Meghan Zimmerman1,2, Amy Scheel3, Alyssa DeWyer4, Jane-Liz Nambogo5, Isaac Omara Otim6, Alison Tompsett7, Joselyn Rwebembera6, Emmy Okello6, Craig Sable7, Andrea Beaton8. 1. Children's Hospital at Dartmouth Hitchcock, Lebanon, PA, United States. 2. Dartmouth College, Hanover, IN, United States. 3. School of Medicine, Emory University, Atlanta, GA, United States. 4. School of Medicine, Virginia Tech Carilion, Roanoke, VA, United States. 5. Kampala CardioLab, Kampala, Uganda. 6. Uganda Heart Institute, Kampala, Uganda. 7. Children's National Hospital, Washington, DC, United States. 8. Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
Abstract
Background: Screening echocardiograms can detect early-stage rheumatic heart disease (RHD), offering a chance to limit progression. Implementation of screening programs is challenging and requires further research. This is the first large-scale study assessing the risk of RHD among previous screen-negative children. Methods: This retrospective cohort study, conducted in Gulu, Uganda, performed school-based echo screening on children ages 5-18 years. Surveys were used to determine which children underwent initial screening 3-5 years prior. Age, gender, and disease severity were compared between cohorts. Relative risk (RR) of RHD was calculated for those with a prior screen-negative echo (exposed cohort) compared to those undergoing first screening (unexposed cohort). Results: Echo screening was completed in 75,708 children; 226 were excluded, leaving 1,582 in the exposed cohort and 73,900 in the unexposed cohort. Prevalence of new RHD was 0.6% (10/1,582) and 1% (737/73,900), in the exposed and unexposed cohorts, respectively. The RR of RHD was 0.64 (95% CI 0.3-1.2, p = 0.15), a nearly 40% reduced risk of RHD in those with a prior negative echo. There was no difference in age or gender between RHD cohorts. All cases in the exposed cohort were borderline/mild; 2.6% of cases in the unexposed cohort had moderate/severe disease. Conclusion: There was no statistical difference in RHD prevalence between previous screen-negative children and children with no prior echocardiogram, however, there was a trend toward decreased risk and severity. This information has important implications for the design of screening programs and the use of screening echocardiograms in endemic RHD regions.
Background: Screening echocardiograms can detect early-stage rheumatic heart disease (RHD), offering a chance to limit progression. Implementation of screening programs is challenging and requires further research. This is the first large-scale study assessing the risk of RHD among previous screen-negative children. Methods: This retrospective cohort study, conducted in Gulu, Uganda, performed school-based echo screening on children ages 5-18 years. Surveys were used to determine which children underwent initial screening 3-5 years prior. Age, gender, and disease severity were compared between cohorts. Relative risk (RR) of RHD was calculated for those with a prior screen-negative echo (exposed cohort) compared to those undergoing first screening (unexposed cohort). Results: Echo screening was completed in 75,708 children; 226 were excluded, leaving 1,582 in the exposed cohort and 73,900 in the unexposed cohort. Prevalence of new RHD was 0.6% (10/1,582) and 1% (737/73,900), in the exposed and unexposed cohorts, respectively. The RR of RHD was 0.64 (95% CI 0.3-1.2, p = 0.15), a nearly 40% reduced risk of RHD in those with a prior negative echo. There was no difference in age or gender between RHD cohorts. All cases in the exposed cohort were borderline/mild; 2.6% of cases in the unexposed cohort had moderate/severe disease. Conclusion: There was no statistical difference in RHD prevalence between previous screen-negative children and children with no prior echocardiogram, however, there was a trend toward decreased risk and severity. This information has important implications for the design of screening programs and the use of screening echocardiograms in endemic RHD regions.
Authors: Chris T Longenecker; Stephen R Morris; Twalib O Aliku; Andrea Beaton; Marco A Costa; Moses R Kamya; Cissy Kityo; Peter Lwabi; Grace Mirembe; Dorah Nampijja; Joselyn Rwebembera; Craig Sable; Robert A Salata; Amy Scheel; Daniel I Simon; Isaac Ssinabulya; Emmy Okello Journal: Circ Cardiovasc Qual Outcomes Date: 2017-11
Authors: Liesl Zühlke; Ganesan Karthikeyan; Mark E Engel; Sumathy Rangarajan; Pam Mackie; Blanche Cupido-Katya Mauff; Shofiqul Islam; Rezeen Daniels; Veronica Francis; Stephen Ogendo; Bernard Gitura; Charles Mondo; Emmy Okello; Peter Lwabi; Mohammed M Al-Kebsi; Christopher Hugo-Hamman; Sahar S Sheta; Abraham Haileamlak; Wandimu Daniel; Dejuma Yadeta Goshu; Senbeta G Abdissa; Araya G Desta; Bekele A Shasho; Dufera M Begna; Ahmed ElSayed; Ahmed S Ibrahim; John Musuku; Fidelia Bode-Thomas; Christopher C Yilgwan; Ganiyu A Amusa; Olukemi Ige; Basil Okeahialam; Christopher Sutton; Rajeev Misra; Azza Abul Fadl; Neil Kennedy; Albertino Damasceno; Mahmoud U Sani; Okechukwu S Ogah; Taiwo OlunugaHuda H M Elhassan; Ana Olga Mocumbi; Abiodun M Adeoye; Phindile Mntla; Dike Ojji; Joseph Mucumbitsi; Koon Teo; Salim Yusuf; Bongani M Mayosi Journal: Circulation Date: 2016-10-04 Impact factor: 29.690
Authors: Marc Rémond; David Atkinson; Andrew White; Alex Brown; Jonathan Carapetis; Bo Remenyi; Kathryn Roberts; Graeme Maguire Journal: Int J Cardiol Date: 2015-07-06 Impact factor: 4.164
Authors: Elizabeth Stein; Jafesi Pulle; Meghan Zimmerman; Isaac Otim; Jenifer Atala; Joselyn Rwebembera; Linda Mary Oyella; Nada Harik; Emmy Okello; Craig Sable; Andrea Beaton Journal: Am J Trop Med Hyg Date: 2020-12-14 Impact factor: 2.345