A series of 31 patients referred for evaluation of paediatric cardiac disease in rural Kenya is reported. The prevalence of symptomatic rheumatic heart disease is unchanged from previous data in the literature which is well over a decade old. We can conclude that recent improvements in medical care in Kenya have not yet reached certain rural areas as far as rheumatic fever is concerned. In addition, a significant number of children presumed to have had no discernible heart disease at this evaluation, suggesting the need for critical re-evaluation of this population at intervals. Finally, cyanotic disease seems under-represented in the series, suggesting that infants with certain cyanotic lesions may have been selected out and hence not referred to us.