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Rheumatic heart disease: pilot study for a population-based evaluation of prevalence and cardiovascular outcomes among schoolchildren in Nepal.
[acute rheumatic fever]
To
evaluate
a
protocol
for
a
population-based
programme
targeting
the
prevention
of
rheumatic
heart
disease
(
RHD
)
progression
by
early
echocardiographic
diagnosis
of
valvular
lesions
and
timely
implementation
of
secondary
prevention
.
Observational
survey
with
a
subsequent
prospective
cohort
study
.
Private
boarding
school
in
the
urban
area
of
the
Sunsari
district
situated
on
the
foothills
of
the
Lower
Himalayan
Range
in
Eastern
Nepal
.
Fifty
-
four
unselected
school
-going
children
5
-
15
years
of
age
,
24
girls
and
30
boys
.
Logistic
feasibility
of
a
large
-scale
population-based
screening
study
using
the
echocardiographic
criteria
formulated
by
the
World
Heart
Federation
,
with
longitudinal
follow-up
of
children
with
definite
or
borderline
RHD
in
a
prospective
cohort
study
.
Standardised
interview
,
physical
examination
and
screening
echocardiography
were
performed
in
a
three
-staged
process
and
took
approximately
6
min
per
child
.
Socio-economic
status
was
assessed
using
surrogate
markers
such
as
the
occupation
of
the
primary
caregiver
,
numbers
of
rooms
at
home
,
car
,
television
,
cell
phone
and
internet
connection
.
Physical
examination
was
focused
on
cardiac
auscultation
and
signs
of
acute
rheumatic
fever
and
targeted
echocardiography
was
performed
by
an
independent
examiner
without
knowledge
of
the
clinical
findings
.
Two
children
with
evidence
of
borderline
RHD
were
re
-examined
at
B
.
P
.
Koirala
Institute
of
Health
Sciences
and
the
indication
for
secondary
antibiotic
prevention
was
discussed
with
the
parents
and
the
children
.
At
6
months
of
follow-up
,
echocardiographic
findings
were
stable
in
both
children
.
Implementation
of
secondary
antibiotic
prevention
was
challenged
by
impaired
awareness
of
subclinical
RHD
among
parents
and
inadequate
cooperation
with
family
physicians
.
This
pilot
study
shows
that
the
methods
outlined
in
the
protocol
can
be
translated
into
a
large
-scale
population-based
study
.
We
learned
that
education
and
collaboration
with
teachers
,
parents
and
family
physicians
/
paediatricians
will
be
of
key
importance
in
order
to
establish
a
sustainable
programme
.
Diseases
Validation
Diseases presenting
"heart disease"
symptom
22q11.2 deletion syndrome
achondroplasia
acute rheumatic fever
adrenal incidentaloma
child syndrome
classical phenylketonuria
cohen syndrome
congenital diaphragmatic hernia
dentinogenesis imperfecta
esophageal adenocarcinoma
fabry disease
familial mediterranean fever
heparin-induced thrombocytopenia
hirschsprung disease
holt-oram syndrome
homocystinuria without methylmalonic aciduria
kabuki syndrome
monosomy 21
omenn syndrome
phenylketonuria
sneddon syndrome
systemic capillary leak syndrome
wiskott-aldrich syndrome
wolf-hirschhorn syndrome
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