الفهرس 
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Abstract
Low detection rate of rheumatic cardiac lesions may lead to an underestimation of the prevalence of RHD in children if screened by clinical features alone.
Rheumatic heart disease, specially the severe one is a serious problem, both for the patient, family and society as well. Unfortunately, the disease frequently affects school-aged children resulting in negative impacts on growth and development. This study was initiated to give a profile about the prevalence of rheumatic heart diseases in Shebin Elkom city, Menoufia government.
In this study, about 5000 schoolchildren aged from 6 to 15 years old, of a total number of 101365 children in both preparatory and primary schools of both rural and urban schools, underwent full history taking and complete clinical examination in surveys were carried out amongst school children for signs of RF/RHD and a registry was established covering a population of 591905 in Shebin El-kom city.
RF was diagnosed using Modifed Jone’s criteria by the AHA in 2015 and RHD with reliable auscultation and WHF guidelines in 2012 and then all cases that fulfill jones and/or WHF criteria for RHD were examined for final confirmation by echocardiography.
In this study, history taking and full clinically performed examination show abnormalities in 110 students. 40 students have recurrent arthralgia with long acting penicillin, 30 students have recurrent tonsillitis and treated by long acting penicillin, 35 students had Murmur discovered accidently on auscultation and only 5 students had family history of rheumatic carditis Of all 110 selected students, 103 students had performed the echocardiograph and 7 families refused. 86 students were echocardiographic normal, 11 students have valvular regurgitation but not meeting the WHF diagnostic criteria for RHD. 2 students had definite RHD and 1 had borderline RHD. So, the final RHD prevalence in our study is approximately is 0.06 % (~1 per 2000).
Majority of our children were initially treated by general practitioners and local hospitals which caused a significant delay in their presentation in tertiary care hospitals. Also, the low socioeconomic level of the patients makes them not to confirm by echocardiogram.
Of whole 5000 students, the majority was in rural schools of percentage 89.4 % studied students. And so as to type of school was 98.1% governmental schools of total number. The middle socioeconomic level predominates with percentage 77.8 % of whole randomly selected students
Our study show that 13.5 % had abnormal structural heart variant between mitral valve regurgitation and less commonly Aortic valve regurgitation.
Our study suggested mild significance of elevated acute phase reactants as abnormal ESR levels (1.4%) , CRP (0.68%) & ASOT estimation show only 52 students with percentage (1.04%) had ASOT more than 400 and 169 (3.38 %) between 200 & 400 iu/ml but finally only 3 cases met the echocardiographic criteria for RHD.
About 70 students of all 5000 selected students given long acting penicillin based only on patient complaint or laboratory elevated acute phase reactants.so we found overdiagnosis of RF/RHD.