Echocardiographic screening in a resource poor setting: Borderline rheumatic heart disease could be a normal variant
Section snippets
Introduction and background
Pacific Island countries have among the highest prevalence of rheumatic heart disease (RHD) and incidences of acute rheumatic fever (ARF) documented in the world [1], [2], [3], [4]. The Global Burden of Disease study estimated that RHD caused 4126 deaths in 2010 in the Oceania and Australasia regions, with 37,789 disability-adjusted life years lost [5], [6]. The true figures are likely to be higher as death reporting in many Pacific countries is poor and autopsies to confirm the cause of death
Setting
Fiji is a nation of approximately 300 islands located in the Western Pacific. It has a population of 837,271 people comprised of 2 main racial groups: iTaukei (Melanesian) (56.8%) and Indo-Fijians (37.5%) with the remaining 5.7% of the population consisting of people of other racial backgrounds (other Pacific Islanders, Chinese, Europeans and mixed race ethnicities) [10]. This project was undertaken in the Central Medical Division of Fiji on the Island of Viti Levu. In Fiji, there is a very
Echocardiography
We screened 1666 children with echocardiography. The most common finding detected by echocardiography was mitral regurgitation with 616 (37%) of all participants having some degree of mitral regurgitation in at least one view. However, only 72 (4.3%) and 34 (2.0%) had a mitral regurgitant jet measurement ≥ 1.5 cm and ≥ 2 cm in one view respectively. There were 65 children (3.9%) in whom morphological changes of the mitral valve were seen, and of these, 25 children (0.3% of total cohort) had more
Discussion
This study found a characteristic distribution of definite RHD in iTaukei female children and in children attending school in a rural location when using both the modified NIH/WHO and WHF criteria, consistent with previous published data [13], [15]. In contrast these associations disappeared or reversed for the probable RHD cases, with more males, more children of Indo-Fijian ethnicity and a predominance of children attending school in an urban location. The lack of classical RHD risk factor
Funding
This project was funded by the National Institutes of Health, Department of Microbiology and Infectious Diseases (DMID funding mechanism: U01AI60579). The funding body assisted with the development of the study protocol only. All data collection, analysis and interpretation of the study data was undertaken by the study team.
Acknowledgements
The authors thank the children and families in Fiji who participated in this study as well as the teachers and nurses who assisted in coordinating the field work. We also wish to acknowledge the Fiji GrASP research team; Frances Matanatabu, Laisiana Matatolu, Kavita Prasad and Sera Rayasidamu for their dedicated work in the field that made the completion of this project possible. We thank the cardiologists/paediatricians at the Starship Children's Hospital, Auckland New Zealand, who assisted in
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