Background: Rheumatic Heart disease (RHD) is the leading cause of acquired cardiac morbidity and mortality in young people worldwide. There are 40.5 million prevalent cases of RHD worldwide with 300,000 deaths yearly. There are an estimated 230,000 cases in Malawi.
Purpose: To describe the characteristics of patients presenting with RHD at Queen Elizabeth Central hospital (QECH), Blantyre, Malawi.
Methods: The study included patients diagnosed between August 2020 and December 2024. Retrospective data were extracted from medical records, including demographic information, disease severity and outcomes. Descriptive statistics to summarise patient characteristics and clinical outcomes were done.
Results: Of the 1028 patients with cardiac disease, 189 (18.6%) had RHD. There were more females (n=117, 61.9%) than males (n=71, 38.1%) and mean age was 13 years (±4 SD). Most patients (n=160, 84.7%) were self-referral while 15.3% (n=29) were referred. The most common reason for referral was respiratory symptoms. Patients coming from outside the immediate catchment area of QECH were more likely to present with severe disease. 129 patients were eligible for cardiac surgery but 4 (3.1%) have undergone mitral valve replacement. 76.2% (n=144) were alive while 9 (4.8%) patients had died. 36 (19.1%) patients had not presented to the clinic for the past 12 months and were assumed to be lost to follow.
Conclusion: RHD remains a significant contributor of acquired heart disease in Malawian children. Late presentation and poor access to care contribute to disease severity. Limited access to surgery requires increased disease awareness and promotion of preventive measures to delay progression.