Prevalence of rheumatic heart disease in North‐Central Nigeria: a school‐based cross‐sectional pilot study

AbstractObjectivesTo present epidemiological data on rheumatic heart disease (RHD), the most common acquired heart disease in children and young adults in low‐ and middle‐income countries, for North‐Central Nigeria.MethodsIn this pilot study, we conducted clinical and echocardiography screening on a cross section of randomly selected secondary schoolchildren in Jos, North‐Central Nigeria, from March to September 2016. For outcome classification into borderline or definite RHD, we performed a confirmatory echocardiography using the World Heart Federation criteria for those suspected to have RHD from the screening.ResultsA total of 417 secondary schoolchildren were screened, of whom 247 (59.2%) were female. The median age was 14 years (IQR: 13–15). Clinical screening detected 8/417 children, whereas screening echocardiography detected 42/417 suspected cases of RHD. Definitive echocardiography confirmed 9/417 with RHD corresponding to a prevalence of 21.6 per 1000 (95% CI, 6.7–36.5). All but one of the confirmed RHD cases (8/9) were borderline RHD corresponding to a prevalence of 19.2 per 1000 (95% CI, 8.3–37.5) for borderline RHD and 2.4 per 1000 (95% CI, 0.1–13.3) for definite RHD. RHD was more common in boys and cardiac auscultation missed over 50% of the cases.ConclusionsThis study showed a high prevalence of RHD among secondary schoolchildren in North‐Central Nigeria with a vast predominance of asymptomatic borderline lesions. Larger school‐based echocardiography screening using portable or handheld echocardiography aimed at early detection of subclinical RHD should be adopted.