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Rheumatic heart disease prevalence in Nepal is 3.1% with significant geographic and temporal disparitiesRheumatic heart disease is much more common in rural Nepal

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Key Takeaway
Note that rheumatic heart disease prevalence is significantly higher in non-Kathmandu areas of Nepal.

This meta-analysis evaluates the prevalence of rheumatic heart disease in Nepal using data from 209,815 participants. The study identifies a pooled prevalence of 3.1% (95% CI 1.6-5.8%). The authors highlight significant geographic disparities, noting a 1.1% prevalence in Kathmandu compared to 7.2% in non-Kathmandu areas. Meta-regression analysis indicates a rising temporal trend (beta = 0.092, p = 0.001) over three decades, suggesting no evidence of decline.

Several limitations affect the certainty of these findings. The analysis reported extreme heterogeneity (I^2 = 99.8%) and low to moderate GRADE certainty due to inconsistency and imprecision. Additionally, the prediction interval of 0.3-28.5% indicates wide variability in true prevalence. A meta-regression also showed that larger sample sizes were associated with lower reported prevalence (beta = -0.79, p < 0.001).

Clinically, the data suggest that rheumatic heart disease remains a significant public health concern in Nepal. The six-fold higher prevalence in non-Kathmandu areas compared to urban centers may inform regional resource allocation. However, the high heterogeneity and wide prediction intervals necessitate cautious interpretation of these prevalence figures for specific local populations.

Living with a heart condition can be a heavy burden, especially when the risk depends largely on where you live. A large review of data from Nepal reveals a striking gap in heart health. People living outside the capital city of Kathmandu are much more likely to have rheumatic heart disease than those living in the city.

Researchers looked at over 200,000 people to track how often this heart condition appears. They found that the prevalence of the disease is about 3.1% overall. However, the numbers jump significantly in non-urban areas, where the rate is 7.2%. In contrast, the rate in Kathmandu is only 1.1%. This means the risk is six times higher for those outside the capital.

While the data shows a rising trend in cases over the last thirty years, the findings come with some caution. Because the studies used to gather this data were very different from one another, the researchers noted that the results have some uncertainty. Still, the clear geographic difference highlights a major health challenge for people in rural regions.

What this means for you:
People in rural Nepal face a much higher risk of rheumatic heart disease than those in the capital city.

Common questions

How common is rheumatic heart disease in Nepal?

The overall prevalence of rheumatic heart disease in the studied population is 3.1%. This number was calculated from 5,440 cases found among 209,815 participants who had confirmed diagnoses through heart imaging.

Is the risk higher in certain areas?

Yes, there is a significant difference based on location. The prevalence is 7.2% in areas outside of Kathmandu, while it is only 1.1% within Kathmandu. This means the condition is much more common in rural areas.

Is the number of cases going up?

The data shows a rising trend in the prevalence of rheumatic heart disease over the last three decades. This trend was confirmed by a meta-regression analysis of the available data.

Study Details

Study typeMeta analysis
Sample sizen = 209,815
EvidenceLevel 1
PublishedSep 2026
View Original Abstract ↓
Background Rheumatic heart disease remains a major cause of preventable cardiovascular morbidity and mortality in low- and middle-income countries. We conducted a systematic review and meta-analysis to estimate the prevalence of rheumatic heart disease, examine temporal and geographic disparities, and assess the certainty of the available evidence. Methods We systematically reviewed observational studies reporting rheumatic heart disease prevalence with extractable numerators and denominators and echocardiography-confirmed diagnoses. Quality was appraised using the Joanna Briggs Institute (JBI) checklist. Pooled prevalence was estimated using generalized linear mixed models (GLMM) with logit transformation (random effects; back-transformed). Subgroup analyses compared Kathmandu-based studies with non-Kathmandu studies; meta-regression examined publication year, log(sample size), and region. The certainty of evidence was assessed using GRADE. Results Ten studies (209,815 participants and 5,440 cases) were included. The pooled prevalence was 3.1% (95% CI 1.6-5.8%) with a wide prediction interval of 0.3-28.5%, indicating that the true prevalence in Nepalese settings could plausibly vary from very low to very high. Heterogeneity was extreme (I^2 = 99.8%). Excluding the nationwide study, the prevalence was 1.1% (0.9-1.3%) in Kathmandu and 7.2% (3.7-13.3%) in non-Kathmandu (p < 0.001). Meta-regression showed a rising temporal trend (beta = 0.092, p = 0.001) and lower prevalence in larger samples (beta = -0.79, p < 0.001); the multivariable model explained about 85% of between-study heterogeneity. Egger's test suggested possible small-study effects (p = 0.096). GRADE certainty was low to moderate and downgraded for inconsistency and imprecision. Conclusion Rheumatic heart disease remains highly prevalent in Nepal, with a six-fold higher prevalence outside Kathmandu than in urban populations, and no evidence of decline over three decades. These findings call for urgent integration of RHD prevention, community-based echocardiographic screening, and equitable access to prophylaxis and surgical care into Nepal's decentralized health system.
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