The personal and clinical impact of screen-detected maternal rheumatic heart disease in Uganda: a prospective follow up study

Voleti, Sonia; Okello, Emmy; Murali, Meghna; Sarnacki, Rachel; Majwala, Albert; Ssembatya, Renny; Bakka, Olivia; Namisanvu, Henriator; Njeri, Angela; Matovu, Alphonsus; DeStigter, Kristen K.; Sable, Craig; Beaton, Andrea

doi:10.1186/s12884-020-03189-z

Cited by 7 publications

(2 citation statements)

References 29 publications

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“…RHD is a neglected chronic disease in many regions and has a high risk in young people after GAS infection [ 36 ]. Meanwhile, poor compliance to penicillin G prophylaxis was widespread in high-risk areas, and as much as 70% of patients in Uganda were non- or poorly compliant [ 37 ]. Educational programs for this disease were generally lacking in these areas and countries [ 38 , 39 ].…”

Section: Discussionmentioning

confidence: 99%

Global burden of rheumatic heart disease: trends from 1990 to 2019

Liang

et al. 2022

Arthritis Res Ther

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Background Rheumatic heart disease (RHD) is a critical public health issue worldwide, and its epidemiological patterns have changed over the decades. This article aimed to estimate the global trends of RHD, and attributable risks from 1990 to 2019. Methods Data on RHD burden were explored from the Global Burden of Disease Study 2019. Trends of the RHD burden were estimated using the estimated annual percentage change (EAPC) and age-standardized rate (ASR). Results During 1990–2019, increasing trends in the ASR of incidence and prevalence of RHD were observed worldwide, with the respective EAPCs of 0.58 (95% confidence interval [CI] 0.52 to 0.63) and 0.57 (95%CI 0.50 to 0.63). Meanwhile, increasing trends commonly occurred in low and middle Socio-Demographic Index (SDI) regions and countries. The largest increasing trends in the ASR of incidence and prevalence were seen in Fiji, with the respective EAPCs being 2.17 (95%CI 1.48 to 2.86) and 2.22 (95%CI 1.53 to 2.91). However, death and disability-adjusted life years (DALYs) due to RHD showed pronounced decreasing trends of ASR globally, in which the EAPCs were − 2.98 (95%CI − 3.03 to − 2.94) and − 2.70 (95%CI − 2.75 to − 2.65), respectively. Meanwhile, decreasing trends were also observed in all SDI areas and geographic regions. The largest decreasing trends of death were observed in Thailand (EAPC = − 9.55, 95%CI − 10.48 to − 8.61). Among the attributable risks, behavioral risk-related death and DALYs caused by RHD had pronounced decreasing trends worldwide and in SDI areas. Conclusions Pronounced decreasing trends of death and DALYs caused by RHD were observed in regions and countries from 1990 to 2019, but the RHD burden remains a substantial challenge globally. The results would inform the strategies for more effective prevention and control of RHD.

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Section: Discussionmentioning

confidence: 99%

Global burden of rheumatic heart disease: trends from 1990 to 2019

Liang

et al. 2022

Arthritis Res Ther

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“…Many aspects of the findings of our research are shared by other countries challenged by low-resources, poor access to services compounded by remoteness and lack of access to specialist services and gaps in health literacy among healthcare providers [ 18 52 53 54 55 56 57 ].…”

Section: Discussionmentioning

confidence: 99%

Caring for Pregnant Women with Rheumatic Heart Disease: A Qualitative Study of Health Service Provider Perspectives

Vaughan

Dawson

Peek

et al. 2021

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Background: Rheumatic heart disease (RHD) persists in low-middle-income countries and in high-income countries where there are health inequities. RHD in pregnancy (RHD-P) is associated with poorer maternal and perinatal outcomes. Our study examines models of care for women with RHD-P from the perspectives of health care providers. Methods: A descriptive qualitative study exploring Australian health professionals' perspectives of care pathways for women with RHD-P. Thematic analysis of semi-structured interviews with nineteen participants from maternal health and other clinical and non-clinical domains related to RHD-P. Results: A constellation of factors challenged the provision of integrated women-centred care, related to health systems, workforces and culture. Themes that impacted on the provision of quality woman-centred care included conduits of care -helping to break down silos of information, processes and access; 'layers on layers' -reflecting the complexity of care issues; and shared understandings -factors that contributed to improved understandings of disease and informed decision-making. Conclusions: Pregnancy for women with RHD provides an opportunity to strengthen health system responses, improve care pathways and address whole-of-life health. To respond effectively, structural and cultural changes are required including enhanced investment in education and capacity building -particularly in maternal health -to support a better informed and skilled workforce. Aboriginal Mothers and Babies programs provide useful exemplars to guide respectful effective models of care for women with RHD, with relevance for non-Indigenous women in high-risk RHD communities.For key goals to be met in the context of RHD, maternal health must be better integrated into RHD strategies and RHD better addressed in maternal health.

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Reasons for disagreement between screening and standard echocardiography in primary care: data from the PROVAR + study

Galdino

Amaral²,

Santos³

et al. 2023

Int J Cardiovasc Imaging

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Purpose: To evaluate the reasons for disagreement between screening echocardiography (echo), acquired by non-experts, and standard echo in the Brazilian primary care (PC).Methods: Over 20 months, 22 PC workers were trained on simpli ed handheld (GE VSCAN) echo protocols. Screening groups, consisting of patients aged 17-20, 35-40 and 60-65 years, and patients referred for clinical indications underwent focused echo. Studies were remotely interpreted in US and Brazil, and those diagnosed with major or severe HD were referred for standard echo performed by an expert. Major HD was de ned as moderate to severe valve disease, ventricular dysfunction/hypertrophy, pericardial effusion or wall-motion abnormalities. A random sample of exams was selected for evaluation of variables accounting for disagreement.Results: A sample of 768 patients was analyzed, 651 (85%) in the referred group. Quality issues were reported in 5.8%, and the random Kappa for major HD between screening and standard echo was 0.51. The most frequent reasons for disagreement were: overestimation of mitral regurgitation (MR) (17.9%, N=138), left ventricular (LV) dysfunction (15.7%, N=121), aortic regurgitation (AR) (15.2%, N=117), LV hypertrophy (13.5%, N=104) and tricuspid regurgitation (12.7%, N=98). Misdiagnosis of mitral and aortic morphological abnormalities was observed in 12.4% and 3.0%, and underestimation of AR and MR occurred in 4.6% and 11.1%. Among 257 patients with suspected mild/moderate MR, 129 were reclassi ed to normal.Conclusion: Although screening echo with task-shifting in PC is a promising tool in low-income areas, estimation of valve regurgitation and LV function and size account for considerable disagreement with standard exams.

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The personal and clinical impact of screen-detected maternal rheumatic heart disease in Uganda: a prospective follow up study

Cited by 7 publications

References 29 publications

Global burden of rheumatic heart disease: trends from 1990 to 2019

Global burden of rheumatic heart disease: trends from 1990 to 2019

Caring for Pregnant Women with Rheumatic Heart Disease: A Qualitative Study of Health Service Provider Perspectives

Reasons for disagreement between screening and standard echocardiography in primary care: data from the PROVAR + study

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