Children in developing countries have silent rheumatic heart disease

Rheumatic heart disease is already a leading cause of death and disability in developing countries, and clinical disease is just the tip of a large iceberg, according to a study of schoolchildren in Mozambique and Cambodia. Researchers looked proactively for rheumatic valve lesions using portable echocardiography, and found ten times more than expected. Around nine out of ten affected children were asymptomatic without an audible heart murmur, and would have been missed by traditional screening for clinical disease.

Among 3677 children in Cambodia, 79 had ultrasound evidence of rheumatic heart disease (21.5 per 1000, 95% CI 16.8 to 26.2). Only eight had clinical symptoms or signs (2.2 per 1000, 0.7 to 3.7). The findings were similar among children in Mozambique, where echocardiography picked up 13 times more cases than would have been found by clinical screening (30.4 per 1000, 23.2 to 37.6 v 2.3 per 1000, 0.3 to 4.3).

Screening with echocardiography may be relatively expensive, but it's important that the authorities in endemic areas learn the true extent of the problem, say the authors. Only then can they plan services and offer treatment, surveillance, and prophylactic antibiotics to affected children. The challenge now is to find a way to make echocardiography affordable to the countries that need it most.