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Background: Rheumatic heart disease (RHD) is the most prevalent acquired cardiac illness in Sudan, arising as a complication of acute rheumatic fever (ARF). Additionally, Sudan exhibited a wide diversity in the distribution of RHD. The echocardiographic screening revealed 3/1000 cases in one region (Khartoum), while in another region (Nort Kordofan), it revealed 61/1000 cases. Consequently, further research is warranted to shed light on this disease, particularly its risk factors. There is a lack of research on the risk factors in Sudan. The objective of this study is to evaluate Sudan's RHD risk factors., Methods: This case-control study was conducted at Jafar Ibn Auf Children's Hospital from August to December 2016. A questionnaire was used to study RHD risk factors, including socioeconomic status, maternal education and employment, housing conditions, residence, and history of sore throat and ARF. Comparison between cases and controls was estimated using conditional logistic regression with 95% confidence intervals (CI)., Results: A total of 78 participants, including 39 established RHD cases and 39 age- and sex-matched normal controls, were recruited. The age in years for cases and controls was 11.1 +/- 2.9 and 11+/- 2.9, respectively. In the univariate analysis, only the history of ARF was significantly associated with RHD (odds ratio (OR) 60.8, 95% CI 10.3-356). There was a trend toward increased risk of RHD in association with a history of sore throat in 69.2% of the patients and origin from western states in 41% of the patients, but this did not reach statistical significance., Conclusions:  ARF history and a six-month history of throat infections are linked to RHD. Mothers do not have a correlation with RHD, but a correlation exists when there is a connection between a history of ARF and a recent throat infection (effect modification). Furthermore, an association was found between throat infections and living in a western state. Consequently, it is imperative to adopt RHD prevention, particularly the prevention and treatment of both ARF and throat infections., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Yousif et al.)