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Original Article
Prevalence of Rheumatic Heart Disease Detected by Echocardiographic Screening
Eloi Marijon, M.D., Phalla Ou, M.D., David S. Celermajer, Ph.D., F.R.A.C.P., Beatriz Ferreira, M.D., Ph.D., Ana Olga Mocumbi, M.D., Dinesh Jani, M.D., Christophe Paquet, M.D., M.P.H., Sophie Jacob, Ph.D., Daniel Sidi, M.D., Ph.D., and Xavier Jouven, M.D., Ph.D.
N Engl J Med 2007; 357:470-476August 2, 2007
Abstract
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References
Citing Articles (31)
Letters
In poor and developing nations, rheumatic heart disease remains a major cause of morbidity and premature death and imposes a substantial burden on health care systems with limited budgets.1,2 Nevertheless, primary and secondary prevention efforts may be highly effective.1,3 Secondary prevention relies on accurate case detection for the appropriate use of prophylactic antibiotics and regular medical surveillance. Exact prevalence data are also highly desirable to facilitate health care planning.
Almost all population-based epidemiologic surveys have relied on careful clinical examination of school-age children, with confirmation of clinically suspected cases by echocardiography. Such surveys show current prevalence rates of rheumatic heart disease of approximately 1 to 5 cases per 1000 among school-age children in developing countries, with the highest rates in sub-Saharan Africa.2
Cardiac ultrasonography is known to be more sensitive than auscultation for the detection of pathologic valve disease,4 and the recent availability of high-quality portable ultrasound equipment makes it possible to screen large numbers of children at schools in developing nations. Furthermore, the 2004 World Health Organization Expert Consultation Report states that echocardiographically diagnosed, clinically silent rheumatic valve involvement should be managed as rheumatic heart disease until proved otherwise.3 We therefore hypothesized that comprehensive screening, including echocardiography in all children, might reveal a