Rheumatic and congenital heart diseases among school children of Khon Kaen, Thailand: declining prevalence of rheumatic heart disease

Abstract

Background: Rheumatic fever (RF), rheumatic heart disease (RHD), and congenital heart disease (CHD) are still major problems among Thai school children.Objective: To examine trends in the prevalence of RF/RHD and CHD along with the socioeconomic status of school children in urban Khon Kaen, northeastern Thailand.Methods: We conducted cross-sectional survey of 8,555 school children aged 5-15 years from 4 schools in urban Khon Kaen from January to March 2006. Pediatric cardiologists examined the school children and all cardiac diagnoses were confirmed by echocardiography. Socioeconomic data were also collected. Schools were divided into high and low socioeconomic status (SES) schools, based on the prevailing levels of parental education and household income. All positive cases of heart disease were followed and reviewed at a university hospital up to December 2013.Results: Of 8,555 children examined, 2 had RF/RHD, and 10 had CHD. The prevalence of RF/RHD was 0.23 per 1,000 (95% CI 0.03-0.84), and the prevalence of CHD was 1.2 per 1,000 (95% CI 0.56-2.15). Prevalence of RF/RHD among urban school children in the center of northeastern Thailand had declined from 1.13 to 0.23 per 1,000 since 1986. The indices of socioeconomic development revealed marked improvement during this 20 year interim. The prevalence of RF/RHD was higher among low SES schools (4.6 per 1,000) compared with high SES schools (0 per 1,000).Conclusion: There is a low prevalence of RHD in school children in this region compared with the period before 1986.

The prevalence of rheumatic heart disease in northeastern Thailand is declining

“…Furthermore, the presented data also correlate with a downtrend of prevalence of RHD in some other developing countries [6]. These data are likely representative of the current status concerning the prevalence of RHD in many developing countries at the beginning of the 21 st century [1][2][3][4][5][6]. The declining prevalence of RHD in Thailand results in a decreased incidence of the heart valve surgery [7] and decreased incidence of stroke [8][9] in many referral centers in Thailand [7][8][9].…”

“…The decline of the prevalence of ARF and RHD in Thailand can be seen with an improvement in living standards and health care services [1] resulting in better identification of cases of RHD, increasing compliance with secondary prophylaxis, and probably decreased acquisition of group A streptococci [1,[13][14][15][16].…”

“…In this issue of Asian Biomedicine, Chaikitpinyo and colleagues have presented evidence of an almost five-fold decrease in the prevalence of rheumatic heart disease (RHD) in schoolchildren in northeastern Thailand during the 20 years from 1986 to 2006 [1]. Although one might question whether these data represent other parts of Thailand, and while one might further question the epidemiology of RHD in Thailand, the presented data nevertheless correlate with a downtrend of prevalence of RHD in other surveys in Thailand [2][3][4][5].…”

Original article. Childhood infective endocarditis in Khon Kaen University Hospital from 1992 to 2011

“…These findings suggest that RHD is becoming less frequent as the underlying heart disease for childhood IE in northeastern Thailand. Related to this, the prevalence of RHD is declining in this community [11]. Conversely, there is a move toward a higher proportion of childhood IE with no underlying heart disease in northeastern Thailand.…”

“…The population of the northeastern Thailand was approximately 20.9 million in 2002. KKU hospital, having approximately 1,100 beds, is located in the central area of Khon Kaen province in northeastern Thailand and is a teaching and tertiary referral center in this region [10,11]. According to the 2002 census, the population of Khon Kaen province was approximately 1.7 million.…”