Abstract / Summary
Abstract Background Rheumatic mitral stenosis remains an important cause of morbidity and mortality among children in low-resource settings. In Tigray, Ethiopia, where access to cardiac surgical and catheter-based interventions is limited, children are managed primarily with medical therapy, and the clinical profile and outcomes of the disease remain poorly characterized. This study aimed to assess the clinical characteristics, complications, and factors associated with mortality among pediatric patients with rheumatic mitral stenosis in this setting. Methods A retrospective cohort study was conducted using medical records of children younger than 18 years with echocardiographically confirmed rheumatic mitral stenosis diagnosed between April 2019 and April 2024. A total of 98 eligible children were included. Data were collected using a structured data abstraction tool, entered into EpiData version 3.0.0.1, and analyzed using SPSS version 27. Multivariable binary logistic regression was performed to identify factors independently associated with mortality. Statistical significance was defined as a p-value < 0.05. Results A total of 98 children with rheumatic mitral stenosis were included, with a mean age at diagnosis of 13.7 ± 3.0 years; the youngest child diagnosed with mitral stenosis was 5 years old. Severe mitral stenosis was present in 60.2% of children at diagnosis. Congestive heart failure was common (84.7%), and a high echocardiographic probability of pulmonary hypertension was documented in 61 of 75 children with available TR velocity measurements (81.3%). Atrial fibrillation and infective endocarditis were each identified in 9.2% of cases. Malnutrition was highly prevalent, with 75.6% of children exhibiting moderate-to-severe thinness and 52.0% having stunting. Sixteen children (16.3%) died during the study period. Factors independently associated with mortality included atrial fibrillation (AOR 10.5, 95% CI: 1.7–63.8; p = 0.011), peripheral edema (AOR 8.0, 95% CI 2.0–32.8; p = 0.004), and infective endocarditis (AOR 7.6, 95% CI 1.2–46.8; p = 0.029). Conclusions This study demonstrates that pediatric rheumatic mitral stenosis in a resource-limited setting is characterized by early onset of disease, advanced disease at presentation, and a high burden of malnutrition, complications, and mortality. Atrial fibrillation, peripheral edema, and infective endocarditis were independently associated with mortality. Strengthening early detection, improving adherence to secondary prophylaxis, integrating nutritional support, and expanding access to timely cardiac intervention are essential to improve outcomes.