Not all cases of rheumatic fever (RF) end up as rheumatic heart disease
(RHD). The fact raises the possibility of existence of a subgroup with
characteristics that prevent RF patients from developing the RHD. The
present study aimed at exploring the risk factors among patients with
RHD. The study assessed the risk of RHD among people both with and
without RF. In total, 103 consecutive RHD patients were recruited as
cases who reported to the National Centre for Control of Rheumatic
Fever and Heart Disease, Dhaka, Bangladesh. Of 309 controls, 103 were
RF patients selected from the same centre, and the remaining 206
controls were selected from Shaheed Suhrawardy Medical College
Hospital, who got admitted for other non-cardiac ailments. RHD was
confirmed by auscultation and colour Doppler echocardiography. RF was
diagnosed based on the modified Jones criteria. An unadjusted odds
ratio was generated for each variable, with 95% confidence interval
(CI), and only significant factors were considered candidate for
multivariate analysis. Three separate binary logistic regression models
were generated to assess the risk factors of RF, risk factors of RHD
compared to non-rheumatic control patients, and risk factors of RHD
compared to control with RF. RF and RHD shared almost a similar set of
risk factors in the population. In general, age over 19 years was found
to be protective of RF; however, age of the majority (62.1%) of the RHD
cases was over 19 years. Women [odds ratio (OR)=2.2, 95% CI 1.1-4.3],
urban resident (OR=3.1, 95% CI 1.2 8.4), dwellers in brick-built
house (OR=3.6, 95% CI 1.6-8.1), having >2 siblings (OR=3.1, 95% CI
1.5- 6.3), offspring of working mothers (OR=7.6, 95% CI 2.0-24.2),
illiterate mother (OR=2.6, 95% CI 1.2-5.8), and those who did not brush
after taking meals (OR=2.5, 95% CI 1.0-6.3) were more likely to develop
RF. However, more than 5 members in a family showed a reduced risk of
RF. RHD shared almost a similar set of factors in general. More than
three people sharing a room also showed an increased risk of RHD
(OR=1.9, 95% CI 1.0-3.4), in addition to the risk factors of RF.
Multivariate model also assessed the factors that may perpetuate RHD
among RF patients. Overcrowding (OR=2.4, 95% CI 1.2-4.7) and illiteracy
(OR=2.4, 95% CI 1.1-5.2) posed the risk of RHD in the RF patients. The
study did not find new factors that might pose an increased risk,
rather looked for the documented risk factors and how these operate in
the population of Bangladesh