Prevalence of Rheumatic Heart Disease and Other Cardiac Conditions in Low-Risk Pregnancies in Kenya: A Prospective Echocardiography Screening Study
John W. Snelgrove,
Joy Marsha Alera,
Michael C. Foster,
Kipchumba C. N. Bett,
Gerald S. Bloomfield,
Candice K. Silversides,
Felix A. Barasa,
Astrid Christoffersen-Deb,
Heather C. Millar,
Julie G. Thorne,
Rachel F. Spitzer,
Rajesh Vedanthan,
Nanette Okun
Affiliations
John W. Snelgrove
Division of Maternal-Fetal Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario; Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario
Joy Marsha Alera
Directorate of Reproductive Health, Moi Teaching and Referral Hospital, Eldoret; Academic Model Providing Access to Healthcare (AMPATH), Eldoret
Michael C. Foster
Heart Center, Duke University Medical Center, Durham, NC
Kipchumba C. N. Bett
Directorate of Reproductive Health, Moi Teaching and Referral Hospital, Eldoret; Academic Model Providing Access to Healthcare (AMPATH), Eldoret
Gerald S. Bloomfield
Heart Center, Duke University Medical Center, Durham, NC; Department of Medicine, Duke Clinical Research Institute and Duke Global Health Institute, Duke University, Durham, NC
Candice K. Silversides
Division of Cardiology, Department of Medicine, Mount Sinai Hospital/Toronto General Hospital, University of Toronto, Toronto, ON
Felix A. Barasa
Department of Cardiology, Moi Teaching and Referral Hospital, Eldoret
Astrid Christoffersen-Deb
Directorate of Reproductive Health, Moi Teaching and Referral Hospital, Eldoret; Academic Model Providing Access to Healthcare (AMPATH), Eldoret, KE; Department of Obstetrics and Gynaecology, BC Children’s Hospital, University of British Columbia, Vancouver, BC
Heather C. Millar
Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, CA; Directorate of Reproductive Health, Moi Teaching and Referral Hospital, Eldoret; Academic Model Providing Access to Healthcare (AMPATH), Eldoret
Julie G. Thorne
Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, CA; Directorate of Reproductive Health, Moi Teaching and Referral Hospital, Eldoret; Academic Model Providing Access to Healthcare (AMPATH), Eldoret
Rachel F. Spitzer
Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario
Rajesh Vedanthan
Section for Global Health, Department of Population Health, New York University School of Medicine, New York, NY
Nanette Okun
Division of Maternal-Fetal Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario; Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario
Background: Rheumatic heart disease (RHD) in sub-Saharan Africa contributes to significant cardiac morbidity and mortality, yet prevalence estimates of RHD lesions in pregnancy are lacking. Objectives: Our first aim was to evaluate women using echocardiography to estimate the prevalence of RHD and other cardiac lesions in low-risk pregnancies. Our second aim was to assess the feasibility of screening echocardiography and its acceptability to patients. Methods: We prospectively recruited 601 pregnant women from a low-risk antenatal clinic at a tertiary care maternity centre in Western Kenya. Women completed a questionnaire about past medical history and cardiac symptoms. They underwent standardized screening echocardiography to evaluate RHD and non-RHD associated cardiac lesions. Our primary outcome was RHD-associated cardiac lesions and our secondary outcome was a composite of any clinically-relevant cardiac lesion or echocardiography finding. We also recorded duration of screening echocardiography and its acceptability among pregnant women in this sample. Results: The point prevalence of RHD-associated cardiac lesions was 5.0/1,000 (95% confidence interval: 1.0–14.5), and the point prevalence of all clinically significant lesions/findings was 21.6/1,000 (11.6–36.7). Mean screening time was seven minutes (SD 1.7, range: 4–17) for women without cardiac abnormalities and 13 minutes (SD 4.6, range: 6–23) for women with abnormal findings. Echocardiography was acceptable to women with 74.2% agreeing to participate. Conclusions: The prevalence of clinically-relevant cardiac lesions was moderately high in a low-risk population of pregnant women in Western Kenya.
