The Tribal Distribution of Endomyocardial Fibrosis in Uganda.

Endomyocardial fibrosis (EMF) is a relatively common form of heart disease in Uganda and accounts for about 14 per cent of subjects with clinical cardiovascular disease admitted to Mulago Hospital, Kampala (Shaper and Williams, 1960) and for 10 per cent of heart disease seen at necropsy (Davies, 1961). Though there have been pathological and clinical descriptions of this disorder (Davies, 1948; Davies and Ball, 1955; Williams, Ball, and Davies, 1954; Shillingford and Somers, 1961), the etiology of EMF remains obscure, and its relation to the obscure forms of heart disease seen in Nigeria (Abrahams and Brigden, 1961; Edington and Jackson, 1963) and in South Africa (Becker, 1963) is uncertain. Mulago Hospital, Kampala, is situated in the Kingdom of Buganda, the largest province of Uganda, and about halfthe patients admitted to the hospital belong to the local Ganda tribe. There is also a large immigrant population in Buganda coming in particular from Ruanda-Urundi (now Ruanda and Burundi)* and from Western Province of Uganda (Kigezi, Ankole, Toro, and Bunyoro districts). In an early report on the distribution and nature of EMF it was noted that the highest incidence was amongst immigrant labourers from Ruanda-Urundi (Ball, Williams, and Davies, 1954). The possibility that the Ruanda immigrants might have an increased susceptibility to EMF was further examined in a general analysis of medical admissions to Mulago Hospital (Shaper and Shaper, 1958) and in more detailed study of cardiovascular disorders seen at that hospital (Shaper and Williams, 1960). In an attempt to assess more accurately the question of tribal predominance, the present study examines the age, sex, and tribal distribution of subjects in whom the presence of EMF had been established at necropsy (Shaper and Wright, 1963) and discusses the environmental and other factors that might be correlated with tribal predominance.