Community-based prevalence of Rheumatic Heart Disease in rural Ethiopia: five-year follow-up.
Community-based prevalence of Rheumatic Heart Disease in rural Ethiopia: five-year follow-up.
Background: As little is known about the prevalence and clinical progression of subclinical (latent) rheumatic heart disease (RHD) in sub-Saharan Africa, we report the results of a 5 year follow-up of a community based, echocardiographic study of the disease, originally carried out in a rural area around Jimma, Ethiopia.
Methods: Individuals with evidence of RHD detected during the baseline study as well as controls and their family members were screened with a short questionnaire together with transthoracic echocardiography.
Results: Of 56 individuals with RHD (37 definite and 19 borderline) in the original study, 36 (26 definite and 10 borderline) were successfully located 57.3 (range 44.9 – 70.7) months later. At follow-up two thirds of the definite cases still had definite disease; while a third had regressed. Approximately equal numbers of the borderline cases had progressed and regressed. Features of RHD had appeared in 5 of the 60 controls. There was an increased risk of RHD
in the family relatives of borderline and definite cases (3.8 and 4.0 times respectively), notably among siblings. Compliance with penicillin prophylaxis was very poor.
Conclusions: We show the persistence of echocardiographically demonstrable RHD in a rural sub-Saharan population. Both progression and regression of the disease were found; however, the majority of the individuals who had definite features of RHD had evidence of continuing RHD lesions five years later. There was an increased risk of RHD in the family relatives of borderline and definite cases, notably among siblings. The findings highlight the problems faced in addressing the problem of RHD in the rural areas of sub-Saharan Africa. They add to the evidence that community-based interventions for RHD will be required, together with appropriate ways of identifying active disease, achieving adequate penicillin prophylaxis and developing vaccines for primary prevention.
Ethiopia, Prevalence, Rheumatic heart disease
1-26
Gemechu, Tadesse
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Parry, Eldryd
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Yacoub, Magdi
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Phillips, David
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Kotit, Susy
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October 2021
Gemechu, Tadesse
0cf9b1df-db41-44a4-81fe-d0289f267d63
Parry, Eldryd
565fdb3e-297a-40a5-a48a-594423f8df73
Yacoub, Magdi
29b7c575-34e6-4ebb-8a88-2c189de53b0a
Phillips, David
29b73be7-2ff9-4fff-ae42-d59842df4cc6
Kotit, Susy
a6e543c2-4fa1-425c-90af-c34df93d5955
Gemechu, Tadesse, Parry, Eldryd, Yacoub, Magdi, Phillips, David and Kotit, Susy
(2021)
Community-based prevalence of Rheumatic Heart Disease in rural Ethiopia: five-year follow-up.
PLoS Neglected Tropical Diseases, 15 (10), , [e0009830].
(doi:10.1371/journal.pntd.0009830).
Abstract
Background: As little is known about the prevalence and clinical progression of subclinical (latent) rheumatic heart disease (RHD) in sub-Saharan Africa, we report the results of a 5 year follow-up of a community based, echocardiographic study of the disease, originally carried out in a rural area around Jimma, Ethiopia.
Methods: Individuals with evidence of RHD detected during the baseline study as well as controls and their family members were screened with a short questionnaire together with transthoracic echocardiography.
Results: Of 56 individuals with RHD (37 definite and 19 borderline) in the original study, 36 (26 definite and 10 borderline) were successfully located 57.3 (range 44.9 – 70.7) months later. At follow-up two thirds of the definite cases still had definite disease; while a third had regressed. Approximately equal numbers of the borderline cases had progressed and regressed. Features of RHD had appeared in 5 of the 60 controls. There was an increased risk of RHD
in the family relatives of borderline and definite cases (3.8 and 4.0 times respectively), notably among siblings. Compliance with penicillin prophylaxis was very poor.
Conclusions: We show the persistence of echocardiographically demonstrable RHD in a rural sub-Saharan population. Both progression and regression of the disease were found; however, the majority of the individuals who had definite features of RHD had evidence of continuing RHD lesions five years later. There was an increased risk of RHD in the family relatives of borderline and definite cases, notably among siblings. The findings highlight the problems faced in addressing the problem of RHD in the rural areas of sub-Saharan Africa. They add to the evidence that community-based interventions for RHD will be required, together with appropriate ways of identifying active disease, achieving adequate penicillin prophylaxis and developing vaccines for primary prevention.
Text
pntd.0009830_1
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More information
In preparation date: 22 June 2021
Accepted/In Press date: 21 September 2021
e-pub ahead of print date: 13 October 2021
Published date: October 2021
Additional Information:
Funding Information:
Funded by a grant to TG, MHY and DIWP by Chain of Hope www.chainofhope.org. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Publisher Copyright:
© 2021 Gemechu et al.
Keywords:
Ethiopia, Prevalence, Rheumatic heart disease
Identifiers
Local EPrints ID: 451636
URI: http://eprints.soton.ac.uk/id/eprint/451636
ISSN: 1935-2727
PURE UUID: 88132b63-8dd0-4d4a-babb-629fba864033
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Date deposited: 15 Oct 2021 16:33
Last modified: 16 Mar 2024 14:10
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Contributors
Author:
Tadesse Gemechu
Author:
Eldryd Parry
Author:
Magdi Yacoub
Author:
David Phillips
Author:
Susy Kotit
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