Abstract
Background
Rheumatic heart disease is a major public health issue in developing countries including Malaysia. RHD is a preventable disease. Early detection and appropriate treatment may decrease the disease burden to the society. Rheumatic heart disease screening using portable echocardiography may improve early detection among school children in vulnerable community. This is a pilot study of rheumatic heart disease screening using Vscan among primary school students in the Bornean state of Sabah Malaysia.
Purpose
To evaluate the resources required for RHD screening, prevalence of RHD among school children and awareness among the parents and teachers.
Methods
A cohort of 211 students from a primary school were recruited in 2017–2018. Parental consents were obtained. Seven sessions were conducted at the school. Echocardiography was performed by 2–3 experienced ultrasonographers. Image interpretation as per the 2012 WHF RHD echocardiographic diagnostic criteria.
Results
Of the 211 students, 50% female, age range 7–12 year-old. Ethnic groups include Kadazandusun (87%), Rungus (2.4%), Lundayeh (2%), Chinese (2%). Overall, the average number of student scanned was 4.6 students/device/hour. There was a learning curve observed, whereby initial session only scanned 2 students/device/hour which improved to a maximum of 5.9 students/device/hour. Preliminary findings noted probable RHD among 36% (n=76) of screened subjects. Incidental diagnosis of congenital heart disease among 5 students. The suspected RHD cases were referred for formal echocardiography in the tertiary centre for confirmation. Thus far, 12 students were diagnosed with borderline RHD; the main diagnostic criteria in these cases were at least two morphological features of RHD of the MV without pathological MR or MS. Secondary prophylaxis with antibiotic, dental hygiene and patient education were given.
Conclusion
This is a pilot RHD screening using portable Vscan echocardiography among primary school students in Malaysia. Our study showed it is feasible to conduct RHD screening in the field using portable Vscan. The number of students screened improved with practice. Our preliminary finding suggest RHD is prevalent in this population in Sabah, Malaysia.
Trial of computerized heart disease screening system of phono- and electrocardiogram in school children.