Prevalence of Rheumatic Heart Disease in Zambian Schoolchildren: an Echocardiographic Screening Study Involving Task-shifting to General Radiographers

It has been estimated that RHD affects over 32 million people worldwide, with the vast majority of cases occurring in the developing world. RHD is the most common cardiovascular disease in children and young adults and is a major cause of death in children above the age of 5 in many parts of the developing world, particularly sub-Saharan Africa.

RHD results from repeated attacks of acute rheumatic fever (ARF). ARF is a systemic inflammatory disease occurring mainly in children, characterized by fever, painful joints, and heart, skin, and neurological manifestations. ARF is linked with preceding Group A streptococcal (GAS) throat infections, which, if left untreated, carry an estimated 2-3% risk of developing ARF.

The pathologic hallmark of RHD is classically a valvulitis that affects mostly the mitral and/or aortic valves. Inflammation of the myocardium and pericardium may exacerbate the effects of valvular insufficiency, resulting in congestive heart failure, stroke and other complications. Over time, severe disability or death can ensue, especially in developing countries where the management of RHD patients is challenging and surgical interventions are not readily available.

ARF and RHD are diseases of poverty, especially in countries with limited healthcare systems. GAS thrives in situations of over-crowding where poor nutrition and sanitation are common and where medical treatment for sore throat is not readily available. For these reasons, RHD is endemic in many parts of the developing world, particularly sub-Saharan Africa, while it almost disappeared from most parts of the developed world (except for indigenous populations in some countries). It should be noted that the initial decline of ARF/RHD in the US and Europe most likely was due to improved living conditions and hygiene (primordial prevention), since it predated the introduction of penicillin.

RHD is one of few truly preventable chronic diseases. Currently, many sub-Saharan African countries do not focus efforts on primary and secondary prevention due to lack of resources. The long-term goal of an ongoing effort in Zambia is to develop capability to provide effective primary and secondary prevention of RHD, with the ultimate goal of eliminating new cases.