The Prevalence of Rheumatic Heart Disease in Western Kenya: An Echocardiographic Study

Background:

Despite its declining incidence in resource-rich nations, rheumatic heart disease (RHD) remains a leading cause of morbidity and mortality in the developing world. Recent studies have demonstrated its high prevalence in Aboriginal populations in northern Australia, in Fiji, Tonga, and even parts of Africa including Nigeria and Mozambique, but little is known about its prevalence in Kenya. This epidemiologic data is needed to help inform prevention efforts.

Methods:

Transthoracic echocardiograms were performed on 526 randomly selected hospitalized patients, ages 5-35, on the surgical wards. These patients did not have known rheumatic heart disease. Data were collected on socioeconomic status, living conditions, and medical comorbidities. The primary outcome was the prevalence of echocardiographically confirmed rheumatic heart disease.

Results:

A total of 526 patients were enrolled. 9 had echocardiographic evidence of rheumatic heart disease (1.7%, 95% CI 0.6-2.8). Patients with rheumatic heart disease were more likely to be female. An association between RHD and crowded living conditions or socioeconomic status was not demonstrated in this study.

Conclusions:

Screening with echocardiography in Western Kenya has the potential to identify subclinical rheumatic heart disease, which can inform secondary prevention efforts. Given low overall rates of rheumatic heart disease in the population in this study, efforts at primary prevention, i.e. identification and treatment of streptococcal pharyngitis and acute rheumatic fever, may yield greater population-level benefits.