External Source:
Prevalence of RHD | New England Journal of Medicine | Volume 357, Issue 5, pp. 470-476

“Our findings suggest that echocardiographic screening might detect approximately 10 times as many cases as clinical screening in school-age children in Southeast Asia and sub-Saharan Africa […] These data have potentially important implications for case finding, delivery of effective secondary and primary prevention, and adequate planning of health services.”


Epidemiologic studies of the prevalence of rheumatic heart disease have used clinical screening with echocardiographic confirmation of suspected cases. We hypothesized that echocardiographic screening of all surveyed children would show a significantly higher prevalence of rheumatic heart disease. Randomly selected school children from 6 through 17 years of age in Cambodia and Mozambique were screened for heart disease according to standard clinical and echocardiographic criteria. Systematic screening with echocardiography, as compared with clinical screening, reveals a much higher prevalence of rheumatic heart disease (approximately 10 times as great). Since rheumatic heart disease frequently has devastating clinical consequences and secondary prevention may be effective after accurate identification of early cases, these results have important public health implications.