Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-26T07:06:21.514Z Has data issue: false hasContentIssue false
  • English
  • Français

Task shifting to clinical officer-led echocardiography screening for detecting rheumatic heart disease in Malawi, Africa

Published online by Cambridge University Press:  19 December 2016

Amy Sims Sanyahumbi ,
Craig A. Sable ,
Melissa Karlsten ,
Mina C. Hosseinipour ,
Peter N. Kazembe ,
Charles G. Minard  and
Daniel J. Penny
Amy Sims Sanyahumbi*
Affiliation:
Department of Cardiology, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, United States of America
Craig A. Sable
Affiliation:
Department of Cardiology, Children’s National Medical Center, Washington, District of Columbia, United States of America
Melissa Karlsten
Affiliation:
Department of Cardiology, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, United States of America
Mina C. Hosseinipour
Affiliation:
University of North Carolina Project, Lilongwe, Malawi
Peter N. Kazembe
Affiliation:
Baylor International Pediatric AIDS Initiative, Lilongwe, Malawi
Charles G. Minard
Affiliation:
Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas, United States of America
Daniel J. Penny
Affiliation:
Department of Cardiology, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, United States of America
*
Correspondence to: A. S. Sanyahumbi, MD, Department of Cardiology, Baylor College of Medicine, Texas Children’s Hospital, 6621 Fannin St, Houston, TX 77030, United States of America. Tel: 832 826 5600; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Echocardiographic screening for rheumatic heart disease in asymptomatic children may result in early diagnosis and prevent progression. Physician-led screening is not feasible in Malawi. Task shifting to mid-level providers such as clinical officers may enable more widespread screening.

Hypothesis

With short-course training, clinical officers can accurately screen for rheumatic heart disease using focussed echocardiography.

Methods

A total of eight clinical officers completed three half-days of didactics and 2 days of hands-on echocardiography training. Clinical officers were evaluated by performing screening echocardiograms on 20 children with known rheumatic heart disease status. They indicated whether children should be referred for follow-up. Referral was indicated if mitral regurgitation measured more than 1.5 cm or there was any measurable aortic regurgitation. The κ statistic was calculated to measure referral agreement with a paediatric cardiologist. Sensitivity and specificity were estimated using a generalised linear mixed model, and were calculated on the basis of World Heart Federation diagnostic criteria.

Results

The mean κ statistic comparing clinical officer referrals with the paediatric cardiologist was 0.72 (95% confidence interval: 0.62, 0.82). The κ value ranged from a minimum of 0.57 to a maximum of 0.90. For rheumatic heart disease diagnosis, sensitivity was 0.91 (95% confidence interval: 0.86, 0.95) and specificity was 0.65 (95% confidence interval: 0.57, 0.72).

Conclusion

There was substantial agreement between clinical officers and paediatric cardiologists on whether to refer. Clinical officers had a high sensitivity in detecting rheumatic heart disease. With short-course training, clinical officer-led echo screening for rheumatic heart disease is a viable alternative to physician-led screening in resource-limited settings.

Keywords

Rheumatic heart diseaseechocardiographyscreeningglobal cardiologytask shiftingpaediatric cardiology
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 6 , August 2017 , pp. 1133 - 1139
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. Marijon, E, Mirabel, M, Celermajer, DS, Jouven, X. Rheumatic heart disease. Lancet 2012; 379: 953–964.Google Scholar
2. Sims Sanyahumbi, A, Colquhoun, S, Wyber, R, Carapetis, J. Global disease burden of group A streptococcus. In: Ferretti JJ, Stevens DL, Fischetti VA (eds). Streptococcus Pyogenes: Basic Biology to Clinical Manifestations. University of Oklahoma Health Sciences Center, Oklahoma City, OK, 2016.Google Scholar
3. Mortality, GBD, Causes of Death C. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015; 385: 117–171.Google Scholar
4. Remenyi, B, Wilson, N, Steer, A, et al. World Heart Federation criteria for echocardiographic diagnosis of rheumatic heart disease – an evidence-based guideline. Nat Rev Cardiol 2012; 9: 297–309.Google Scholar
5. Carapetis, JR, Steer, AC, Mulholland, EK, Weber, M. The global burden of group A streptococcal diseases. The Lancet infectious diseases 2005; 5: 685–694.Google Scholar
6. Zachariah, JP, Samnaliev, M. Echo-based screening of rheumatic heart disease in children: a cost-effectiveness Markov model. Journal of medical economics 2015; 18: 410–419.Google Scholar
7. Rheumatic fever and rheumatic heart disease. World Health Organization Technical Report Series. 2004; 923: 1–122. PubMed PMID: 15382606.Google Scholar
8. Some, D, Edwards, JK, Reid, T, et al. Task shifting the management of non-communicable diseases to nurses in Kibera, Kenya: does it work? PLoS One 2016; 11: e0145634.CrossRefGoogle ScholarPubMed
9. World Health Organization. Treat Train Retrain. Task Shifting: Global Recommendations and Guidelines. WHO, Geneva, Switzerland, 2007.Google Scholar
10. World Health Organization. The World Health Report 2006 Working Together for Health. World Health Organization, Geneva, Switzerland.Google Scholar
11. World Bank Data Indicators: 2014 GNI per capita 2014. Retrieved March 24, 2016, from http://dataworldbankorg/indicator/NYGNPPCAPCD Google Scholar
12. World Health Organization: Global Health Observatory Data Repository. Retrieved March 24, 2016, from http://apps.who.int/gho/data/node.main.A1444 Google Scholar
13. Pelajo, CF, Lopez-Benitez, JM, Torres, JM, de Oliveira, SK. Adherence to secondary prophylaxis and disease recurrence in 536 Brazilian children with rheumatic fever. Pediatr Rheumatol Online J 2010; 8: 22.CrossRefGoogle ScholarPubMed
14. Karthikeyan, G, Zuhlke, L, Engel, M, et al. Rationale and design of a Global Rheumatic Heart Disease Registry: the REMEDY study. Am Heart J 2012; 163: 535–540 e1.Google Scholar
15. Sims Sanyahumbi, A, Sable, C, Beaton, A, Chimalizeni, Y, et al. School and community screening shows Malawi, Africa, to have a high prevalence of latent rheumatic heart disease. Congenit Heart Dis. 2016. Epub 2016 Mar 31.Google Scholar
16. Soliman, EZ, Juma, H. Cardiac disease patterns in northern Malawi: epidemiologic transition perspective. J Epidemiol 2008; 18: 204–208.Google Scholar
17. Kennedy, N, Miller, P. The spectrum of paediatric cardiac disease presenting to an outpatient clinic in Malawi. BMC Res Notes 2013; 6: 53.Google Scholar
18. Beaton, A, Nascimento, BR, Diamantino, AC, et al. Efficacy of a standardized computer-based training curriculum to teach echocardiographic identification of rheumatic heart disease to nonexpert users. Am J Cardiol. 2016. PubMed PMID: 27084054.CrossRefGoogle Scholar
19. Colquhoun, SM, Carapetis, JR, Kado, JH, et al. Pilot study of nurse-led rheumatic heart disease echocardiography screening in Fiji – a novel approach in a resource-poor setting. Cardiol Young 2013; 23: 546–552.Google Scholar
20. Zeger, S, Liang, KY. Longitudinal data analysis for discrete adn continuous outcomes. Biometrics 1986; 42: 121–130.Google Scholar
21. Lu, JC, Sable, C, Ensing, GJ, et al. Simplified rheumatic heart disease screening criteria for handheld echocardiography. J Am Soc Echocardiogr 2015; 28: 463–469.Google Scholar
22. Marijon, E, Ou, P, Celermajer, DS, et al. Prevalence of rheumatic heart disease detected by echocardiographic screening. N Engl J Med 2007; 357: 470–476.Google Scholar
23. Marijon, E, Ou, P, Celermajer, DS, et al. Echocardiographic screening for rheumatic heart disease. Bull World Health Organ 2008; 86: 84.CrossRefGoogle ScholarPubMed
24. Remenyi, B, Carapetis, J, Wyber, R, Taubert, K, Mayosi, BM. 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
25. Engelman, D, Kado, JH, Remenyi, B, et al. Screening for rheumatic heart disease: quality and agreement of focused cardiac ultrasound by briefly trained health workers. BMC Cardiovasc Disord 2016; 16: 30.Google Scholar
26. Saxena, A, Ramakrishnan, S, Roy, A, et al. Prevalence and outcome of subclinical rheumatic heart disease in India: the RHEUMATIC (Rheumatic Heart Echo Utilisation and Monitoring Actuarial Trends in Indian Children) study. Heart 2011; 97: 2018–2022.Google Scholar
27. Reeves, BM, Kado, J, Brook, M. High prevalence of rheumatic heart disease in Fiji detected by echocardiography screening. J Paediatr Child Health 2011; 47: 473–478.Google Scholar
28. Engelman, D, Kado, JH, Remenyi, B, et al. Teaching focused echocardiography for rheumatic heart disease screening. Ann Pediatr Cardiol 2015; 8: 118–121.Google Scholar