Necropsy study of endomyocardial fibrosis and rheumatic heart disease in Uganda 1950-1965.

TLDR: An analysis of the tribal origins of cases of endomyocardial fibrosis coming to necropsy at Mulago Hospital in the period 19501961 showed a preponderance of this condition among those groups immigrant to Buganda, in particular those originating from Rwanda and Burundi.

Abstract: Endomyocardial fibrosis is a relatively common form of heart disease in Uganda (Davies, 1948; Shaper and Williams, 1960) and accounts for some 10 per cent of heart disease seen at necropsy in Kampala (Davies, 1961). It is characterized in the established condition by fibrosis in the endocardium and subjacent myocardium affecting particularly the inflow tract and the apex of one or both ventricles. The aetiology of this disorder is not known, and hypotheses have been put forward in attempts to incriminate virus or filarial infections, plantain diets, and rheumatic heart disease. The disorder has also been described in West Africa, Ceylon, South India, and Central Africa, and wellauthenticated cases have been seen in Europeans resident in tropical areas (Brockington, Olsen, and Goodwin, 1967). Mulago Hospital, Kampala, is situated in Buganda, the largest province of Uganda, and about half the patients admitted to the hospital belong to the local Ganda tribe (Fig. 1). There is also a large immigrant population in Buganda, coming in particular from Rwanda and Burundi (herein referred to as 'Rwandans') and from the Western Province of Uganda (Kigezi, Ankole, Toro, and Bunyoro districts). An analysis of the tribal origins of cases of endomyocardial fibrosis coming to necropsy at Mulago Hospital in the period 19501961 showed a preponderance of this condition among those groups immigrant to Buganda, in particular those originating from Rwanda and Burundi. The condition was far less common than expected among the indigenous Ganda people (Shaper and Coles, 1965). This analysis of the tribal origins of subjects with endomyocardial fibrosis has now been extended to cover the period 1950-1965, and a similar analysis