Socioeconomic and Environmental Risk Factors among Rheumatic Heart Disease Patients in Uganda

Abstract

BackgroundAlthough low socioeconomic status, and environmental factors are known risk factors for rheumatic heart disease in other societies, risk factors for rheumatic heart disease remain less well described in Uganda.Aims and ObjectiveThe objective of this study was to investigate the role of socio-economic and environmental factors in the pathogenesis of rheumatic heart disease in Ugandan patients.MethodsThis was a case control study in which rheumatic heart disease cases and normal controls aged 5–60 years were recruited and investigated for socioeconomic and environmental risk factors such as income status, employment status, distance from the nearest health centre, number of people per house and space area per person.Results486 participants (243 cases and 243 controls) took part in the study. Average age was 32.37+/−14.6 years for cases and 35.75+/−12.6 years for controls. At univariate level, Cases tended to be more overcrowded than controls; 8.0+/−3.0 versus 6.0+/−3.0 persons per house. Controls were better spaced at 25.2 square feet versus 16.9 for cases. More controls than cases were employed; 45.3% versus 21.1%. Controls lived closer to health centers than the cases; 4.8+/−3.8 versus 3.3+/−12.9 kilometers. At multivariate level, the odds of rheumatic heart disease was 1.7 times higher for unemployment status (OR = 1.7, 95% CI = 1.05–8.19) and 1.3 times higher for overcrowding (OR = 1.35, 95% CI = 1.1–1.56). There was interaction between overcrowding and longer distance from the nearest health centre (OR = 1.20, 95% CI = 1.05–1.42).ConclusionThe major findings of this study were that there was a trend towards increased risk of rheumatic heart disease in association with overcrowding and unemployment. There was interaction between overcrowding and distance from the nearest health center, suggesting that the effect of overcrowding on the risk of acquiring rheumatic heart disease increases with every kilometer increase from the nearest health center.

Acute rheumatic fever and rheumatic heart disease

“…Household overcrowding is perhaps the best described risk factor and reduced overcrowding has been cited as one of the most important factors underlying the decline in ARF incidence in wealthy countries during the twentieth century 21 . Recent data clearly show an association of ARF and RHD with household crowding 20,22,23 (see discussion on primordial prevention below).…”

Handheld Echocardiography Versus Auscultation for Detection of Rheumatic Heart Disease

“…1,3,5,6 RHD is endemic in subSaharan Africa, and it is estimated that .1 million children are affected. 2 The prevalence of RHD in this region varies between 6.5 to 30 per 1000 7,8 ; however, given the challenges associated with large-scale screening and varying methods used for the diagnosis of RHD, the true prevalence remains unknown. Early identification of RHD is of paramount importance because secondary prevention with monthly penicillin injections has been shown to be an effective method of preventing disease progression.…”

Prevalence of group a streptococcus pharyngeal carriage and clinical manifestations in school children aged 5–15 yrs in Wakiso District, Uganda

“…The current estimated prevalence of RHD in Kampala, Uganda is 14 per 1000 cases among primary school children and this is a sequeale of group a streptococcus pharyngitis [7]. The prevalence of group a streptococcus in school children in Uganda had not been described, despite having several studies done regarding the most adverse sequeale i.e.…”