The benefits and harms of rheumatic heart disease screening from the perspective of the screened population

Gurney, Jason; Chong, Angela; Culliford-Semmens, Nicola; Tilton, Elizabeth; Wilson, Nigel; Sarfati, Diana

doi:10.1016/j.ijcard.2016.07.025

Cited by 10 publications

(8 citation statements)

References 19 publications

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“…Secondary antibiotic prophylaxis, using monthly benzathine penicillin G (BPG) injections, still remains the most effective therapeutic intervention for prevention of disease progression in low‐ and middle‐income countries [1,2]. Therefore, screening of high‐risk populations for early identification of subclinical disease and the use of penicillin prophylaxis to prevent disease progression are essential steps for reducing the burden of disease in these countries where ARF and RHD still remain of public health importance [2,6,7].…”

Section: Introductionmentioning

confidence: 99%

Prevalence of rheumatic heart disease in North‐Central Nigeria: a school‐based cross‐sectional pilot study

Nkereuwem

Ige

Yilgwan

et al. 2020

Tropical Med Int Health

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Objectives To present epidemiological data on rheumatic heart disease (RHD), the most common acquired heart disease in children and young adults in low‐ and middle‐income countries, for North‐Central Nigeria. Methods In this pilot study, we conducted clinical and echocardiography screening on a cross section of randomly selected secondary schoolchildren in Jos, North‐Central Nigeria, from March to September 2016. For outcome classification into borderline or definite RHD, we performed a confirmatory echocardiography using the World Heart Federation criteria for those suspected to have RHD from the screening. Results A total of 417 secondary schoolchildren were screened, of whom 247 (59.2%) were female. The median age was 14 years (IQR: 13–15). Clinical screening detected 8/417 children, whereas screening echocardiography detected 42/417 suspected cases of RHD. Definitive echocardiography confirmed 9/417 with RHD corresponding to a prevalence of 21.6 per 1000 (95% CI, 6.7–36.5). All but one of the confirmed RHD cases (8/9) were borderline RHD corresponding to a prevalence of 19.2 per 1000 (95% CI, 8.3–37.5) for borderline RHD and 2.4 per 1000 (95% CI, 0.1–13.3) for definite RHD. RHD was more common in boys and cardiac auscultation missed over 50% of the cases. Conclusions This study showed a high prevalence of RHD among secondary schoolchildren in North‐Central Nigeria with a vast predominance of asymptomatic borderline lesions. Larger school‐based echocardiography screening using portable or handheld echocardiography aimed at early detection of subclinical RHD should be adopted.

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Section: Introductionmentioning

confidence: 99%

Prevalence of rheumatic heart disease in North‐Central Nigeria: a school‐based cross‐sectional pilot study

Nkereuwem

Ige

Yilgwan

et al. 2020

Tropical Med Int Health

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“…There has been some concern about the benefits and potential harms of screening for RHD since the screening process may generate considerable anxiety in screened individuals, especially among those who are determined to be positives. 27 However, awareness about the disease is seen as a pre-requisite for any effective prevention program, and an educational presentation has been shown to reduce some of the apprehension related to screening studies. 28 In a study conducted in Gulu, Uganda, 4,773 students in the age group 5–15 from five schools underwent echocardiographic screening for RHD.…”

Section: Discussionmentioning

confidence: 99%

A questionnaire survey for improving awareness of rheumatic heart disease among school-aged children in India

Ray

Guha²,

Ray

et al. 2020

Indian Heart Journal

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Objectives We examined the level of awareness about Rheumatic Heart Disease (RHD) among school-aged children in a rural district of India and evaluated the effects of a questionnaire-based survey in improving the level of awareness. Methods The study involved 8,646 students aged 10–16 years from 20 schools in West Midnapore, India which was conducted in August 2017. We examined changes in the level of awareness of RHD using a 29-point scoring system in seven domains. The baseline questionnaire survey assessed students’ knowledge and was followed by a multimedia presentation about RHD and a post-intervention survey using the same questionnaire. The questionnaire included 9 questions on different aspects of RHD including prevalence, nature of disease, symptoms, determinants, treatment options, impact of the disease and diagnosis. Results The mean age of the study population was 13 years and 46% were boys. At baseline, the mean level of knowledge about RHD was 42% (12.2 out of 29 points). After the school-based presentation, the score improved to a mean of 55% (15.9 points on the 29-point scale), a 31% relative improvement. Improvement in students' knowledge was noted across all seven domains, individually and combined ( p < 0.001). Conclusions Awareness among children in rural India about RHD is modest. A school-based intervention could help in improving awareness about this chronic condition and may promote secondary prophylaxis to reduce the morbidity and mortality from RHD.

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“…Echocardiographic screening may have detrimental effects, specifically increased anxiety as well as a decrease in physical activity among those who receive an abnormal screening result. [35] Furthermore if the goal of screening is to institute secondary penicillin prophylaxis, we must determine whether prophylactic penicillin can mitigate progression in latent disease as it does in RHD diagnosed after clinically manifest ARF. [36][37][38][39][40] Administration of intra-muscular penicillin to children must be rigorously justified given it is painful [41] and causes significant trauma for the patient, parents and health care worker [42] with reports of significant peri-procedural anxiety, needle phobia, and medical fear.…”

Section: Plos Onementioning

confidence: 99%

Echocardiographic screening to determine progression of latent rheumatic heart disease in endemic areas: A systematic review and meta-analysis

et al. 2020

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Background The World Health Organisation previously recommended routine screening in school-aged children in countries with a high prevalence of rheumatic heart disease (RHD); however, it is unclear if screening-detected (latent) valve disease will inevitably evolve to a pathological lesion. Understanding the natural history of latent RHD is essential prior to recommendation of screening in endemic areas. Studies documenting the progression of latent RHD have had contrasting conclusions about the pathogenicity of latent valvular lesions. This review provides estimates of rates of progression of latent RHD. Methods and findings In this systematic review and meta-analysis, we searched EMBASE, MEDLINE, Global Index Medicus, Africa Wide, Cochrane Database of Systematic Reviews and Global Health Database for studies published before April 30, 2019. Study data were extracted from all studies which reported follow-up data on progression of latent valve lesions. Studies with control cohorts were used to calculate comparative prevalence ratios. This study is registered with PROSPERO, number CRD42019119427. We identified 12 studies reporting follow-up data on latent RHD for 950 people in 9 countries. The estimated pooled prevalence rate for progression per year of latent RHD was 5%/year (95% CI 2-8). Eight studies reported on the progression of borderline latent RHD with an estimated pooled prevalence of 2%/year (95% CI 0-4). Three studies included control groups. There was a significant increase in the risk of progression of valvular disease in the latent group compared with controls (RR = 3.57 (95%CI = 1.65-7.70, P = 0.001). The overall risk of bias was low. Given most studies included penicillin administration we were unable to document the natural history of latent RHD. Furthermore, we were unable to perform a sensitivity analysis to

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The benefits and harms of rheumatic heart disease screening from the perspective of the screened population

Cited by 10 publications

References 19 publications

Prevalence of rheumatic heart disease in North‐Central Nigeria: a school‐based cross‐sectional pilot study

Prevalence of rheumatic heart disease in North‐Central Nigeria: a school‐based cross‐sectional pilot study

A questionnaire survey for improving awareness of rheumatic heart disease among school-aged children in India

Echocardiographic screening to determine progression of latent rheumatic heart disease in endemic areas: A systematic review and meta-analysis

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