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Rheumatic heart disease in school-attending Nepalese children: A descriptive analysis of the national heart screening
Prakash Raj Regmi1, Ajay Adhikaree2, Urza Bhattarai3
1National Academy of Medical Sciences, Kathmandu, Nepal; Nepal Heart Foundation, Kathmandu, Nepal.
Insights
Rheumatic Heart Disease (RHD) affects Nepalese children, with a prevalence of 2.22 per 1000. Prevention programs should target high-risk areas like the southern Terai zone.
Area of Science:
- Cardiology
- Public Health
- Pediatrics
Background:
- Rheumatic Heart Disease (RHD) is a major cause of death in children and young adults in low-middle income countries.
- Nepal lacks a national RHD database, hindering effective prevention strategies.
Purpose of the Study:
- To estimate the prevalence of Rheumatic Heart Disease (RHD) in school-attending children across Nepal.
- To identify geographical variations in RHD prevalence within Nepal.
Main Methods:
- A cross-sectional analysis of a nationally representative database from the Nepal Heart Foundation (NHF) national RHD screening program.
- Screening involved 107,340 children (aged 5-16) across 236 schools from May 2015 to March 2020.
- Transthoracic echocardiography was used for diagnosis in children with murmurs.
Main Results:
- The overall prevalence of RHD was 2.22 per 1000 school-attending children (95% CI: 1.94-2.50).
- The southern Terai ecological zone showed the highest prevalence (2.89 per 1000).
- Karnali province (3.45 per 1000) and Kalikot district (5.47 per 1000) had the highest RHD prevalence.
Conclusions:
- Targeted primordial, primary, and secondary prevention efforts are crucial for RHD in Nepal.
- Special attention should be given to the southern Terai zone and underprivileged children in remote districts.
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.
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