title: Echocardiographic screening in a resource poor setting: borderline rheumatic heart disease could be a normal variant.
abstract: OBJECTIVE
  To estimate the echocardiography confirmed prevalence of rheumatic heart disease (RHD) in school children in Fiji.
  
  
  METHODS
  Cross-sectional observational study.
  
  
  METHODS
  Ten primary schools in Fiji.
  
  
  METHODS
  School children aged 5-14 years.
  
  
  METHODS
  Each child had an echocardiogram performed by an echocardiographic technician subsequently read by a paediatric cardiologist not involved with field screening, and auscultation performed by a paediatrician.
  
  
  METHODS
  Echocardiographic criteria for RHD diagnosis were based on those previously published by the National Institutes of Health (NIH) and World Health Organization (WHO), and data were also analyzed using the new World Heart Federation (WHF) criteria. Prevalence figures were calculated with binomial 95% confidence intervals.
  
  
  RESULTS
  Using the modified NIH/WHO criteria the prevalence of definite RHD prevalence was 7.2 cases per 1000 (95% CI 3.7-12.5), and the prevalence of probable RHD 28.2 cases per 1000 (95% CI 20.8-37.3). By applying the WHF criteria the prevalence of definite and borderline RHD was 8.4 cases per 1000 (95% CI 4.6-14.1) and 10.8 cases per 1000 (95% CI 6.4-17.0) respectively. Definite RHD was more common in females (OR 5.1, 95% CI 1.1-48.3) and in children who attended school in a rural location (OR 2.3, 95% CI 0.6-13.50). Auscultation was poorly sensitive compared to echocardiography (30%).
  
  
  CONCLUSIONS
  There is a high burden of undiagnosed RHD in Fiji. Auscultation is poorly sensitive when compared to echocardiography in the detection of asymptomatic RHD. The results of this study highlight the importance of the use of highly sensitive and specific diagnostic criteria for echocardiography diagnosis of RHD.
authors.affiliation: Menzies School of Health Research, Darwin, Australia; Centre for International Child Health, University of Melbourne, Melbourne, Australia; Group A Streptococcal Research Group, Murdoch Children's Research Institute, Melbourne, Australia. Electronic address: samantha.colquhoun@rch.org.au.
authors.forename: S M
authors.initials: SM
authors.lastname: Colquhoun
authors.affiliation: Fiji Ministry of Health, Suva, Fiji.
authors.forename: J H
authors.initials: JH
authors.lastname: Kado
authors.affiliation: Menzies School of Health Research, Darwin, Australia; Starship Children's Hospital, Auckland, New Zealand.
authors.forename: B
authors.initials: B
authors.lastname: Remenyi
authors.affiliation: Auckland District Health Board, Auckland, New Zealand.
authors.forename: N J
authors.initials: NJ
authors.lastname: Wilson
authors.affiliation: Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, Australia.
authors.forename: J R
authors.initials: JR
authors.lastname: Carapetis
authors.affiliation: Centre for International Child Health, University of Melbourne, Melbourne, Australia; Group A Streptococcal Research Group, Murdoch Children's Research Institute, Melbourne, Australia.
authors.forename: A C
authors.initials: AC
authors.lastname: Steer
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003906:Developing Countries / Q000706:statistics & numerical data; D004452:Echocardiography / Q000706:statistics & numerical data*; D005260:Female; D005367:Fiji / Q000453:epidemiology; D006326:Heart Auscultation / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D015995:Prevalence; D040841:Resource Allocation / Q000706:statistics & numerical data; D012214:Rheumatic Heart Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D012574:Schools; D012680:Sensitivity and Specificity; D014944:World Health Organization
keywords: Developing country; Echocardiography; Epidemiology; Fiji; Prevalence; Rheumatic heart disease