We performed a systematic review of population-based studies reporting prevalence of rheumatic heart disease among children and adolescents in endemic regions. Reported prevalence of rheumatic heart disease was assessed according to age, gender, screening modality and geographical regions and dichotomized into clinically silent and manifest.
Pooled prevalence detected by means of cardiac auscultation and echocardiography amounted to 2·9/1000 (95% CI 1·7-5·0) and 12·9 (95% CI 8·9-18·6), respectively, with great heterogeneity between individual reports for both screening modalities. We documented a correlation between social inequality expressed by Gini coefficient and prevalence (p<0·001). The prevalence of clinically silent RHD was seven to eightfold higher than the prevalence of clinically manifest disease (21·1/1000; 95% CI 14·1-31·4 versus 2·7/1000; 95% CI 1·6-4·4). Prevalence progressively increased with advancing age from 4·7/1000 (95% CI 1·8-11·2) in 5-year-old children to 21·0/1000 (95% CI 6·8-35·1) in adolescents 16 years of age, while the estimated incidence rate amounted to 1·6/1000 (95% CI 0·8-2·3) and remained constant across age categories. We found no gender-related differences in prevalence (p=0·825). Differences in reported prevalence of RHD may reflect true disparities, but also originate from inconsistencies in the methodology and conduct of surveys. Measures for countering the global burden of RHD need to be taken at different levels. While the reduction in social inequalities represents the cornerstone for community-based prevention, the importance of early detection of silent RHD remains to be further determined. Read full publication at http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(14)70310-9/abstract
