Prevalence of rheumatic heart disease in Zambian school children

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dc.contributor.authorSchwaninger, Sherri
dc.contributor.authorMusuku, John
dc.contributor.authorEngel, Mark E
dc.contributor.authorMusonda, Patrick
dc.contributor.authorLungu, Joyce C
dc.contributor.authorMachila, Elizabeth
dc.contributor.authorMtaja, Agnes
dc.contributor.authorMulendele, Evans
dc.contributor.authorKavindele, Dorothy
dc.contributor.authorSpector, Jonathan
dc.contributor.authorTadmor, Brigitta
dc.contributor.authorGutierrez, Marcelo M
dc.contributor.authorVan Dam, Joris
dc.contributor.authorColin, Laurence
dc.contributor.authorLong, Aidan
dc.contributor.authorFishman, Mark C
dc.contributor.authorMayosi, Bongani M
dc.contributor.authorZühlke, Liesl J
dc.date.accessioned2018-07-10T13:03:45Z
dc.date.available2018-07-10T13:03:45Z
dc.date.issued2018-07-03
dc.date.updated2018-07-08T03:42:20Z
dc.description.abstractBackground 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 ).
dc.identifier.apacitationSchwaninger, S., Musuku, J., Engel, M. E., Musonda, P., Lungu, J. C., Machila, E., ... Zühlke, L. J. (2018). Prevalence of rheumatic heart disease in Zambian school children. <i>BMC Cardiovascular Disorders</i>, http://hdl.handle.net/11427/28284en_ZA
dc.identifier.chicagocitationSchwaninger, Sherri, John Musuku, Mark E Engel, Patrick Musonda, Joyce C Lungu, Elizabeth Machila, Agnes Mtaja, et al "Prevalence of rheumatic heart disease in Zambian school children." <i>BMC Cardiovascular Disorders</i> (2018) http://hdl.handle.net/11427/28284en_ZA
dc.identifier.citationSchwaninger, S., Musuku, J., Engel, M. E., Musonda, P., Lungu, J. C., Machila, E., ... & Tadmor, B. (2018). Prevalence of rheumatic heart disease in Zambian school children. BMC cardiovascular disorders, 18(1), 135.
dc.identifier.ris TY - Journal Article AU - Schwaninger, Sherri AU - Musuku, John AU - Engel, Mark E AU - Musonda, Patrick AU - Lungu, Joyce C AU - Machila, Elizabeth AU - Mtaja, Agnes AU - Mulendele, Evans AU - Kavindele, Dorothy AU - Spector, Jonathan AU - Tadmor, Brigitta AU - Gutierrez, Marcelo M AU - Van Dam, Joris AU - Colin, Laurence AU - Long, Aidan AU - Fishman, Mark C AU - Mayosi, Bongani M AU - Zühlke, Liesl J AB - 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 ). DA - 2018-07-03 DB - OpenUCT DP - University of Cape Town J1 - BMC Cardiovascular Disorders LK - https://open.uct.ac.za PB - University of Cape Town PY - 2018 T1 - Prevalence of rheumatic heart disease in Zambian school children TI - Prevalence of rheumatic heart disease in Zambian school children UR - http://hdl.handle.net/11427/28284 ER - en_ZA
dc.identifier.urihttps://doi.org/10.1186/s12872-018-0871-8
dc.identifier.urihttp://hdl.handle.net/11427/28284
dc.identifier.vancouvercitationSchwaninger S, Musuku J, Engel ME, Musonda P, Lungu JC, Machila E, et al. Prevalence of rheumatic heart disease in Zambian school children. BMC Cardiovascular Disorders. 2018; http://hdl.handle.net/11427/28284.en_ZA
dc.language.isoen
dc.publisherBioMed Central
dc.publisher.departmentDepartment of Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rights.holderThe Author(s).
dc.sourceBMC Cardiovascular Disorders
dc.source.urihttps://bmccardiovascdisord.biomedcentral.com/
dc.subject.otherRheumatic heart disease
dc.subject.otherRheumatic fever
dc.subject.otherScreening
dc.subject.otherCardiovascular disease
dc.subject.otherControl strategies
dc.subject.otherEpidemiology
dc.subject.otherEchocardiography
dc.subject.otherZambia
dc.subject.otherPrevalence
dc.subject.otherStreptococcal pharyngitis
dc.titlePrevalence of rheumatic heart disease in Zambian school children
dc.typeJournal Article
uct.type.filetypeText
uct.type.filetypeImage
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