Poverty and eosinophilia are risk factors for endomyocardial fibrosis (EMF) in Uganda

OBJECTIVE TO determine the relative risks of socio-demographic, dietary, an d environmental factors for endomyocardial fibrosis (EMF) in Uganda. METHOD Unmatched case control study in Mulago Hospital, Kampala. Cases (n = 61) were sequential patients hospitalized with an echocardiographic diagno sis of EMF from June 1995 to March 1996. Controls (n = 120) were concurrent patients with other forms of heart disease (heart controls, n = 59) and su bjects admitted for trauma or elective surgery (hospital controls, n = 61). All consenting subjects answered a structured questionnaire administered b y trained interviewers. Complete blood counts, malaria films and stool exam ination for ova and parasites were performed. Questionnaires elicited infor mation on home address, economic circumstances, variables concerned with en vironmental exposures and usual diet before becoming ill. RESULTS After adjustment for age and sex, cases were significantly more lik ely than controls' to have Rwanda/Burundi ethnic origins (P = 0.008). Compa red with controls, cases had a lower level of education (P < 0.001 for hear t controls and P = 0.07 for hospital controls), were more likely to be peas ants (P < 0.001), and to come from Luwero or Mukono Districts (P = 0.003). After further adjustment for peasant occupation, cases were more likely tha n controls to walk barefoot (P = 0.015), consume cassava as their staple fo od (P < 0.001) and to lack fish or:meat in dietary sauces (P = 0.02). Cases were more likely to exhibit absolute eosinophilia (P = 0.006). The effect of cassava diet was more marked in the younger age group, while the effect of eosinophilia was greater in adults. Socio-economic disadvantage is a ris k for EMF Absolute eosinophilia is a putative cause of EMF, a finding not e xplained by parasitism. CONCLUSION Data indicate that relative poverty and environmental factors tr iggering eosinophilia appear to act in a geographically restricted region o f Uganda in the aetiology of EMF.