Prevalence of Early Rheumatic Heart Disease Among Asymptomatic Students in Underserved Communities in Ethiopia: Cross-Sectional Observational Study

BACKGROUND: Rheumatic heart disease (RHD) is a sequela of recurrent, untreated group A Streptococcus infections. RHD disproportionately affects children and young adults in the Global South. Intermittent mass screening of early RHD by using affordable tools in these disease-endemic regions is essential for effective prevention. OBJECTIVE: This study examined multimodal physiological data for assessing the prevalence of early RHD in a cohort of asymptomatic, at-risk students in rural Ethiopia. METHODS: A total of 584 asymptomatic children aged 10 to 20 years were randomly selected for screening and stratified into 2 groups (≤14 and >14 years). Electrocardiogram, phonocardiogram, and echocardiography screening were performed, with diagnoses based on the 2012 World Heart Federation criteria. RESULTS: After excluding 1.4% (8/584) of the children, who had nonrheumatic findings, 576 participants were analyzed, including 334 (58.0%) female and 242 (42.0%) male children. The mean age was 16.1 (SD 2.4) years (95% CI 15.9-16.3). Echocardiographic screening identified 19 cases of RHD (n=10, 52.6% borderline and n=9, 47.4% definite). Female children accounted for 68.4% (13/19) of cases, and the association between female sex and RHD was not statistically significant (odds ratio 1.59, 95% CI 0.60-4.25; P=.35). The estimated prevalence of RHD was 32.5 per 1000 population (95% CI 18.1-46.9; SE 7.4; 19/576, 3.3%), which was significantly higher than the most recent multicenter prevalence estimate of 19 per 1000 population (95% CI 13.9-23.4; odds ratio 2.12; P=.03). Mitral regurgitation was the predominant lesion (16/19, 84.2%), followed by mitral stenosis (2/19, 10.5%) and aortic regurgitation (1/19, 5.3%). Phonocardiogram analysis showed mitral regurgitation (10/19, 52.6%), mitral stenosis (2/19, 10.5%), and subclinical findings in the rest of patients with RHD. Prolonged PR intervals were observed in 10.5% (2/19) of the RHD-positive participants. CONCLUSIONS: This study confirms persistent high prevalence of asymptomatic RHD among students in rural regions of Ethiopia. Although there was a female predominance in RHD incidence, the difference between the sexes was not statistically significant.