Abstract:
Epidemiologic studies of the prevalence of rheumatic heart disease have used clinical
screening with echocardiographic confirmation of suspected cases. We hypothesized
that echocardiographic screening of all surveyed children would show a significantly
higher prevalence of rheumatic heart disease.
Randomly selected schoolchildren from 6 through 17 years of age in Cambodia and
Mozambique were screened for rheumatic heart disease according to standard clin-
ical and echocardiographic criteria.
Clinical examination detected rheumatic heart disease that was confirmed by echo-
cardiography in 8 of 3677 children in Cambodia and 5 of 2170 children in Mozam-
bique; the corresponding prevalence rates and 95% confidence intervals (CIs) were
2.2 cases per 1000 (95% CI, 0.7 to 3.7) for Cambodia and 2.3 cases per 1000 (95% CI,
0.3 to 4.3) for Mozambique. In contrast, echocardiographic screening detected 79
cases of rheumatic heart disease in Cambodia and 66 cases in Mozambique, corre-
sponding to prevalence rates of 21.5 cases per 1000 (95% CI, 16.8 to 26.2) and 30.4
cases per 1000 (95% CI, 23.2 to 37.6), respectively. The mitral valve was involved in
the great majority of cases (87.3% in Cambodia and 98.4% in Mozambique).
Systematic screening with echocardiography, as compared with clinical screening, re-
veals a much higher prevalence of rheumatic heart disease (approximately 10 times
as great). Since rheumatic heart disease frequently has devastating clinical consequenc-
es and secondary prevention may be effective after accurate identification of early
cases, these results have important public health implications.
