Rheumatic heart disease in Timor-Leste school students

An echocardiography-based prevalence study

Kimberly Davis, Bo Remenyi, Anthony D.K. Draper, Januario Dos Santos, Noel Bayley, Elizabeth Paratz, Benjamin Reeves, Alan Appelbe, Andrew Cochrane, Timothy D. Johnson, Laura M. Korte, Ivonia M. Do Rosario, Inez T. Da Silva Almeida, Kathryn V. Roberts, Jonathan R. Carapetis, Joshua R. Francis

    Research output: Contribution to journalArticleResearchpeer-review

    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.

    Original languageEnglish
    Pages (from-to)303-307
    Number of pages5
    JournalMedical Journal of Australia
    Volume208
    Issue number7
    DOIs
    Publication statusPublished - 2018

    Fingerprint

    Rheumatic Heart Disease
    Echocardiography
    Cross-Sectional Studies
    Students
    Penicillin G Benzathine
    Odds Ratio
    Timor-Leste
    Education
    Penicillins
    Heart Diseases
    Primary Health Care
    Demography
    Outcome Assessment (Health Care)

    Cite this

    Davis, K., Remenyi, B., Draper, A. D. K., Dos Santos, J., Bayley, N., Paratz, E., ... Francis, J. R. (2018). Rheumatic heart disease in Timor-Leste school students: An echocardiography-based prevalence study. Medical Journal of Australia, 208(7), 303-307. https://doi.org/10.5694/mja17.00666
    Davis, Kimberly ; Remenyi, Bo ; Draper, Anthony D.K. ; 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. / Rheumatic heart disease in Timor-Leste school students : An echocardiography-based prevalence study. In: Medical Journal of Australia. 2018 ; Vol. 208, No. 7. pp. 303-307.
    @article{a9baa6657dba4cdc9be39b35675cd62b,
    title = "Rheumatic heart disease in Timor-Leste school students: An echocardiography-based prevalence study",
    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.",
    author = "Kimberly Davis and Bo Remenyi and Draper, {Anthony D.K.} and {Dos Santos}, Januario and Noel Bayley and Elizabeth Paratz and Benjamin Reeves and Alan Appelbe and Andrew Cochrane and Johnson, {Timothy D.} and Korte, {Laura M.} and {Do Rosario}, {Ivonia M.} and {Da Silva Almeida}, {Inez T.} and Roberts, {Kathryn V.} and Carapetis, {Jonathan R.} and Francis, {Joshua R.}",
    year = "2018",
    doi = "10.5694/mja17.00666",
    language = "English",
    volume = "208",
    pages = "303--307",
    journal = "Medical Journal of Australia",
    issn = "0025-729X",
    publisher = "Australasian Medical Publishing Company",
    number = "7",

    }

    Davis, K, Remenyi, B, Draper, ADK, Dos Santos, J, Bayley, N, Paratz, E, Reeves, B, Appelbe, A, Cochrane, A, Johnson, TD, Korte, LM, Do Rosario, IM, Da Silva Almeida, IT, Roberts, KV, Carapetis, JR & Francis, JR 2018, 'Rheumatic heart disease in Timor-Leste school students: An echocardiography-based prevalence study', Medical Journal of Australia, vol. 208, no. 7, pp. 303-307. https://doi.org/10.5694/mja17.00666

    Rheumatic heart disease in Timor-Leste school students : An echocardiography-based prevalence study. / Davis, Kimberly; Remenyi, Bo; Draper, Anthony D.K.; 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.

    In: Medical Journal of Australia, Vol. 208, No. 7, 2018, p. 303-307.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Rheumatic heart disease in Timor-Leste school students

    T2 - An echocardiography-based prevalence study

    AU - Davis, Kimberly

    AU - Remenyi, Bo

    AU - Draper, Anthony D.K.

    AU - Dos Santos, Januario

    AU - Bayley, Noel

    AU - Paratz, Elizabeth

    AU - Reeves, Benjamin

    AU - Appelbe, Alan

    AU - Cochrane, Andrew

    AU - Johnson, Timothy D.

    AU - Korte, Laura M.

    AU - Do Rosario, Ivonia M.

    AU - Da Silva Almeida, Inez T.

    AU - Roberts, Kathryn V.

    AU - Carapetis, Jonathan R.

    AU - Francis, Joshua R.

    PY - 2018

    Y1 - 2018

    N2 - 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.

    AB - 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.

    UR - http://www.scopus.com/inward/record.url?scp=85046281955&partnerID=8YFLogxK

    U2 - 10.5694/mja17.00666

    DO - 10.5694/mja17.00666

    M3 - Article

    VL - 208

    SP - 303

    EP - 307

    JO - Medical Journal of Australia

    JF - Medical Journal of Australia

    SN - 0025-729X

    IS - 7

    ER -