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- Title
Rheumatic heart disease in Timor-Leste school students: an echocardiography-based prevalence study.
- Authors
Davis, Kimberly; Remenyi, Bo; Draper, Anthony D. K.; Dos Santos, Januario; Bayley, Noel; Paratz, Elizabeth; Reeves, Benjamin; Appelbe, Alan; Cochrane, Andrew; Johnson, Timothy D.; Korte, Laura M.; Do Rosario, Ivonia M.; Da Silva Almeida, Inez T.; Roberts, Kathryn V.; Carapetis, Jonathan R.; Francis, Joshua R.; Draper, Anthony Dk
- Abstract
<bold>Objectives: </bold>To determine the prevalence of rheumatic heart disease (RHD) in school-aged children and young people in Timor-Leste.<bold>Design: </bold>Prospective cross-sectional survey. Echocardiography was performed by Australian cardiologists to determine the presence of RHD. Demographic data were also collected. Patients in whom RHD was detected were entered into a register to allow monitoring of adherence to secondary prophylaxis; the first dose of benzathine penicillin G (BPG) was administered on the day of screening.<bold>Setting: </bold>Schools in urban (Dili) and rural (Ermera) Timor-Leste.<bold>Participants: </bold>School students aged 5-20 years.<bold>Outcome Measures: </bold>Definite and borderline RHD, as defined by World Heart Federation echocardiographic criteria.<bold>Results: </bold>1365 participants were screened; their median age was 11 years (IQR, 9-14 years), and 53% were girls. The estimated prevalence of definite RHD was 18.3 cases per 1000 population (95% CI, 12.3-27.0 per 1000), and of definite or borderline RHD 35.2 per 1000 (95% CI, 26.5-46.4 per 1000). Definite (adjusted odds ratio [aOR], 3.5; 95% CI, 1.3-9.4) and definite or borderline RHD (aOR, 2.7; 95% CI, 1.4-5.2) were more prevalent among girls than boys. Eleven children (0.8%) had congenital heart disease. Of the 25 children in whom definite RHD was identified, 21 (84%) received education and a first dose of BPG on the day of screening; all 25 have since received education about primary care for RHD and have commenced penicillin prophylaxis.<bold>Conclusions: </bold>The rates of RHD in Timor-Leste are among the highest in the world, and prevalence is higher among girls than boys. Community engagement is essential for ensuring follow-up and the effective delivery of secondary prophylaxis.
- Subjects
RHEUMATIC heart disease; HEALTH of school children; SCHOOL children; PATIENTS; JUVENILE diseases; ECHOCARDIOGRAPHY; LONGITUDINAL method; DISEASE prevalence; CROSS-sectional method
- Publication
Medical Journal of Australia, 2018, Vol 208, Issue 7, p303
- ISSN
0025-729X
- Publication type
journal article
- DOI
10.5694/mja17.00666