Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-25T01:15:11.344Z Has data issue: false hasContentIssue false
  • English
  • Français

Child and teacher acceptability of school-based echocardiographic screening for rheumatic heart disease in Uganda

Published online by Cambridge University Press:  17 March 2016

Michelle Ploutz ,
Twalib Aliku ,
Tyler Bradley-Hewitt ,
Andrea Dantin ,
Bethan Lemley ,
Catherine W. Gillespie ,
Peter Lwabi ,
Craig Sable  and
Andrea Beaton
Michelle Ploutz*
Affiliation:
Division of Cardiology, Children’s National Health System, Washington, District of Columbia, United States of America
Twalib Aliku
Affiliation:
Division of Pediatric Cardiology, Gulu Regional Referral Hospital, Gulu, Uganda
Tyler Bradley-Hewitt
Affiliation:
Division of Cardiology, Children’s National Health System, Washington, District of Columbia, United States of America
Andrea Dantin
Affiliation:
University of St Augustine, Austin, Texas, United States of America
Bethan Lemley
Affiliation:
Division of Cardiology, Children’s National Health System, Washington, District of Columbia, United States of America
Catherine W. Gillespie
Affiliation:
AARP Public Policy Institute, Washington, District of Columbia, United States of America
Peter Lwabi
Affiliation:
Division of Pediatric Cardiology, Uganda Heart Institute, Kampala, Uganda
Craig Sable
Affiliation:
Division of Cardiology, Children’s National Health System, Washington, District of Columbia, United States of America
Andrea Beaton
Affiliation:
Division of Cardiology, Children’s National Health System, Washington, District of Columbia, United States of America
*
Correspondence to: Dr M. Ploutz, Division of Cardiology, Children’s National Health System, 111 Michigan Avenue NW, Washington, DC 20010, United States of America. Tel: +202 476 2020; Fax: +202 476 5700; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction

Rheumatic heart disease causes substantial morbidity in children in low-income countries. School-based echocardiographic screening has been suggested as a means to identify children with latent disease; however, little is known about the experience of children and teachers participating in screenings. The aim of our study was to assess students’ and teachers’ experience of school-based echocardiographic screening and identify areas for improvement.

Materials and methods

A school-based echocardiographic screening programme was conducted in five schools in Northern Uganda in 2013. After 8 months, an age- and gender-stratified population that included 5% of the participating students and teachers completed a questionnaire via an in-person interview. Responses were reviewed by question and coded to identify key themes.

Results

A total of 255 students (mean 10.7 years; 48% male) and 35 teachers participated in our study. In total, 95% of the students and 100% of the teachers were happy to have participated in the screening; however, students reported feeling scared (35%) and nervous (48%) during the screening process. Programmatic strengths included the following: knowing one’s health status, opportunity to receive treatment, and staff interactions. Although 43% of the patients did not suggest a change with open-ended questioning, concerns regarding privacy, fear of the screening process, and a desire to include others in the community were noted.

Discussion

School-based echocardiographic rheumatic heart disease screening was well received by students and teachers. Future programmes would likely benefit from improved pre-screening education regarding the screening process and diagnosis of rheumatic heart disease. Furthermore, education of teachers and students could improve screening perception and establish realistic expectations regarding the scope of screening.

Keywords

Rheumatic heart diseaseechocardiographyscreeningquality improvement
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 1 , January 2017 , pp. 82 - 89
Check for updates
Copyright
© Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Global Burden of Disease Study C. Global, regional, and national incidence,prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013; 380: 2095–2128.Google Scholar
2. Carapetis, JR, Steer, AC, Mulholland, EK, et al. The global burden of group a streptococcal diseases. Lancet Infect Dis 2005; 5: 685–694.CrossRefGoogle Scholar
3. Feinstein, AR, Stern, EK, Spagnuolo, M. The prognosis of acute rheumatic fever. Am Heart J 1964; 68: 817–834.CrossRefGoogle ScholarPubMed
4. Majeed, HA, Batnager, S, Yousof, AM, et al. Acute rheumatic fever and the evolution of rheumatic heart disease: a prospective 12 year follow-up report. J Clin Epidemiol 1992; 45: 871–875.CrossRefGoogle ScholarPubMed
5. Marijon, E, Tafflet, M, Jouven, X. Time to use ultrasound and not stethoscopes for rheumatic heart disease screening. Nat Clin Pract Cardiovasc Med 2008; 5: E1–E3.CrossRefGoogle Scholar
6. Zhang, W, Mondo, C, Okello, E, et al. Presenting features of newly diagnosed rheumatic heart disease patients in Mulago Hospital: a pilot study. Cardiovasc J Afr 2013; 24: 28–33.CrossRefGoogle ScholarPubMed
7. Remenyi, B, Carapetis, J, Wyber, R, et al. Position statement of the World Heart Federation on the prevention and control of rheumatic heart disease. Nat Rev Cardiol 2013; 10: 284–292.CrossRefGoogle ScholarPubMed
8. Beaton, A, Okello, E, Lwabi, P, et al. Echocardiography screening for rheumatic heart disease in Ugandan schoolchildren. Circulation 2012; 125: 3127–3132.CrossRefGoogle Scholar
9. Zachariah, JP, Samnaliev, M. Echo-based screening of rheumatic heart disease in children: a cost-effectiveness Markov model. J Med Econ 2015; 9: 1–10.Google Scholar
10. Manji, RA, Witt, J, Tappia, PS, et al. Cost-effectiveness analysis of rheumatic heart disease prevention strategies. Expert Rev Pharmacoecon Outcomes Res 2013; 13: 715–724.CrossRefGoogle ScholarPubMed
11. Carapetis, JP, Paar, J, Cherian, T. Standardization of epidemiologic protocols for surveillance of post-streptococcal sequelae: acute rheumatic fever, rheumatic heart disease and acute post-streptococcal glomerulonephritis. Nat Inst Allergy Infect Dis 2006.Google Scholar
12. Roberts, K, Colquhoun, S, Steer, A, et al. Screening for rheumatic heart disease: current approaches and controversies. Nat Rev Cardiol 2013; 1: 49–58.CrossRefGoogle Scholar
13. Webb, RH, Gentles, TL, Stirling, JW, et al. Valvular regurgitation using portable echocardiography in a healthy student population: implications for rheumatic heart disease screening. J Am Soc Echocardiogr 2015; 28: 981–988.CrossRefGoogle Scholar
14. Wark, EM, Hodder, YC, Woods, CE, et al. Patient and health-care impact of a pilot rheumatic heart disease screening program. J Paediatr Child Health 2013; 49: 297–302.CrossRefGoogle ScholarPubMed
15. Beaton, A, Lu, JC, Aliku, T, et al. The utility of handheld echocardiography for early rheumatic heart disease diagnosis: a field study. Eur Heart J Cardiovasc Imaging 2015; 16: 475–482.CrossRefGoogle ScholarPubMed
16. Meyer, EC, Ritholz, MD, Burns, JP, et al. Improving the quality of end-of-life care in the pediatric intensive care unit: parents’ priorities and recommendations. Pediatrics 2006; 117: 649–657.CrossRefGoogle ScholarPubMed
17. Perelini, F, Blair, N, Wilson, N, et al. Family acceptability of school-based echocardiographic screening for rheumatic heart disease in a high-risk population in New Zealand. J Paediatr Child Health 2015; 51: 682–688.CrossRefGoogle Scholar
18. WHO. programme for the prevention of rheumatic fever/rheumatic heart disease in 16 developing countries: report from phase I (1986–90): WHO cardiovascular diseases unit and principal investigators. Bull World Health Organ 1992; 70: 213–218.Google Scholar
19. Harris, Paul A., Taylor, Robert, Thielke, Robert, et al. Research electronic data capture (REDCap) – A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42: 377–381.CrossRefGoogle ScholarPubMed
20. Zapka, J, Taplin, SH, Price, RA, et al. Factors in quality care-the case of follow-up to abnormal cancer screening tests- problems in steps and interfaces of care. J Natl Cancer Inst Monogr 2010; 20: 58–71.CrossRefGoogle Scholar