Prevalence of rheumatic heart disease diagnosed according to the echocardiographic criteria of the World Heart Federation in Africa: A systematic review and meta-analysis

• Published in: Cardiovascular revascularization medicine 2024-11, Vol.68, p.73-78
• Main Authors: Morais, Humberto, da Silva Ferreira, Hilaryano
• Format: Article
• Language: English
• Subjects: Africa - epidemiology; Echocardiography; Echocardiography - statistics & numerical data; Humans; Predictive Value of Tests; Prevalence; Rheumatic heart disease; Rheumatic Heart Disease - diagnostic imaging; Rheumatic Heart Disease - epidemiology; Risk Factors; Screening
• ISSN: 1553-8389; 1878-0938; 1878-0938
• DOI: 10.1016/j.carrev.2024.05.025

Rheumatic heart disease (RHD) is a chronic complication arising from acute rheumatic fever (ARF), an autoimmune response triggered by group A streptococcal infection. It primarily affects children and young adults in developing countries. RHD continues to show substantial global heterogeneity. Socioeconomic factors lead the virtual disappearance of RHD in industrialized countries with the introduction of penicillin. By contrast, RHD is still endemic in Africa, Asia, South America, and developing communities of Australasia. We provide an estimate of the current prevalence of latent RHD in Africa using the echocardiographic diagnostic criteria of the World Heart Federation (WHF). Systematic review and meta-analysis of 21 studies reporting the prevalence of RHD, encompassing 40.639 patients. Estimated prevalence of RHD was 25.5 cases per 1000 population (P ≤0.02; 95 % CI, 18.1–32.9 per 1000): definite RHD 13.1 cases per 1000 population (95 % CI, 7.7–18.5 per 1000): and borderline 12,4 cases per 1000 population (95 % CI, 7.7–17.0 per 1000). The prevalence of definite RHD was a significantly higher in adults (M = 28.2, SD = 6.1) compared to children (M = 10.3, SD = 9.2), t(17) = 2.6, p = .0179. Prevalence of definite RHD in schools was 7,92 cases per 1000 population (95 % CI, 4,49–11,35 per 1000) and in community was 26,17 cases per 1000 population (95 % CI, 12,27–40,06 per 1000). This meta-analysis may have produced a better estimate of the prevalence of RHD in Africa using only studies performed according to the 2012 WHF, and clearly showed the high prevalence of RHD in the community and in adults. •Estimated RHD prevalence in Africa at 25.5 per 1000, using WHF criteria•Significant difference in definite RHD prevalence between adults (28.2 per 1000) and children (10.3 per 1000)•Higher definite RHD prevalence in community (2617 per 1000) versus schools (792 per 1000)•Utilization of 2012 WHF guidelines improved RHD prevalence estimation accuracy.•Demonstrated the critical role of community-based screenings for RHD detection