A Better Understanding of Acute Rheumatic Fever in Uganda
Emmy Okello1,3, Tom Parks2, James Tumwine3, Andrea Beaton5
- Uganda Heart Institute
- London School of Hygiene and Tropical Medicine
- Makerere University
- Children’s National Medical Center & George Washington University
Introduction:
The pathogenesis of rheumatic heart disease (RHD) requires preceding Group A Streptococcal infection(s), triggering rheumatic fever (RF), leading to RHD. Despite a large burden of RHD in Africa, diagnosis with RF is rare.
The aim of this study was to determine the incidence of RF and describe the clinical, laboratory, and echocardiographic features of Ugandan children with RF.
Method:
A prospective epidemiological study of RF is currently being conducted in Lira, Uganda. Children without a confirmed alternate diagnosis explaining symptomatology are enrolled if they have one of the following: (1) fever and joint pain in the last 48 hours, (2) suspicion of carditis, or (3) suspicion of chorea. History, physical exam, ECG, echocardiography, and labs needed to rule in and rule out RF are performed for all enrolled children.
Results:
In the first 6-months of community recruitment, 201 children met inclusion criteria and were enrolled. Of these, 62 (29%) met criteria for definite RF, with 14 (7%) of these being recurrent RF in a child with clear echocardiographic evidence of pre-existing RHD. 39/62 (63%) of children with definite RF were residents of Lira District. Using the 2017 Lira District Census, and extrapolating to annual risk, the incidence of RF in Lira District is 41 cases per 100,000 persons for new RF cases, or 52 cases per 100,000 persons if recurrent RF is included.
Conclusion:
These data suggest that poor health seeking behaviour and/or lack of diagnostic capacity are major barriers to RF diagnosis in the community. Further data collection is ongoing to define the true annual incidence.