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.