Open Access

Research
The burden of rheumatic heart disease among children in Lagos: how
are we fairing?

Barakat Adeola Animasahun1,&, Akpoembele Deborah Madise Wobo1, Adejumoke Yemisi Itiola1, Motunrayo Oluwabukola
Adekunle1, Olusola Yejide Kusimo1, Fidelia Bode Thomas2

1
Department of Paediatrics and Child Health, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria, 2Department of Paediatrics, Jos
University Teaching Hospital, Lagos, Nigeria

&
Corresponding author: Barakat Adeola Animasahun, Department of Paediatrics and Child Health, Lagos State University College of Medicine, Ikeja,
Lagos, Nigeria

Key words: Rheumaric, heart, disease, children, Nigeria

Received: 24/04/2017 - Accepted: 05/03/2018 - Published: 14/03/2018

Abstract
Introduction: Rheumatic heart disease still remains a cause of morbidity and mortality in low and middle income countries, despite its eradication
in developed societies. The study aimed to document the features of children with rheumatic heart disease using clinical evaluation and
echocardiography and compare it with reports from other part of the country. Methods: A review of a prospectively collected data of patients with
rheumatic heart disease who had echocardiography done from April 2007-Dec 2016. Information obtained from patients include age, sex, clinical
indication for echocardiography, echocardiographic characterization of the valvular lesions and associated complications. Results: A total of
324,676 patients were seen at the Paediatric unit of LASUTH from 2007 to 2016, out of which 36 had Rheumatic heart disease. This translates to a
prevalence of 1.1 per 10,000 patients who presented at the study site during the study period. The prevalence of RHD amongst all the patients
with structural heart disease was 2.6%. The mean age of patients was 9.12 ± 2.75 years with a male to female ratio of 1.6: 1. The most common
valve affected was mitral valve. Heart failure was the most common mode of presentation found in 91.6%. Other complications were pulmonary
hypertension and pericardial effusion. Conclusion: Rheumatic heart disease is still prevalent among children in Lagos although the prevalence is
reducing. Heartfailure is the commonest mode of presentation and complication in them.

Pan African Medical Journal. 2018;29:150. doi:10.11604/pamj.2018.29.150.12603

This article is available online at: http://www.panafrican-med-journal.com/content/article/29/150/full/

© Barakat Adeola Animasahun et al. The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the
original work is properly cited.

Pan African Medical Journal – ISSN: 1937- 8688 (www.panafrican-med-journal.com)

Published in partnership with the African Field Epidemiology Network (AFENET). (www.afenet.net)

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Introduction Methods

Rheumatic heart disease (RHD) is a non-suppurative complication of Study setting: The study was conducted at the Lagos State
group A Beta hemolytic streptococcal throat infection. It affects University Teaching Hospital, (LASUTH) Ikeja. A 600 bedded Urban
children and young adults in developing countries and most of these Tertaiary Centre in Lagos State, Westen Nigeria which serves as a
patients presents in heart failure and require surgical intervention refering centre for not only more than twenty general hospitals in
[1]. It is estimated that 12 million people worldwide are affected by Lagos, but also private hospitals and federal medical centre in
rheumatic fever and rheumatic heart disease and two-thirds of Lagos. It receives patient from South Western Nigeria and from all
these are children between ages of five and fifteen, with 79% of over the country especially Paediatric patients due to the free health
cases from developing countries particularly those in the African policy for the under twelve years of age.
continent [2]. Rheumatic heart disease is one of the most common
form of acquired cardiovascular disease, in Sub Saharan Africa. Subject recruitment and data collection: The present study is
According to a World Health Organization (WHO) estimate over a a review of a prospectively collected data of patients diagnosed with
decade ago, RHD affects children of school going age with a Rheumatic Heart disease using clinical evaluation and
prevalence of 5.7 cases per 1000 school children.1 The prevalence echocardiography at the Paediatric Cardiology unit between January
varies from one region to another but it is known that the rates are 2007 and December 2016. All patients had chest radiograph,
still high in sub-Saharan Africa compared with the Western countries electrocardiography and echocardiographic evaluation. Anti-
[3]. A systematic review conducted in South Africa revealed a high streptolysin O antibody was assayed on all patients with a strong
prevalence of RHD, with up to 20.2 per 1,000 children with suspicion of acute rheumatic fever. The age, sex, clinical indications
asymptomatic RHD in some regions in that country [4]. In Nigeria, and echocardiographic characterization of valvular lesions and
the prevalence rates varies from region to region with some centres associated complications of the patients were documented.
reporting rates of 12.4 per 1,000 children seen in the hospital [5].
The new clinical criteria of 2012 for the diagnosis of ARF/RHD Case definition of RHD and pulmonary artery hypertension:
classified ARF into definite initial episode of ARF, definite recurrent Rheumatic heart disease was defined by the presence of any
episode of ARF in a patient with known past ARF or RHD and definite evidence of valve regurgitation or stenosis seen in two
probable ARF (first episode or recurrence) [6]. Proven preventive planes on Doppler examination and at least two morphologic
strategies including the use of prophylaxis for rheumatic fever and abnormalities such as restricted leaflet mobility, focal or generalized
socio-economic improvement was recognized over thirty years ago valvular thickening and abnormal sub-valvular thickening of the
[7]. However, in developing countries, social determinants of the affected valves [9]. Pulmonary artery hypertension (PAH) was
disease such as adequate housing, access to primary health care, identified using a combination of ECG and transthoracic
education and availability of cardiologic diagnostic tools and cardiac echocardiography (Two-dimensional and Doppler) [10]. ECG
surgery are still a major challenge [8]. The decline in the prevalence findings include evidence of right ventricular dilatation and
of rheumatic heart disease in developed countries has been hypertrophy. Two-dimensional features include; increased thickness
attributed to high standard of living and access to medical care [8]. of the right ventricle, paradoxical bulging of the septum into the left
There is no doubt that rheumatic heart disease still remains a cause ventricle during systole, right ventricular dilation, right atrial
of morbidity and mortality in low and middle income countries, dilatation and or tricuspid regurgitation. Doppler echocardiography
despite its eradication in developed societies. This study presents was used to measure the pulmonary artery pressure by means of
the distribution or rheumatic valvular lesions as seen at tricuspid regurgitation velocity measurements. Pulmonary pressure
echocardiography in the Paediatric cardiology unit of the Lagos greater than 25mmHg at rest is diagnostic of PAH [11]. The severity
State University Teaching Hospital (LASUTH) over a ten period of PAH is classified as mild (PAH from 25-40mmHg), moderate (PAH
(from January 2007 to December 2016). from 41 to 55mmHg) and severe (PAH > 55mmHg) [12]. Cardiac
catheterization is not routinely done on all patients and thus
diagnosis of PAH was not made with cardiac catheterization.

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Data analysis: Data were analyzed using Statistical Package for or combination with mitral valve prolapse. Of the 36 patients with
Social Sciences (SPSS) version 20.0. The frequencies of each RHD, 20 (62.5%) had tricuspid regurgitation from pulmonary artery
valvular lesions, clinical indications for echocardiography, male to hypertension. The valvular lesions are depicted in Table III. The
female ratio and mean age at diagnosis of the patient were most common valve affected was mitral (95%), while the least
documented. Mean, standard deviation and other parameters were affected was Aortic (7.5%). Half of the patient (50%) had mitral
generated as necessary for continuous data. Means of continuous valve affectation with tricuspid regurgitation from pulmonary artery
variables were compared using the Student t test and proportions hypertension as depicted in Table 3.
using Chi-square test. Level of significance set at p < 0.05
Pre-echocardiographic diagnosis and complications: All the
Ethical consideration: Consent was obtained for patients were referred from both within and outside the hospital.
Echocardiography from the parents of the children. In the data The reason for referral and cardiac evaluation are depicted in Figure
storage and presentation, no personal information was used 1. The most common was a clinical diagnosis of RHD followed by a
unlawfully. The details of each subject was made confidential. suspicion of an Acyanotic Congenital Heart Disease (ACHD). Other
indications include, acute rheumatic fever and a murmur. The
complications encountered were heart failure, mild, moderate and

Results severe pulmonary hypertension and cardiomegaly. The most

common of the complications was congestive cardiac failure which
occurred in half of the patients. This was closely followed by
Prevalence of RHD: A total of 1,846 echocardiographs were
pulmonary artery hypertension. Table 4 depicts the complications in
performed in the study period, out of which 1364 had structural
the study subjects. Table 5 shows the echocardiographic parameters
heart diseases (congenital and acquired). Rheumatic valvular
of the subjects. There was reduced mean left ventricular ejection
disease was documented in 36 of those patients. The prevalence of
fraction (53.6), increased mean left ventricular mass index (27.1g),
RHD amongst all the patients with structural heart disease was
and increased left atrial diameter (39.2mm) among the subjects.
2.6%. There were 136 cases of acquired heart diseases in the
period under review, the prevalence of RHD amongst those with
acquired heart disease (AHD) was 26.5%. Within the study period, a
total of 324,676 children were seen in the Department of Discussion
Paediatrics. They comprised of 173,695 males and 150,981 females.
The prevalence of RHD amongst the children who presented to the Rheumatic heart disease is one of the most common and
study center during the period of study was 1.1 per 10, 000 preventable acquired heart disease with valvular heart damage as
children. Table 1 shows the prevalence of RHD in Nigeria in the last the hallmark [5]. While the number of cases in developed countries
two decades. have reduced drastically, the same cannot be said of developing
countries like those in sub-Saharan Africa. The prevalence of RHD
Demographic characteristics of the study subjects: Of the 36 among children in the present study was 2.6 and 26.5% in
patients with RHD, there were 22 males and 14 females with a male structural and acquired heart diseases respectively. The general
to female ratio of 1.6:1. The children were aged 4 to 13years. Most trend noted in Nigeria from the literature is 2.9 to 9.8% and 17.4 to
of the patients, (50%) were between five and 10 years of age at 57.7% for the prevalence amongst the structural and acquired heart
diagnosis with a mean age of 9.12 ± 2.75 years. The mean age of diseases respectively. The values documented in the present study
the males and females were 9.24 ±2.14 and 8.96 ± 3.52. There is thus within the reported range in Nigeria [5, 13-16]. In the
was no significant difference in the both the mean age and the age present study, the hospital based population prevalence of RHD was
distribution of both gender; p = 0.619 and 0.591 respectively. 1.1 per 10,000 children. This was slightly lower than an earlier
The Table 2 depicts the gender and age distribution of the patients. report by Okoromah et al, [14] within the same location almost a
decade ago and significantly lower than that by Sani and Colleagues
Valvular lesions: The most common valve affected in the patients [5] from the North Western region of Nigeria. The range of values in
was the mitral valve with mitral regurgitation, which occurred alone Nigeria is wide and possible explanation lies in the different

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geographic locations where the research was carried out and RHD. The finding in this regard is in contrast with most reports
heterogeneity of the sample methods in the various studies as where there is a female predominance in both adult and children
depicted in Table 1. It was observed that the prevalence appears to [5,13,16,22,23]. However, few studies have reported a male
be lower in South-Western Nigeria compared to the Northern parts predominance [16, 24,25]. The reason for the female predilection in
of the countries. The reason is not presently clear but possible most of the studies is not known. Given that most of the studies are
explanation may be adduced from a more improved living hospital based, not all the patients with the disease are captured. A
conditions, increased access to antibiotics for throat infections and community based study will present data that will be more
improved access to health care in the southern parts of the country. representative of the demographics of RHD. In the present study,
The health indices in the country is also skewed with much better Mitral regurgitation was the most common valvular lesion occurring
indices in the south compared to the north [17]. All of these may be either alone or in combination with other valvular lesions. This
responsible for the lower prevalence of RHD in the South. The finding mirrors reports from previous studies [5,13,19]. It has been
heterogeneous nature of the method among the studies is also shown from previous reports that mitral valvular disorders are more
responsible for the wide range of prevalence values. For example, common compared to the other valvular lesions. However, the
Sani et al16 and Danbauchi et al [18] both included adult population reason for the overwhelming predisposition of mitral valve is yet to
in their study, this may have been responsible for a higher be unraveled [26]. Tricuspid regurgitation was second most
prevalence of RHD in those studies. Furthermore, the duration of common valvular lesion seen. It was documented in half of the
the studies varies from one study to another, while some studies patients. This finding is not out of place because pulmonary artery
were over a 12-month period, others were 5-10years. This may hypertension (PAH) is a common complication of RHD and severe
have also contributed to the varying prevalence in the country. The forms of PAH will result in tricuspid regurgitation [19,27]. In
prevalence of RHD in the present study is lower than the contracts to the regurgitant lesions, stenotic valvular lesions were
documented prevalence in other countries in Africa. The prevalence only seen in two patients. One patient had a mitral stenosis and
rate in a recent study in Kenya was 22.1% and 50.4% for structural another with aortic stenosis. The finding in this regard is not out of
and acquired heart diseases respectively [19]. Similarly, a study in place given that stenotic valvular lesions depicts advanced or
Cameroon documented a prevalence of 41.1% among the acquired chronic RHD which is not seen until late adolescents and adulthood.
heart diseases [20]. The values are lower in the present study Rheumatic heart disease is a major cause of morbidity and mortality
compared to those reported in other African studies because of the in affected children. Heart failure and pulmonary artery
regional differences in the pattern of RHD in countries in Africa. hypertension were the most common complications observed in the
Despite the relatively lower values documented in the present study, patients. This finding is in keeping with reports from a previous
rates of RHD are known to be high in Africa. studies [19,22,27].

According to a WHO report, Africa is one of the regions with the Heart failure results from valvular insufficiency or stenosis. Given
highest prevalence of RHD and the rate doesn't appear to be that majority of the patients had mitral insufficiency, it was not
decreasing compared to regions like the European countries where surprising that heart failure was a common morbidity amongst
it is almost extinct [3]. The reasons adduced for the higher rates them. Similarly, PAH results from severe mitral valvular lesions
includes the availability of major advances in medical and surgical [19,28]. The finding of pulmonary hypertension in half of the
treatment with improved survival and that RHD is more rigorously patients is thus in keeping with the prevalent valvular lesions
sort out by echocardiography. Given the lower prevalence of RHD in amongst them. The implication of this is that common co-
Southern Nigeria compared to the north, it is imperative that health morbidities such as heart failure and PAH should be anticipated and
policies and practices be scaled up in the northern part of the managed promptly in all patients with RHD. In a review of
country to reduce the burden therein. The mean age at diagnosis in predictors of mortality in chronic rheumatic heart disease, Talwar
the present study, is consistent with reports from other studies and Gupta [29] noted that, the severity of valvular damage and it's
[5, 13,16,20, 21]. Most of the children with RHD were over 5 years haemodynamic consequences to which PAH and heart failure
of age and majority were between 5-10years of age. It has been belongs, is a major factor attributable to mortality in RHD. Other
shown that RHD is more common in children between 5-15years. In morbidities such as arrhythmia and infective endocarditis are
the present study, there were more males than the females with consequence of severe valvular disease that have been associated

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in the mortality of patients with RHD, but those were not  Rheumatic heart disease is still prevalent among children
documented in our subjects. Rheumatic heart disease is a major in Lagos;
public health problem in Nigeria and most developing countries. This
 The prevalence of rheumatic heart disease among
is because these countries are still burdened with poverty, low level
children in the southern part of Nigeria is lower than
of awareness, poor health seeking behaviour and inadequate
those from the northern part of Nigeria;
treatment. These factors result in persistence of the disease and a
 The prevalence of rheumatic heart disease among
poorer outcome [25]. The huge strides achieved in the developed
children in the southern part of Nigeria is reducing.
regions of the world in diagnostic options, surgical and
interventional management of heart disease has not been replicated
in Africa [30]. The diagnostic challenge has reduced in a few centers
due to the availability of echocardiography imaging facilities, but
Competing interests
this has not been matched with the availability of cardiac surgeries.
It has been recommended that primary and secondary prevention of The authors declare no conflicts of interest.
rheumatic fever should be strengthened at all levels of care
[31, 32]. This includes prompt use of penicillin prophylaxis in the
vulnerable age group, as well as early treatment of streptococcal Authors’ contributions
sore throat which precludes the development of Rheumatic fever
and Rheumatic Heart Disease. In addition, long term treatment of
Barakat Adeola Animasahun was the project leader, she also
rheumatic fever can halt the disease progression [25]. Furthermore,
conceived the study. Barakat Adeola Animasahun, Akpoembele
emphasis should be placed on programs such as early case finding
Deborah Madise-wobo, Adejumoke Yemisi Itiola, Fidelia Bode
and prompt diagnosis of children with rheumatic heart disease,
Thomas and Olusola Yejide Kusimo were involved in the design of
provision of adequate medical services of high quality in hospitals
the study and data collection, they also drafted the manuscript,
and a good follow up care [8].
Barakat Adeola Animasahun, Akpoembele Deborah Madise Wobo
and Fidelia Bode Thomas and Motunrayo Oluwabukola Adekunle
were involved in the analysis and interpretation of data with critical
Conclusion review of the manuscript for important intellectual content. All the
authors approved the final manuscript.
In conclusion, there has been a decline in the prevalence of
Rheumatic heart disease among children in Lagos in the last
decade. Males were more commonly affected than females. Heart Acknowledgments
failure and pulmonary hypertension were the commonest
complications and Mitral valves are the most commonly affected
We gratefully acknowledge the subjects who participated in this
valve.
study, their parents and caregivers including other staff who were
involved in their care.
What is known about this topic

 Rheumatic heart disease is an important cause of

morbidity and mortality among children in the African Sub
Tables and figures
region;

 It is almost non-existent in the developed countries since

Table 1: Literature extraction of Nigeria prevalence of RHD in the
the advent of penicillin;
last two decade
 Study done in a populous city is likely to be more
Table 2: Gender and age distribution of the patients
representative of the pattern in the developing world.
Table 3: Pattern of valvular lesions in RHD
What this study adds
Table 4: Complications in the study subjects

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Table 5: Shows Echocardiographic features of the study subjects 10. Jone PN, Ivy D. Echocardiography in pediatric pulmonary
Figure 1: Indication for electrocardiography hypertension. Front Pediatr. 2014; 2: 124.PubMed | Google
Scholar

References 11. Rosenzweig EB, Widlitz AC, Barst RJ. Pulmonary arterial
hypertension in children. Pediatr Pulmonol. 2004; 38(1): 2-
22. PubMed | Google Scholar
1. WHO. Rheumatic fever and rheumatic heart disease. Report of
a WHO Expert Consultation, Geneva 29 October-1 November
12. Khan MG. Pulmonary hypertension and co-pulmonale, In: Khan
2001. Accessed April 24 2017
MG, Lynch JP III, eds Pulmonary disease diagnosis and
therapy: a practical approach. Baltimore: Williams and Wilkins.
2. Prevention, WHO and C for DC and P, Rheumatic Fever and
1997; 603-16.
Rheumatic Heart Disease. In: Mackay J, Mensah G, editors The
Atlas of Heart Disease and Stroke. Geneva: WHO. 2004; 20-
13. Sadoh E, Uzodimma C, Daniels Q. Childhood acquired heart
1. Google Scholar
disease in Nigeria: an echocardiographic study from three
centres. Afr Health Sci. 2014; 14(3): 602-8. Google Scholar
3. Press D. The worldwide epidemiology of acute rheumatic fever
and rheumatic heart disease. 2011; 1(434). Google Scholar
14. Okoromah CAN, Ekure EN, Ojo OO, Animasahun BA, Bastos MI.
Structural heart disease in children in Lagos: profile, problems
4. Zuhlke L, Engel M, Watkins D, Mayosi B. Incidence, prevalence
and prospects. Niger Postgrad Med J. 2008; 15(2): 82-
and outcome of rheumatic heart disease in South Africa: a
8. Google Scholar
systematic review of contemporary studies. Int J Cardiol. 2015;
199: 375-83. PubMed| Google Scholar
15. Adebayo BE, Ogunkunle OO, Omokhodion SI, Luke RD. O
riginal Article The spectrum of structural heart defects seen in
5. Sani UM, Ahmed H, Jiya NM. Pattern of acquired heart diseases
children at the University College Hospital, Ibadan. Nig J
among children seen in Sokoto, NorthWestern Nigeria. Niger J
Cardiol. 2016; 13(2): 130-5.Google Scholar
Clin Pract. 2015; 18(6): 718-25. PubMed | Google Scholar

16. Bode-Thomas F, Ige O, Yilwan C. Childhood acquired heart

6. RHD Australia. ARF RHD Guideline. The Australian guideline for
disease in Jos, North central Nigeria. Nig Med J. 2013; 54(1):
the prevention, diagnosis and management of acute rheumatic
51-8. PubMed | Google Scholar
fever and rheumatic heart disease. 2nd edition. 2012. Accessed
September 06 2017
17. Wollum A, Burstein R, Fullman N, Dwyer-lindgren L, Gakidou E.
Benchmarking health system performance across states in
7. Jaiyesimi F. Chronic rheumatic heart disease in childhood: Its
Nigeria: a systematic analysis of levels and trends in key
cost and economic implications. Trop Cardiol. 1982; 8: 55-7.
maternal and child health interventions and outcomes 2000-
2013. BMC Med. 2015; 13: 208 PubMed | Google Scholar
8. Wallace H. Changing status of rheumatic fever and rheumatic
heart disease in children and youth. Am J Dis Child. 1955;
18. Danbauchi SS, Alhassan MA, David SO, Wammanda R, Oyati
89(1): 7-14. PubMed | Google Scholar
IA. Spectrum of rheumatic heart disease in Zaria. Ann Afr Med.
2004; 3(1): 17-21. Google Scholar
9. Snider R. The normal echocardiograph examination, In: Snider
R, Serwer G, editors. Echocardiography in Paediatric haert
19. Kironget A, Kiptoon P, Koech M. Echocardiographic
disease 2nd ed. USA: Walsworth. 1997.
characteristics of children with rheumatic heart disease at MOI
Teaching And Referral Hospital (MTRH), Eldoret, Kenya. Eur J
Biol Med Sci Res. 2014; 2(4): 17-29. Google Scholar

Page number not for citation purposes 6

 epidemiological and laboratory investigation. Heart. 2005;
20. Nkoke C, Menanga A, Boombhi J, Chelo D, Kingue S. A new 91(1): 3-4. PubMed |Google Scholar
look at acquired heart diseases in a contemporary sub-Saharan
African pediatric population: the case of Yaoundé, Cameroon. 27. Essien I, Onwubere B, Anisuba B, Ejim E, Andy J, Ike S. one
Cardiovasc Diagn Ther. 2015; 5(6): 428- year echocardiographic study of rheumatic heart disease at
34. PubMed | Google Scholar Enugu, Nigeria. Niger Postgr Med J. 2008; 15(3): 175-
8. PubMed | Google Scholar
21. Asani MO, Sani M, Karaye K, Adeleke S, BAba U. Structural
heart diseases in Nigerian children. Niger J Med. 2005; 14(4): 28. Sani MU, Karaye KM, Borodo MM. Prevalence and pattern of
374-7. PubMed | Google Scholar rheumatic heart disease in the Nigerian savannah. an
echocardiographic study. Cardiovascular Topics. 2007; 18(5):
22. Ogah O, Adegbite G, Udoh S, Ogbodo E, Ogah F. Chronic 295-9. Google Scholar
rheumatic heart disease in Abeokuta , Nigeria: Data from the
Abeokuta heart disease registry. Nig J Cardiol. 2014; 11(2): 98- 29. Talwar KK, Gupta A. Predictors of mortality in chronic
103. Google Scholar rheumatic heart disease. Indian J Med Res. 2016; 144(3): 311-
313. PubMed | Google Scholar
23. Jaiyesimi F, Antia A. Childhood rheumatic heart disease in
Nigeria. Trop Georg Med. 1981; 33(1): 8- 30. Mocumbi A. The challenges of cardiac surgery for African
13.PubMed | Google Scholar children. Cardiovasc J Afr. 2012; 23(3):1 65-
7.PubMed | Google Scholar
24. Akpa M, Dodiyi-Manuel S, Agada Z, Odia O. Rheumatic heart
disease in Port Harcourt, Nigeria: clinical, demographic and 31. Omokhodion S. Management of patients with rheumatic fever
echographic features. Port Harcourt Med J. 2012; 6: 3. Google and rheumatic heart disease in Nigeria-need for a National
Scholar system of primary, secondary and tertiary prevention. S Afr
Med J. 2006; 96(3 Pt 2): 237-9. PubMed | Google Scholar
25. Akintunde A, Opadijo O. Late presentation of rheumatic heart
disease: a justification for renewal of preventive methods. Pan 32. Karthikeyan G, Mayosi B. Is primary prevention of rheumatic
Afr Med J. 2009; 3: 22-5. PubMed | Google Scholar fever the missing link in the control of rheumatic heart disease
in Africa. Circulation. 2009; 120(8): 709-
26. Kaplan E. Pathogenesis of acute rheumatic fever and rheumatic 13. PubMed | Google Scholar
heart disease: evasive after half a century of clinical,

Page number not for citation purposes 7

 Table 1: Literature extraction of Nigeria prevalence of RHD in the last two decade
Author/Yea Study
Total no No NO Age
r of Period Total Prevalence Prevalence
with with with M:F range
publication In adm in AHD in SHD
RHD AHD SHD in yrs
Months
Lagos(South-West) Present
120 36 136 1364 324,676 1.7:1 4-13 26.5 2.6
study
Lagos/Benin/Abuja(m Sadoh et
42 23 132 NA NA 1:1.5 5-17 17.4 NA
ulti-location) al /2014
Lagos(South-West) Okoromah et
48 12 42 270 26,568 ? ? 28.6 4.4
al /2008
Ibadan (South-West) Adebayo et
12 6 18 210 NA NA 5-14 33.3 2.9
al /2016
Abeokuta(South- Ogah et
60 107 NA NA NA 1:1.6 3-92 NA N/A
West) al /2014
Port-Harcourt(South- Akpa et al
12 32 NA NA NA 1.4:1 17-65 N/A N/A
South) /2012
Jos(North-Central) Bode-
Thomas et 120 101 175 564 NA 1:1.4 1-18 57.7 17.9
al /2013
Zaria(North-Central) Danbauchi et
36 47 NA 7600 NA 1.4:1 5-52 NA 7.8
al /2004
Kano(North-West) Sani et
4 129 NA 1312 NA 1>1.7 5-60 NA 9.8
al /2007
Sokoto(North-West) Sani et al
60 47 110 NA 3810 1:1.5 4-15 42.7 NA
/2015
No-Number NA-Data not available RHD-Rheumatic heart disease
AHD-Acquired heart disease
SHD-Structural heart disease
Adm-Admission

Table 2: Gender and age distribution of the patients

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Age group
Male Female Total (%) P value
(years)
1-4.9 1 2 3 (6.5) 0.840
5-10 12 6 18 (51.6)
>10 7 6 13 (41.9)
Median 9.1 10 9.12
The ages of 2 children

Table 3: Pattern of valvular lesions in RHD

Pattern of valvular
Frequency %
lesions
Isolated MVP/MVR 17 42.5
Isolated AR 1 2.5
Isolated MS 1 2.5
MVP with AR 1 2.5
MVR with TR 19 47.5
AS, MVP, TR 1 2.5

Table 4: Complications in the study

subjects
Number
Complication of %
patients
CCF 27 51.0
PAH 41.5
Mild 15
Moderate 4
Severe 3
Cardiomegaly 4 7.5
CCF- Congestive cardiac failure; PAH-
Pulmonary artery hypertension

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Table 5: Shows echocardiographic features of the
study subjects
Features Range Mean±SD
LVDd 40-64 50.5±8.5
LVDs 6-40 27.1±14.6
IVSd 6-9 7.3±
PWd 4-11 8.5±3.8
Ejection fraction 20-68 53.6±19.2
Fractional shortening 9-37 28±11.0
Aortic root diameter 18-30 22±8.5
Left Atrial diameter 26-53 39.2±10.8

Figure 1: Indication for electrocardiography

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