Currently accepted at: JMIR Public Health and Surveillance
Date Submitted: Nov 3, 2025
Open Peer Review Period: Nov 4, 2025 - Dec 30, 2025
Date Accepted: Feb 25, 2026
(closed for review but you can still tweet)
This paper has been accepted and is currently in production.
It will appear shortly on 10.2196/87039
The final accepted version (not copyedited yet) is in this tab.
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Prevalence of Early Rheumatic Heart Disease among Asymptomatic Schoolchildren in Ethiopia
ABSTRACT
Background:
Rheumatic heart disease (RHD) is a sequela of recurrent, untreated Group A Streptococcus (GAS) infections. RHD disproportionately affects children and young adults in the Global south. Intermittent mass screening of early RHD using affordable tools in these disease endemic regions is essential for effective prevention.
Objective:
This study examined multimodal physiologic data for assessing the prevalence of early RHD in a cohort of asymptomatic, at-risk schoolchildren in a rural Ethiopia.
Methods:
A total of 584 asymptomatic children, aged 10 to 20 years, were randomly selected for screening, and stratified into two groups (≤14 and >14 years). Electrocardiogram (ECG), Phonocardiogram (PCG), and echocardiography were performed, with diagnoses based on the 2012 World Heart Federation criteria.
Results:
After excluding 8 (1.4%) children who had non-rheumatic findings, 576 children comprised of 334 (58%) females and 242 (42%) males were analyzed. The mean age of the cohort was 16.1±2.5 years. Echocardiographic evaluation identified 19 RHD cases (10 borderline, 9 definite), with a higher prevalence among females (68%). The prevalence estimate derived from this analysis was 32.5 per 1000 population (95% CI: [18.1, 46.9]). Mitral valve was most affected (47%), followed by combined mitral and aortic involvement (42%). Mitral regurgitation (MR) was the most common (84%), then mitral stenosis (10%) and aortic regurgitation (6%). PCG showed MR (52.6%), MS (10.5%), and silent/unknown in the rest. Prolonged PR intervals was observed in 11% of RHD cases.
Conclusions:
The study confirms persistent high prevalence of asymptomatic RHD among schoolchildren in rural regions with female predominance. Clinical Trial: B3222022001075
Citation
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