Prevalence of

Rheumatic Heart Disease

in School-Children of Shimla
Supervisor :Dr. Anupam Parashar
Co-supervisor :Dr. Renu
Presented by:
Vaibhav sharma (0458)
Vikrant Sharma (0459)
Vikrant Thakur (0460)
VineetBhardwaj (0461)
Virat Kuntalam (0463)
Virender Chauhan (0464)
 We are Grateful to…
Dr. A. K. Bhardwaj Prof. & Head
Dept. of Community Medicine
Dr. Anmol Gupta Assoc. Prof
Dept. of Community Medicine
Dr. Anupam Parashar Asst. Professor
Dept. of Community Medicine
Dr. Renu Dept. of Community Medicine
Mrs. Veena Sharma Principal
Model Public School, Sanjauli.

And all the students who participated in this study.

 Why RHD ??

“We do not inherit Health & Happiness from our

Ancestors but we borrow it from our Future
generations…”
ØCrippling our Future generation
Ø Catches them young
Ø incidence among Females
Ø Already Low Sex Ratio
Ø RHD Constitutes 30-35% of hospital admission due to CVD
Ø Prevalence low but Significant Morbidity & Mortality
Ø School going Children constitutes 20-25% of total population of India.
Ø Average age at the time of death due to RHD is 35 yrs.
 What are we dealing with?
• RHD – Crippling, non-communicable disease
resulting due to deranged immune response
to a communicable disease GABH
Streptococcal Pharyngitis.

“ a child who has pain in Legs is soon going to

become Short of breath as well…”
- Hippocrates.
 Healthy Individual
GABHS Pharyngitis

Recovery most of Cross Reacting Antigens

the Time

Immune Response

Deranged Immune
Response
Antibodies against ‘own’ tissue

Symptoms

Various Manifestations
Signs
 Aims & Objectives…
To determine the Prevalence of RHD
among School-children in Shimla.
To Study the relation of RHD with
Factors like Age & Sex.
Ø(To Learn How an Epidemiological Study is
done? )
 Modus Operandi...
• Sample size of 217
• Age Group 5-11 years.
• School not covered in ongoing study
conducted by Dept. of Community Medicine,
IGMC, Shimla.
• Questionnaire based survey was done
• Questions were Close Ended Questions with
answers in ‘YES’ or ‘NO’.
• Criteria for Study: Modified Jones Criteria
• Short History, Criteria Based Quick Exam &
Detailed CVS Examination was done.
• Students with positive findings for RHD were
to be further evaluated by specialists at IGMC.
• Final Diagnosis was to be made only after
Echocardiography and Color Doppler.
 Modified Jones Criteria

Major Minor
üCarditis * Clinical Findings:
üPolyarthritis # Arthralgia
üChorea # Fever

üErythema Marginatum * Lab Findings:

üs.c. nodules # ESR
# CRP
# Prolonged PR interval
 Questionnaire
• H/o Recurrent Sore Throat
• H/o Chest Pain
• H/o Fever/ Body aches/ Chills/ Rigors
• H/o Palpitations ( if yes, assess severity)
• H/o Syncope
• H/o Joint Pain ( fleeting type)
• H/o Penicillin Prophylaxis
• H/o SOB
• H/o abnormal involuntary movements of limb
• H/o PND/ Orthopnoea
• H/o Cough/ Hemoptysis
• H/o Pain upper abdomen
 Observations…
• Out of 217 students
– 91 Girls & 126 Boys

• Recurrent Sore Throat 16 (7.4%)

• Chest Pain 8 (3.7%)
• Palpitation 4 (1.8%)
• Syncope 7 (3.2%)
• SOB 14 (5.1%)
• Cough 23 (10.5%)
• Joint Pain 5 (2.3%)
Observations In Pies & Bars…
What ‘Pie’ Says…
 Findings on GPE…
• Pallor 39
• Cyanosis 17
• Jaundice Nil
• Clubbing Nil
• LAP 15
• JVP
Findings on CVS examination

There was only one significant finding of

Parasternal Heave and Palpable P2.

No any other findings specifically pointing

towards Probable RHD was detected.
 Previous Studies…
• India:
§ ICMR 2.1-11/1000 (avg. 7/1000)
§ CMC Vellore (Largest Study till date; n=2,29,829)
0.68/1000
• Himachal Pradesh:
§ 2.98/1000 in Shimla in 1994
§ 3.9/1000 in Shimla in 1956
(Highest ever Incidence reported in India at that time)
§ 3.627/1000 in Shimla in 1998
§ 1 case so far in approx. 5000 surveyed
students. (ongoing study; Dept. of
Community Med. IGMC, Shimla.)
 The Loopholes…
• Time
• Inadequate sample Size combined with
very low prevalence.
• Selection Bias
• We are not Expert in the Field concerned.
• Compliance of Student.
• Reliability of History given.
• Investigating facilities inadequate.
• Clinical features not very specific.
 The Last words…
• Teachers were recommended to remain
ultra vigilant for the warnings symptoms
• Practical suggestions like opening certain
windows for effective cross ventilation
were advocated.
• It was suggested that at least one parents
teacher meeting must be held regarding
informing the parents about warning
symptoms of the disease.
Contd…
• Emphasis was told to be laid on those
children who were suffering from pallor
and there routine checkup was advised.
THANK YOU !!