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Multicenter Study
. 2023 Sep-Oct;75(5):363-369.
doi: 10.1016/j.ihj.2023.07.003. Epub 2023 Jul 24.

Rheumatic heart disease in school-attending Nepalese children: A descriptive analysis of the national heart screening database

Prakash Raj Regmi  1 , Ajay Adhikaree  2 , Urza Bhattarai  3 , Sunit Chhetri  4 , Urmila Shakya  5 , Surendra Uranw  6 , Pratik Lamichhane  7 , Sanjib Kumar Sharma  8
Affiliations
Multicenter Study

Rheumatic heart disease in school-attending Nepalese children: A descriptive analysis of the national heart screening database

Prakash Raj Regmi et al. Indian Heart J. 2023 Sep-Oct.

Abstract

Objective: Rheumatic Heart Disease (RHD) remains a significant public health problem with high morbidity and mortality in children and young adults from lower-middle income countries like Nepal. However, a nation-wide database of the disease is lacking for designing effective future prevention and control programmes and strategies. The aim of our study is to estimate the prevalence of RHD in school-attending Nepalese children.

Methods: We performed a cross-sectional descriptive analysis of a nationally representative database of Nepal Heart Foundation (NHF) national RHD screening programme which included school-attending Nepalese children between five and sixteen years of age. The screening was conducted between May 2015 and March 2020 in 236 schools, representing all seven provinces, across all three ecological zones of Nepal. Transthoracic two-dimensional echocardiography was performed in all eligible children with more than grade one murmur on cardiac auscultation. We estimated the prevalence of RHD among school-attending children as the number of RHD cases per 1000 school-attending children with a 95% confidence interval.

Results: The database included a total of 107,340 children who were screened clinically, of whom 10,600 (9·9%) underwent transthoracic two-dimensional echocardiography. The overall prevalence of RHD was 2.22 cases per 1000 school-attending children (95% CI:1·94 - 2·50). The highest prevalence was observed among children living in the southern Terai ecological zone (2·89 per 1000, 95% CI (2·32-3·46)) of Nepal. Among the provinces, Karnali had the highest prevalence of RHD (3·45 per 1000, 95% CI (2·42-4·48)). Among the districts screened, Kalikot had the highest RHD prevalence (5.47 per 1000, 95% CI (3.02-7.92)).

Conclusion: Primordial, primary and secondary prevention programmes should pay special attention to southern Terai zone, particularly the under-privileged children from remote districts.

Keywords: National survey; Nepal; Prevalence; Rheumatic heart disease; School-attending children.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Map of Nepal showing ecological zones,provinces and districts
Fig. 2
Fig. 2
Flow diagram of the screening for RHD
See this image and copyright information in PMC

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