In 1987, a survey of rheumatic heart disease (RHD) in school children identified the Asir Region of Saudi Arabia as a high-prevalence area (5.1 per 1,000). In 1992, we conducted a second survey to monitor the progress in control and to identify characteristics that could help target primary and secondary preventive measures.
Methodology
We selected primary and intermediate schools randomly and performed cardiac auscultation on all students. Echocardiography was done on any student with a murmur. We defined RHD as mitral valve thickening or dysfunction typical of RHD. We selected 192 control students at random from the enrollment lists of all students in the selected schools. We interviewed parents of all RHD and control students using a standard questionnaire.
Results
From 5,962 male students we identified 165 students (2.7%) with a murmur and 33 with echocardiographic evidence of RHD, giving a crude prevalence rate of 5.5 per 1,000. All 33 students with RHD had a history of past illness compatible with acute rheumatic fever (ARF), and 70% were under medical management. Students with RHD were more likely to have an illiterate father (OR=48; 95% CI 13, 210) with low economic status (OR=19; 95% CI 7.1, 51) and to live in the poorest level of housing (OR=11; 95% CI 4.4, 26). The risk of RHD increased 15-fold as the number of children sleeping in the same room increased from one to five (p<0.0001; chi square for linear trend).
Conclusion
Despite improvements in access to medical treatment for pharyngitis and ARF, the prevalence of RHD has remained unchanged in the past five years in Asir. The extreme concentration of RHD in the poor and uneducated should enable health and education authorities to direct and adapt their resources to this group.