Echocardiographic screening for rheumatic heart disease in Nepal

February 11, 2021

Rheumatic heart disease (RHD) develops as a long term complication of childhood streptococcal angina. Latent RHD can be detected with echocardiography years before it becomes symptomatic. RHD is curable when treated early with medication.

RHD is responsible for over 300 000 deaths worldwide each year, accounting for just over two-thirds of all deaths from valvular heart diseases. RHD is disproportionally prevalent across sub-Saharan Africa, South Asia and the Pacific Islands and largely a phenomenon of marginalized communities in developing and emerging countries whereas it disappeared mostly in developed countries like Switzerland.

RHD reduction by two thirds in schools with early detection screening

The most important finding of the study was a significant reduction of RHD in schools with previous echocardiographic screening for silent disease, followed by antibiotic prophylaxis in children with echocardiographic evidence of RHD. In schools, where children with RHD were treated after initial screening, a reduction of the prevalence of RHD by two thirds was achieved.

Prof. Thomas Pilgrim points out: "The results of our study support the hypothesis that early detection of clinically silent RHD and timely initiation of secondary antibiotic prophylaxis are an effective approach to control RHD in endemic regions."

Sound, large-scale study

The research team looked at 35 schools (clusters) that were randomly allocated to an experimental group or to a control group (methodology of a cluster randomized clinical trial): 19 were included in the experimental group and 16 schools were assigned to the control group. In the 19 schools, the systematic initial screening was followed by antibiotic prophylaxis in children found to have RHD. After more than four years, all children in the screening group (n=2648) and the control group (n=1325) were examined for RHD by echocardiography.

Particular challenges of field research in Nepal

The publication sparked a lively discussion shortly after its publication in «JAMA cardiology» on January 20, 2021. The practical challenges of large-scale screening in economically disadvantaged areas were mentioned on several occasions. Also particular to this study was the aftermath of two devastating earthquakes and political instability during the study period. It is an extraordinary achievement to conduct scientific research with sound data in this environment. In «TCT.MD of the Cardiovascular Research Foundation», Prof. Partho Sengupta, MD, MBBS (West Virginia University Heart and Vascular Institute, Morgantown) describes the study as «very carefully and meticulously executed" and explains that it "fills an important gap in the early detection and treatment of RHD.»

What's next?

In order to carry out extensive screening projects in economically disadvantaged regions, various hurdles, some often high, have to be overcome. These include training specialists and doctors as well as ensuring consistently high quality across all areas and project phases. There are also financial challenges. For the Sunsari district, the study calculated total costs for comprehensive screening over ten years of 1.4 million USD, which corresponds to an amount of almost 5 USD per child or 483 USD per detected RHD case.
-end-


Inselspital, Bern University Hospital

Related Children Articles from Brightsurf:

Black and Hispanic children in the US have more severe eczema than white children
A presentation at this year's virtual American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting reveals the disparities that exist for Black and Hispanic children when it comes to Atopic Dermatitis (AD), commonly known as eczema.

Black children with cancer three times less likely to receive proton radiotherapy than White children
A retrospective analysis led by investigators from Brigham and Women's Hospital has found racial disparities in the use of the therapy for patients enrolled in trials.

The Lancet Child & Adolescent Health: First Europe-wide study of children confirms COVID-19 predominately causes mild disease in children and fatalities are very rare
Children with COVID-19 generally experience a mild disease and fatalities are very rare, according to a study of 582 patients from across Europe published today in The Lancet Child & Adolescent Health journal.

Children not immune to coronavirus; new study from pandemic epicenter describes severe COVID-19 response in children
- While most children infected with the novel coronavirus have mild symptoms, a subset requires hospitalization and a small number require intensive care.

How many children is enough?
Most Russians would like to have two children: a boy and a girl.

Preterm children have similar temperament to children who were institutionally deprived
A child's temperament is affected by the early stages of their life.

Only-children more likely to be obese than children with siblings
Families with multiple children tend to make more healthy eating decisions than families with a single child.

Children living in countryside outperform children living in metropolitan area in motor skills
Residential density is related to children's motor skills, engagement in outdoor play and organised sports. that Finnish children living in the countryside spent more time outdoors and had better motor skills than their age peers in the metropolitan area.

Hispanic and black children more likely to miss school due to eczema than white children
In a study that highlights racial disparities in the everyday impact of eczema, new research shows Hispanic and black children are more likely than white children to miss school due to the chronic skin disease.

Children, their parents, and health professionals often underestimate children's higher weight status
More than half of parents underestimated their children's classification as overweight or obese -- children themselves and health professionals also share this misperception, according to new research being presented at this year's European Congress on Obesity (ECO) in Glasgow, UK (April 28-May 1).

Read More: Children News and Children Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.