Incidence of Rheumatic Fever and Rheumatic Heart Disease and Its Associated Factors Among Paediatric Patients in Malaysia

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Published: Jul 31, 2025
DOI: https://doi.org/10.47836/mjmhs.21.4.10
Keywords:
Rheumatic fever, Rheumatic heart disease, Incidence, Risk factors, Paediatric

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Mohd Anas Che Nik
Hospital Pakar Universiti Sains Malaysia, Jalan Raja Perempuan Zainab II, 16150 Kubang Kerian Kelantan, Malaysia
Najib Majdi Yaacob
Unit of Biostatistic and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, MalaysiaKelantan, Malaysia
Nor Fadhilah Zahari
Department of Paediatrics, Hospital Raja Perempuan Zainab II, 16150 Kota Bharu, Kelantan, Malaysia
Sharifah Huda Engku Alwi
Department of Paediatrics, Hospital Sultanah Nur Zahirah, 20400 Kuala Terengganu, Terengganu, Malaysia
Siew Sing Chua
Department of Paediatrics, Hospital Sultan Ismail Petra, 18000 Kuala Krai, Kelantan, Malaysia
Amir Hamzah Abd Rahman
Department of Paediatrics, Hospital Tengku Ampuan Afzan, 25100 Kuantan, Pahang, Malaysia
Thiyagar Nadarajaw
Department of Paediatrics, Hospital Sultanah Bahiyah, 05460 Alor Star, Kedah, Malaysia
Mohammad Tamim Jamil
Department of Paediatric Cardiology, Hospital Pulau Pinang, 10450 Georgetown, Penang, Malaysia
Norliza Ali
Department of Paediatrics, Hospital Sultan Idris Shah, 43000 Kajang, Selangor, Malaysia
Mohd Nizam Mat Bah
Department of Paediatrics, Hospital Sultanah Aminah, 80100 Johor Bahru, Johor, Malaysia
Martin Ngie Liong Wong
Department of Paediatrics, Hospital Umum Sarawak, 93586 Kuching, Sarawak, Malaysia
Norazah Zahari
Department of Paediatrics, Faculty of Medicine, University Malaya, 50603 Kuala Lumpur, Malaysia
Anand Mohan
Department of Paediatrics, Hospital Bintulu, 97000 Bintulu, Sarawak, Malaysia
Siew Chen Ang
Department of Paediatrics, Hospital Tawau, 91000 Tawau, Sabah, Malaysia
Irene MeeYieng Ngu
Department of Paediatrics, Hospital Kapit, 96800 Kapit, Sarawak, Malaysia
Hui Lynn Khoo
Department of Paediatrics, Hospital Lahad Datu, 91110 Lahad Datu, Sabah, Malaysia
See Chang Wong
Department of Paediatrics, Hospital Sibu, 96000 Sibu, Sarawak, Malaysia
Tiong Yinn
Department of Paediatrics, Hospital Sibu, 96000 Sibu, Sarawak, Malaysia
Siva Rao Muniandy
Department of Paediatric Cardiology, Hospital Queen Elizabeth II, 88300 Kota Kinabalu, Sabah, Malaysia
Amelia Alias
Department of Paediatrics, Hospital Tunku Azizah, 50300 Kuala Lumpur, Malaysia
Siaw Chin Wong
Department of Paediatrics, Hospital Sarikei, 96100 Sarikei, Sarawak, Malaysia
Nithia Kamala
Department of Paediatrics, Hospital Miri, 98000 Miri, Sarawak, Malaysia
Chee Keong Tan
Department of Paediatrics, Hospital Labuan, 87000 W.P Labuan, Malaysia
Geetha Kandavello
Paediatric and Congenital Heart Centre, National Heart Institute, 50400 Kuala Lumpur, Malaysia
Mohd Rizal Mohd Zain
Hospital Pakar Universiti Sains Malaysia, Jalan Raja Perempuan Zainab II, 16150 Kubang Kerian Kelantan, Malaysia

Abstract

In impoverished and developing regions, acute rheumatic fever (ARF) remains a significant cause of morbidity and premature death. In Malaysia, particularly in the East Coast of Peninsular Malaysia and East Malaysia, ARF continues to be a leading cause of acquired cardiac disease. Despite this, there is a lack of published data on ARF incidence. This study aimed to determine the incidence of ARF and identify associated risk factors to enhance ARF prevention strategies. Materials and methods: The study, conducted over one year from July 2021 to June 2022 across 23 centres in Malaysia, included all newly diagnosed ARF and RHD cases, with a ratio of one case to two control patients. Sociodemographic and clinical data were collected, and multivariate analyses were conducted to identify associated risk factors. Results: The incidence of ARF was found to be 34.1 per 100,000 paediatric admissions, primarily concentrated in Kelantan and Sabah. Carditis (85.7%) and migrating polyarthritis (31.4%) were the most common clinical manifestations, with valve involvement, particularly mitral regurgitation, being the most frequent anomaly (97.1%). Multivariate analysis indicated that age, low income, and rural residence were significant risk factors for ARF. Conclusion: This study highlighted a persistently high incidence of acute rheumatic fever in Malaysia, with strong correlations observed between age, low socioeconomic status, and rural residence, and the likelihood of contracting ARF. These findings can inform more effective strategies for ARF prevention in the country.

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How to Cite
Che Nik, M. A., Yaacob, N. M., Zahari, N. F., Engku Alwi, S. H., Chua, S. S., Abd Rahman, A. H., Nadarajaw, T., Jamil, M. T., Ali, N., Mat Bah, M. N., Wong, M. N. L., Zahari, N., Mohan, A., Ang, S. C., Ngu , I. M., Khoo, H. L., Wong, S. C., Yinn, T., Muniandy, S. R., Alias, A., Wong, S. C., Kamala, N., Tan, C. K., Kandavello, G., & Mohd Zain, M. R. (2025). Incidence of Rheumatic Fever and Rheumatic Heart Disease and Its Associated Factors Among Paediatric Patients in Malaysia. Malaysian Journal of Medicine and Health Sciences, 21(4), 74–82. https://doi.org/10.47836/mjmhs.21.4.10
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Vol. 21 No. 4 (2025)
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Original Articles
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References

Noubiap JJ, Agbor VN, Bigna JJ, Kaze AD, Nyaga UF, Mayosi BM. Prevalence and progression of rheumatic heart disease: a global systematic review and meta-analysis of population-based echocardiographic studies. Sci Rep. 2019;9(1):1–14. doi: 10.1038/s41598-019-53540-4.

Gururaj AK, Choo KE, Ariffin WA, Sharifah A. A clinical, laboratory and echocardiographic profile of children with acute rheumatic fever. Singapore Med J. 1990;31(4):364–7. Available from: https://smj.sma.org.sg/3104/3104a15.pdf.

Omar A. Pattern of acute rheumatic fever in a local teaching hospital. Med J Malaysia. 1995;50(2):125–30. Available from: https://www.e-mjm.org/1995/v50n2/Acute_Rheumatic_Fever.pdf

Chew NK, Choy KL, Tan CT, Omar A. A clinical study of Sydenham’s chorea at University Malaya Medical Centre. Neurol J Southeast Asia. 2002;7:93–8. Available from: https://www.neurology-asia.org/articles/20022_093.pdf

Riaz BK, Selim S, Karim MN, Chowdhury KN, Chowdhury SH, Rahman MR. Risk factors of rheumatic heart disease in Bangladesh: A case-control study. J Health Popul Nutr. 2013;31(1):70–7. doi: 10.3329/jhpn.v31i1.14751.

Oliver JR, Pierse N, Stefanogiannis N, Jackson C, Baker MG. Acute rheumatic fever and exposure to poor housing conditions in New Zealand: A descriptive study. J Paediatr Child Health. 2017 Apr 1;53(4):358–64. doi: 10.1111/jpc.13421. Epub 2017 Jan 4. doi: 10.1111/jpc.13421.

Shrestha NR, Karki P, Mahto R, Gurung K, Pandey N, Agrawal K, et al. Prevalence of subclinical rheumatic heart disease in Eastern Nepal: A school-based cross-sectional study. JAMA Cardiol. 2016;1(1):89–96. doi: 10.1001/jamacardio.2015.0292.

Watkins DA, Johnson CO, Colquhoun SM, Karthikeyan G, Beaton A, Bukhman G, et al. Global, Regional, and National Burden of Rheumatic Heart Disease, 1990–2015. New England Journal of Medicine. 2017;377(8):713–22. doi: 10.1056/NEJMoa1603693.

Syam DR, Yosy DS, Bakri A, Nova R. Epidemiologic profiles of subclinical rheumatic heart disease in children. Paediatrica Indonesiana. 2020;60(6). Doi: 10.14238/pi60.6.2020.334-40.

Markham JL, Richardson T, DePorre A, Teufel RJ, Hersh AL, Fleegler EW, et al. Inpatient use and outcomes at children’s hospitals during the early COVID-19 pandemic. Pediatrics. 2021;147(6). doi: 10.1542/peds.2020-044735.

Kaya Akca U, Atalay E, Cuceoglu MK, Balik Z, Sener S, Ozsurekci Y, et al. Impact of the COVID-19 pandemic on the frequency of the pediatric rheumatic diseases. Rheumatol Int. 2022;42(1):51–7. doi: 10.1007/s00296-021-05027-7.

Baker MG, Gurney J, Oliver J, Moreland NJ, Williamson DA, Pierse N, et al. Risk factors for acute rheumatic fever: Literature review and protocol for a case-control study in New Zealand. Int J Environ Res Public Health. 2019;16(22). doi: 10.3390/ijerph16224515.

Sara H, Bouchra O, Angéla F kava, Samira EF, Nehemie N, Samir A. Acute rheumatic fever in children: Experience at the hospital Hassan II of Fez, Morocco. Clin Epidemiol Glob Health. 2020;8(4):1062–6. doi: 10.1016/j.cegh.2020.03.020.

Gurney J, Sarfati D, Stanley J, Wilson N, Webb R. The incidence of acute rheumatic fever in New Zealand, 2010-2013. New Zealand Medical Journal. 2015;128(1417):65–7. Available from: https://nzmj.org.nz/media/pages/journal/vol-128-no-1417/the-incidence-of-acute-rheumatic-fever-in-new-zealand-20102013/da4b524ad2-1696473905/the-incidence-of-acute-rheumatic-fever-in-new-zealand-20102013.pdf.

Patel FR, Tan JW, Rao S. Acute rheumatic fever in the paediatric population: A descriptive study in the Malaysian state of Sabah. Cardiol Young. 2021; doi: 10.1017/S1047951121001621.

Islam AKMM, Majumder AAS. Rheumatic fever and rheumatic heart disease in Bangladesh: A review. Indian Heart J. 2016;68(1):88–98. doi: 10.1016/j.ihj.2015.07.039

Okello E, Kakande B, Sebatta E, Kayima J, Kuteesa M, Mutatina B, et al. Socioeconomic and environmental risk factors among rheumatic heart disease patients in Uganda. PLoS One. 2012;7(8):1–7. doi: 10.1371/journal.pone.0043917.

Tellawy M, Alfallaj M, Aldaghmi R, Alharbi S, Alruwaili R, Alhablani F, et al. Parents knowledge and attitudes toward rheumatic heart disease in Saudi Arabia. International Journal of Medicine in Developing Countries. 2021;5(October):1980–7. doi: 10.24911/IJMDC.51-1633287158

Brook I. The impact of smoking on oral and nasopharyngeal bacterial flora. J Dent Res. 2011 Jun;90(6):704–10. doi: 10.1177/0022034510391794.

Tay L, Chay SO. A three-year streptococcal survey among Singapore school children. Part I - Carriership of streptococci. Ann Acad Med Singap. 1981;10(1):14–24. Available from: https://pubmed.ncbi.nlm.nih.gov/7025738/

Faruq, QO., Rashid, AK., Ahmed J, Waiz A., Haque KM., Rouf MA, et al. Prevalence of streptococcal sorethroat in the school children of Dhaka. Bangladesh Med Res Counc Bull. 1995; 21(3): 87–94.

Zaman MM, Yoshiike N, Chowdhury AH, Nakayama T, Yokoyama T, Faruque GM, et al. Nutritional factors associated with rheumatic fever. J Trop Pediatr. 1998;44(3):142–7. doi: 10.1093/tropej/44.3.142.

Lilyasari O, Prakoso R, Kurniawati Y, Roebiono PS, Rahajoe AU, Sakidjan I, et al. Clinical Profile and Management of Rheumatic Heart Disease in Children and Young Adults at a Tertiary Cardiac Center in Indonesia. Front Surg. 2020;7:47. doi: 10.3389/fsurg.2020.00047.

Negi PC, Kandoria A, Asotra S, Ganju N kumar, Merwaha R, Sharma R, et al. Gender differences in the epidemiology of Rheumatic Fever/Rheumatic heart disease (RF/RHD) patient population of hill state of northern India; 9 years prospective hospital based, HP-RHD registry. Indian Heart J. 2020;72(6):552–6. doi: 10.1016/j.ihj.2020.09.011.

Passos LSA, Nunes MCP, Aikawa E. Rheumatic heart valve disease pathophysiology and underlying mechanisms. Front Cardiovasc Med. 2020. 7: 612716. Doi: 10.3389/fcvm.2020.612716.

Chung H-M, Liao Y-M, Tsai Y-C, Liu M-C. Microscopic hematuria in children. Urol Sci. 2011;22(3):93–6. doi: 10.1016/j.urols.2011.08.001.

Martin WJ, Steer AC, Smeesters PR, Keeble J, Inouye M, Carapetis J, et al. Post-infectious group A streptococcal autoimmune syndromes and the heart. Autoimmun Rev. 2015;14(8):710–25. doi: 10.1016/j.autrev.2015.04.005.

Nakauyaca A V, Ralph AP, Majoni WS, Kangaharan N. Case report: Concurrent rheumatic fever and acute post-streptococcal glomerulonephritis in a high-burden setting. American Journal of Tropical Medicine and Hygiene. 2019;101(5):1054–7. doi: 10.4269/ajtmh.18-0954.

Ghosh S, King-Morris K, Shultz J. Concomitant Acute Rheumatic Fever and Acute Post Streptococcal Glomerulonephritis. Cureus. 2021;13(7). doi: 10.7759/cureus.16357.