Rheumatic heart disease (RHD) among Indian children could be 20 times more than what is believed. A study conducted by the All India Institute of Medical Sciences (AIIMS) in and around Delhi to see prevalence of RHD among children in northern India found prevalence of 20.4/1000 school children as against 1 per 1000 children earlier believed.

The study carried out echocardiographic screening of 6,270 randomly selected school children aged 5-15 years. RHD was twice as prevalent among children aged 11-15 years (prevalence of 26.5 per 1000 children) compared to children aged 5-10 years (12.6 per 1000 children). Girls had a higher prevalence of RHD (27.9/1000 girls) compared to boys (13.3/1000 boys).

The study said though RHD was thought to be on the decline in India because of improving standards of living, the estimated prevalence of echocardiograpically detected RHD in India was comparable to those measured in Mozambique (21.5 cases per 1000). The study was published in the British journal 'Heart'. Dr S Ramakrishnan from AIIMS' department of cardiology told TOI, "Usually, doctors while carrying out a clinical examination listen to the child's heart to check for abnormal rhythms or murmurs that may signify that the heart has been strained. Only when a murmur is detected is an echocardiographic screening done. Our study has now shown that the prevalence of RHD is several fold higher using echocardiographic screening compared with clinical examination (estimated less than 1 in 1000 children)." Dr Ramakrishnan added, "Though many believe that RHD in India is dipping, we have now shown how rampant it could be."

Dr Anita Saxena from the same department and lead author said RHD can cause chronic heart valve damage which can eventually lead to heart failure. She said in case of an RHD, two valves of the heart among the four get affected. The mitrial valve is the commonest sufferer. The study also showed that thickening of the mitral and/or aortic valve was present in all cases. Of the 128 children, mild valve leakage was found in 101 children, and moderate valve leakage in 11 children.