TY - JOUR
T1 - Morbidity and mortality of rheumatic heart disease and acute rheumatic fever in the inpatient setting in Timor-Leste
AU - Davis, Kimberly
AU - de Oliveira, Lidia N.L.
AU - da Silva Almeida, Ines
AU - Noronha, Mario
AU - Martins, Joao
AU - dos Santos, Milena
AU - Monteiro, Andre
AU - Brewster, David
AU - Horton, Ari
AU - Remenyi, Bo
AU - Francis, Joshua R.
N1 - Funding Information:
Conflict of interest: JR Francis receives funding from a National Health and Medical Research Council Investigator Grant (APP1194707), and from both the Department of Foreign Affairs and Trade and the Fleming Fund for health system strengthening and research work in Timor‐Leste. D Brewster was employed by the Royal Australasian College of Surgeons. K Davis, LNL de Oliveira, I da Silva Almeida, J Martins, M dos Santos, A Horton, B Remenyi and A Monteiro declare no conflicts.
Publisher Copyright:
© 2021 The Authors Journal of Paediatrics and Child Health published by John Wiley & Sons Australia, Ltd on behalf of Paediatrics and Child Health Division (The Royal Australasian College of Physicians).
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/9
Y1 - 2021/9
N2 - Aim: To describe the clinical features, treatment and outcomes of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) in children admitted to the national referral hospital in Dili, Timor-Leste. Methods: This prospective study documented cases of ARF and RHD in children aged 14 years and under who were admitted between June 2017 and May 2019. ARF was diagnosed using an adapted version of the 2015 Jones criteria and presumed (rather than proven) exposure to group A Streptococcus. Clinical and echocardiographic findings, comorbidities and discharge outcomes are reported. Results: A total of 63 patients were admitted with ARF or RHD; 54 were diagnosed with RHD for the first time. Median age was 11 years (range 3–14); 48% were female. Of those with echocardiograms, 56/58 had RHD, 55/56 (98%) had mitral regurgitation (37/55 (67%) severe), 11/56 (20%) had mitral stenosis and 43/56 (77%) had aortic regurgitation. Left ventricular dysfunction (55%), pulmonary hypertension (64%) and cardiac failure (78%) were common. Four (6%) patients died in hospital, and 30/59 (51%) of surviving patients were lost to follow up. Conclusions: Community echocardiography screening has reported a high prevalence of undetected mild to moderate cases of RHD in Timor-Leste, whereas this hospital study documents mostly severe disease among hospitalised patients with a high case fatality rate and loss to follow up. RHD is a significant health problem in Timor-Leste and improved recognition and diagnosis, as well as effective delivery of treatment and follow-up are imperative.
AB - Aim: To describe the clinical features, treatment and outcomes of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) in children admitted to the national referral hospital in Dili, Timor-Leste. Methods: This prospective study documented cases of ARF and RHD in children aged 14 years and under who were admitted between June 2017 and May 2019. ARF was diagnosed using an adapted version of the 2015 Jones criteria and presumed (rather than proven) exposure to group A Streptococcus. Clinical and echocardiographic findings, comorbidities and discharge outcomes are reported. Results: A total of 63 patients were admitted with ARF or RHD; 54 were diagnosed with RHD for the first time. Median age was 11 years (range 3–14); 48% were female. Of those with echocardiograms, 56/58 had RHD, 55/56 (98%) had mitral regurgitation (37/55 (67%) severe), 11/56 (20%) had mitral stenosis and 43/56 (77%) had aortic regurgitation. Left ventricular dysfunction (55%), pulmonary hypertension (64%) and cardiac failure (78%) were common. Four (6%) patients died in hospital, and 30/59 (51%) of surviving patients were lost to follow up. Conclusions: Community echocardiography screening has reported a high prevalence of undetected mild to moderate cases of RHD in Timor-Leste, whereas this hospital study documents mostly severe disease among hospitalised patients with a high case fatality rate and loss to follow up. RHD is a significant health problem in Timor-Leste and improved recognition and diagnosis, as well as effective delivery of treatment and follow-up are imperative.
KW - acute rheumatic fever
KW - child mortality
KW - paediatric cardiology
KW - rheumatic heart disease
KW - Timor-Leste
UR - http://www.scopus.com/inward/record.url?scp=85103681678&partnerID=8YFLogxK
U2 - 10.1111/jpc.15476
DO - 10.1111/jpc.15476
M3 - Article
AN - SCOPUS:85103681678
VL - 57
SP - 1391
EP - 1396
JO - Journal of Paediatrics and Child Health
JF - Journal of Paediatrics and Child Health
SN - 1034-4810
IS - 9
ER -