Rheumatic heart disease in school-attending Nepalese children: A descriptive analysis of the national heart screening database

Prakash Raj Regmi; Ajay Adhikaree; Urza Bhattarai; Sunit Chhetri; Urmila Shakya; Surendra Uranw; Pratik Lamichhane; Sanjib Kumar Sharma

doi:10.1016/j.ihj.2023.07.003

Rheumatic heart disease in school-attending Nepalese children: A descriptive analysis of the national heart screening database

Indian Heart J. 2023 Sep-Oct;75(5):363-369. doi: 10.1016/j.ihj.2023.07.003. Epub 2023 Jul 24.

Authors

Prakash Raj Regmi¹, Ajay Adhikaree², Urza Bhattarai³, Sunit Chhetri⁴, Urmila Shakya⁵, Surendra Uranw⁶, Pratik Lamichhane⁷, Sanjib Kumar Sharma⁸

Affiliations

¹ National Academy of Medical Sciences, Kathmandu, Nepal; Nepal Heart Foundation, Kathmandu, Nepal. Electronic address: pregmi68@gmail.com.
² Pokhara Academy of Health Sciences, Pokhara, Nepal. Electronic address: ajay.bijay@gmail.com.
³ B.P. Koirala Institute of Health Sciences, Dharan, Nepal. Electronic address: bhattaraiurza@gmail.com.
⁴ B.P. Koirala Institute of Health Sciences, Dharan, Nepal. Electronic address: sntcht@gmail.com.
⁵ Shahid Gangalal National Heart Center, Kathmandu, Nepal. Electronic address: ushakya136@gmail.com.
⁶ B.P. Koirala Institute of Health Sciences, Dharan, Nepal. Electronic address: surendrauranw@yahoo.com.
⁷ Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal. Electronic address: pratiklamichhane@iom.edu.np.
⁸ B.P. Koirala Institute of Health Sciences, Dharan, Nepal. Electronic address: drsanjib@yahoo.com.

Abstract

Objective: Rheumatic Heart Disease (RHD) remains a significant public health problem with high morbidity and mortality in children and young adults from lower-middle income countries like Nepal. However, a nation-wide database of the disease is lacking for designing effective future prevention and control programmes and strategies. The aim of our study is to estimate the prevalence of RHD in school-attending Nepalese children.

Methods: We performed a cross-sectional descriptive analysis of a nationally representative database of Nepal Heart Foundation (NHF) national RHD screening programme which included school-attending Nepalese children between five and sixteen years of age. The screening was conducted between May 2015 and March 2020 in 236 schools, representing all seven provinces, across all three ecological zones of Nepal. Transthoracic two-dimensional echocardiography was performed in all eligible children with more than grade one murmur on cardiac auscultation. We estimated the prevalence of RHD among school-attending children as the number of RHD cases per 1000 school-attending children with a 95% confidence interval.

Results: The database included a total of 107,340 children who were screened clinically, of whom 10,600 (9·9%) underwent transthoracic two-dimensional echocardiography. The overall prevalence of RHD was 2.22 cases per 1000 school-attending children (95% CI:1·94 - 2·50). The highest prevalence was observed among children living in the southern Terai ecological zone (2·89 per 1000, 95% CI (2·32-3·46)) of Nepal. Among the provinces, Karnali had the highest prevalence of RHD (3·45 per 1000, 95% CI (2·42-4·48)). Among the districts screened, Kalikot had the highest RHD prevalence (5.47 per 1000, 95% CI (3.02-7.92)).

Conclusion: Primordial, primary and secondary prevention programmes should pay special attention to southern Terai zone, particularly the under-privileged children from remote districts.

Keywords: National survey; Nepal; Prevalence; Rheumatic heart disease; School-attending children.