Prevalence of rheumatic heart disease in Zambian school children

BMC Cardiovascular Disorders

Aidan Long¹  Mark E. Engel²  Bongani M. Mayosi³  Joyce Chipili Lungu⁴  Evans Mulendele⁴  Elizabeth Machila⁴  Dorothy Kavindele⁴  Agnes Mtaja⁴  John Musuku⁴  Liesl J. Zühlke⁵  Laurence Colin⁶  Joris Van Dam⁶  Sherri Schwaninger⁷  Jonathan Spector⁷  Marcelo M. Gutierrez⁷  Mark C. Fishman⁸  Brigitta Tadmor⁹  Patrick Musonda^1,10 

[1] Department of Allergy and Clinical Immunology, Massachusetts General Hospital;Department of Medicine, Groote Schuur Hospital and University of Cape Town;Department of Medicine, University of Cape Town;Department of Paediatrics & Child Health, University Teaching Hospital;Department of Paediatrics, Red Cross War Memorials Children’s Hospital;Global Drug Development, Novartis Institutes for BioMedical Research;Global Health, Novartis Institutes for BioMedical Research;Harvard Department of Stem Cell and Regenerative Biology, Harvard University;Novartis Institutes for BioMedical Research;School of Public Health University of Zambia;

关键词: Rheumatic heart disease;    Rheumatic fever;    Screening;    Cardiovascular disease;    Control strategies;    Epidemiology;   

DOI  :  10.1186/s12872-018-0871-8

来源: DOAJ

【 摘 要 】

Abstract Background The large global burden of rheumatic heart disease (RHD) has come to light in recent years following robust epidemiologic studies. As an operational research component of a broad program aimed at primary and secondary prevention of RHD, we sought to determine the current prevalence of RHD in the country’s capital, Lusaka, using a modern imaging-based screening methodology. In addition, we wished to evaluate the practicality of training local radiographers in echocardiography screening methods. Methods Echocardiography was conducted on a random sample of students in 15 schools utilizing a previously validated, abbreviated screening protocol. Through a task-shifting scheme, and in the spirit of capacity-building to enhance local diagnostic and research skills, general radiographers based at Lusaka University Teaching Hospital (UTH) were newly trained to use portable echocardiography devices. Students deemed as screen-positive were referred for comprehensive echocardiography and clinical examination at UTH. Cardiac abnormalities were classified according to standard World Heart Federation criteria. Results Of 1102 students that were consented and screened, 53 students were referred for confirmatory echocardiography. Three students had definite RHD, 10 had borderline RHD, 29 were normal, and 11 students were lost to follow-up. The rates of definite, borderline, and total RHD were 2.7 per 1000, 9.1 per 1000, and 11.8 per 1000, respectively. Anterior mitral valve leaflet thickening and chordal thickening were the most common morphological defects. The pairwise kappa test showed fair agreement between the local radiographers and an echocardiographer quality assurance specialist. Conclusion The prevalence of asymptomatic RHD in urban communities in Zambia is within the range of results reported in other sub-Saharan African countries using the WHF criteria. Task-shifting local radiographers to conduct echocardiography was feasible. The results of this study will be used to inform ongoing efforts in Zambia to control and eventually eliminate RHD. Trial registration The study was registered on clinicaltrials.gov (#NCT02661763).

【 授权许可】

Unknown