Abstract:
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 prev-
alence 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 out-
come 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.