Is Rheumatic Heart Disease Still Endemic in Tunisia? A Review of 14-year Period and Future Projections

Houda Ben Ayed^1*, Sourour Yaich¹, Mariem Ben Hmida¹, Maissa Ben Jemaa¹, Maroua Trigui², Jihene Jedidi¹, Raouf Karray¹, Habib Feki², Yosra Mejdoub¹, Mondher Kassis¹ & Jamel Damak¹

¹Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
²Preventive Medicine and Hygiene Department, Hedi Chaker University Hospital, University of Sfax, Tunisia

Dr. Houda Ben Ayed, Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Tunisia.

Keywords: Epidemiology; Chronological Trends; Incidence; Projection; Rheumatic Heart Diseases

Abstract

Introduction
Rheumatic heart disease (RHD) ranks among the leading causes of non-communicable diseases in developing countries. Tunisia is recognized as an endemic area of RHD. Our study aimed to determine the epidemiological specificities of RHD and to assess its chronological trends over time.
Methods
We retrospectively collected data from the regional morbidity register of Hedi Chaker University Hospital, South of Tunisia between 2003 and 2016. Joinpoint regression analysis was performed to study the chronological trends of RHD over time (Annual Percentage Change (APC); p).
Results
Overall, 1063 were hospitalized for RHD. We noted 635 women with RHD (59.7%). There were 432 cases (40.6%) aged between 40 and 59 years. The case-fatality rate was 1.6%. The mean annual number of RHD new cases was 76 cases/year. The incidence rate of RHD was 7.95 cases/100 000 person-year. Trends analysis showed a decreasing trend in overall RHD new cases from 2003 to 2016, but no significant change was noted (APC=-4.4%; 95%CI= [-10.4;2.1%]; p=0.2). The same results were applied for males (APC=-5.4%; 95%CI= [-12.4; 2.2%]; p=0.1) and females (APC=- 3.8%; 95%CI= [-9.3; 2.2%]; p=0.2). According to age-groups, we noted a significant decline in RHD new cases for patients aged under 25 years (APC=-15.95%; 95%CI= [-21.8; -9.6%];
Conclusions
Inspite of declining curves in the hospitalizations of RHD, it still remains a major public health problem for both sexes and in all age-groups. The decreasing trend was mainly observed among young patients, with a significant change over time.

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