الفهرس 
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Abstract
Rheumatic valvular heart disease remains the most common acquired heart disease worldwide. It is the major cause of cardiovascular death in pediatric age group, so an accurate diagnosis of RF is very important.
Although acute rheumatic fever (ARF) has declined in Europe and North America in incidence over the past 4 to 6 decades the disease remains one of the most important causes of cardiovascular morbidity and mortality among socially and economically disadvantaged population all over the world especially in the developing countries that are home to the majority of world’s population. Incidence rates in these countries still reach epidemic levels.
Rheumatic heart disease is a sequelae of acute rheumatic fever, which is usually a disease of poverty associated with overcrowding, poor sanitation and other social determinants of poor health. The near elimination of acute rheumatic fever and reduction in the rates of rheumatic heart disease in high-income countries during the late 20th century was attributed in part to improvements in socioeconomic conditions and the widespread use of penicillin G benzathine to treat streptococcal pharyngitis. The remaining burden of rheumatic heart disease is found mostly in low-income and middle-income countries and among immigrants and older adults in high-income countries.
The present study was done to detect the prevalence of rheumatic heart disease among the primary and preparatory school children 6-15 years old in Quesna district, Menoufia governorate in Egypt.
The aim of our present study is to determine the prevalence of rheumatic heart disease in school children in Quesna district, Menoufia governorate. This present study was conducted on 5000 children (2285 males and 2715 females) in 11 primary and 7 preparatory governmental schools in Quesna district (5 urban and 13 rural schools) in the period from November 2015 to November 2017.
In our study detection of prevalence of RHD in school children was done by taking detailed history thorough a questionnaires, full clinical examination and listening for murmurs by stethoscope followed by echocardiographic confirmation only in suspected cases by using the 2012 WHF criteria for detecting RHD and were categorized to definite, borderline and no RHD which reported by (Reményi et al., 2012).
In Quesna district 5000 children were examined and 95(1.9%) children out of the examined were found to have abnormal history and examination (30 cases had recurrent tonsillitis with long acting penicillin, 39 cases had positive family history of rheumatic heart disease and 26 cases had discovered murmur during auscultation), 5 cases refused doing echo, the remaining 90 cases did echo, 2 children of them (2.22%) were found to have definite rheumatic valvular heart disease (one of them were found to have mitral regurgitation and one had aortic regurgitation), 72 children of them (75.8%) were normal by echocardiography.
The prevalence rate of rheumatic heart disease in primary and preparatory school children in (Quesna district) was found to be 0.06% (0.6/1000) according to the present study.
The rheumatic heart disease was diagnosed in 2 males of 3 diagnosed cases and 1 female, with prevalence rate (33.3%) were females and (66.7 %) were males. 66.7% of our cases live in rural areas and 33.3% of them live in urban areas, (66.7%) of them of low socioeconomic state and ( 33.3%) of middle socioeconomic state.
Two cases considered RHD by echo as they were silent carditis. 1 case of the 3 diagnosed cases had history of arthritis (33.3%).
Anthropometric measurements revealed a significant decrease in anthropometric parameters in 2 of the affected children, indicating that malnutrition and growth retardation are prevailing in RHD patients.
Cardiac examination of selected students revealed that 3 cases (100%) had apical holosystolic murmur on mitral area .
According to our study we are about to belongs to low risk populations (prevalence rate < 2per 100,000 school aged children for ARF and < 1per 1000 for RHD) so we may soon follow Jones criteria that revised by AHA 2015 depending on prevalence of RHD (low risk or high risk population) (Gewitz et al., 2015).