Rheumatic Heart Disease in East Africa: A Systematic Review and Meta-Analysis

Mebrahtom, Guesh; Hailay, Abrha; Aberhe, Woldu; Zereabruk, Kidane; Haile, Teklehaimanot

doi:https://doi.org/10.1155/2023/8834443

International Journal of Rheumatology

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Abstract Introduction Materials and Methods Results Discussion Conclusions Abbreviations Data Availability Conflicts of Interest Authors’ Contributions Supplementary Materials References Copyright Related Articles

Review Article | Open Access

Volume 2023 | Article ID 8834443 | https://doi.org/10.1155/2023/8834443

Rheumatic Heart Disease in East Africa: A Systematic Review and Meta-Analysis

Guesh Mebrahtom,¹Abrha Hailay,¹Woldu Aberhe,¹Kidane Zereabruk,¹and Teklehaimanot Haile²

Academic Editor: Samar Tharwat

Received01 Apr 2023

Revised01 Aug 2023

Accepted14 Aug 2023

Published19 Sept 2023

Abstract

Background. Despite being a grave problem, there is little information on rheumatic heart disease’s prevalence in East Africa. Therefore, the purpose of this systematic review and meta-analysis was to estimate the pooled prevalence of rheumatic heart disease in East Africa. Materials and Methods. A computerized systematic search of using multiple database searching engines was performed in search of relevant English articles from the inception of the databases to December 2019. It was done in accordance with the preferred reporting items for systematic review and meta-analysis (PRISMA) standard. The funnel plot was used to assess publication bias. R and RStudio for Windows were used for all statistical analysis. The random-effect model was used for calculating the pooled estimate of the prevalence of rheumatic heart disease. Results. The database search retrieved 1073 papers, and 80 articles (78 cross-sectional and two cohort study designs) with a total of 184575 individuals were found to be appropriate for the review. In East Africa, the overall prevalence of rheumatic heart disease was 14.67% (95% CI: 13.99% to 15.35%). In Ethiopia, Uganda, Tanzania, and Sudan, respectively, the subgroup analysis of rheumatic heart disease pooled prevalence was 22% (95% CI: 13% to 36%), 11% (95%t CI: 5% to 20%), 9% (95%t CI: 5% to 16%), and 3% (95%t CI: 1% to 10%), while the pooled prevalence of rheumatic heart disease in adults was 20% (95% CI: 12% to 30%), and in children, it was 4% (95% CI: 2% to 8%). Conclusions. From this report, the prevalence of rheumatic heart disease in East Africa is very high, affecting about one in seven people. Therefore, future strategies should emphasize preventive measures at appropriate times to minimize the burden of this type of preventable heart disease.

1. Introduction

Rheumatic heart disease (RHD) is the long-term consequence of acute rheumatic fever (ARF) and the autoimmune response to group A streptococcal pharyngitis, which is the leading cause of morbidity and mortality among children and young adults in developing and low-income countries [1, 2]. The 2004 World Health Organization (WHO) report and 2005 publication on the global burden of group A streptococcal disease estimated the global prevalence of RHD to be 15.6 million, which included approximately 1.01 million children in sub-Saharan Africa [3]. This estimate of the global RHD population has been doubled to 32.9 million according to the 2013 Global Burden of Disease (GBD) study [4], which accounts for at least 345,000 annual deaths [1].

Group A beta-hemolytic streptococcal infection of the upper respiratory tract, particularly pharyngitis, is the most significant avoidable risk factor for rheumatic heart disease [5]. Socioeconomic and environmental factors such as poor housing, undernutrition, overcrowding, and poverty are well-known contributors to the incidence, magnitude, and severity of rheumatic fever and rheumatic heart disease [6]. Rheumatic heart disease affects the physical, financial, and psychological well-being of individuals [6, 7]. Rheumatic heart disease continues to be a significant, preventable cause of cardiovascular death and disability in the developing countries [8].

In Africa, including East Africa, where rheumatic heart disease is an endemic leading cause of cardiovascular morbidity and mortality, at least 1.11 million children are currently estimated to have latent or confirmed rheumatic heart disease [9]. Rheumatic heart disease (RHD) is still a major public health issue, and it persists throughout Africa largely due to poverty and a weak primary health care system [7]. With little data on the prevalence of such a disabling, avoidable cardiac disorder, which additionally causes an enormous external load on health care expenses, rheumatic heart disease has continued to be the primary health concern in Africa, including Eastern African nations [10]. Therefore, in East African nations, conducting research and estimating the prevalence of rheumatic heart disease are necessary for reducing the burden of this disease. Yet, many studies have been conducted to assess the magnitude of RHD among East African countries, but reports from these countries have been inconsistent, ranging from 27/10000 to 92% [11, 12]. Additionally, no previous study had estimated the overall prevalence of rheumatic heart disease among populations in East Africa. Hence, having an overall prevalence will help to overcome those discrepancies and to have a common understanding. Therefore, the purpose of this systematic review and meta-analysis was to figure out the overall prevalence of rheumatic heart disease in Eastern Africa.

2. Materials and Methods

2.1. Setting

The nations in Eastern Africa where this systematic review and meta-analysis was conducted included Djibouti, Eritrea, Ethiopia, Kenya, Madagascar, Malawi, Rwanda, Sudan, Tanzania, and Uganda [13].

2.2. Search Strategy and Information Sources

From inception to December 2019, articles in English were identified using a comprehensive search approach that included PubMed/MEDLINE, Embase, Google Scholar, Web of Science, Cochrane Library, Africa Wide Information, Africa Index Medicus, Scopus, Africa journal online, and the World Health Organization (WHO) Afro Library. The literature search approach was employed using the headings of the medical subject headings (MeSH), and the MEDLINE/PubMed (AND/OR) database was used. A combination of key terms, including “rheumatic heart disease,” “acute rheumatic fever,” “valvular heart diseases,” “nation’s name,” “systematic review,” and/or protocols had been used. The presence of precursor systematic reviews and/or protocols on the topic of interest was checked by searching different databases for systematic reviews. The databases searched include the international database of prospectively registered systematic reviews (PROSPERO) in the National Institute for Health and Care Research (NIHR), the Cochrane database of systematic reviews, the Joanna Briggs Institute database of systematic reviews and implementation reports (JBI-DSRIR), health technology assessment (HTA), the Campbell collaboration library, and evidence for policy and practice information (EPPI-center). There were no systematic reviews or protocols on the subject of interest, according to the search of the aforementioned databases. The reference lists of all identified articles were further searched for further articles.

2.3. Data Extraction, Selection, and Process

Prior to the screening and selection process, reviewers prepared a tool according to the inclusion and exclusion criteria. Before data extraction started, the tool had been piloted and revised. The search results were first uploaded to EndNote software in order to remove duplicates. Two independent reviewers extracted the data using an established and standardized collection form. For the purpose of identifying possibly eligible articles, the two reviewers (GM and KZ) independently reviewed the titles, abstracts of all retrieved citations, and the full-text search results.

Reviewers have been notified if more data is needed to verify eligibility studies. Disagreements between the reviewers were resolved by discussion with the help of a third independent reviewer (HA). When there was missing information, the reviewers got in touch with the corresponding author to ask for data. Before dropping an article, a maximum of three emails were sent to the corresponding author of the retrieved studies to request more information. For studies that occur in multiple publications, we took into account the most recent, comprehensive, and with the greatest sample size. For surveys that appear in a single article with several surveys done at various times, we treated each survey as a separate study. Information about the publication’s year, country, authors, cases, total/sample size, study setting/area, study design, RHD diagnosis method, population, response rate, and prevalence or incidence of RHD were all included in the data extraction format.

2.4. Criteria for considering Studies for the Review

2.4.1. Inclusion Criteria

Design: all observational studies.

Population: any age group in the population participated in the study.

Publication status: published and unpublished.

Settings: both community and health institution-based studies conducted in Eastern African nations.

Language: the only articles considered in this review were those written in English. This is due to the ease with which one is able to read and understand other languages.

Publication or report year: it is preferred that this study will include the past 5 to 20 years for systematic review and meta-analysis. However, due to the limitation of literatures and to look at the trend of pooled prevalence of RHD, we reviewed all publications until December 2019.

Method of diagnosis: all studies used different types of diagnostic criteria, like the World Health Organization (WHO) or World Heart Federation (WHF), echocardiography, the American Heart Association, clinical auscultation and/or electrocardiogram (ECG), and/or radiography, to diagnose rheumatic heart disease.

Outcome: prevalence of rheumatic heart disease.

2.4.2. Exclusion Criteria

The following research are excluded from consideration: case report and case series studies, as well as any other studies that lacked pertinent information required to estimate the prevalence of rheumatic heart disease.

2.5. Risks of Bias and Quality Assessment of the Included Studies

Two reviewers (GM and WA), working independently and blindly, assessed the quality of the methodology and risk of bias. The reviewers maintained the blinding reviewing method using the Covidence software, which permits or requires each reviewer to operate without being aware of the other reviewer’s option. This helps reduce errors and the risk of bias during the study selection process. Discrepancies between the reviewers were settled through dialogue and, where necessary, involving a third reviewer.

We estimated the precision (C) or margin of error for each included study, taking into account the sample size () and the prevalence () of RHD observed from the following formula: where was the value fixed at 1.96 across studies (corresponding to 95% confidence interval). The desirable margin of error is 5% (0.05) or lower.

Methodological quality was measured using the Newcastle-Ottawa scale for the included studies. The Newcastle-Ottawa scale was designed to assess the quality of meta-analyses of nonrandomized studies. This scale is primarily formulated by a star allocation system, which assigns a maximum of 10 stars for the risk of bias in three areas: a selection of study groups (4 or 5 stars), comparability of groups (2 stars), and determination of the outcome of interest or exposure (3 stars). No validation study provides a cut-off score for grading low-quality studies; a priori, we have arbitrarily established that 0–3, 4–6, and 7–10 stars would be considered at high, moderate, and low bias risk, respectively [14].

2.6. Data Analysis and Presentation of Results

This review has been registered in the international prospective register of reviews (PROSPERO) with the registration number (CRD42020184085), and the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines have been used to report the result (file 1) [15]. R 3.5.3 and RStudio 1.2.5003 were both used as data analysis software. Forest plots were drawn in order to calculate the pooled prevalence of rheumatic heart disease (RHD) and the degree of statistical heterogeneity between studies. Statistical heterogeneity was assessed using the standard chi-squared test (Cochrane’s test) and quantified by calculating the statistic (with values of 25%, 50%, and 75% being representative of low, medium, and high heterogeneity, respectively) [16]. There was clinical heterogeneity between the included studies. Consequently, we used a random-effect meta-analysis to estimate the overall pooled prevalence of rheumatic heart disease in Eastern Africa. The 95% confidence interval (CI) was used to explain the results, and funnel plot and Egger’s regression test methods were used to assess possible publication bias. A value of 0.05 indicated the presence of significant publication bias [17].

3. Results

3.1. Screening Flow

A schematic representation of the process that was used to identify and select the studies that were included is illustrated in Figure 1. The included databases and number of included studies thereof were PubMed (464), Google Scholar (193), Cochrane Library (39), Africa Wide Information (23), the World Health Organization (WHO) Afro Library (19), African Journal Online (212), Web of Science (43), Scopus (65), and African Index Medicus (15). Based on the predefined criteria and quality assessment, 593 duplicates were identified and removed. Subsequently, we screened 480 titles and abstracts and excluded 224 irrelevant papers. Then, of the 256 articles and conference abstracts assessed for eligibility criteria, 176 did not report a prevalence of RHD. In the end, this systematic review and meta-analysis included 80 full-text articles and 184575 participants of all ages. The detailed steps of the screening process are shown below in a PRISMA flow chart of the study selection.

3.2. Study Characteristics

The meta-analysis included a total of 78 cross-sectional and two cohort studies. More than one-third (33, 41.25%) of the studies were conducted in Ethiopia, followed by (12, 15%) in Sudan and (12, 15%) in Uganda, five (6.25%) from Kenya, four from Rwanda (5%), four (5%) from Tanzania, three (3.75%) from Madagascar, three (3.75%) from Malawi, two (2.5%) from Djibouti, and two (2.5%) from Eritrea. The quality of each primary study assessed using the Newcastle-Ottawa scale shows no significant risk. Thus, there was a low chance of bias in any of the included studies that were taken for consideration in this systematic review and meta-analysis (Table 1).

3.3. The Pooled Prevalence of Rheumatic Heart Disease and Its Trends in East Africa

The rheumatic heart disease pooled prevalence in East Africa was 14.67% (95% CI: 13.99% to 15.35%), and the inverse variance () was 100%, indicating heterogeneity in the reported prevalence of RHD among the included studies (appendix 2). This heterogeneity could be a result of differences in the diagnostic or screening criteria for RHD used by the included studies. A leave-one-out sensitivity analysis was carried out to see whether the findings of a single study had a significant impact on the pooled prevalence of RHD in East Africa. However, all the results of this sensitivity analysis were within the 95% CI limits of the pooled prevalence (13.99 to 15.35%), indicating that no significant study may have had an impact on the observed pooled prevalence of RHD (appendix 3).

The pooled prevalence trends of rheumatic heart disease were decreasing over the last nine years (2011–2019) (Figure 2). The pooled prevalence of rheumatic heart disease in East Africa from 1960 to 2000 was 11% (95% CI: 11% to 12%) (Figure 3), and from 2001 to 2020 it was 25% (95% CI: 15% to 35%) (Figure 4).

Because the funnel plot showed an asymmetrical distribution (Figure 5), we conducted Egger’s regression test, which was found to be significant with a value of 0.00, which indicates evidence of publication bias in the included studies. Hence, there are unpublished articles that could modify the pooled prevalence of rheumatic heart disease.

3.4. Subgroup Analysis of Rheumatic Heart Disease Prevalence by Study Countries in East Africa

Based on the subgroup analysis of rheumatic heart disease by the study country, the pooled point estimate prevalence of rheumatic heart disease in Ethiopia was 22% (95% CI: 13% to 36%) (Figure 6); in Sudan, it was 3% (95% CI: 1% to 10%) (Figure 7); in Uganda, it was 11% (95% CI: 5% to 20%) (Figure 8); and in Tanzania, it was 9% (95% CI: 5% to 16%) (Figure 9).

3.5. Subgroup Analysis of the Prevalence of Rheumatic Heart Disease in East Africa among Adults and Children

Based on the subgroup analysis of rheumatic heart disease among adults and children in East Africa, the pooled point estimate prevalence of rheumatic heart disease among the adult population was 20% (95% CI: 12% to 30%) (Figure 10), and among children, it was 4% (95% CI: 2% to 8%) (Figure 11).

4. Discussion

Rheumatic heart disease is a preventable yet serious public health problem in low- and middle-income countries and in marginalized communities in high-income countries, including indigenous populations, where poverty is prevalent, people are living in overcrowded conditions, poor housing, and undernutrition, and access to health services is limited [6, 92]. Furthermore, studies addressing the prevalence of rheumatic heart disease among populations in East Africa are limited. Thus, the purpose of this systematic review and meta-analysis was to estimate the pooled prevalence of rheumatic heart disease in East Africa. It focuses on the epidemiology of rheumatic heart disease in East African nations to acquire a better understanding of the medical condition and mitigate the burden of rheumatic heart disease.

A total of eighty studies were included in the final analysis, providing an overall pooled prevalence of rheumatic heart disease in East Africa of 14.67% (95% CI: 13.99% to 15.35%). This is lower than a global systematic review and meta-analysis of population-based echocardiographic study, which reported 26.1% [93], and this discrepancy could be explained by a difference in definition for case detection and diagnostic criteria for rheumatic heart disease [92, 94].

However, this research result is higher than a systematic review and meta-analysis of prevalence among children and adolescents which reported that the pooled prevalence of rheumatic heart disease detected by cardiac auscultation was 2·9 per 1000 people, and by echocardiography, it was 12·9 per 1000 people [95]. This discrepancy could be explained by differences in definition for case detection and diagnostic criteria for rheumatic heart disease, in the living environment, in easily accessible health care, in early treatment and vaccination for group A streptococcal throat infection prevention and awareness, in the socioeconomic status of the populations, in the duration of studies, and in immune and genetic factors [92, 94, 96–99].

The prevalence of rheumatic heart disease in the studies included in this systematic review and meta-analysis varied, ranging from 27/10000 by Anabwani and Bonhoeffer [11] in Kenya to 92% by Guteta et al. [12] in Ethiopia, respectively. This discrepancy could be due to differences in the objectives of these studies, a variation in the diagnostic assessment, or a variation in the duration of the studies. Additionally, to look at the pattern of rheumatic heart disease prevalence in East Africa, we analyzed RHD pooled prevalence in year intervals and found that rheumatic heart disease prevalence has declined in the last years (2011–2019). This might be due to increased health care services and the health-seeking behavior of the communities. Another possible explanation might be the increased interventions carried out to reduce the prevalence of rheumatic heart disease in Africa, including East Africa. In 2015, the social cluster of the Africa Union Commission hosted a consultation with rheumatic heart disease experts in Addis Ababa, Ethiopia, to develop a roadmap for eliminating rheumatic heart disease in Africa [100]. Hence, this might increase awareness of primary and secondary prevention and early detection of rheumatic heart disease.

To look at the heterogeneity of the studies included in this meta-analysis, we considered subgroup analysis of the prevalence of rheumatic heart disease in East Africa among adult and children’s populations. Hence, the subgroup analysis of rheumatic heart disease pooled prevalence among the adult population in East Africa was 20% (95% CI: 12% to 30%), which is higher than the prevalence of chronic rheumatic heart disease among Chinese adults, which was reported at 186/100,000, or 2 out of 1000 adults [101], and the overall pooled prevalence of rheumatic heart disease in East Africa. This could be explained by the fact that more than half of those studies among adults were conducted in Ethiopia, which is the country with the highest pooled prevalence of rheumatic heart disease in our study. Also, most of those studies were conducted in hospital settings, which might have better diagnostic tools and services than communities.

While the subgroup analysis of the prevalence of rheumatic heart disease among East African children was 4% (95% CI: 2% to 8%), which is lower than the echocardiographic prevalence of rheumatic heart disease among Brazilian schoolchildren (42/1000) [102] and the overall pooled prevalence of rheumatic heart disease in East Africa but higher than the study conducted in Lagos, which reported 1.1 per 10,000 children [103], this variation could be explained by the higher prevalence of rheumatic heart disease found among adults who might visit health care after developing complications due to lower awareness of prevention and early health care-seeking behavior in low socioeconomic status populations like Ethiopians. Also, most of the studies among children were conducted in a school community where the symptomatic and sick children might not come to school due to differences in definition for case detection and diagnostic criteria for rheumatic heart disease, in the living environment, in the duration of studies, as well as in immune and genetic factors [92, 98, 99, 104].

Also, we considered country-wise subgroup analyses of rheumatic heart disease among four East African countries and found that 22% (95% CI: 13% to 36%), 11% (95% CI: 5% to 20%%), 9% (95% CI: 5% to 16%), and 3% (95% CI: 1% to 10%%) of the pooled prevalence of rheumatic heart disease were in Ethiopia, Uganda, Tanzania, and Sudan, respectively. This discrepancy might be explained by differences in the definition of case detection and diagnostic criteria in study settings, as most of the studies in Ethiopia were conducted in hospital settings where the number of cases detected might be higher compared to school as well as community settings; a difference in the number of studies since more than one-third of the studies were from Ethiopia; a variation in the duration of studies; a difference in living environments; and immune and genetic factors. Also, low socioeconomic status, low access to health care, and low awareness of the prevention of rheumatic heart disease are common among Ethiopians compared to Sundaneses, Ugandans, and Tanzanians [52, 100].

Generally, there is no use of standardized assessment requirements or diagnostic procedures in all health care settings of clinical practice, or specific clinicians are using their particular clinical expertise in the diagnosis and examination of patients for rheumatic heart disease. Our meta-analysis findings have implications in clinical practice that help pay attention to the prevention and care of rheumatic heart disease patients. This pooled estimate point for rheumatic heart disease provides updated evidence to advance the prevention strategy and serves as a key health and safety indicator. Finding the prevalence of rheumatic heart disease may provide guidance on preventions, such as improving living conditions, reducing overcrowding, increasing awareness on the prevention of rheumatic heart disease, vaccination, and early detection and treatment of group A streptococcal throat infections. The significance of this study, especially the profound difference between countries and studies, reflects screening and evaluation of rheumatic heart disease, which require the establishment of standard evaluation tools and diagnostic criteria in both community and hospital settings.

5. Conclusions

According to our study results, one in seven people in East Africa suffers from rheumatic heart disease. This finding implies that rheumatic heart disease is considerably more common in East Africa. The country’s Ministry of Health, health policymakers, WHO, clinicians, and other health care providers should pay attention to strengthening rheumatic heart disease preventive measures. In Eastern African countries, we suggest that more attention be given to addressing the profound consequences of rheumatic heart disease. We recommended strengthening preventive measures, such as enhancing living conditions, reducing overcrowding, raising awareness of the prevention of rheumatic heart disease, nutrition, vaccination, early detection and treatment of group A streptococcal throat infections, and establishing country-based interventions, because rheumatic heart disease is preventable.

6. Limitations of This Study

This systematic review and meta-analysis draw up an overview of the pooled prevalence of rheumatic heart disease in East African countries. However, the findings of this study could have certain limitations. Among the limitations, subgroup analysis for studies between all countries was difficult to carry out due to statistical constraints and a limited number of studies, which is why we only conducted subgroup analysis for Ethiopia, Uganda, Tanzania, and Sudan. This makes our review subject to a high degree of heterogeneity between studies, which could affect the meta-analysis results as we do not report from all countries of the study. But the model of random effects was used to achieve the pooled results that minimize this heterogeneity among studies. In addition, methodological variations in assessments and diagnosis of RHD among studies included in this work could also affect meta-analysis results with extensive clinical heterogeneity across studies. Publication bias was also another limitation of our review.

Abbreviations

CI:	Confidence interval
RHD:	Rheumatic heart disease
PRISMA-P:	Preferred reporting items for systematic reviews and meta-analysis protocol
WHO:	World Health Organization.

Data Availability

The data analyzed during the current meta-analysis is available from the corresponding author on a reasonable request.

Conflicts of Interest

The authors declare that there are no conflicts of interest regarding the publication of this paper.

Authors’ Contributions

GM, AH, WA, KZ, and TH contributed substantially to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; study selection; data extraction; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Supplementary Materials

The supplementary materials for the systematic review and meta-analysis of this review include Appendix 1 for the search strategy and information sources, Appendix 2 for the forest plot of the overall pooled prevalence of RHD in East Africa, Appendix 3 for the sensitivity analysis of the included studies, File 1 for the PRISMA-P of the preferred reporting items for systematic reviews and meta-analysis protocol, and File 2 for the Newcastle-Ottawa scale for the methodological quality assessment of the included studies. (Supplementary Materials)

References

R. Lozano, M. Naghavi, K. Foreman et al., “Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010,” The Lancet, vol. 380, no. 9859, pp. 2095–2128, 2012.
View at: Publisher Site | Google Scholar
K. Roberts, S. Colquhoun, A. Steer, B. Reményi, and J. Carapetis, “Screening for rheumatic heart disease: current approaches and controversies,” Nature Reviews Cardiology, vol. 10, no. 1, pp. 49–58, 2013.
View at: Publisher Site | Google Scholar
World Health Organization, The Current Evidence for the Burden of Group A Streptococcal Diseases, World Health Organization, 2005.
T. Vos, R. M. Barber, B. Bell et al., “Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013,” The Lancet, vol. 386, no. 9995, pp. 743–800, 2015.
View at: Publisher Site | Google Scholar
J. Irlam, B. M. Mayosi, M. Engel, and T. A. Gaziano, “Primary prevention of acute rheumatic fever and rheumatic heart disease with penicillin in South African children with pharyngitis: a cost-effectiveness analysis,” Circulation: Cardiovascular Quality and Outcomes, vol. 6, no. 3, pp. 343–351, 2013.
View at: Publisher Site | Google Scholar
World Health Organization, Rheumatic fever and rheumatic heart disease Report by the Director General Seventy-First World Health Assembly, World Health Organization, Geneva, Switzerland, 2018.
K. A. Robertson and B. M. Mayosi, “Rheumatic heart disease: social and economic dimensions,” SAMJ: South African Medical Journal, vol. 98, no. 10, pp. 780-781, 2008.
View at: Google Scholar
L. J. Zühlke and A. C. Steer, “Estimates of the global burden of rheumatic heart disease,” Global Heart, vol. 8, no. 3, pp. 189–195, 2013.
View at: Publisher Site | Google Scholar
M. E. Engel, R. Stander, J. Vogel, A. A. Adeyemo, and B. M. Mayosi, “Genetic susceptibility to acute rheumatic fever: a systematic review and meta-analysis of twin studies,” PLoS One, vol. 6, no. 9, article e25326, 2011.
View at: Publisher Site | Google Scholar
B. Muhamed, D. Mutithu, O. Aremu, L. Zühlke, and K. Sliwa, “Rheumatic fever and rheumatic heart disease: facts and research progress in Africa,” International Journal of Cardiology, vol. 295, pp. 48–55, 2019.
View at: Publisher Site | Google Scholar
G. Anabwani and P. Bonhoeffer, “Prevalence of heart disease in school children in rural Kenya using colour-flow echocardiography,” East African Medical Journal, vol. 73, no. 4, pp. 215–217, 1996.
View at: Google Scholar
S. Guteta, D. Yadeta, A. Azazh, and D. Mekonnen, “Cardiac surgery for valvular heart disease at a referral hospital in Ethiopia: a review of cases operated in the last 30 years,” Ethiopian Medical Journal, vol. 54, no. 2, pp. 49–55, 2016.
View at: Google Scholar
University of Piitsburgh, “African Studies and African Country Resources @ Pitt/East African Countries,” 2023, https://pitt.libguides.com/c.php?g=12378&p=65814.
View at: Google Scholar
B. J. Shea, B. C. Reeves, G. Wells et al., “AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both,” BMJ, vol. 358, article j4008, 2017.
View at: Publisher Site | Google Scholar
D. Moher and A. Liberati, “Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement,” Annals of Internal Medicine, vol. 151, no. 4, pp. 264–269, 2009.
View at: Publisher Site | Google Scholar
P. T. Julian, “Measuring inconsistency in meta-analyses,” BMJ, vol. 327, no. 7414, pp. 557–560, 2003.
View at: Publisher Site | Google Scholar
J. Jan, “Meta-analysis of prevalence,” Journal of Epidemiology and Community Health, vol. 67, no. 11, pp. 974–978, 2013.
View at: Publisher Site | Google Scholar
P. L. Massoure, N. C. Roche, G. Lamblin et al., “Heart failure patterns in Djibouti: epidemiologic transition,” Medecine et Sante Tropicales, vol. 23, no. 2, pp. 211–216, 2013.
View at: Publisher Site | Google Scholar
P.-L. Massoure, N.-C. Roche, G. Lamblin, C. Dehan, E. Kaiser, and L. Fourcade, “Cardiovascular disease in children in Djibouti: a single-centre study,” The Pan African Medical Journal, vol. 14, p. 141, 2013.
View at: Publisher Site | Google Scholar
E. Rossi, A. R. Felici, and L. Banteyrga, “Subclinical rheumatic heart disease in an Eritrean high-school population, detected by echocardiography,” The Journal of Heart Valve Disease, vol. 23, no. 2, pp. 235–239, 2014.
View at: Google Scholar
H. Otto, S. G. Saether, L. Banteyrga, B. O. Haugen, and T. Skjaerpe, “High prevalence of subclinical rheumatic heart disease in pregnant women in a developing country: an echocardiographic study,” Echocardiography, vol. 28, no. 10, pp. 1049–1053, 2011.
View at: Publisher Site | Google Scholar
W. Tewodros, L. Muhe, E. Daniel, C. Schalén, and G. Kronvall, “A one-year study of streptococcal infections and their complications among Ethiopian children,” Epidemiology & Infection, vol. 109, no. 2, pp. 211–225, 1992.
View at: Publisher Site | Google Scholar
D. Bacha, H. Abera, A. Adem, F. Tadesse, and D. Bekele, “The occurrence and pattern of cardiovascular diseases among pregnant mothers attending saint Paul’s hospital in Addis Ababa,” Ethiopian Medical Journal, vol. 57, no. 4, 2019.
View at: Google Scholar
A. Adem, S. Abebe, A. Hailu et al., “Heart diseases in north ethiopia pattern of echocardiographic abnormalities among adult cardiac patients-an experience from Ayder Hospital of Mekelle University,” Ethiopian Medical Journal, vol. 52, no. 4, pp. 173–183, 2014.
View at: Google Scholar
R. M. Hodes, “Pattern of heart disease in Ethiopia as seen in a cardiology referral clinic,” Cardiology, vol. 75, no. 6, pp. 458–464, 1988.
View at: Publisher Site | Google Scholar
N. Navuluri, “An Ethiopian medical intensive care unit: characteristics and outcomes at Tikur Anbessa Specialized Hospital (TASH) in Addis Ababa, Ethiopia, in B47,” in Critical Care: Clinical Research Discoveries, Epidemiology, and Health Services for Sepsis, pp. A3692–A3692, American Thoracic Society, 2016.
View at: Google Scholar
Y. G. Tefera, T. M. Abegaz, T. B. Abebe, and A. B. Mekuria, “The changing trend of cardiovascular disease and its clinical characteristics in Ethiopia: hospital‑based observational study,” Vascular Health and Risk Management, vol. 13, pp. 143–151, 2017.
View at: Publisher Site | Google Scholar
E. Parry and C. Gordon, “Ethiopian cardiovascular studies: case-finding by mass miniature radiography,” Bulletin of the World Health Organization, vol. 39, no. 6, pp. 859–871, 1968.
View at: Google Scholar
T. Hailemariam, “Prevalence of cardiovascular emergencies in specialized ospital, Addis Ababa Ethiopia,” Emergency Medicine, vol. 4, 2014.
View at: Google Scholar
D. Yadeta, S. Guteta, B. Alemayehu et al., “Spectrum of cardiovascular diseases in six main referral hospitals of Ethiopia,” Heart Asia, vol. 9, no. 2, 2017.
View at: Publisher Site | Google Scholar
G. T. Tegegne, B. Yimam, E. A. Yesuf, B. K. Gelaw, and A. D. Defersha, “Drug therapy problem among patients with cardiovascular diseases in Felege Hiwot referral Hospital, Northeast,” Bahir Dar Ethiopia International Journal of Pharmacy Teaching & Practices, vol. 4, pp. 2828–2838, 2014.
View at: Google Scholar
T. Moges, E. Gedlu, P. Isaakidis, A. Kumar, R. Van Den Berge, and M. Khogali, “Infective endocarditis in Ethiopian children: a hospital based review of cases in Addis Ababa,” The Pan African Medical Journal, vol. 20, p. 75, 2015.
View at: Publisher Site | Google Scholar
R. Hodes, “Endocarditis in Ethiopia. Analysis of 51 cases from Addis Ababa,” Tropical and Geographical Medicine, vol. 45, no. 2, pp. 70–72, 1993.
View at: Google Scholar
E. Mark, “Prevalence of rheumatic heart disease in 4720 asymptomatic scholars from South Africa and Ethiopia,” Heart, vol. 101, no. 17, pp. 1389–1394, 2015.
View at: Publisher Site | Google Scholar
M. Maru, “The changing pattern of cardiovascular diseases in Ethiopia,” East African Medical Journal, vol. 70, no. 12, pp. 772–776, 1993.
View at: Google Scholar
B. Nigussie and H. Tadele, “Heart failure in Ethiopian children: mirroring the unmet cardiac services,” Ethiopian Journal of Health Sciences, vol. 29, no. 1, 2019.
View at: Publisher Site | Google Scholar
G. T. Tegegne, B. Yimam, and E. A. Yesuf, “Drug therapy problems and contributing factors among patients with cardiovascular diseases in Felege Hiwot referral and Jimma University Specialized Hospital, Ethiopia,” Indian Journal of Research in Pharmacy and Biotechnology, vol. 3, no. 2, p. 85, 2015.
View at: Google Scholar
T. Malede and A. Haileamlak, “Pattern of heart disease in children over five years period in Jimma University Hospital: a retrospective study,” Ethiopian Journal of Health Sciences, vol. 16, no. 1, 2006.
View at: Google Scholar
B. Habte, F. Alemseged, and D. Tesfaye, “The pattern of cardiac diseases at the cardiac clinic of Jimma University Specialised Hospital, south West Ethiopia,” Ethiopian Journal of Health Sciences, vol. 20, no. 2, pp. 99–105, 2011.
View at: Publisher Site | Google Scholar
H. Amare, L. Hamza, and H. Asefa, “Malnutrition and associated factors among heart failure patients on follow up at Jimma University Specialized Hospital, Ethiopia,” BMC Cardiovascular Disorders, vol. 15, no. 1, p. 128, 2015.
View at: Publisher Site | Google Scholar
H. A. Mulatu, M. Woldemichael, and M. Aberra, “Prevalence of rheumatic heart disease among primary school students in mid-eastern Ethiopia,” Biological Systems: Open Access, vol. 5, no. 1, pp. 1–4, 2015.
View at: Publisher Site | Google Scholar
D. Yadeta, A. Hailu, A. Haileamlak et al., “Prevalence of rheumatic heart disease among school children in Ethiopia: A multisite echocardiography-based screening,” International Journal of Cardiology, vol. 221, pp. 260–263, 2016.
View at: Publisher Site | Google Scholar
A. Bekelea, H. Teklieb, M. Tadessec et al., “Pattern and trend of medical admissions of patients of chronic non-communicable diseases in selected Hospitals in Addis Ababa, Ethiopia,” American Scientific Research Journal for Engineering, Technology, and Sciences, vol. 13, no. 1, pp. 34–48, 2015.
View at: Google Scholar
A. Hailu, A. Yeman, E. Abate et al., “Management and outcome of pulmonary hypertension in pregnancy: experience from a university hospital in northern Ethiopia,” Ethiopian Medical Journal, vol. 57, no. 3, 2019.
View at: Google Scholar
E. Daniel and B. Abegaz, “Profile of cardiac disease in an out-patient cardiac clinic,” Tropical and Geographical Medicine, vol. 45, no. 3, pp. 121–123, 1993.
View at: Google Scholar
Y. Mehadi, E. Gedlu, and D. Chali, “Pattern of cardiac disease at pediatric cardiac clinic of Tikur Anbessa Hospital,” Ethiopian Journal of Pediatrics and Child Health, vol. 2, no. 1, pp. 27–36, 2006.
View at: Google Scholar
S. Gebremariam and T. Moges, “Pediatric heart failure, lagging, and sagging of care in low income settings: a hospital-based review of cases in Ethiopia,” Cardiology Research and Practice, vol. 2016, Article ID 7147234, 7 pages, 2016.
View at: Publisher Site | Google Scholar
D. Ephrem, B. Abegaz, and L. Muhe, “Profile of cardiac diseases in Ethiopian children,” East African Medical Journal, vol. 67, no. 2, pp. 113–117, 1990.
View at: Google Scholar
T. Gemechu, H. Mahmoud, E. H. O. Parry, D. I. W. Phillips, and M. H. Yacoub, “Community-based prevalence study of rheumatic heart disease in rural Ethiopia,” European Journal of Preventive Cardiology, vol. 24, no. 7, pp. 717–723, 2017.
View at: Publisher Site | Google Scholar
M. Tirfe, T. Nedi, D. Mekonnen, and A. B. Berha, “Treatment outcome and its predictors among patients of acute heart failure at a tertiary care hospital in Ethiopia: a prospective observational study,” BMC Cardiovascular Disorders, vol. 20, no. 1, p. 16, 2020.
View at: Publisher Site | Google Scholar
K. Oli, R. Tekle-Haimanot, L. Forsgren, and J. Ekstedt, “Rheumatic heart disease prevalence among schoolchildren of an Ethiopian rural town,” Cardiology, vol. 80, no. 2, pp. 152–155, 1992.
View at: Publisher Site | Google Scholar
K. Oli and J. Porteous, “Prevalence of rheumatic heart disease among school children in Addis Ababa,” East African Medical Journal, vol. 76, no. 11, pp. 601–605, 1999.
View at: Google Scholar
T. Moges, “Pattern of cardiac illness in children at Zewditu Memorial Hospital,” Ethiopian Journal of Pediatrics and Child Health, vol. 4, no. 1, pp. 9–15, 2008.
View at: Google Scholar
H. Rebecca, “Clinical and geographic patterns of rheumatic heart disease in outpatients attending cardiology clinic in western Kenya,” International Journal of Cardiology, vol. 223, pp. 228–235, 2016.
View at: Publisher Site | Google Scholar
G. O. Oyoo and E. Ogola, “Clinical and socio demographic aspects of congestive heart failure patients at Kenyatta National Hospital, Nairobi,” East African Medical Journal, vol. 76, no. 1, pp. 23–27, 1999.
View at: Google Scholar
M. M. Koech, F. Barasa, and T. K. Ng'eno, “Why prevention of rheumatic heart disease should be a component of primary healthcare,” Journal of Tropical Pediatrics, vol. 58, no. 5, pp. 414-415, 2012.
View at: Publisher Site | Google Scholar
G. Anabwani, A. Amoa, and A. Muita, “Epidemiology of rheumatic heart disease among primary school children in western Kenya,” International Journal of Cardiology, vol. 23, no. 2, pp. 249–252, 1989.
View at: Publisher Site | Google Scholar
C. M. Campanale, G. Di Gioia, S. Di Maria et al., “Prevalence of rheumatic heart disease in North Madagascar: an echocardiographic screening in young and adult populations,” Australasian Medical Journal, vol. 10, no. 7, p. 620, 2017.
View at: Publisher Site | Google Scholar
N. Kennedy and P. Miller, “The spectrum of paediatric cardiac disease presenting to an outpatient clinic in Malawi,” BMC Research Notes, vol. 6, no. 1, p. 53, 2013.
View at: Publisher Site | Google Scholar
E. Z. Soliman and H. Juma, “Cardiac disease patterns in northern Malawi: epidemiologic transition perspective,” Journal of Epidemiology, vol. 18, no. 5, pp. 204–208, 2008.
View at: Publisher Site | Google Scholar
A. S. Sanyahumbi, C. A. Sable, A. Beaton et al., “School and community screening shows Malawi, Africa, to have a high prevalence of latent rheumatic heart disease,” Congenital Heart Disease, vol. 11, no. 6, pp. 615–621, 2016.
View at: Publisher Site | Google Scholar
L. A. Eberly, E. Rusingiza, P. H. Park et al., “Understanding the etiology of heart failure among the rural poor in sub-Saharan Africa: a 10-year experience from district hospitals in Rwanda,” Journal of Cardiac Failure, vol. 24, no. 12, pp. 849–853, 2018.
View at: Publisher Site | Google Scholar
J. Mucumbitsi, B. Bulwer, L. Mutesa et al., “Prevalence of rheumatic valvular heart disease in Rwandan school children: echocardiographic evaluation using the World Heart Federation criteria,” Cardiovascular Journal of Africa, vol. 28, no. 5, pp. 285–292, 2017.
View at: Publisher Site | Google Scholar
S. Ali, S. Domi, B. Abbo et al., “Echocardiographic screening for rheumatic heart disease in 4 515 Sudanese school children: marked disparity between two communities,” Cardiovascular Journal of Africa, vol. 29, no. 5, pp. 273–277, 2018.
View at: Publisher Site | Google Scholar
D. S. R. Kafle and V. M. Alurkar, “Pattern of heart disease at AlShab Teaching Hospital; a decade into the new millennium,” Sudan Journal of Medical Sciences, vol. 47, no. 2, pp. 86–93, 2011.
View at: Google Scholar
A. Halim and J. E. Jacques, “Rheumatic heart disease in the Sudan,” British Heart Journal, vol. 23, no. 4, pp. 383–386, 1961.
View at: Publisher Site | Google Scholar
A. El Hag, “Pattern of congenital heart disease in Sudanese children,” East African Medical Journal, vol. 71, no. 9, pp. 580–586, 1994.
View at: Google Scholar
H. H. Musa, E. A. Elbashi, and I. H. Musa, “Clinical and sociodemographic characteristics of cardiovascular disease in Sudan,” Polish Annals of Medicine/Rocznik Medyczny, vol. 25, no. 1, 2018.
View at: Publisher Site | Google Scholar
S. I. Khalil, S. Khalil, H. K. Albadri et al., “Emergence of ischemic cardiomyopathy as the main cause of heart failure in urban Sudanese population,” International Cardiovascular Forum Journal, vol. 2, no. 1, 2015.
View at: Publisher Site | Google Scholar
S. Ali, H. Awadallah, A. Al Hamim et al., “Handheld echocardiography for screening and control of rheumatic heart disease study in Gezira state, Sudan: a double approach model,” Cardiovascular Diagnosis and Therapy, vol. 8, no. 4, pp. 500–507, 2018.
View at: Publisher Site | Google Scholar
P. Yadav, P. Joshi, J. Gupta, D. Joseph, and P. Sakhi, “Prevalence of rheumatic fever and rheumatic heart disease in school children in Malwa region of MP,” National. Journal of Community Medicine, vol. 1, pp. 156–158, 2010.
View at: Google Scholar
S. Ali, S. B. Domi, and A. M. H. Elfaki, “The echocardiographic prevalence of rheumatic heart disease in North Kordofan and initiation of a control program,” Sudan Medical Journal, vol. 53, no. 2, pp. 63–68, 2017.
View at: Publisher Site | Google Scholar
A. A. Hasab, A. Jaffer, and A. M. Riyami, “Rheumatic heart disease among Omani schoolchildren,” EMHJ-Eastern Mediterranean Health Journal, vol. 3, no. 1, pp. 17–23, 1997, 1997.
View at: Publisher Site | Google Scholar
K. Yassin, A. M. H. Elfil, H. Hamid, A. K. Saeed, and A. Aziem, “A Epidemiology of cardiac disease during pregnancy in Khartoum Hospital, Sudan,” Journal of Women's Health Care, vol. 4, 2015.
View at: Google Scholar
S. Ibrahim-Khalil, M. Elhag, E. Ali et al., “An epidemiological survey of rheumatic fever and rheumatic heart disease in Sahafa town, Sudan,” Journal of Epidemiology & Community Health, vol. 46, no. 5, pp. 477–479, 1992.
View at: Publisher Site | Google Scholar
A. Zuechner, T. Mhada, N. G. Majani, G. G. Sharau, W. Mahalu, and M. W. Freund, “Spectrum of heart diseases in children presenting to a paediatric cardiac echocardiography clinic in the Lake zone of Tanzania: a 7 years overview,” BMC Cardiovascular Disorders, vol. 19, no. 1, p. 291, 2019.
View at: Publisher Site | Google Scholar
S. Mmbali and P. Chillo, “Applicability of structured telephone monitoring to follow up heart failure patients discharged from Muhimbili National Hospital, Tanzania,” Tanzania Journal of Health Research, vol. 19, no. 2, p. 19(2), 2017.
View at: Publisher Site | Google Scholar
A. Makubi, C. Hage, J. Lwakatare et al., “Contemporary aetiology, clinical characteristics and prognosis of adults with heart failure observed in a tertiary hospital in Tanzania: the prospective Tanzania Heart Failure (TaHeF) study,” Heart, vol. 100, no. 16, pp. 1235–1241, 2014.
View at: Publisher Site | Google Scholar
P. Luggajo, Prevalence and characteristics of echocardiographically diagnosed patients with rheumatic heart disease at muhimbili national hospital, Dar-es-salaam, [Ph.D. thesis], Muhimbili University of Health and Allied Science, 2009.
P. d'Arbela, R. Kanyerezi, and J. Tulloch, “A study of heart disease in the Mulago hospital, Kampala, Uganda,” Transactions of the Royal Society of Tropical Medicine and Hygiene, vol. 60, no. 6, pp. 782–790, 1966.
View at: Publisher Site | Google Scholar
J. L. Caddell, A. Warley, D. H. Connor, P. G. D'Arbela, and J. R. Billinghurst, “Acquired heart disease in Ugandan children,” British Heart Journal, vol. 28, no. 6, pp. 759–765, 1966.
View at: Publisher Site | Google Scholar
C. Lugero, D. Kibirige, J. Kayima, C. K. Mondo, and J. Freers, “Atrial fibrillation among the black population in a Ugandan tertiary hospital,” International Journal of General Medicine, vol. 9, p. 191, 2016.
View at: Google Scholar
A. Grimaldi, E. Ammirati, N. Karam et al., “Cardiac surgery for patients with heart failure due to structural heart disease in Uganda: access to surgery and outcomes,” Cardiovascular Journal of Africa, vol. 25, no. 5, pp. 204–211, 2014.
View at: Publisher Site | Google Scholar
J. Ellis, R. Martin, P. Wilde, A. Tometzki, J. Senkungu, and D. Nansera, “Echocardiographic, chest X-ray and electrocardiogram findings in children presenting with heart failure to a Ugandan paediatric ward,” Tropical Doctor, vol. 37, no. 3, pp. 149-150, 2007.
View at: Publisher Site | Google Scholar
A. Scheel, I. Ssinabulya, T. Aliku et al., “Community study to uncover the full spectrum of rheumatic heart disease in Uganda,” Heart, vol. 105, no. 1, pp. 60–66, 2019.
View at: Publisher Site | Google Scholar
A. Beaton, E. Okello, P. Lwabi, C. Mondo, R. McCarter, and C. Sable, “Echocardiography screening for rheumatic heart disease in Ugandan schoolchildren,” Circulation, vol. 125, no. 25, pp. 3127–3132, 2012.
View at: Publisher Site | Google Scholar
J. Freers, H. Mayanja-Kizza, J. L. Ziegler, and M. Rutakingirwa, “Echocardiographic diagnosis of heart disease in Uganda,” Tropical Doctor, vol. 26, no. 3, pp. 125–128, 1996.
View at: Publisher Site | Google Scholar
M. Ploutz, J. C. Lu, J. Scheel et al., “Handheld echocardiographic screening for rheumatic heart disease by non-experts,” Heart, vol. 102, no. 1, pp. 35–39, 2016.
View at: Publisher Site | Google Scholar
I. W. Hovis, J. Namuyonga, G. P. Kisitu et al., “Decreased prevalence of rheumatic heart disease confirmed among HIV-positive youth,” The Pediatric Infectious Disease Journal, vol. 38, no. 4, pp. 406–409, 2019.
View at: Publisher Site | Google Scholar
B. Gleason, G. Mirembe, J. Namuyonga et al., “Prevalence of latent rheumatic heart disease among HIV-infected children in Kampala, Uganda,” Journal of Acquired Immune Deficiency Syndromes, vol. 71, no. 2, p. 196, 1999.
View at: Google Scholar
J. Rwebembera, W. Manyilirah, Z. W. Zhu et al., “Prevalence and characteristics of primary left-sided valve disease in a cohort of 15,000 patients undergoing echocardiography studies in a tertiary hospital in Uganda,” BMC Cardiovascular Disorders, vol. 18, no. 1, p. 82, 2018.
View at: Publisher Site | Google Scholar
World Health Organization, Rheumatic Fever and Rheumatic Heart Disease: Report of a WHO expert Consultation, Geneva, World Health Organization, 2004.
J. J. Noubiap, V. N. Agbor, J. J. Bigna, A. D. Kaze, U. F. Nyaga, and B. M. Mayosi, “Prevalence and progression of rheumatic heart disease: a global systematic review and meta-analysis of population-based echocardiographic studies,” Scientific Reports, vol. 9, no. 1, pp. 1–14, 2019.
View at: Google Scholar
B. Reményi, N. Wilson, A. Steer et al., “World Heart Federation criteria for echocardiographic diagnosis of rheumatic heart disease--an evidence-based guideline,” Nature Reviews Cardiology, vol. 9, no. 5, pp. 297–309, 2012.
View at: Publisher Site | Google Scholar
M. Rothenbühler, C. J. O'Sullivan, S. Stortecky et al., “Active surveillance for rheumatic heart disease in endemic regions: a systematic review and meta-analysis of prevalence among children and adolescents,” The Lancet Global Health, vol. 2, no. 12, pp. e717–e726, 2014.
View at: Publisher Site | Google Scholar
J.-C. Chatard, T. Dubois, F. Espinosa et al., “Screening rheumatic heart disease in 1530 new Caledonian adolescents,” Journal of the American Heart Association, vol. 9, no. 9, article e015017, 2020.
View at: Publisher Site | Google Scholar
A. Wollum, R. Burstein, N. Fullman, L. Dwyer-Lindgren, and E. Gakidou, “Benchmarking health system performance across states in Nigeria: a systematic analysis of levels and trends in key maternal and child health interventions and outcomes, 2000–2013,” BMC Medicine, vol. 13, no. 1, p. 208, 2015.
View at: Publisher Site | Google Scholar
A. O. Mocumbi, “Rheumatic heart disease in Africa: is there a role for genetic studies?” Cardiovascular Journal of Africa, vol. 26, no. 2, pp. S21–S26, 2015.
View at: Publisher Site | Google Scholar
K. A. Robertson, J. A. Volmink, and B. M. Mayosi, “Towards a uniform plan for the control of rheumatic fever and rheumatic heart disease in Africa-the awareness surveillance advocacy prevention (ASAP) programme,” South African Medical Journal, vol. 96, no. 3, pp. 241–245, 2006.
View at: Google Scholar
D. Watkins, L. Zuhlke, M. Engel et al., “Seven key actions to eradicate rheumatic heart disease in Africa: the Addis Ababa communiqué,” Cardiovascular Journal of Africa, vol. 27, no. 3, pp. 184–1847, 2016.
View at: Publisher Site | Google Scholar
Z. Wang, Z. Yubao, S. Lei et al., “Prevalence of chronic rheumatic heart disease in Chinese adults,” International Journal of Cardiology, vol. 107, no. 3, pp. 356–359, 2006.
View at: Publisher Site | Google Scholar
B. R. Nascimento, A. Z. Beaton, M. C. P. Nunes et al., “Echocardiographic prevalence of rheumatic heart disease in Brazilian schoolchildren: data from the PROVAR study,” International Journal of Cardiology, vol. 219, pp. 439–445, 2016.
View at: Publisher Site | Google Scholar
B. A. Animasahun, A. D. M. Wobo, A. Y. Itiola, M. O. Adekunle, O. Y. Kusimo, and F. B. Thomas, “The burden of rheumatic heart disease among children in Lagos: how are we fairing?” The Pan African Medical Journal, vol. 29, 2018.
View at: Google Scholar
A. D. Mebratie, E. Van de Poel, Z. Yilma, D. Abebaw, G. Alemu, and A. S. Bedi, “Healthcare-seeking behaviour in rural Ethiopia: evidence from clinical vignettes,” BMJ Open, vol. 4, no. 2, article e004020, 2014.
View at: Publisher Site | Google Scholar

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