Prevalence of Rheumatic Heart Disease and Other Cardiac Conditions in Low-Risk Pregnancies in Kenya: A Prospective Echocardiography Screening Study

Glob Heart. 2021 Feb 9;16(1):10. doi: 10.5334/gh.826.

Abstract

Background: Rheumatic heart disease (RHD) in sub-Saharan Africa contributes to significant cardiac morbidity and mortality, yet prevalence estimates of RHD lesions in pregnancy are lacking.

Objectives: Our first aim was to evaluate women using echocardiography to estimate the prevalence of RHD and other cardiac lesions in low-risk pregnancies. Our second aim was to assess the feasibility of screening echocardiography and its acceptability to patients.

Methods: We prospectively recruited 601 pregnant women from a low-risk antenatal clinic at a tertiary care maternity centre in Western Kenya. Women completed a questionnaire about past medical history and cardiac symptoms. They underwent standardized screening echocardiography to evaluate RHD and non-RHD associated cardiac lesions. Our primary outcome was RHD-associated cardiac lesions and our secondary outcome was a composite of any clinically-relevant cardiac lesion or echocardiography finding. We also recorded duration of screening echocardiography and its acceptability among pregnant women in this sample.

Results: The point prevalence of RHD-associated cardiac lesions was 5.0/1,000 (95% confidence interval: 1.0-14.5), and the point prevalence of all clinically significant lesions/findings was 21.6/1,000 (11.6-36.7). Mean screening time was seven minutes (SD 1.7, range: 4-17) for women without cardiac abnormalities and 13 minutes (SD 4.6, range: 6-23) for women with abnormal findings. Echocardiography was acceptable to women with 74.2% agreeing to participate.

Conclusions: The prevalence of clinically-relevant cardiac lesions was moderately high in a low-risk population of pregnant women in Western Kenya.

Keywords: Africa; Kenya; echocardiography; epidemiology; pregnancy; rheumatic heart disease.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Echocardiography
  • Female
  • Humans
  • Kenya / epidemiology
  • Mass Screening
  • Pregnancy
  • Prevalence
  • Prospective Studies
  • Rheumatic Heart Disease* / diagnostic imaging
  • Rheumatic Heart Disease* / epidemiology

Grant support

This study was funded by departmental grants from the Department of Obstetrics & Gynaecology, Mount Sinai Hospital, Toronto, Canada and the Global Health Program, Department of Obstetrics & Gynaecology, University of Toronto, Toronto, Canada. The funding sources did not have any role in the design, data collection, analysis, interpretation, or reporting of the study.