Household Socioeconomic Inequities as Determinants of Subclinical Rheumatic Heart Disease in a Rural District of Mozambique
1
Programa de Residencia de Medicina Familiar e Comunitaria, Clinica Universitaria da UEM, Maputo, Mozambique
2
Centro de Analises de Politicas, Universidade Eduardo Mondlane, Maputo, Mozambique
3
Co-Secretariat NCDI Poverty Network, Universidade Eduardo Mondlane, Maputo, Mozambique
4
Consulta Integrada de Doencas Cronicas, Hospital Rural de Nhamatanda, Sofala, Mozambique
5
Cardiologia, Hospital Provincial de Maputo, Matola, Mozambique
6
Direccao Executiva, Consultório Expresso Medical, Lda, Maputo, Mozambique
7
Serviço de Cirurgia Cardiovascular e Torácica, Complexo Hospitalar de Doenças Cardio-Pulmonares Cardeal Dom Alexandre do Nascimento., Maputo, Mozambique
8
Doenças Não Transmissíveis, Instituto Nacional de Saude, Maputo, Mozambique
Popul. Med. 2026;8(Supplement Supplement 1):A1344
ABSTRACT
INTRODUCTION:
Social determinants of health (SoDH) strongly shape the occurrence of Rheumatic heart disease (RHD), the most preventable of all cardiovascular diseases. In endemic areas for RHD schoolchildren face overlapping social and environmental vulnerabilities that may increase susceptibility. This study aimed to compare household socioeconomic profile of schoolchildren with and without subclinical RHD.
METHODS:
We used school-based echocardiographic screening to recruit 79 children with subclinical RHD and 288 age-/classroom-matched controls (total 367 students; aged 6-17 years) in the rural district of Nhamatanda, Mozambique. Questionnaires to parents were used to document the socioeconomic/household characteristics. We used Multidimensional Poverty Index (MPI) to classify deprivation and measured the associations between RHD status and socioeconomic indicators through comparative distribution and correlation analyses.
RESULTS:
Age and educational distribution were similar between groups; 25.3% of participants were enrolled in 6ª grade, and school grade was not associated with RHD (r=0.04, p=0.52). We found the following socioeconomic disparities: children with RHD more often lived in larger households (≥ 6 members: 21.6% vs 13.1%) and with lower asset ownership (television/electricity: 15.2% vs 30.8%; refrigerator: 6.1% vs 23.1%). Correlation analyses confirmed that household size (r=0.31, p<0.01) and lower household income (r=-0.28, p<0.01) were associated with RHD, but school grade (r=0.04, p=0.52). RHD children attended slightly more crowded classrooms (44 students) and were in classrooms with more constrained ventilation (65%), but these differences were not statistically significant. While classroom characteristics were not independently associated with RHD, they were clustered with household-level poverty (higher MPI).
CONCLUSIONS:
Subclinical RHD was linked to household poverty rather than school-level factors, underscoring the role of social determinants in disease vulnerability. Addressing RHD in endemic settings requires integrated public health strategies that combine early detection with tailored and culturally appropriate interventions to reduce household deprivation, strengthen social protection, and promote equity.
Social determinants of health (SoDH) strongly shape the occurrence of Rheumatic heart disease (RHD), the most preventable of all cardiovascular diseases. In endemic areas for RHD schoolchildren face overlapping social and environmental vulnerabilities that may increase susceptibility. This study aimed to compare household socioeconomic profile of schoolchildren with and without subclinical RHD.
METHODS:
We used school-based echocardiographic screening to recruit 79 children with subclinical RHD and 288 age-/classroom-matched controls (total 367 students; aged 6-17 years) in the rural district of Nhamatanda, Mozambique. Questionnaires to parents were used to document the socioeconomic/household characteristics. We used Multidimensional Poverty Index (MPI) to classify deprivation and measured the associations between RHD status and socioeconomic indicators through comparative distribution and correlation analyses.
RESULTS:
Age and educational distribution were similar between groups; 25.3% of participants were enrolled in 6ª grade, and school grade was not associated with RHD (r=0.04, p=0.52). We found the following socioeconomic disparities: children with RHD more often lived in larger households (≥ 6 members: 21.6% vs 13.1%) and with lower asset ownership (television/electricity: 15.2% vs 30.8%; refrigerator: 6.1% vs 23.1%). Correlation analyses confirmed that household size (r=0.31, p<0.01) and lower household income (r=-0.28, p<0.01) were associated with RHD, but school grade (r=0.04, p=0.52). RHD children attended slightly more crowded classrooms (44 students) and were in classrooms with more constrained ventilation (65%), but these differences were not statistically significant. While classroom characteristics were not independently associated with RHD, they were clustered with household-level poverty (higher MPI).
CONCLUSIONS:
Subclinical RHD was linked to household poverty rather than school-level factors, underscoring the role of social determinants in disease vulnerability. Addressing RHD in endemic settings requires integrated public health strategies that combine early detection with tailored and culturally appropriate interventions to reduce household deprivation, strengthen social protection, and promote equity.
| eISSN: | 2654-1459 |
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