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Title: Rheumatic heart disease in Timor-Leste school students: an echocardiography-based prevalence study.
Authors: Davis, Kimberly
Remenyi, Bo
Draper, Anthony Dk
Dos Santos, Januario
Bayley, Noel
Paratz, Elizabeth
Reeves, Benjamin
Appelbe, Alan
Cochrane, Andrew
Johnson, Timothy D
Korte, Laura M
Do Rosario, Ivonia M
Da Silva Almeida, Inez T
Roberts, Kathryn V
Carapetis, Jonathan R
Francis, Joshua R
Affiliation: Royal Darwin Hospital, Darwin, NT
Royal Darwin Hospital, Darwin, NT..
Centre for Disease Control, Northern Territory Department of Health, Darwin, NT..
Maluk Timor, Dili, Timor-Leste..
East Timor Hearts Fund, Melbourne, VIC..
St Vincent's Hospital, Melbourne, VIC..
Cairns Hospital, Cairns, QLD..
Geelong Cardiology Group, Barwon Health, Geelong, VIC..
Monash Medical Centre Clayton, Melbourne, VIC..
Telethon Kids Institute, University of Western Australia, Perth, WA..
Paediatric WA Country Health Service - Kimberley, Broome, WA..
Hospital Nacional Guido Valadares, Dili, Timor-Leste..
Hospital Nacional Guido Valadares, Dili, Timor-Leste..
Royal Darwin Hospital, Darwin, NT..
Telethon Kids Institute, University of Western Australia, Perth, WA..
Royal Darwin Hospital, Darwin, NT..
Issue Date: 16-Apr-2018
Citation: The Medical journal of Australia 2018-04-16; 208(7): 303-307
Abstract: To determine the prevalence of rheumatic heart disease (RHD) in school-aged children and young people in Timor-Leste. 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. Schools in urban (Dili) and rural (Ermera) Timor-Leste. School students aged 5-20 years. Definite and borderline RHD, as defined by World Heart Federation echocardiographic criteria. 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. 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.
Type: Journal Article
Subjects: Echocardiography
Global health issues
Health inequalities
Rheumatic fever
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