High prevalence of rheumatic heart disease by clinical and echocardiographic screening among children in Fiji.
OBJECTIVE
Rheumatic heart disease (RHD) is an important cause of morbidity and mortality in young people in developing countries. Many cases of RHD are first detected when they progress to cardiac failure. Screening for RHD represents a means of detecting cases early so that preventative measures to halt the disease progression can be put into place.


METHODS
A cross-sectional screening survey of RHD in 3,462 children aged 5 to 15 years in Fiji was performed in 2006. A three-stage screening method was used: stage 1 involved auscultatory screening; stage 2 was a limited echocardiography of children identified as having a suspicious murmur in stage 1; and stage 3 involved a full echocardiography of children identified as having pathology in stage 2.


RESULTS
Among the 3,462 children screened, 359 (10.4%) had a significant murmur; subsequent echocardiography was performed on 331 of these children, with RHD being detected in 29 cases. The prevalence of definite RHD was 4.1 per 1,000 (95% CI 2.2-6.8), and the overall prevalence (definite or probable RHD) was 8.4 cases per 1,000 (95% CI 5.6-12).


CONCLUSIONS
The study results suggest that there is a significant burden of undetected RHD in Fiji. The three-stage approach described here represents a practical means of screening for clinical RHD in developing countries, although it does not allow detection of the subclinical disease.
Steer
Andrew C
AC
Centre for International Child Health, University of Melbourne, Department of Paediatrics, Royal Children's Hospital, Parkville, Melbourne, VIC, Australia 3052. andrew.steer@rch.org.au
Kado
Joseph
J
Wilson
Nigel
N
Tuiketei
Timaima
T
Batzloff
Michael
M
Waqatakirewa
Lepani
L
Mulholland
E Kim
EK
Carapetis
Jonathan R
JR
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D018618:Echocardiography, Doppler, Color / Q000379:methods; D005260:Female; D005367:Fiji / Q000453:epidemiology; D006326:Heart Auscultation / Q000379:methods; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D015995:Prevalence; D012214:Rheumatic Heart Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000208:ethnology; D012720:Severity of Illness Index