Epidemiology of rheumatic heart disease in black shcoolchildren of Soweto, Johannesburg.

The challenge of screening for asymptomatic rheumatic heart disease in South Africa

“…(14,15) Clinical and echocardiographic screening studies indicate that the overwhelming majority of cases (over 85%) with defi nite rheumatic heart disease are asymptomatic. (1,8,11,12) These observations indicate that the disease has a pre-symptomatic stage that can be detected by portable echocardiography and penicillin prophylaxis is available to prevent recurrent attacks of rheumatic fever and potentially ameliorate the development of chronic rheumatic heart disease. There is therefore a strong case to be made for the screening of the general population for rheumatic heart disease in South Africa and other countries where the disease remains endemic.…”

“…(1,8,13) A 2002 report from a paediatric cardiology workshop highlights the belief among clinicians that South Africa continues to experience a high burden of cases of symptomatic rheumatic heart disease. (5) Recent reports show that rheumatic heart disease is present in 1% of pregnant patients presenting to tertiary centres and is associated with high maternal morbidity and mortality and poor foetal outcomes.…”

“…(9) of rheumatic heart disease at the population level was estimated for the fi rst time by Barlow and his team among 12 000 school children in Soweto in 1971. (1) This auscultatory screening study of asymptomatic school children reported an overall prevalence of 6.9 per 1 000, with a peak prevalence rate of 19.2/1 000 in older children. A decade later, there was a similar survey of 1 000 school children in Inanda near Durban that found a lower prevalence of rheumatic heart disease of 1/1 000.…”

“…(2) These fi ndings led to calls for the establishment of a national programme for the prevention of rheumatic fever and rheumatic heart disease in South Africa. (1) The government responded appropriately by declaring acute rheumatic fever and the initial diagnosis of rheumatic heart disease as notifi able conditions in 1979. (3) The fi rst national guideline on the prevention of rheumatic fever and rheumatic heart disease at the primary care level was published in 1997.…”

Children’s heart disease in sub-Saharan Africa: Challenging the burden of disease

“…(26) In Africa, early reports based on auscultatory screening of school-going children gave incidences from 2.7 to 20 per 1 000 population. (16,27,28,29) Recently Marijon et al reported an incidence in Mozambique of 30.4 per 1 000 using echo-based screening of schoolchildren, (30) probably a better estimate. Because of the difficulty in obtaining data, it is possible that the true incidence in many areas is even higher.…”