title: Undetected rheumatic heart disease revealed using portable echocardiography in a population of school students in Tairawhiti, New Zealand.
abstract: OBJECTIVE
  The aim of this programme was to find undetected rheumatic heart disease (RHD) in students from selected schools in the Tairawhiti region (eastern part of the North Island) of New Zealand.
  
  
  METHODS
  Portable echocardiography was used to scan students in 5 urban and rural schools in Tairawhiti where the population is predominantly Maori. The age range of students in the urban schools was 10-13 years and in the rural schools 5-17 years. Those with abnormal echocardiograms were referred for a paediatric consultation, with hospital-based echocardiography if required for the clarification of diagnoses and further management.
  
  
  RESULTS
  A total of 685 students, representing over 95% of the schools' students, consented to having echocardiographic scanning. After repeat hospital based echocardiography for 11 students, a total of 52 scans were regarded as abnormal. In this population definite (n=4) or probable (n=7) RHD was found in 11 students a prevalence of 1.61% (95%CIs 0.80-2.85). Possible RHD was found in 19 students. Previously undetected confirmed (n=1) or probable (n=7) RHD was found in 8 students a prevalence of 1.17% (95%CIs 0.51-2.29). Congenital heart defects (CHD) were found in 22 students a prevalence of 3.21% (95%CIs 2.02-4.83).
  
  
  CONCLUSIONS
  Echocardiography was a popular modality and detected a significant burden of previously unknown RHD in this young Maori population who are now receiving penicillin. However, echocardiography detected a greater prevalence of possible RHD for which optimum management is at present uncertain. Echocardiography also detected students with a range of severity of CHD. Screening with echocardiography for RHD would involve a significant use of public health, paediatric and cardiac resources with 7.6% of students and their families requiring clinical consultations and ongoing management of the abnormal echocardiographic results.
authors.affiliation: Te Puna Waiora, Tairawhiti District Health, Private Bag 7001, Gisborne, New Zealand. geoffreyc@tdh.org.nz
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Cramp
authors.forename: Mary
authors.initials: M
authors.lastname: Stonehouse
authors.forename: Rachel
authors.initials: R
authors.lastname: Webb
authors.forename: Rachel
authors.initials: R
authors.lastname: Webb
authors.forename: Gina
authors.initials: G
authors.lastname: Chaffey-Aupouri
authors.forename: Nigel
authors.initials: N
authors.lastname: Wilson
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D019719:Diagnostic Equipment; D003951:Diagnostic Errors / Q000517:prevention & control*; D003954:Diagnostic Services / Q000458:organization & administration / Q000706:statistics & numerical data; D004452:Echocardiography / Q000295:instrumentation / Q000379:methods; D004867:Equipment Design; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D008297:Male; D009520:New Zealand / Q000453:epidemiology; D010406:Penicillins / Q000627:therapeutic use*; D015995:Prevalence; D011336:Probability; D016730:Program Development; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012214:Rheumatic Heart Disease / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D012572:School Health Services / Q000458:organization & administration / Q000706:statistics & numerical data; D012574:Schools; D012720:Severity of Illness Index; D013334:Students
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins