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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 5, September/October 2017
AFRICA
289
males when compared with female subjects, this difference was
not statistically significant (
p
=
0.062).
The individual echocardiographic findings for the 17 subjects
who fulfilled the WHF criteria are depicted in Fig. 4. As would
be expected, the most frequently affected valve was the mitral
valve. There was only one subject with solitary aortic valve
findings.
An example of definite valvular RHD (subject #06-0206) is
illustrated in Fig. 5. By contrast, an example of borderline RHD
(subject #06-0168) is shown in Fig. 6.
The majority of the 17 subjects (76%) echocardiographically
classified as having RHD were categorised as ‘economically
disadvantaged students’. Additionally, 13 of the 17 subjects
(76%) with echocardiographic findings compatible with RHD
were students at schools that were demographically classified
as rural. Although not of statistical significance, these trends
are important and may have significant medical care and public
health programme implications.
Of the 2 501 subjects completely analysed, only two (0.03%)
were found to have congenital heart disease (a 2.8-cm secundum
atrial septal defect and a small pressure-restrictive patent ductus
arteriosus). No other significant underlying chronic medical
problems were identified among the subjects during these
cardiac-specific evaluations. No subjects demonstrated heart
failure and no subjects with acute rheumatic fever were identified.
Discussion
RHD prevalence reports from echocardiographic screening
studies in sub-Saharan Africa vary and high prevalence rates
are not uncommon.
6,7,13-15
To date, no published data exist about
RHD prevalence rates among school children in urban or rural
Rwanda. The geographic district of Gasabo was identified
because it was socio-economically diverse, as well as being near
Kigali city. Because of this, and following consultations with the
Republic of Rwanda Ministry of Health and school authorities,
and approval by the Rwandan National Ethics Committee, this
project was initiated.
If this reported sample, randomly selected from the
approximately 67 000 school children in the Gasabo district,
is representative, the results (the prevalence of valvular RHD
was determined echocardiographically to be 6.8/1 000), suggest
Fig. 5.
Example of definite RHD consistent with WHF 2012 criteria. A. Parasternal long-axis (PLAX) view showing thickened anterior
mitral leaflet exceeding 3 mm in young adult study subject. B. Colour-flow Doppler interrogation of the mitral valve shows
an eccentric jet of mitral regurgitation (MR) with jet length exceeding 2 cm. C. Colour-flow Doppler interrogation of the mitral
valve using the apical four-chamber (A4C) view shows eccentric jet of mitral regurgitation with jet length measuring 3.8 cm.
D. Continuous-wave (CW) Doppler interrogation of the MR jet showed maximum velocities exceeding 4.7 m/s.
A
C
B
D