Abstract
BackgroundThe 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.MethodsEchocardiography 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.ResultsOf 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.ConclusionThe 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 registrationThe study was registered on clinicaltrials.gov (#NCT02661763).
Highlights
The large global burden of rheumatic heart disease (RHD) has come to light in recent years following robust epidemiologic studies
In sub-Saharan Africa, studies from multiple countries report that approximately 0.5–3% of school-age children have echocardiographic signs of definite or borderline disease according to World Heart Federation (WHF) criteria [6,7,8,9]
The sample population consisted of 2276 students in 15 schools that were eligible for participation
Summary
The large global burden of rheumatic heart disease (RHD) has come to light in recent years following robust epidemiologic studies. Rheumatic heart disease (RHD) is a common and neglected health problem in the developing world and in indigenous regions of some high-income countries [1, 2]. RHD is a preventable sequela of streptococcal pharyngitis, commonly known as “strep throat.”. A small percentage of patients with untreated streptococcal pharyngitis will develop autoimmune-mediated acute rheumatic fever (ARF) and RHD, which is characterized by heart valve damage and progressive cardiac failure [10]. No specific treatment for RHD exists but, if detected early, continuous antibiotic prophylaxis ( known as “secondary prevention” of RHD) can decrease ARF attack rates and mitigate progression of heart disease [11,12,13]. RHD leads to chronic morbidity and premature death [15]
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