Rajendra Singh Thangjam, Anil Singh Irom, Rothangpui, Rameshchandra Singh Thockchom, Ramakrishnan S, Anita Saxena
BACKGROUND RHD is the leading cause of morbidity and mortality in the underdeveloped world. The burden of RHD has been estimated variably depending on the method and tool of examination. Recent echocardiography-based studies, generally accepted as the best tools to detect RHD, had shown 10-fold increased prevalence of RHD compared to clinical examination albeit fear for overestimation of the disease. While studies using more stringent criteria of WHF 2012 are limited and no such study has been conducted in this part of the country, we felt it necessary to conduct such a study in this hilly state of India. MATERIALS AND METHODS This is a community based cross sectional study in which each and every selected child aged 5-15 years from randomly selected schools of Manipur were examined physically and by 2D colour Doppler Echocardiography. The anthropometric parameters, clinical details and echocardiography findings were all recorded. Echocardiography loops were recorded for review by another cardiologist later. Analysis was done by using T test, descriptive statistics and with 95% confidence interval. All the analysis was done using STATA 13.0 (Stata Corp, USA). RESULTS 3600 children were screened in two years. The mean age was 11.77 years ± 2.50 SD, 1865 (51.8%) were male, 1442 (40%) were from government school and majority belonged to rural population (67%). Only 1 case of Clinical RHD with a combination of MR and AS was found giving a prevalence of 0.28/1000 (CI: 0.04-1.97). Echocardiography detected 3 cases of definite subclinical (prevalence rate of 0.83/1000 (CI: 0.27-2.58) and 14 cases of borderline subclinical RHD (prevalence rate of 3.9/1000 (CI: 2.30-6.56) befitting WHF 2012 criteria. CONCLUSION Prevalence of clinical RHD (0.28/1000) is very low compared to that of other Indian states. Using echocardiography, the prevalence becomes several folds higher compared to clinical examination alone, 0.83/1000 for Definite Subclinical and 3.9/1000 for Borderline Subclinical RHD. Further follow up studies using less stringent criteria (modified WHO criteria), may still have a role in detection of true burden of RHD in our community from the public health point of view.
