Prevalence of Rheumatic Heart Disease in Cambodia and Mozambique

Reported prevalence of rheumatic heart disease in countries where it is common is based on clinical screening, which is less sensitive than echocardiography in the detection of valvular abnormalities. To determine the true prevalence of rheumatic heart disease, and to compare rates based on echocardiographic evidence with those based on clinical criteria, investigators conducted population-based studies of schoolchildren in Cambodia and Mozambique. The authors hypothesized that the use of echocardiography would demonstrate twice as many cases as might be expected from published estimates.

In Cambodia, 3677 children (mean age, 12 years) were examined. Rheumatic heart disease was identified in 8 children by clinical criteria and in 79 by echocardiography. Prevalence based on clinical criteria was 2.2 cases per 1000 children, and prevalence based on echocardiography was 21.5 per 1000.

In Mozambique, 2170 children (mean age, 11 years) were examined. Rheumatic heart disease was identified in 5 children by clinical criteria and in 66 by echocardiography. Prevalence based on clinical criteria was 2.3 cases per 1000 children, and prevalence based on echocardiography was 30.4 per 1000. Clinical examination provoked suspicion of organic valvular abnormalities in 91 children, but echocardiography revealed cardiac lesions in only 10.