Echocardiographic screening for early detection of rheumatic heart disease in schools

Rheumatic heart disease (RHD) develops as a long-term complication of childhood streptococcal angina. Late RHD can be detected by echocardiography years before it becomes a symbol. RHD can be treated when treated early with medication.

RHD is responsible for over 300 000 deaths worldwide each year, accounting for just over two-thirds of deaths from valvular heart disease. RHD is common throughout sub-Saharan Africa, South Asia and the Pacific Islands and is largely a phenomenon of marginalized communities in developing and emerging countries but has largely disappeared. in developed countries such as Switzerland.

Reduction of RHD 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 prior 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 the initial screening, a one-third reduction in RHD was reduced by two-thirds.

The results of our study support the notion that early detection of clinically silent RHD and timely onset of secondary antibiotic prophylaxis is an effective approach to control RHD in endemic regions. “

Professor Thomas Pilgrim

Large scale, sound analysis

The research team looked at 35 schools (collections) that were randomly assigned to an experimental or control group (browser randomized clinical trial procedure): 19 were included in the experimental group and 16 schools were assigned to the experimental group. assigned to the control group. In the 19 schools, the first systematic screening was followed by antibiotic prophylaxis in children diagnosed with RHD. After more than four years, all children in the screening group (n = 2648) and control group (n = 1325) were screened for RHD by echocardiography.

Particular challenges of site survey in Nepal

The publication sparked a lively debate shortly after its publication in JAMA Cardiology on 20 January 2021. The practical challenges of large-scale screening in economically disadvantaged areas have been mentioned several times.

Also notable in this study were two devastating earthquakes and political instability during the study period. It is a remarkable achievement to conduct scientific study with robust data in this environment. In TCT.MD of the Cardiovascular Research Foundation, Professor Partho Sengupta, MD, MBBS (University of West Virginia Heart and Viral Institute, Morgantown) describes the study as «carefully executed and carefully “and explains that it” fills an important gap in early detection and treatment of RHD. “

What now?

In order to undertake extensive screening projects in economically disadvantaged areas, various barriers, some of which are often high, must be overcome. These include trained specialists and doctors as well as ensuring consistently high quality across all areas and project stages. There are also financial challenges. For the Sunsari area, the study calculated total costs for complete screening over ten years of 1.4 million USD, which equates to a sum of almost 5 USD per child or 483 USD per RHD case detected.