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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Echocardiography screening for rheumatic heart disease in ugandan schoolchildren
Circulation, Volume 125, No. 25, Year 2012
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Description
Background-Historically, sub-Saharan Africa has had the highest prevalence rates of clinically detected rheumatic heart disease (RHD). Echocardiography- based screening improves detection of RHD in endemic regions. The newest screening guidelines (2006 World Health Organization/National Institutes of Health) have been tested across India and the Pacific Islands, but application in sub-Saharan Africa has, thus far, been limited to Mozambique. We used these guidelines to determine RHD prevalence in a large cohort of Ugandan school children, to identify risk factors for occult disease, and to assess the value of laboratory testing. Methods and Results-Auscultation and portable echocardiography were used to screen randomly selected schoolchildren, 5 to 16 years of age, in Kampala, Uganda. Disease likelihood was defined as definite, probable, or possible in accordance with the 2006 National Institutes of Health/World Health Organization guidelines. Ninety-seven percent of eligible students received screening (4869 of 5006). Among them, 130 children (2.7%) had abnormal screening echocardiograms. Of those 130, secondary evaluation showed 72 (55.4%) with possible, probable, or definite RHD; 18 (13.8%) with congenital heart disease; and 40 (30.8%) with no disease. Echocardiography detected 3 times as many cases of RHD as auscultation: 72 (1.5%) versus 23 (0.5%; P<0.001). Children with RHD were older (10.1 versus 9.3 years; P=0.002). Most cases (98%) involved only the mitral valve. Lower socioeconomic groups had more RHD (2.7% versus 1.4%; P=0.036) and more advanced disease (64% versus 26%; P<0.001). Antistreptolysin O titers were elevated in children with definite RHD. Conclusions-This is one of the largest single-country childhood RHD prevalence studies and the first to be conducted in sub-Saharan Africa. Our data support inclusion of echocardiography in screening protocols, even in the most resource-constrained settings, and identify lower socioeconomic groups as most vulnerable. Longitudinal follow-up of children with echocardiographically diagnosed subclinical RHD is needed. © 2012 American Heart Association, Inc.
Authors & Co-Authors
Beaton, Andrea Zawacki
United States, Washington, D.c.
Childrens National Health System
Okello, Emmy S.
Uganda, Kampala
Uganda Heart Institute
Lwabi, Peter Solomon
Uganda, Kampala
Uganda Heart Institute
Mondo, Charles Kiiza
Uganda, Kampala
Uganda Heart Institute
McCarter, Robert
United States, Washington, D.c.
Childrens National Health System
Sable, Craig Andrew
United States, Washington, D.c.
Childrens National Health System
Statistics
Citations: 241
Authors: 6
Affiliations: 2
Identifiers
Doi:
10.1161/CIRCULATIONAHA.112.092312
ISSN:
00097322
e-ISSN:
15244539
Research Areas
Maternal And Child Health
Noncommunicable Diseases
Study Design
Cross Sectional Study
Cohort Study
Study Locations
Mozambique
Uganda