Prevalence of rheumatic heart disease among school children in Alexandria, Egypt: a prospective epidemiological study

ABSTRACT

The aim of this work was to study the epidemiologic features of Rheumatic Heart Disease [RHD] among basic education students in Alexandria, including the demographic and clinical profiles as well as risk factors for RHD development. A stratified random sampling technique was used to allocate 5465 school children in the six educational zones of Alexandria. Clinical RHD cases were confirmed by using chest X-ray, ECG and echocardiography. Factors related to occurrence of RHD were studied using a case control design. Thirty four RHD cases [with an estimated prevalence of 6.2/1000 students] were diagnosed. Low socioeconomic status, chronic tonsillitis, positive family history of acute rheumatic fever/RHD and paternal consanguinity were significantly associated with the occurrence of RHD. Almost all previously diagnosed cases were enrolled in a prophylaxis program, with a defaulter rate of 31%. More than half of the identified cases had moderately severe valvular lesions. We recommend the implementation of an educational program targeted to both parents and teachers; the training of upgrading of school health physicians, and the standardization of secondary prophylaxis programs nationwide, with emphasis on assurance of compliance