Survey of rheumatic heart disease in school children of Kinshasa town

Study objective: To determine the prevalence of rheumatic heart disease and study the association of this disease to factor such as personal host and environment. Design: A cross sectional survey was carried out by a specially trained medical team. Setting: The study involved high risk school children aged 5-16 years from Binza-Kinshasa urban area and adjoining slums in semi- urban area of Kinshasa town. Methods: A total of 4848 children randomly selected on the list of semi-urban and urban schools and representing 10% of the schools population were included in the survey with clinical echocardiographic examinations. Results: Of the 4848 children screened, prevalence of rheumatic heart disease was 14.03/1000. The prevalence was significantly greater in slums schools (22.2/1000) than in urban school (4/1000). In slums area, the mitral valve was the valve most commonly affected by rheumatic heart disease. Risk factors such as birth in rainy season (RR=2.2), low birth weight (RR=1.81), low socioeconomic status (RR=2.68), malnutrition8 persons/household (RR=4.10) and migrant status (RR=4.79) predicted significantly rheumatic heart disease occurrence in children living in the semi-urban area (slums). Only birth in rainy season (RR=3.24) predicted significantly rheumatic heart disease onset in children having residence in the urban area. Conclusions: Rheumatic heart disease runs a more severe course in Kinshasa, because appropriate medical care, sanitary conditions, primary and secondary prophylaxis are not available. Echocardiograpy is necessary to identify cases of rheumatic heart disease.