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. 1975 Aug 23;3(5981):474–478. doi: 10.1136/bmj.3.5981.474

Epidemiology of rheumatic heart disease in black shcoolchildren of Soweto, Johannesburg.

M J McLaren, D M Hawkins, H J Koornhof, K R Bloom, D M Bramwell-Jones, E Cohen, G E Gale, K Kanarek, A S Lachman, J B Lakier, W A Pocock, J B Barlow
PMCID: PMC1674319  PMID: 1156827

Abstract

A survey to determine the prevalence of rheumatic heart disease (R.H.D.) in Black children was conducted in the creeches and primary schools of the South Western Townships of Johannesburg (Soweto). A total of 12 050 Black children were examined by 10 cardiologists in May to October 1972. The overal prevalence rate of R.H.D. was 6.9 per 1000, with a peak rate of 19.2 per 1000 in children of the seventh school grade. The maximal age incidence was 15-18 years and there was a female preponderance of 1 6:1. A rise in prevalence occurred with increasing family size. Most children (92%) were asymptomatic, and in 82.5% R.H.D. was diagnosed for the first time during the school survey. The commonest valve lesion was mitral regurgitation, which was present in 93% and occurred as an isolated lesion in 47.5%. Lancefield's group A beta-haemolytic streptococcus was isolated from the throats of 52 per 1000 Soweto children. The auscultatory features of a non-ejection systolic click and late systolic murmur were prevalent (13.9 per 1000) and had several epidemiological factors in common with R.H.D. A comprehensive preventative campaign is urgently needed in South Africa, directed at both primary and secondary prophylaxis of R.H.D. The socioeconomic status of the community must be improved if optimal prevention is to be achieved.

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Selected References

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

  1. Barlow J. B., Bosman C. K., Pocock W. A., Marchand P. Late systolic murmurs and non-ejection ("mid-late") systolic clicks. An analysis of 90 patients. Br Heart J. 1968 Mar;30(2):203–218. doi: 10.1136/hrt.30.2.203. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. 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]
  3. Brett B. The prevention of rheumatic fever. Can J Public Health. 1972 Nov-Dec;63(6):486–492. [PubMed] [Google Scholar]
  4. Brownell K. D., Bailen-Rose F. Acute rheumatic fever in children. Incidence in a borough of New York City. JAMA. 1973 Jun 18;224(12):1593–1597. [PubMed] [Google Scholar]
  5. Chesler E., Levin S., Du Plessis L., Freiman I., Rogers M., Joffe N. The pattern of rheumatic heart disease in the urbanized Bantu of Johannesburg. S Afr Med J. 1966 Oct 15;40(37):899–904. [PubMed] [Google Scholar]
  6. FEINSTEIN A. R., STERN E. K., SPAGNUOLO M. THE PROGNOSIS OF ACUTE RHEUMATIC FEVER. Am Heart J. 1964 Dec;68:817–834. doi: 10.1016/0002-8703(64)90132-2. [DOI] [PubMed] [Google Scholar]
  7. Gharagozloo R. A., Margolis E., Marcus H., Ala A. P., Jafari R., Nezam H. Streptococcal infection, rheumatic fever and rheumatic heart disease among 500 Jewish school schildren in Teheran. Isr J Med Sci. 1972 Jan;8(1):18–21. [PubMed] [Google Scholar]
  8. Gordis L. Effectiveness of comprehensive-care programs in preventing rheumatic fever. N Engl J Med. 1973 Aug 16;289(7):331–335. doi: 10.1056/NEJM197308162890701. [DOI] [PubMed] [Google Scholar]
  9. Gordis L., Lilienfeld A., Rodriguez R. Studies in the epidemiology and preventability of rheumatic fever. II. Socio-economic factors and the incidence of acute attacks. J Chronic Dis. 1969 Feb;21(9):655–666. doi: 10.1016/0021-9681(69)90037-x. [DOI] [PubMed] [Google Scholar]
  10. Hassell T. A., Renwick S., Stuart K. L. Rheumatic fever and rheumatic heart disease in Barbados: detection and prophylaxis. Br Med J. 1972 Aug 12;3(5823):387–389. doi: 10.1136/bmj.3.5823.387. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Idsoe O., Guthe T., Willcox R. R., de Weck A. L. Nature and extent of penicillin side-reactions, with particular reference to fatalities from anaphylactic shock. Bull World Health Organ. 1968;38(2):159–188. [PMC free article] [PubMed] [Google Scholar]
  12. Jeresaty R. M. Mitral valve prolapse--Click syndrome. Prog Cardiovasc Dis. 1973 May-Jun;15(6):623–652. doi: 10.1016/s0033-0620(73)80026-x. [DOI] [PubMed] [Google Scholar]
  13. Markowitz M. Eradication of rheumatic fever: an unfulfilled hope. Circulation. 1970 Jun;41(6):1077–1084. doi: 10.1161/01.cir.41.6.1077. [DOI] [PubMed] [Google Scholar]
  14. Morton W. E., Huhn L. A., Litchy J. A. Rheumatic heart disease epidemiology. Observations in 17,366 Denver school children. JAMA. 1967 Mar 20;199(12):879–884. doi: 10.1001/jama.199.12.879. [DOI] [PubMed] [Google Scholar]
  15. Morton W. E., Warner A. L., Weil J. V., Shmock C. L., Jr, Snyder J., Lichty J. A. Rheumatic heart disease epidemiology. 3. The San Luis Valley prevalence study. Circulation. 1970 May;41(5):773–781. doi: 10.1161/01.cir.41.5.773. [DOI] [PubMed] [Google Scholar]
  16. Osterud H. T., McFadden R. B., Morton W. E. The frequency of rheumatic heart disease among freshmen at eight Oregon colleges in 1966. J Am Coll Health Assoc. 1971 Jun;19(5):293–297. [PubMed] [Google Scholar]
  17. Pocock W. A., Barlow J. B. Etiology and electrocardiographic features of the billowing posterior mitral leaflet syndrome. Analysis of a further 130 patients with a late systolic murmur or nonejection systolic click. Am J Med. 1971 Dec;51(6):731–739. doi: 10.1016/0002-9343(71)90301-9. [DOI] [PubMed] [Google Scholar]
  18. Shiokawa Y., Murakami M. Epidemiology of rheumatic fever and rheumatic heart disease in Japan. Jpn Circ J. 1969 Dec;33(12):1490–1496. doi: 10.1253/jcj.33.1490. [DOI] [PubMed] [Google Scholar]
  19. Sievers J., Hall P. Incidence of acute rheumatic fever. Br Heart J. 1971 Nov;33(6):833–836. doi: 10.1136/hrt.33.6.833. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Spagnuolo M. Secondary prevention of rheumatic fever. Conn Med. 1973 Feb;37(2):52–54. [PubMed] [Google Scholar]
  21. Strasser T., Rotta J. The control of rheumatic fever and rheumatic heart disease: an outline of WHO activities. WHO Chron. 1973 Feb;27(2):49–54. [PubMed] [Google Scholar]
  22. Tompkins D. G., Boxerbaum B., Liebman J. Long-term prognosis of rheumatic fever patients receiving regular intramuscular benzathine penicillin. Circulation. 1972 Mar;45(3):543–551. doi: 10.1161/01.cir.45.3.543. [DOI] [PubMed] [Google Scholar]
  23. Weitzman S., Pocock W. A., Hawkins D. M., Barlow J. B. Observer variation in radiological assessment of pulmonary vasculature. Br Heart J. 1974 Mar;36(3):280–290. doi: 10.1136/hrt.36.3.280. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. du Plessis L. A., Schnaid E., Bloom K. R. Follow-up of Starr-Edwards mitral valve replacements in children. S Afr Med J. 1973 Sep 1;47(34):1521–1526. [PubMed] [Google Scholar]
  25. van der Horst R. L., Le Roux B. T., Rogers N. M., Gotsman M. S. Mitral valve replacement in childhood. A report of 51 patients. Am Heart J. 1973 May;85(5):624–634. doi: 10.1016/0002-8703(73)90168-3. [DOI] [PubMed] [Google Scholar]

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