Prevalence of Rheumatic Heart Disease and Congenital Heart Disease in the Schoolchildren of Lalitpur, Nepal. Bacteria strain:Beta Hemolytic Streptococcus (Group A)

aAARJIT ADHIKARY, aA levels, Rato Bangala School, Lalitpur, Nepal; Key words. Prevalence • schoolchildren • Rheumatic Heart Disease (RHD) • Congenital Heart Disease (CHD) • Ministry of Health (MoH) • Lalitpur ABSTRACT Rheumatic heart disease and congenital heart disease are common causes of cardiovascular diseases among the children and young adults in Nepal. In the project ‘Have a Heart! Save a Heart!’ implemented by the 2011 SAYS (South Asian Youth Summit) team from Nepal in cooperation with Nepal Heart Foundation (NHF) in the months of October-December, 2011. A mass-screening program was conducted among 3002 schoolchildren of Lalitpur to devise the prevalence rate of RHD. The results show that the devised prevalence rate of RHD among schoolchildren in Lalitpur is 2.3/1000. The issue of CHD came as an outcome of the screening for RHD when students with CHD were also detected. Hence, as an additional outcome of the study, the devised prevalence rate of CHD among schoolchildren in Lalitpur is 3.3/1000. Address for correspondence: Phone (R): ++977-1-5539858 Email: [e-mail]; [e-mail] INTRODUCTION RHD and CHD remain significant health problems in school-going children of Lalitpur Sub-Metropolitan City. According to a research (1990-2003) conducted by NHF, an increase in the prevalence of these diseases has been reported. Another research (November-December 2003) centered in Kathmandu Valley (which incorporates Lalitpur) conducted by the Department of Cardiology at Shahid Gangalal National Heart Centre reveals that the prevalence of RHD and CHD among schoolchildren is 1.2/1000 and 1.3/1000 respectively. With the increasing cases of RHD every year, this program was primarily launched in order to alleviate the prevalence of RHD by generating awareness adjunct to determining the prevalence rate of RHD in the schoolchildren of Lalitpur. The Have a Heart!Save a Heart! project is one of the collaborative efforts that NHF has with other partners such as the MoH (Government of Nepal) and the Rotary International. OBJECTIVES The following were the main objectives of the research study: ● To visit seven public schools in Lalitpur for screening approximately 3,000 schoolchildren for RHD with the help of a team of cardiologists and health professionals from NHF. ● To refer the suspected cases of RHD for secondary screening via Doppler Echocardiography. ● To direct confirmed cases to the Department of Cardiology, Shahid Gangalal National Heart Centre, Kathmandu for prophylaxis. ● To determine the prevalence of RHD in the schoolchildren of Lalitpur. METHODOLOGY The research was conducted in seven randomly selected public schools in Lalitpur Sub-Metropolitan City during a time period of five weeks (November-December 2011). The study team had taken permission from all the schools prior to the school visits. A total of 3,002 students including both boys and girls from classes 1 to 10 were screened by a team of cardiologists from NHF. The suspected cases of screening were convened to Lalitpur Heart Clinic for further diagnosis through Doppler Echocardiography. Apart from screening, the research also comprised of a survey followed up by awareness generation on RHD by SAYS participants. The time taken for the visit in each school ranged from one to five hours. DISCUSSION Despite the sophisticated measures undertaken to prepare the study, some aspects of qualitative data were overlooked. The cases of RHD and CHD were not segregated on the basis of Sex (Male or Female) nor were they partitioned on the basis of Age (5-16). These overlooked aspects, if applied, could have provided significant qualitative outcomes for further research and understanding on the prevalence of RHD and CHD. Nevertheless, it is agreed that the outcomes generated by this unique study initiated by Nepali youth with the aid of United States’ State Department, US Embassy (Kathmandu), Nepal Break Dance Foundation (NBF) and most importantly, NHF, will prove to be valuable in forthcoming national and international research in analogous fields. CONCLUSION The aim of the study was to determine the prevalence rate of RHD in the schoolchildren of Lalitpur. The study revealed that the prevalence rate of RHD among schoolchildren in Lalitpur is 2.3/1000. An additional outcome was the prevalence rate of CHD i.e., 3.3/1000. ACKNOWLEDGEMENTS This study was a part of Have a Heart! Save a Heart! Project conducted by the SAYS 2011 team in cooperation with NHF. The project was funded by the Bureau of Educational and Cultural Affairs, US Department of State. NBF provided overall coordination and fund management and the preliminary planning sessions were hosted by the Godavari Alumni Association.