The personal and clinical impact of screen-detected maternal rheumatic heart disease in Uganda: a prospective follow up study

BMC Pregnancy and Childbirth

Andrea Beaton¹  Sonia Voleti²  Rachel Sarnacki²  Meghna Murali²  Craig Sable²  Henriator Namisanvu³  Renny Ssembatya³  Olivia Bakka³  Angela Njeri³  Alphonsus Matovu⁴  Emmy Okello⁵  Albert Majwala⁵  Kristen DeStigter⁶ 

[1] Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, USA;The University of Cincinnati School of Medicine, Cincinnati, OH, USA;Department of Cardiology, Children’s National Medical Center, 111 Michigan Avenue NW, 20010, Washington, DC, USA;Imaging the World Africa, Naayla-Namugongo Rd, Naayla, Uganda;Mubende Regional Referral Hospital, Mubende, Uganda;The Uganda Heart Institute, Ward 1 C, Mulago Hospital Complex, Kampala, Uganda;University of Vermont Medical Center, 111 Colchester Avenue, Burlington, VT, USA;

关键词: Rheumatic heart disease;    Maternal health;    Uganda;    Health disparities;    Echocardiography;    Screening;   

DOI  :  10.1186/s12884-020-03189-z

来源: Springer

【 摘 要 】

BackgroundPre-existing maternal cardiac disease is a significant contributor to adverse maternal, fetal, and neonatal outcomes. In 2015–2017, our team conducted the first community-based study of maternal rheumatic heart disease (RHD) in sub-Saharan Africa and identified RHD in 88% of those with pre-existing heart disease.Here we conducted a follow up investigation of women previously identified with RHD, describing clinical and echocardiographic outcomes, identifying barriers to medical adherence and evaluating the personal impact of RHD.MethodsA 2 week prospective follow up was completed at sites in Central and Eastern Uganda. Participants underwent a three-step mixed methods study comprising of 1) direct structured interview targeting clinical history and medication adherence, 2) echocardiogram to evaluate left-sided heart valves, and 3) semi-structured guideline interview to elicit personal impacts of RHD.ResultsThe team evaluated 40 (80%) of the original 51 mothers with RHD at a median post-partum time of 2.5 years after delivery (IQR 0.5). Echocardiographic data showed improvement in nine women with the remaining 31 women showing stable echocardiographic findings. Adherence to Benzathine penicillin G (BPG) prophylaxis was poor, with 70% of patients either poorly adherent or non-adherent.Three major themes emerged from interviews: 1) social determinants of health (World Health Organization, Social determinants of health, 2019) negatively affecting healthcare, 2) RHD diagnosis negatively affecting female societal wellbeing, 3) central role of spouse in medical decision making.ConclusionsScreening echocardiography can identify women with pre-existing rheumatic heart disease during pregnancy, but long-term follow-up in Uganda reveals adherence to medical care following diagnosis, including BPG, is poor. Additionally, mothers diagnosed with RHD may experience unintended consequences such as social stigmatization. As identification of occult RHD is critical to prevent adverse pregnancy outcomes, further research is needed to determine how to best support women who face a new diagnosis of RHD, and to determine the role of screening echocardiography in high-risk settings.

【 授权许可】

CC BY