Thesis title: The prevalence of Rheumatic Heart Disease Among Pregnant Women and School Aged Children in Mogadishu and Surrounding Area (Somalia)
Prevalence of Rheumatic Heart Disease among Pregnant Women and School aged Children in Mogadishu and Surrounding Area (Somalia). An Echographic study
Rheumatic heart disease (RHD), is the result of damage of the heart valve which occurs after repeated episode of acute rheumatic fever. The permanent damage of the heart valves which caused by an untreated ''strep throat'' infection, is the leading cause of cardiovascular mortality and morbidity in children and young adults worldwide and a simple penicillin treatment after the early diagnosis of RHD can stop recurring bouts of the condition, which lead to the most severe valvulopathy, and ultimately, heart failure.
Recent research estimates that RHD remains a major global public heath challenge, affecting about 33 million people across the globe with estimated 3,6 million being children between 5 and 14 years of age living in developing countries and in low income countries RHD accounts for approximately 90% of all cardiovascular disease among pregnant women. The main socioeconomic determinant of RHD include poverty, overcrowding, low educational level, unemployment, malnutrition and ill equipped health systems and Sub Saharan African countries, which is home to only 10% of the world's population, is thought to account for 50% of children who suffer from RHD. RHD is one of the preventable and treatable forms of a disease that requires early detection, screening, diagnosis and treatment. Echocardiography is seen to be essential tool to define the diagnosis and to detect early diagnosis of the disease, its progression and complication.
Somalia is categorized as a very poor income country, with approximately 15 million of people, 54% in poverty, with life expectance of 55,4% and mortality rate of 137/1000 birth in children below 5 years old and its population health system has collapsed 30 years ago because of civil war and No Open heart Surgery facility are present in the country which makes the only way to avoid the rheumatic heart disease valvular surgery is to prevent it having the disease.
Aim of the Study:
The aim of this research was to assess the presence of the RHD at early stage using Echocardiography, as currently recommended by the WHO Expert committee, to prevent the late dramatic consequences of rheumatic valvular heart disease among pregnant women and school aged children in Mogadishu (the capital of Somalia) and Surrounding area.
Methodology:
Cross-sectional study was conducted among patients on the Wardi Community Hospital and Outpatients Nunow's Mother and Child Voluntary Hospital in Mogadishu. Male and female patients aged 5-35 years and not having any contraindication, such as chest trauma to performing and echocardiography were eligible for participation. After informed consent by the patients or their guardian, the intake questionnaire was administered and the echocardiography subsequently was performed in suspected patients with RHD echographic evidences. Images were sent to the Supervisor of the research at Umberto I Hospital, Rome, Italy for his suggestions.
Sample size: planned size was 600 subject but later were reduced to 550 subject and the general elements were age, gender, place of residence (rural vs urban), pregnancy, reason (diagnosis) for current sing and symptoms, comorbid medical conditions including prior history of cardiovascular disease, cerebrovascular disease and HIV status (if known). Rheumatic heart disease were defined according the criteria recommended internationally and combined with WHO Doppler criteria and morphologic criteria.
Results
In a total of 550 patients enrolled (450 pregnant women between 18 - 37 years old and 100 children between 5 and 18 years) 5 had echographic evidence of rheumatic heart disease (0.9%). Two were pregnant women and 3 were children (2 girl and 1 boy). Patients with RHD were more likely to be female. an association between RHD and crowded living conditions or socioeconomic status was not demonstrated in this study.
Conclusions: Prevalence of RHD in Mogadishu and Surrounding area seems to be 9.1/1000 population but rural area may be more than that and need further investigation on the subject after the security of the country improves and the corona virus pandemic end.