Frequency and severity of rheumatic heart disease in the catchment area of Gauteng hospitals, 1993-1995

Abstract

Objective: Identification of frequency and severity of rheumatic fever/rheumatic heart disease (RF/RHD) in the catchment area of Gauteng hospitals.

Design: A retrospective descriptive analysis using hospital-based computer databases.

Setting: Helen Joseph, Chris Hani Baragwanath and Johannesburg General hospitals, Gauteng, South Africa.

Subjects: Three hundred and twelve of 493 (63%) paediatric RF/RHD patients with documented addresses seen from 1993 to 1995.

Methods: A proportional analysis, with the total congenital heart disease (CHD) patients seen in an area as the denominator, was employed to identify areas with prevalent and/or severe RF/RHD. Severe disease was defined as that requiring surgery or balloon valvuloplasty.

Results: 32.7% of RF/RHD patients came from outside Gauteng, and 70.2% of those seen at Chris Hani Baragwanath Hospital were not from Soweto. KwaZulu-Natal, Northern Province, Mpumalanga and Evaton had a significantly higher-than-expected ratio of RHD/CHD patients and were identified as priority areas at high risk for RHD. Gauteng and some Johannesburg suburbs had a significantly lower-than-expected ratio and therefore had a relatively low risk for RHD. 32.9% of RHD patients had severe disease. The severity rate for Gauteng residents was 34.8% and for non-Gauteng residents 51%. Significantly more severe cases than expected came from KwaZulu-Natal, Northern Province, Mpumalanga and Gauteng south. Significantly fewer severe RHID patients than expected came from Gauteng, especially Gauteng centre.

Conclusions: A high frequency of RF/RHD and severe disease was recorded in patients living in KwaZulu-Natal, Northern Province and Mpumalanga.