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Original research article
Community study to uncover the full spectrum of rheumatic heart disease in Uganda
  1. Amy Scheel1,
  2. Isaac Ssinabulya2,
  3. Twalib Aliku2,
  4. Tyler Bradley-Hewitt1,
  5. Alexa Clauss1,
  6. Sarah Clauss1,
  7. Lexi Crawford1,
  8. Alyssa DeWyer1,
  9. Mary T Donofrio1,
  10. Marni Jacobs1,
  11. Jennifer Klein1,
  12. Teresa E Moore1,
  13. Emmy Okello2,
  14. Janet Scheel3,
  15. Rebekah Shaw1,
  16. Craig Sable1,
  17. Peter Lwabi2,
  18. David A Watkins4,
  19. Andrea Beaton1
  1. 1Children’s National Health System, Washington, District of Columbia, USA
  2. 2Department of Cardiology, Uganda Heart Institute, Kampala, Uganda
  3. 3Department of Cardiology, St. Louis Children’s, St. Louis, Missouri, USA
  4. 4Department of General Internal Medicine, University of Washington, Seattle, Washington, USA
  1. Correspondence to Amy Scheel, Children’s National Health System, Washington, DC 20010, USA; ascheel3{at}


Objective Estimates of the prevalence of rheumatic heart disease (RHD) in many endemic countries are limited to samples of children attending schools, which generate an incomplete picture of disease burden in communities. The present study conducted household-based RHD screening in a representative community in Gulu district, Uganda.

Methods Members of households identified through a two-stage cluster-sampling approach between the ages of 5 years and 50 years were invited to undergo limited cardiac testing with a handheld echocardiogram to assess for the presence of RHD. Suspicious cases underwent confirmatory echocardiogram with a fully functional machine.

Results Of the 2453 community members screened, 2.45% (95% CI 1.87% to 3.14%) showed echocardiographic evidence of RHD with 1.26% (95% CI 0.860% to 1.79%) having definite RHD. The overall prevalence of RHD among participants <20 years was 2.52% (95% CI 1.78% to 3.45%), with a borderline prevalence of 1.97% (95% CI 1.33% to 2.82%) and a definite prevalence of 0.544% (95% CI 0.235% to 1.07%). Prevalence rates among youth increased with age and peaked in the age group of 16–20 years. The overall adult prevalence (>20 years) of RHD was 2.34% (95% CI 1.49% to 3.49%). The majority of definite cases were mild (81%) and marked by mitral regurgitation and associated morphological valve changes (71%).

Conclusion Our data reveal a high prevalence of undiagnosed RHD within an endemic community and fill a critical gap in RHD epidemiology in African adults.

  • valvular heart disease
  • global disease patterns

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  • Contributors All authors contributed to study design and oversight of data collection. AS, CS, and AB analysed and interpreted the data and drafted the manuscript. All authors critically revised the manuscript for important intellectual content. AB, EO, and PL supervised the study.

  • Funding This study was supported with a grant from the Karp Family Foundation and Children’s National Global Health Initiative.

  • Disclaimer The funders did not contribute to the design of the study. The funders did not take part in study design, data collection or writing of this manuscript.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The Makerere University College of Health Sciences Research and Ethics Committee, The Ugandan Bureau of Science and Technology and the Children’s National Health System Institutional Review Board approved the research protocol.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice Since this paper was first published online, the affiliations 3 and 4 have been corrected.