The Silent Epidemic of Rheumatic Heart Disease in Eastern Nepal

We conducted a study to determine the prevalence and incidence of clinically silent and manifest rheumatic heart disease in Eastern Nepal. The study has been published online in JAMA Cardiology.

Three in 4 children grow up in parts of the world where rheumatic heart disease (RHD) is endemic. Nearly eradicated in high-income countries, RHD ranks among the important noncommunicable diseases in low- and middle­ income countries. It is a sentinel of social inequality and a physical manifestation of poverty and continues to be a substantial health care challenge in less privileged regions of the world.

Our study included 5,178 children, 5 to 15 years of age, from Eastern Nepal. A focused medical history was followed by a brief physical examination. Cardiac auscultation and transthoracic echocardiography were performed by 2 independent physicians. The prevalence of borderline or definite rheumatic heart disease was 10.2 per 1,000 children and increased with advancing age from 5.5 per 1,000 children 5 years of age to 16.0 in children 15 years of age, whereas the average incidence remained stable at 1.1 per 1,000 children per year. Children with rheumatic heart disease were older than children without rheumatic heart disease and more often female. Silent disease (n = 44) was 5 times more common than manifest disease (n = 9). Early detection of silent disease may help prevent progression to severe valvular damage.

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