Screening for Rheumatic Heart Diseases among high secondary school female students at El-Obeid city, Sudan

Abstract

Background and objectives:  Rheumatic heart disease (RHD) remains a significant cause of cardiovascular mortality and morbidity in poor countries. It is a leading acquired cardiovascular disease among young people in low-income and middle-income countries and in some at-risk populations living in rich countries. This study aimed at determining the prevalence of RHD among secondary school female students at Ellobiid, north Kordofan, Sudan.

Patients and method: The study took place from December 2017 through June 2018. An ethical clearance was obtained from the state ministry of health. Eight female secondary schools were randomly selected. In each school, a mobile echo machine was used to screen the students. The Participants were randomly selected. In this study, Pathological regurgitation is defined according to WHO criteria   as    follows: Mitral regurgitation jet equals or more than 2 cm, Aortic regurgitation jet equals or more than 1cm. Morphological criteria are defined as follows: For the mitral valve: anterior mitral valve leaflet thickness more than 3mm, chordae tendineae thickening, restricted leaflet motion, and excessive mitral valve leaflet tip motion in systole. For the aortic valve: Irregular thickening, coaptation defect, restricted leaflet motion and leaflet prolapse. For those with echo criteria of RHD, personal and demographic data were obtained. Cardiovascular system examination was made. A well-designed data sheet was formed and the data were then analyzed using SPSS version 18.

Results: In this study, 760 students from 8 female secondary schools were examined by portable echo machine. In this cohort, 27 students were found to have RHD giving a prevalence of 36/1000.The mean age of the affected individuals was 15.9 years. The commonest valvular lesion seen was mild mitral regurgitation in 18 participants (66%), followed by mild aortic regurgitation then combination of mild mitral regurgitation and mild tricuspid regurgitation and mild aortic regurgitation and moderate mitral regurgitation respectively. Twenty participants (74%) had past history of sore throat, while 14 participants confessed to have a remote history of   joint pains and fever.  Most of the patients were found to have normal auscultatory findings. The only positive clinical sign was pansystolic murmur in the mitral area which was detected in 26% of the participants.

Conclusion: We concluded that the use of portable Echo, is a useful technique for early detection of RHD and the prevalence of RHD in our population is moderately high compared with other studies. The application of secondary antibiotic prophylaxis (SAP), is highly recommended to reduce the incidence of RHD.