Skip to main content
PMC home page
Journal of Epidemiology and Community Health logoLink to Journal of Epidemiology and Community Health
. 1996 Feb;50(1):62–67. doi: 10.1136/jech.50.1.62

Epidemiological survey of rheumatic heart disease among school children in the Shimla Hills of northern India: prevalence and risk factors.

J S Thakur 1, P C Negi 1, S K Ahluwalia 1, N K Vaidya 1
PMCID: PMC1060206  PMID: 8762356

Abstract

STUDY OBJECTIVE: To determine the prevalence of rheumatic heart disease (RHD) and study the relationship of this disease to factors such as age, sex, housing, and socioeconomic status in Shimla town and the adjoining rural area. DESIGN: A cross sectional survey, carried out by a specially trained examiner in cardiology. SETTING: The study involved high risk school children (5-16 years of age) from Shimla town and the adjoining rural area of Kasumpti-Suni Block in the period 1992-93. SUBJECTS: A total of 15,080 children on the school register (8120 boys and 6960 girls) were examined generally and specifically for evidence of RHD. MAIN RESULTS: Of the 15,080 children screened, the prevalence of rheumatic fever (RF)/RHD was 2.98 per thousand with no significant difference between the age groups of 5-10 and 11-16 years or in either sex (p > 0.05). The prevalence was significantly greater in rural schools (4.8/1000) than in urban schools (1.98/1000) (p < 0.05). There was overcrowding and poor housing in most cases. There were fewer cases of RHD with severe valvular lesions in the younger age group than in the older children. The mitral valve was the valve most commonly affected by RF/RHD. CONCLUSIONS: RHD continues to be a serious health problem. Regular surveys are needed to identify cases early and to ensure secondary prophylaxis with penicillin is given thereby preventing recurrence of RF and progression of the severity of the valvular lesion. Echocardiography is necessary to identify cases of RF/RHD. Strategies for preventing RHD should involve primary prevention to avert the first attack of carditis and strengthening of secondary prophylaxis through improved education and motivation of patients, parents, and physicians.

Full text

PDF
67

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anabwani G. M., Amoa A. B., Muita A. K. Epidemiology of rheumatic heart disease among primary school children in western Kenya. Int J Cardiol. 1989 May;23(2):249–252. doi: 10.1016/0167-5273(89)90254-4. [DOI] [PubMed] [Google Scholar]
  2. Avasthi G., Singh D., Singh C., Aggarwal S. P., Bidwai P. S., Avasthi R. "Prevalence survey of rheumatic fever (RF) and rheumatic heart disease (Rhd) in urban & rural school children in Ludhiana". Indian Heart J. 1987 Jan-Feb;39(1):26–28. [PubMed] [Google Scholar]
  3. Berry J. N. Prevalence survey for chronic rheumatic heart disease and rheumatic fever in northern India. Br Heart J. 1972 Feb;34(2):143–149. doi: 10.1136/hrt.34.2.143. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Grover A., Dhawan A., Iyengar S. D., Anand I. S., Wahi P. L., Ganguly N. K. Epidemiology of rheumatic fever and rheumatic heart disease in a rural community in northern India. Bull World Health Organ. 1993;71(1):59–66. [PMC free article] [PubMed] [Google Scholar]
  5. Gupta I., Gupta M. L., Parihar A., Gupta C. D. Epidemiology of rheumatic and congenital heart diseases in school children. J Indian Med Assoc. 1992 Mar;90(3):57–59. [PubMed] [Google Scholar]
  6. Ibrahim-Khalil S., Elhag M., Ali E., Mahgoub F., Hakiem S., Omer N., Shafie S., Mahgoub E. An epidemiological survey of rheumatic fever and rheumatic heart disease in Sahafa Town, Sudan. J Epidemiol Community Health. 1992 Oct;46(5):477–479. doi: 10.1136/jech.46.5.477. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Koshi G., Benjamin V., Cherian G. Rheumatic fever and rheumatic heart disease in rural South Indian children. Bull World Health Organ. 1981;59(4):599–603. [PMC free article] [PubMed] [Google Scholar]
  8. Kumar P., Garhwal S., Chaudhary V. Rheumatic heart disease: a school survey in a rural area of Rajasthan. Indian Heart J. 1992 Jul-Aug;44(4):245–246. [PubMed] [Google Scholar]
  9. Mathur K. S., Wahal P. K. Epidemiology of rheumatic heart disease--a study of 29,922 school children. Indian Heart J. 1982 Nov-Dec;34(6):367–371. [PubMed] [Google Scholar]
  10. Oli K., Tekle-Haimanot R., Forsgren L., Ekstedt J. Rheumatic heart disease prevalence among schoolchildren of an Ethiopian rural town. Cardiology. 1992;80(2):152–155. doi: 10.1159/000174993. [DOI] [PubMed] [Google Scholar]
  11. Shrestha N. K., Padmavati S. Prevalence of rheumatic heart disease in Delhi school children. Indian J Med Res. 1979 May;69:821–833. [PubMed] [Google Scholar]
  12. Shrestha U. K., Bhattarai T. N., Pandey M. R. Prevalence of rheumatic fever and rheumatic heart disease in school children in a rural community of the hill region of Nepal. Indian Heart J. 1991 Jan-Feb;43(1):39–41. [PubMed] [Google Scholar]
  13. Veasy L. G., Wiedmeier S. E., Orsmond G. S., Ruttenberg H. D., Boucek M. M., Roth S. J., Tait V. F., Thompson J. A., Daly J. A., Kaplan E. L. Resurgence of acute rheumatic fever in the intermountain area of the United States. N Engl J Med. 1987 Feb 19;316(8):421–427. doi: 10.1056/NEJM198702193160801. [DOI] [PubMed] [Google Scholar]
  14. al-Sekait M. A., al-Sweliem A. A., Tahir M. Rheumatic heart disease in schoolchildren in western district, Saudi Arabia. J R Soc Health. 1990 Feb;110(1):15-6, 19. doi: 10.1177/146642409011000107. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Epidemiology and Community Health are provided here courtesy of BMJ Publishing Group

RESOURCES