title: School and Community Screening Shows Malawi, Africa, to Have a High Prevalence of Latent Rheumatic Heart Disease.
abstract: Rheumatic heart disease (RHD) is the largest cardiac cause of morbidity and mortality in the world's youth. Early detection of RHD through echocardiographic screening in asymptomatic children may identify an early stage of disease, when secondary prophylaxis has the greatest chance of stopping disease progression. Latent RHD signifies echocardiographic evidence of RHD with no known history of acute rheumatic fever and no clinical symptoms.
  
  
  OBJECTIVE
  Determine the prevalence of latent RHD among children ages 5-16 in Lilongwe, Malawi.
  
  
  METHODS
  This is a cross-sectional study in which children ages 5 through 16 were screened for RHD using echocardiography.
  
  
  METHODS
  Screening was conducted in 3 schools and surrounding communities in the Lilongwe district of Malawi between February and April 2014.
  
  
  METHODS
  Children were diagnosed as having no, borderline, or definite RHD as defined by World Heart Federation criteria. The primary reader completed offline reads of all studies. A second reader reviewed all of the studies diagnosed as RHD, plus a selection of normal studies. A third reader served as tiebreaker for discordant diagnoses. The distribution of results was compared between gender, location, and age categories using Fisher's exact test.
  
  
  RESULTS
  The prevalence of latent RHD was 3.4% (95% CI = 2.45, 4.31), with 0.7% definite RHD and 2.7% borderline RHD. There was no significant differences in prevalence between gender (P = .44), site (P = .6), urban vs. peri-urban (P = .75), or age (P = .79). Of those with definite RHD, all were diagnosed because of pathologic mitral regurgitation (MR) and 2 morphologic features of the mitral valve. Of those with borderline RHD, most met the criteria by having pathological MR (92.3%).
  
  
  CONCLUSIONS
  Malawi has a high rate of latent RHD, which is consistent with other results from sub-Saharan Africa. This study strongly supports the need for a RHD prevention and control program in Malawi.
authors.affiliation: Baylor College of Medicine/Texas Children's Hospital, Houston, Tex.
authors.forename: Amy
authors.initials: A
authors.lastname: Sims Sanyahumbi
authors.affiliation: Children's National Medical Center, Washington, DC.
authors.forename: Craig A
authors.initials: CA
authors.lastname: Sable
authors.affiliation: Children's National Medical Center, Washington, DC.
authors.forename: Andrea
authors.initials: A
authors.lastname: Beaton
authors.affiliation: Malawi College of Medicine, Blantyre, Malawi.
authors.forename: Yamikani
authors.initials: Y
authors.lastname: Chimalizeni
authors.affiliation: Baylor College of Medicine, Dan L Duncan Institute for Clinical and Translational Research, Houston, Tex.
authors.forename: Danielle
authors.initials: D
authors.lastname: Guffey
authors.affiliation: University of North Carolina Project, Lilongwe, Malawi.
authors.forename: Mina
authors.initials: M
authors.lastname: Hosseinipour
authors.affiliation: Baylor College of Medicine/Texas Children's Hospital, Houston, Tex.
authors.forename: Melissa
authors.initials: M
authors.lastname: Karlsten
authors.affiliation: Baylor College of Medicine Children's Clinical Center of Excellence, Lilongwe, Malawi.
authors.forename: Peter N
authors.initials: PN
authors.lastname: Kazembe
authors.affiliation: Malawi College of Medicine, Blantyre, Malawi.
authors.forename: Neil
authors.initials: N
authors.lastname: Kennedy
authors.affiliation: Baylor College of Medicine, Dan L Duncan Institute for Clinical and Translational Research, Houston, Tex.
authors.forename: Charles G
authors.initials: CG
authors.lastname: Minard
authors.affiliation: Baylor College of Medicine/Texas Children's Hospital, Houston, Tex.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Penny
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D058070:Asymptomatic Diseases; D002648:Child; D002675:Child, Preschool; D003153:Community Health Services; D003430:Cross-Sectional Studies; D018618:Echocardiography, Doppler, Color; D005260:Female; D006306:Health Surveys; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008403:Mass Screening / Q000379:methods*; D015588:Observer Variation; D011237:Predictive Value of Tests; D015995:Prevalence; D015203:Reproducibility of Results; D012214:Rheumatic Heart Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D012572:School Health Services; D017678:Sex Distribution
keywords: Echocardiography; Pediatrics; Rheumatic Heart Disease; Screening