Prevalence of rheumatic heart disease in children and young adults in Botswana

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Background. Rheumatic heart disease (RHD) primarily affects children and young adults in low-income countries, and marginalised groups in high-income countries. It results from acute rheumatic fever, leading to valvular lesions that may become clinically apparent several years later. Early echocardiograms enable prompt intervention and minimise the risks of progression. However, data on echocardiographic findings in Botswana are lacking. Objective. To assess the prevalence of RHD in individuals aged 6 - 35 years. Methods. This cross-sectional study, conducted from 2018 to 2023, screened schoolchildren and young adults in rural and urban districts of Botswana. Participants aged 6 - 35 years were randomly selected from primary schools, secondary schools and the community. Based on the 2012 World Heart Federation echocardiographic guidelines for RHD, they were classified as having one of normal findings, borderline RHD, or definite RHD. Results. We included 4 786 participants, with a median (interquartile range) age of 17 (12 - 25) years; 64.8% were female. There were 19 cases of either borderline (n=7) or definite (n=12) RHD, resulting in a prevalence of 4 cases/1 000 population (95% confidence interval 2.5 - 6.2). The number of RHD cases varied by geographical location, with the highest being in the Northwest district. We also detected several asymptomatic congenital and non-RHD-acquired heart diseases. Conclusion. RHD affected 4 cases per 1 000 population, representing a significant proportion of children and young adults in Botswana. The study also identified undiagnosed congenital cardiovascular diseases among the participants. The findings emphasise the need for a screening programme and a registry for children and young adults. Identifying those with mild conditions who could benefit from secondary antibiotic prophylaxis is essential.