Epidemiology of Rheumatic Heart Disease in Black Schoolchildren of Soweto, Johannesburg

M. J. McLaren, Douglas M Hawkins, D. M. Bramwell-Jones, E. Cohen, G. E. Gale, K. S. Kanarek, A. S. Lachman, J. B. Lakier, W. A. Pocock, J. B. Barlow, H. T. Koornhof

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A survey to determine the prevalence of rheumatic heart disease (R.H.D.) in Black children was conducted in the creches and primary schools of the South Western Townships of Johannesburg (Soweto). A total of 12 050 Black children were examined by 10 cardiologists in May to October 1972. The overall prevalence rate of R.H.D. was 6.9 per 1000, with a peak rate of 19.2 per 1000 in children of the seventh school grade. The maximal age incidence was 15–18 years and there was a female preponderance of 1.6:1. A rise in prevalence occurred with increasing family size. Most children (92%) were asymptomatic, and in 82.5% R.H.D. was diagnosed for the first time during the school survey. The commonest valve lesion was mitral regurgitation, which was present in 93% and occurred as an isolated lesion in 47.5%. Lance-field’s group A β-haemolytic streptococcus was isolated from the throats of 52 per 1000 Soweto children. The auscultatory features of a non-ejection systolic click and late systolic murmur were prevalent (13.9 per 1000) and had several epidemiological factors in common with R.H.D. A comprehensive preventative campaign is urgently needed in South Africa, directed at both primary and secondary prophylaxis of R.H.D. The socioeconomic status of the community must be improved if optimal prevention is to be achieved.

Original languageEnglish (US)
Pages (from-to)474-478
Number of pages5
JournalBritish Medical Journal
Issue number5981
StatePublished - Aug 23 1975

Bibliographical note

Funding Information:
We are indebted to the South African Medial Research Council, Anglo American Corporation of South Africa Limited, Soutfh African Breweries Institute, and the Cardio-Vascular Research Fund of the University of the Witwaterarand for their financial support without which this survey would not have been possible. We thank the Joharmesburg Non-European Affairs Department, the Department of Bantu Education, the Urban Bantu Council, and the African Self Help Organization for their co-operation; Dr. B. Richard and Dr. M. Coster of the Johannesburg City Health Department for their interest and help in providing nursing staff; Mr. B. Thomas of the department of applied mathenatics for his enthusiastic help in analysing the data; and Dr. Elaine Epstein and Dr. M. M. Zion for their assessments of the chest radio- graphs. Finally, we adknowledge the considerable contribution of many technologists in the cardiac unit and the South African Institute for Medical Research, especially that of Solveig Jacobsen, Nanette Goldberg, and the late Bill Schmnolke.


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