Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania.
Department of Paediatric Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 54141, Dar es Salaam, Tanzania.
BMC Cardiovasc Disord. 2021 Dec 20;21(1):610. doi: 10.1186/s12872-021-02377-9.
Rheumatic heart disease (RHD) is the most common acquired heart disease occurring in children and adolescents. RHD is associated with significant morbidity and mortality particularly in low and middle- income countries (LMICs) where the burden is estimated to be higher compared to high income countries. Subclinical RHD is the presence of valvular lesion diagnosed by echocardiography in a person with no clinical manifestation of RHD. This study aimed at determining the prevalence, types and factors associated with subclinical RHD among primary school children in Dar Es Salaam, Tanzania.
A descriptive community-based cross-sectional study was conducted in primary school children from February to May 2019. A standardized structured questionnaire was used to collect demographic characteristics, history of upper respiratory tract infections (URTIs), anthropometric measurements, and chest auscultation findings. Moreover echocardiographic screening was done to all children recruited into the study. World Heart Federation echocardiographic classification was used to define the types and prevalence of subclinical RHD.
A total of 949 primary school children were enrolled with females being predominant (57.1%). The prevalence of subclinical RHD was 34 per 1000. All the participants had mitral valve disease only whereby 17 had definite disease and 15 had a borderline disease. The associated factors for subclinical RHD were older age of more than 9 years (OR 10.8, 95% CI 1.4-82.2, P = 0.02) having three or more episodes of URTI in previous six months (OR 21, 95% CI 9.6-46, P = 0.00) and poor hygiene (OR 3, 95% CI 1.3-6.8, P = 0.009).
Subclinical RHD as detected by echocardiographic screening is prevalent in primary school children, uniformly affects the mitral valve, and is associated with potentially modifiable risk factors. Children with a history of more than three episodes of URTI in six months represents a high-risk population that should be targeted for RHD screening.
风湿性心脏病（RHD）是儿童和青少年中最常见的后天性心脏病。RHD 与较高的发病率和死亡率相关，尤其是在中低收入国家（LMICs），其负担估计比高收入国家更高。亚临床 RHD 是指在没有 RHD 临床症状的个体中通过超声心动图诊断出的瓣膜病变。本研究旨在确定坦桑尼亚达累斯萨拉姆的小学生中亚临床 RHD 的患病率、类型和相关因素。
这是一项于 2019 年 2 月至 5 月在坦桑尼亚达累斯萨拉姆的小学生中进行的描述性社区横断面研究。使用标准化的结构化问卷收集人口统计学特征、上呼吸道感染（URTI）史、人体测量学测量值和胸部听诊结果。此外，对所有入组研究的儿童进行超声心动图筛查。使用世界心脏联合会超声心动图分类来定义亚临床 RHD 的类型和患病率。
共有 949 名小学生入组，其中女生占多数（57.1%）。亚临床 RHD 的患病率为每 1000 人中有 34 例。所有参与者均患有二尖瓣疾病，其中 17 例为明确的疾病，15 例为边缘性疾病。亚临床 RHD 的相关因素为年龄大于 9 岁（OR 10.8，95%CI 1.4-82.2，P=0.02）、过去 6 个月有 3 次或更多次 URTI 发作（OR 21，95%CI 9.6-46，P=0.00）和卫生条件差（OR 3，95%CI 1.3-6.8，P=0.009）。
通过超声心动图筛查发现，亚临床 RHD 在小学生中较为普遍，普遍影响二尖瓣，且与潜在可改变的危险因素相关。过去 6 个月有 3 次或更多次 URTI 发作的儿童代表高危人群，应针对 RHD 进行筛查。
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