Impact of Socio-Economic Factors on Increased Risk and Progression of Rheumatic Heart Disease in Developing Nations

Sharma, Neha; Toor, Devinder

doi:10.1007/s11908-019-0677-6

Cited by 23 publications

(16 citation statements)

References 37 publications

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“…With a higher family size in the evaluated participants, there was a notable increase in the rate of ARF and its sequelae, which may reflect the effect of household crowding and deprivation [4,40,42]. This was consistent in previous reports from around the world [3,4,9,10,11,31,33,34,41,42]. Likewise, a higher crowding index and poor ventilation obviously affected the occurrence of ARF and its complications in this cohort.…”

Section: Characteristics Of the Screened Cohortsupporting

confidence: 89%

“…Household overcrowding is the most important factor underlying the high ARF incidence [ 40 , 41 ]. With a higher family size in the evaluated participants, there was a notable increase in the rate of ARF and its sequelae, which may reflect the effect of household crowding and deprivation [ 4 , 40 , 42 ]. This was consistent in previous reports from around the world [ 3 , 4 , 9 , 10 , 11 , 31 , 33 , 34 , 41 , 42 ].…”

Section: Discussionmentioning

confidence: 99%

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How accurate is the diagnosis of rheumatic fever in Egypt? Data from the national rheumatic heart disease prevention and control program (2006-2018)

2020

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Rheumatic heart disease (RHD) as a chronic sequela of repeated episodes of acute rheumatic fever (ARF), remains a cause of cardiac morbidity in Egypt although it is given full attention through a national RHD prevention and control program. The present report reviews our experience with subjects presenting with ARF or its sequelae in a single RHD centre and describes the disease pattern over the last decade. A cross-sectional study was conducted in El-Mahalla RHD centre between 2006 and 2018. A total of 17014 individual were enrolled and evaluated. Diagnosis ARF was based on the 2015 revised Jones criteria and RHD was ruled in by echocardiography. The majority of the screened subjects were female (63.2%), in the age group 5-15 years (64.6%), rural residents (61.2%), had primary education (43.0%), and of low socioeconomic standard (50.2%). The total percentage of cases presenting with ARF sequelae was 29.3% [carditis/RHD (10.8%), rheumatic arthritis (Rh.A) (14.9%), and Sydenham's chorea (0.05%)]. Noticeably, 72% were free of any cardiac insult, of which 37.7% were victims of misdiagnoses made elsewhere by untrained practitioners who prescribed for them long term injectable long-acting penicillin [Benzathine Penicillin G (BPG)] without need. About 54% of the study cohort reported the occurrence of recurrent attacks of tonsillitis of which 65.2% underwent tonsillectomy. Among those who experienced tonsillectomy and/or received BPG in the past, 14.5% and 22.3% respectively had eventually developed RHD. Screening of family members of some RHD cases who needed cardiac surgery revealed 20.7% with undiagnosed ARF sequalae [RHD (56.0%) and Rh.A (52.2%)]. Upon the follow-up of RHD cases, 1.2% had improved, 98.4% were stable and 0.4% had their heart condition deteriorated. Misdiagnosis of ARF or its sequelae and poor compliance with BPG use may affect efforts being exerted to curtail the disease. Updating national guidelines, capacity building, and reliance on appropriate investigations should be emphasized. Since the genetic basis of RHD is literally confirmed, a family history of RHD warrants screening of all family members for early detection of the disease.

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Section: Characteristics Of the Screened Cohortsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

How accurate is the diagnosis of rheumatic fever in Egypt? Data from the national rheumatic heart disease prevention and control program (2006-2018)

2020

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“…RHD is a disease of poverty, social inequality, overcrowding and limited access to health care [3]. RHD and ARF have remained vastly neglected despite the heavy morbidity and socio‐economic burden they impose on populations in endemic countries [5]. Recurrent episodes of ARF can insidiously lead to subclinical RHD which may ultimately progress to severe valvular damage and heart failure [1].…”

Section: Introductionmentioning

confidence: 99%

Prevalence of rheumatic heart disease in North‐Central Nigeria: a school‐based cross‐sectional pilot study

Nkereuwem

Ige

Yilgwan

et al. 2020

Tropical Med Int Health

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Objectives To present epidemiological data on rheumatic heart disease (RHD), the most common acquired heart disease in children and young adults in low‐ and middle‐income countries, for North‐Central Nigeria. Methods In this pilot study, we conducted clinical and echocardiography screening on a cross section of randomly selected secondary schoolchildren in Jos, North‐Central Nigeria, from March to September 2016. For outcome classification into borderline or definite RHD, we performed a confirmatory echocardiography using the World Heart Federation criteria for those suspected to have RHD from the screening. Results A total of 417 secondary schoolchildren were screened, of whom 247 (59.2%) were female. The median age was 14 years (IQR: 13–15). Clinical screening detected 8/417 children, whereas screening echocardiography detected 42/417 suspected cases of RHD. Definitive echocardiography confirmed 9/417 with RHD corresponding to a prevalence of 21.6 per 1000 (95% CI, 6.7–36.5). All but one of the confirmed RHD cases (8/9) were borderline RHD corresponding to a prevalence of 19.2 per 1000 (95% CI, 8.3–37.5) for borderline RHD and 2.4 per 1000 (95% CI, 0.1–13.3) for definite RHD. RHD was more common in boys and cardiac auscultation missed over 50% of the cases. Conclusions This study showed a high prevalence of RHD among secondary schoolchildren in North‐Central Nigeria with a vast predominance of asymptomatic borderline lesions. Larger school‐based echocardiography screening using portable or handheld echocardiography aimed at early detection of subclinical RHD should be adopted.

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“…[7][8][9] Poor socioeconomic status, undernutrition, overcrowded homes, are proven to be most common risk factors for the same. 10,11 The overall prevalence of acute rheumatic fever in India varies from 0.5 to 11/1000 children of age group 5 to 14 years. 12 Shah et al observed that in India, children get afflicted even at earlier age compared to developed countries.…”

Section: Discussionmentioning

confidence: 99%

Atypical arthritis in a toddler: beware, save the heart

Boopathy

Thandapani

Arunagirinathan

2020

Int J Contemp Pediatr

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Acute rheumatic fever still poses a dreadful threat to pediatric morbidity and mortality. A 2 year old toddler presented to us with non migratory polyarticular joint pain and swelling. General physical and systemic examination was normal. Local examination revealed swelling and tenderness of multiple small and large joints. Further evaluation fulfilled Modified Jones criteria and she was diagnosed to have acute rheumatic fever. Other close differentials were simultaneously ruled out. Child was started on naproxen because of aspirin toxicity. There was significant response for therapy and complete resolution of joint involvement was noted on follow up. We report this case to emphasize the fact that rheumatic fever might have bizarre clinical presentation and may also affect infants and toddlers deviating the typical age of onset. There is a need for earliest possible initiation of adequate management and follow up to prevent permanent cardiac complications. This warrants high index of suspicion even in uncommon age group.

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Impact of Socio-Economic Factors on Increased Risk and Progression of Rheumatic Heart Disease in Developing Nations

Cited by 23 publications

References 37 publications

How accurate is the diagnosis of rheumatic fever in Egypt? Data from the national rheumatic heart disease prevention and control program (2006-2018)

How accurate is the diagnosis of rheumatic fever in Egypt? Data from the national rheumatic heart disease prevention and control program (2006-2018)

Prevalence of rheumatic heart disease in North‐Central Nigeria: a school‐based cross‐sectional pilot study

Atypical arthritis in a toddler: beware, save the heart

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