolis, Minnesota, USA
E L Kaplan, MD,
kapla001@umn.edu