Echocardiographic screening for rheumatic heart disease in 4 515 Sudanese school children: marked disparity between two communities

Abstract

Introduction: Echocardiographic (echo) screening has unmasked a high prevalence of subclinical rheumatic heart disease (RHD) in many countries, and it can be used as a surveillance tool to control the disease.

Methods: School children of 10 to 15 years of age were selected in two areas of Sudan, Khartoum, the capital, and Niyala in western Sudan. Echo screening using a hand-held echo (HHE) was conducted in Khartoum using a three-view protocol, and in Niyala, a one-view protocol, both modified from the World Heart Federation protocol. Suspected cases were referred for standard echo study. Training of health personnel was conducted and health education sessions were delivered to the public.

Results: In Khartoum, a total of 3 000 school children were screened; seven cases were positive for RHD using HHE and one case was confirmed by standard echocardiography. The prevalence of RHD using echocardiography was 0.3 per 1 000 children. In Niyala, a total of 1 515 school children were screened. Using HHE, 59 cases were positive for RHD; 44 had definite and 15 borderline disease. Out of 34 who underwent standard echocardiography, 29 (85.2%) were found to have RHD; 22 had definite and seven borderline disease. The prevalence using echocardiography was 19 per 1 000 children. A total of 779 health workers were trained in South Darfur and 50 000 posters and pamphlets were distributed.

Conclusion: Using echocardiography, there was a significant disparity in RHD prevalence between the two communities in Sudan. Efforts to control RHD should be directed to this area, and other rural communities should be investigated.

Fig. 1

Prevalence of RHD in Khartoum and Niyala, Darfur (per 1 000 population) by hand-held echo (HHE) and standard echo (SE).

Fig. 2

Total subjects screened in Darfur and their results.

Fig. 3

A: Hand-held echo in parasternal long-axis view with colour Doppler showing mitral regurgitation. B: Standard echo in parasternal long-axis view with colour Doppler of the same patient, showing mitral regurgitation.

Fig. 4

A: Hand-held echo in parasternal long-axis view showing irregularity and prolapse of the aortic valve cusp. B: Hand-held echo in parasternal long-axis view with colour Doppler for the same patient, showing aortic regurgitation.