School and Community Screening Shows Malawi, Africa, to Have a High Prevalence of Latent Rheumatic Heart Disease

Sanyahumbi, Amy; Sable, Craig; Beaton, Andrea; Chimalizeni, Yamikani; Guffey, Danielle; Hosseinipour, Mina C.; Karlsten, Melissa; Kazembe, Peter N.; Minard, Charles G.; Penny, Daniel J.

doi:10.1111/chd.12353

Cited by 37 publications

(45 citation statements)

References 23 publications

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“…In screening over 15,000 school children in Uganda, our team has detected a 3% prevalence of latent RHD 10, 11 . These findings have been replicated in other parts of Africa 12, 13 , Asia 14, 15 , South and Central America 8, 16 and the Pacific 17–20 – uncovering a large population that may benefit from early detection.…”

Section: Introductionmentioning

confidence: 78%

Latent Rheumatic Heart Disease

et al. 2017

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Background Screening echocardiography (echo) has emerged as a potentially powerful tool for early diagnosis of rheumatic heart disease (RHD). The utility of screening echo hinges on the rate of RHD progression and the ability of penicillin prophylaxis to improve outcome. We report the longitudinal outcomes of a cohort of children with latent RHD and identify risk factors for unfavorable outcomes. Methods This was a prospective natural history study conducted under the Ugandan RHD registry. Children with latent RHD and ≥1 year of follow-up were included. All echos were re-reviewed by experts (2012 WHF criteria) for inclusion and evidence of change. Bi- and multi- variable logistic regression, Kaplan-Meier analysis, as well as Cox proportional hazard models were developed to search for risk factors for unfavorable outcome and compare progression-free survival between those treated and not treated with penicillin. Propensity and other matching methods with sensitivity analysis were implemented for the evaluation of the penicillin effect. Results Blinded review confirmed 227 cases of latent RHD: 164 borderline and 63 definite (42 mild, 21 moderate/severe). Median age at diagnosis was 12 years and median follow-up was 2.3 years (IQR 2.0–2.9). Penicillin prophylaxis was prescribed in 49.3% with overall adherence of 84.7%. Of children with moderate/severe definite RHD, 47.6% had echo progression (including 2 deaths), and 9.5% echo regression. Children with mild definite and borderline RHD showed 26% and 9.8% echo progression and 45.2% and 46.3% echo improvement respectively. Of those with mild definite RHD or borderline RHD, more advanced disease category, younger age, and morphological mitral valve features were risk factors for an unfavorable outcome. Conclusions Latent RHD is a heterogeneous diagnosis with variable disease outcomes. Children with moderate to severe latent RHD have poor outcomes. Children with both borderline and mild definite RHD are at substantial risk of progression. While long-term outcome remains unclear, the initial change in latent RHD may be evident during the first 1–2 years following diagnosis. Natural history data is inherently limited and a randomized clinical trial is needed to definitively determine the impact of penicillin prophylaxis on the trajectory of latent RHD.

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Section: Introductionmentioning

confidence: 78%

Latent Rheumatic Heart Disease

et al. 2017

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“…Echocardiographic screening for RHD is superior to clinical screening alone which underestimates the burden of RHD. Since the standardization of criteria for echocardiographic screening of RHD by WHF, several studies have been done on school children in Africa and other regions. There are regional variations in prevalence of RHD as risk factors of the disease are largely socio‐economic in nature.…”

Section: Discussionmentioning

confidence: 99%

Echocardiographic screening of 4107 Nigerian school children for rheumatic heart disease

Ekure

Amadi

Sokunbi

et al. 2019

Tropical Med Int Health

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“…5 Likewise, a school screening echocardiographic study in India identified an odds ratio of 1.84 for females presenting with rheumatic heart disease, 6 and women were also disproportionately overrepresented in Indonesian and Ethiopian echocardiographic studies. 7,8 However, paediatric screening echocardiography programmes in Malawi, Senegal, Peru and the Northern Territory of Australia [9][10][11][12] have not identified significant gender differences in the burden of rheumatic heart disease. The reason for the different findings of each of these studies is not clear and may relate to the different ages of patients enrolled in each study, cultural patterns of medical referral and outreach in each country and varying use of WHO and World Heart Federation echocardiographic criteria for diagnosis of rheumatic heart disease.…”

Section: Discussionmentioning

confidence: 99%

Heart disease in East Timor: cross‐sectional analysis of 474 patients attending Timor‐Leste's first cardiology service

Paratz¹,

Bayley²

2017

Internal Medicine Journal

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School and Community Screening Shows Malawi, Africa, to Have a High Prevalence of Latent Rheumatic Heart Disease

Abstract: Malawi has a high rate of latent RHD, which is consistent with other results from sub-Saharan Africa. This study strongly supports the need for a RHD prevention and control program in Malawi.

Cited by 37 publications

References 23 publications

Latent Rheumatic Heart Disease

Latent Rheumatic Heart Disease

Echocardiographic screening of 4107 Nigerian school children for rheumatic heart disease

Heart disease in East Timor: cross‐sectional analysis of 474 patients attending Timor‐Leste's first cardiology service

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