ArticleBMJ open2026
Prevalence and associated factors of rheumatic heart disease among school-aged children in Taiz Governorate, Yemen: a cross-sectional echocardiographic screening study.
Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo estimate the prevalence of rheumatic heart disease (RHD) and identify associated factors among school-aged children in Taiz Governorate, Yemen.
designCross-sectional, school-based echocardiographic screening study.
settingPublic schools in urban and rural areas of Taiz Governorate, Yemen.
participantsA total of 4135 school-aged children (5-15 years) were screened using a purposive stratified sampling approach to ensure representation by sex and place of residence.
main outcome measuresRHD status (definite and borderline) was determined using echocardiography based on the World Heart Federation criteria. Socio-economic status was assessed using a modified Water/Sanitation, Assets, Maternal Education and Income index and nutritional status using body mass index-for-age Z-scores. Multinomial logistic regression was used to identify factors associated with RHD.
resultsThe overall RHD prevalence was 55.9 per 1000 children, including 9.9 per 1000 definite cases and 45.9 per 1000 borderline cases. Prevalence was higher among females (63.8 vs 45.9 per 1000; p=0.013), rural children (63.1 vs 47.3 per 1000; p=0.022) and undernourished children (69.9 per 1000). Caregiver awareness of RHD was low (36%).In multivariable analysis, definite RHD was associated with older age (relative risk ratio (RRR)=1.22, 95% CI 1.10 to 1.36), female sex (RRR=3.21, 95% CI 1.51 to 6.86) and rural residence (RRR=2.21, 95% CI 1.16 to 4.20). Borderline RHD was associated with increasing age (RRR=1.07; 95% CI 1.01 to 1.14), while moderate socio-economic status was protective (RRR=0.71, 95% CI 0.52 to 0.97).
conclusionThe burden of RHD among schoolchildren in Taiz is high, with borderline disease substantially exceeding definite cases. Higher risk among girls, rural populations and socio-economically disadvantaged groups highlights important health inequities. These findings support the need for a national RHD control strategy in Yemen, including school-based screening, improved access to penicillin prophylaxis, strengthened referral systems and community awareness programmes.
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