Abstract
BackgroundRheumatic heart disease (RHD) is a chronic condition responsible of congestive heart failure, stroke and arrhythmia. Almost eradicated in high-income countries (HIC), it persists in low- and middle-income countries. The purpose of the study was to assess the feasibility and meaningfulness of ultrasound-based RHD screening among the population of unaccompanied foreign minors in Italy and determine the burden of asymptomatic RHD among this discrete population.MethodsFrom February 2016 to January 2018, Médecins Sans Frontières conducted a weekly mobile screening by echocardiography in reception centers and family houses for unaccompanied foreign minors in Rome, followed by fix echocardiographic retesting for those resulting positive at screening. ‘Definite’ and ‘borderline’ cases were defined according to the World Hearth Federation criteria.ResultsSix hundred fifty-three individuals (13–26 years old) were screened; 95.6% were below 18 years old (624/653). Six ‘definite RHD’ were identified at screening, yielding a detection rate of 9.2‰ (95% CI 4.1–20.3‰), while 285 (436.4‰) were defined as ‘borderline’ (95% CI 398.8–474.9‰). Out of 172 “non-negative borderline” cases available for being retested (113 “non-negative borderline” lost in follow-up), additional 11 were categorized as ‘definite RHD’, for a total of 17 ‘definite RHD’, yielding a final prevalence of 26.0‰ (95% CI 16.2–41.5‰) (17/653), and 122 (122/653) were confirmed as ‘borderline’ (final prevalence of 186.8‰, 95% CI 158.7–218.7). In multivariate logistic regression analysis the presence of systolic murmur was a strong predictor for both ‘borderline’ (OR 4.3 [2.8–6.5]) and ‘definite RHD’ (OR 5.2 [1.7–15.2]), while no specific country/geographic area of origin was statistically associated with an increased risk of latent, asymptomatic RHD.ConclusionsScreening for RHD among the unaccompanied migrant minors in Italy proved to be feasible. The burden of ‘definite RHD’ was similar to that identified in resource-poor settings, while the prevalence of ‘borderline’ cases was higher than reported in other studies. In view of these findings, the health system of high-income countries, hosting migrants and asylum seekers, are urged to adopt screening for RHD in particular among the silent and marginalized population of refugee and migrant children.
Highlights
Rheumatic Heart Disease (RHD), a sequaela of Rheumatic Fever (RF) affecting the heart valve system, often evolves in congestive heart failure and arrhythmias, requiring surgery after a period of asymptomatic, latent phase [1]
While Rheumatic heart disease (RHD) and its socio-economic determinants are concentrated in low resource settings, it is useful to recognize that the recently intensified synergic phenomena of globalization, migration and refugee crises have displaced the common belief according to which RHD is just confined to developing nations
Material and methods The strategy of this observational study revolved around the idea to carry out, in first instance, an echocardiographic screening through portable device among young people between 10 and 25 years, belonging to groups of migrants coming from endemic areas (Northern Africa, Western Sub-Saharan Africa, Eastern Sub-Saharan Africa and Southern Asia)
Summary
Rheumatic Heart Disease (RHD), a sequaela of Rheumatic Fever (RF) affecting the heart valve system, often evolves in congestive heart failure and arrhythmias, requiring surgery after a period of asymptomatic, latent phase (silent) [1]. Almost eradicated in high income countries (HICs) (eg: prevalence in the US is less than 0.05‰) [3], the disease persists in the middle and low income countries (MICs and LICs). Attempts to tackle the burden of RHD, spearheaded by WHO and World Heart Federation’s (WHF) [9, 10], have not been effectively implemented in LICs and MICs because of the structural weaknesses of their health systems: today, RHD remains still the main cause of cardiac-related mortality in poor countries [11]. Rheumatic heart disease (RHD) is a chronic condition responsible of congestive heart failure, stroke and arrhythmia. Almost eradicated in high-income countries (HIC), it persists in low- and middle-income countries. The purpose of the study was to assess the feasibility and meaningfulness of ultrasound-based RHD screening among the population of unaccompanied foreign minors in Italy and determine the burden of asymptomatic RHD among this discrete population
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