‘5 in 1,000 schoolchildren in state live with subclinical rheumatic heart disease’
Guwahati, Nov 12: In a revelation that may cause concern in Meghalaya, nearly five in every thousand schoolchildren in the state are living with subclinical rheumatic heart disease (RHD). This is a silent yet potentially deadly condition that often goes undetected until it causes irreversible heart damage, according to a new study published in the Indian Heart Journal.
The study led by Dr. Manish Kapoor of Department of Cardiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEGRIMS), and colleagues, is the first of its kind from Meghalaya and one of the most comprehensive echocardiographic screenings ever conducted in the Northeast. Supported by the Indian Council of Medical Research (ICMR), the study screened 4,039 children aged 5–15 years from nine districts using portable echocardiography — a non-invasive ultrasound test of the heart.
An earlier study found that India, home to 40% of all people living with rheumatic heart disease (RHD), is considered the RHD capital of the world. While its prevalence has sharply declined in industrialized nations over the past century, RHD remains a major public health challenge in developing countries and a leading cause of acquired heart disease among children and young adults.
The study in Meghalaya was performed using World Heart Federation (WHF) echocardiographic criteria with a portable echo machine.
The team found only two children (0.49 per 1,000) had clinically apparent RHD, but there were 19 subclinical cases (4.7 per 1,000). “Subclinical RHD prevalence in Meghalaya’s children is significantly higher than clinical RHD” the study found.
Amongst subclinical cases, 8 were of definite RHD, and 11 were borderline RHD [4 with at least two morphological features of RHD of the mitral valve (MV) without pathological mitral regurgitation (MR) or mitral stenosis (MS) while 7 with features of pathological rheumatic MR] .
On categorizing them into age groups of 5–10 and 11–15 years, the prevalence of subclinical RHD was found to be higher in age group 11–15 with a prevalence of 5.16/1000 compared to age group 5–10 with a prevalence rate of 4.28/1000.
Gender-wise, prevalence was higher among females with a rate of 6.29/1000 compared to males 3.04/1000. Based on location, the prevalence was higher among the rural population with a prevalence of 5.23/1000 compared to urban with 3.86/1000 while based on type of schools, the prevalence of RHD was highest for Government schools with 7.68/1000, followed by Private with 5.99/1000 and Government aided private school with 1.93/1000.
The study recommended echocardiographic screening as it is cost-effective for finding the prevalence of RHD in the community.
“We feel the need for an active echo surveillance program, preferably under a national registry, of at least five years of follow-up of these patients by echocardiographically, bacteriologically, and through disease activity markers to better understand the long-term epidemiology and progression pattern of subclinical RHD and also to decide threshold at which to initiate the penicillin prophylaxis” the study noted.
