We explain our experience examining 45 children, one morning, at the Zengach full cycle school about 90 minute drive North West of Gondar, Ethiopia. The children were selected by the local medical staff for examination by 2 Pediatric Residents from the Gondar University Medical Center. This is a program run by the American Jewish Joint Distribution Committee. They were selected for typical pediatric acute illnesses. Although about 200 children were brought, only 50 were examined after a quick screening by the Pediatricians. One of us simultaneously examined the precordium and heart sounds of 45 of these children.
Of 45 examined children, we found 6 that had suspicious auscultory findings, including one with almost definite findings, of mitral valve disease. We performed echocardiography with a portable Sonosite Echocardiogram on these 6 and found one case of RHD previously undiagnosed and asymptomatic.
Recent research on populations of healthy school children from African and Asian countries have found an incidence of subclinical- examination silent- RHD, seen only on echocardiography, of up to 50 cases per 1000 population. This is up to 10 times the incidence found when screening is performed with auscultation. Our small population study suggests a very high incidence of RHD in rural Gondar in schoolchildren. Together with the local pediatricians, we hope to screen large, stable populations of school children by echocardiography to learn more about the natural history of subclinical disease, and the ability to change this with prophylaxis.
