Format

Send to

Choose Destination
Med J Aust. 2018 Apr 16;208(7):303-307.

Rheumatic heart disease in Timor-Leste school students: an echocardiography-based prevalence study.

Author information

1
Royal Darwin Hospital, Darwin, NT josh.francis@nt.gov.au.
2
Royal Darwin Hospital, Darwin, NT.
3
Centre for Disease Control, Northern Territory Department of Health, Darwin, NT.
4
Maluk Timor, Dili, Timor-Leste.
5
East Timor Hearts Fund, Melbourne, VIC.
6
St Vincent's Hospital, Melbourne, VIC.
7
Cairns Hospital, Cairns, QLD.
8
Geelong Cardiology Group, Barwon Health, Geelong, VIC.
9
Monash Medical Centre Clayton, Melbourne, VIC.
10
Telethon Kids Institute, University of Western Australia, Perth, WA.
11
Paediatric WA Country Health Service - Kimberley, Broome, WA.
12
Hospital Nacional Guido Valadares, Dili, Timor-Leste.

Abstract

OBJECTIVES:

To determine the prevalence of rheumatic heart disease (RHD) in school-aged children and young people in Timor-Leste.

DESIGN:

Prospective cross-sectional survey. Echocardiography was performed by Australian cardiologists to determine the presence of RHD. Demographic data were also collected. Patients in whom RHD was detected were entered into a register to allow monitoring of adherence to secondary prophylaxis; the first dose of benzathine penicillin G (BPG) was administered on the day of screening.

SETTING:

Schools in urban (Dili) and rural (Ermera) Timor-Leste.

PARTICIPANTS:

School students aged 5-20 years.

OUTCOME MEASURES:

Definite and borderline RHD, as defined by World Heart Federation echocardiographic criteria.

RESULTS:

1365 participants were screened; their median age was 11 years (IQR, 9-14 years), and 53% were girls. The estimated prevalence of definite RHD was 18.3 cases per 1000 population (95% CI, 12.3-27.0 per 1000), and of definite or borderline RHD 35.2 per 1000 (95% CI, 26.5-46.4 per 1000). Definite (adjusted odds ratio [aOR], 3.5; 95% CI, 1.3-9.4) and definite or borderline RHD (aOR, 2.7; 95% CI, 1.4-5.2) were more prevalent among girls than boys. Eleven children (0.8%) had congenital heart disease. Of the 25 children in whom definite RHD was identified, 21 (84%) received education and a first dose of BPG on the day of screening; all 25 have since received education about primary care for RHD and have commenced penicillin prophylaxis.

CONCLUSIONS:

The rates of RHD in Timor-Leste are among the highest in the world, and prevalence is higher among girls than boys. Community engagement is essential for ensuring follow-up and the effective delivery of secondary prophylaxis.

KEYWORDS:

Echocardiography; Global health issues; Health inequalities; Rheumatic fever

PMID:
29642817
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Wiley
Loading ...
Support Center