In 1987 a survey for rheumatic heart disease (RHD) in school children in the Qassim region of Saudi Arabia found a prevalence rate of 1.4 per 1,000. In 1992, we did a second survey to monitor progress in control and to identify characteristics that could help target primary and secondary preventive measures.
Methodology
We defined a school cluster as an intermediate school plus all primary schools that feed that intermediate school. From 200 clusters we selected 26 at random. We did cardiac auscultation on all students in each cluster. We did echocardiography on any student with a murmur. We defined RHD as mitral valve thickening or dysfunction typical of RHD. We selected 512 control students at random from the enrollment lists of all students in the clusters. Parents of all RHD and control students were interviewed using a standard questionnaire.
Results
We found 42 cases of RHD among 14,472 students. This yielded estimates of 192 (SE 41) cases in males and 158 (SE 30) cases in females in the region. The prevalence estimate was 3.1/1,000 (SE 0.8) for males and 2.7/1,000 (SE 0.6) for females. All 42 children with RHD had visited primary health care centers during the preceding year, compared with 98% of the control children. However, only eight RHD cases had been previously recognized as RHD and were under medical management. RHD risk increased with the number of children sleeping in the same room (odds ratio [OR]=1.2 per additional child; 95% confidence interval [CI]=1.1-1.4) and the number of adults living in the same house (OR=1.2 per additional adult; 95% CI=1.1-1.4).
Conclusion
The prevalence of RHD has increased in the last five years despite increased access to medical care in Qassim. Since children with RHD often visit clinics for other reasons, these visits are opportunities to detect these children and put them under medical management. Crowding in the children's bedrooms probably reflects increased potential for transmission of streptococci.