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da Cruz ZV, Araujo AL, Ribas A, Nithikathkul C. Dengue in Timor-Leste during the COVID-19 phenomenon. Front Public Health 2023; 11:1057951. [PMID: 37674687 PMCID: PMC10478102 DOI: 10.3389/fpubh.2023.1057951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 07/18/2023] [Indexed: 09/08/2023] Open
Abstract
Dengue is a significant public health problem in mostly tropical countries, including Timor-Leste. Dengue continues to draw attention from the health sector during the COVID-19 phenomenon. Therefore, the goal of this study is to evaluate the dengue incidence rate in comparison with the COVID-19 cumulative number and associated dengue risk factors, including the fatality rate of dengue infection in each municipality during the COVID-19 phenomenon in Timor-Leste, by applying the data processing program in Geographic Information Systems (GIS). A descriptive study using GIS was performed to provide a spatial-temporal mapping of dengue cases. Secondary data, which were sourced from the Department of Health Statistics Information under the Ministry of Health Timor-Leste, were collected for the period during the COVID-19 outbreak in 2020-2021. These data were grounded at the municipal (province) level. Quantum GIS and Microsoft Excel were used to analyze the data. During the COVID-19 outbreak (2020-2021), dengue spread nationwide. It was found that there was an increase in municipalities with high dengue cases and cumulative COVID-19 numbers. The high number of dengue cases associated with the COVID-19 cumulative number found in municipalities with an urban characteristic and in terms of severity, dengue fever (DF) is most commonly reported with a total of 1,556 cases and is followed by dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). Most cases were reported in the months of the monsoon season, such as December, January, and March. Dengue GIS mapping helps understand the disease's presence and dynamic nature over time.
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Affiliation(s)
- Zito Viegas da Cruz
- Master of Science Program in Tropical Health Innovation, Faculty of Medicine, Mahasarakham University, Muang, Mahasarakham, Thailand
| | - Afonso Lima Araujo
- Health Statistics Information Ministry of Health (MoH), Dili, Timor-Leste
| | - Alexis Ribas
- Parasitology Section, Department of Biology, Healthcare and Environment, Faculty of Pharmacy and Food Science, Institut de Recerca de la Biodiversitat, University of Barcelona, Barcelona, Spain
| | - Choosak Nithikathkul
- Master of Science Program in Tropical Health Innovation, Faculty of Medicine, Mahasarakham University, Muang, Mahasarakham, Thailand
- Tropical Health Innovation Research Unit, Faculty of Medicine, Mahasarakham University, Muang, Mahasarakham, Thailand
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2
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Francis JR, Fairhurst H, Yan J, Fernandes Monteiro A, Lee AM, Maurays J, Kaethner A, Whalley GA, Hardefeldt H, Williamson J, Marangou J, Reeves B, Wheaton G, Robertson T, Horton A, Cush J, Wade V, Monteiro A, Draper ADK, Morris PS, Ralph AP, Remenyi B. Abbreviated Echocardiographic Screening for Rheumatic Heart Disease by Nonexperts with and without Offsite Expert Review: A Diagnostic Accuracy Study. J Am Soc Echocardiogr 2023; 36:733-745. [PMID: 36806665 DOI: 10.1016/j.echo.2023.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/04/2023] [Accepted: 02/06/2023] [Indexed: 02/19/2023]
Abstract
BACKGROUND Early detection of rheumatic heart disease (RHD) through echocardiographic screening can facilitate early access to effective treatment, which reduces the risk for progression. Accurate, feasible approaches to echocardiographic screening that can be incorporated into routine health services are needed. The authors hypothesized that offsite expert review could improve the diagnostic accuracy of nonexpert-obtained echocardiographic images. METHODS This prospective cross-sectional study was performed to evaluate the diagnostic accuracy of health worker-conducted single parasternal long-axis view with a sweep of the heart using hand-carried ultrasound for the detection of RHD in high-risk populations in Timor-Leste and Australia. In the primary analysis, the presence of any mitral or aortic regurgitation met the criteria for a positive screening result. Sensitivity and specificity were calculated for a screen-and-refer approach based on nonexpert practitioner assessment (approach 1) and for an approach using offsite expert review of nonexpert practitioner-obtained images to decide onward referral (approach 2). Each participant had a reference test performed by an expert echocardiographer on the same day as the index test. Diagnosis of RHD was determined by a panel of three experts, using 2012 World Heart Federation criteria. RESULTS The prevalence of borderline or definite RHD among 3,329 participants was 4.0% (95% CI, 3.4%-4.7%). The sensitivity of approach 1 for borderline or definite RHD was 86.5% (95% CI, 79.5%-91.8%), and the specificity was 61.4% (95% CI, 59.7%-63.1%). Approach 2 achieved similar sensitivity (88.4%; 95% CI, 81.5%-93.3%) and improved specificity (77.1%; 95% CI, 75.6%-78.6%). CONCLUSION Nonexpert practitioner-obtained single parasternal long-axis view with a sweep of the heart images, reviewed by an offsite expert, can detect borderline and definite RHD on screening with reasonable sensitivity and specificity. Brief training of nonexpert practitioners with ongoing support could be used as an effective strategy for scaling up echocardiographic screening for RHD in high-risk settings.
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Affiliation(s)
- Joshua R Francis
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia; Department of Paediatrics, Royal Darwin Hospital, Darwin, Australia.
| | - Helen Fairhurst
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Jennifer Yan
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia; Department of Paediatrics, Royal Darwin Hospital, Darwin, Australia
| | - Anferida Fernandes Monteiro
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | | | | | - Alex Kaethner
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia; NT Cardiac, Darwin, Australia
| | - Gillian A Whalley
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | | | - Jacqui Williamson
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - James Marangou
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia; NT Cardiac, Darwin, Australia; Division of Medicine, Royal Darwin Hospital, Darwin, Australia
| | - Benjamin Reeves
- Department of Paediatric Cardiology, Cairns Hospital, Cairns, Australia
| | - Gavin Wheaton
- Department of Cardiology, Women's and Children's Hospital, Adelaide, Australia
| | - Terry Robertson
- Department of Cardiology, Women's and Children's Hospital, Adelaide, Australia
| | - Ari Horton
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Australia; NT Cardiac, Darwin, Australia; Paediatric Cardiology, Monash Heart and Monash Children's Hospital, Melbourne, Australia
| | - James Cush
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Australia
| | - Vicki Wade
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Andre Monteiro
- Department of Cardiology, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Anthony D K Draper
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia; Centre for Disease Control, Northern Territory Department of Health, Darwin, Australia; National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Peter S Morris
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia; Department of Paediatrics, Royal Darwin Hospital, Darwin, Australia
| | - Anna P Ralph
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia; Division of Medicine, Royal Darwin Hospital, Darwin, Australia
| | - Bo Remenyi
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia; Department of Paediatrics, Royal Darwin Hospital, Darwin, Australia; NT Cardiac, Darwin, Australia
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3
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Talley NJ. Welcoming the new MJA Editor-in-Chief, and the top ten original research articles in the MJA in 2022. Med J Aust 2023; 218:22-24. [PMID: 36481979 DOI: 10.5694/mja2.51801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 12/13/2022]
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4
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Martins N, Gusmao C, Soares D, Laot M, Amaral S, Messner J, Yan J, Francis JR. Strengthening Health Research and Ethics Systems in Timor-Leste. WHO South East Asia J Public Health 2023; 12:63-70. [PMID: 37843183 DOI: 10.4103/who-seajph.who-seajph_184_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Introduction Meaningful health research should lead to evidence-based decision-making that can be translated into policy and practice. Every country needs to have a well-functioning and resourced ethics review and clearance system to ensure health and medical research is conducted in line with ethical standards, preventing harm to research participants, and contributing to better health outcomes and national priorities. The purpose of this study is to describe the origins of the system for managing health research and ethics in Timor-Leste and how it has evolved over time; to identify the strengths and limitations of the current system; and to recommend areas for improvement. Materials and Methods A narrative review of the literature (published papers, gray literature, and unpublished data) was conducted alongside key informant interviews with 15 Ministry of Health (MOH) policymakers and National Institute of Health staff between October 2020 and March 2021. Results The system for managing health research and ethics in Timor-Leste has remained largely the same since it was first established in 2009, with some adaptations to cope with a progressively increasing workload. Main findings include: the Department of Research and Studies (DRS) oversees complex ethics approval process in addition to other responsibilities; the DRS lacks the legal authority, policies, and procedures to help implement its full range of functions and responsibilities; national research priorities should be identified; MOH experiences difficulties in securing funding to support health research; training in health research, ethics and governance is an important priority for DRS. Conclusion It is timely and important to invest in strengthening key components of health research and ethics systems in Timor-Leste. Despite limited resources, improvements can be achieved in key areas with focused assistance and collaboration with local, national, and international partners.
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Affiliation(s)
- Nelson Martins
- Department for Research and Study, National Institute of Public Health of Timor-Leste; Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Caetano Gusmao
- Department for Research and Study, National Institute of Public Health of Timor-Leste, Dili, Timor-Leste
| | - Dirce Soares
- Department for Research and Study, National Institute of Public Health of Timor-Leste, Dili, Timor-Leste
| | - Meri Laot
- Department for Research and Study, National Institute of Public Health of Timor-Leste, Dili, Timor-Leste
| | - Salvador Amaral
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Julia Messner
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Jennifer Yan
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Joshua Reginald Francis
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
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5
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Paratz E, Maurays J, Flavio R, Appelbe A, Bayley N. Doctors with borders: the impact of international border closures on Timorese people who need cardiac procedures. Med J Aust 2022; 216:583-584. [DOI: 10.5694/mja2.51491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 12/23/2021] [Indexed: 11/17/2022]
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6
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Wegener A, Holm AE, Gomes LC, Lima KO, Kaagaard MD, Matos LO, Vieira IVM, de Souza RM, Marinho CRF, Nascimento BR, Biering-Sørensen T, Silvestre OM, Brainin P. Prevalence of rheumatic heart disease in adults from the Brazilian Amazon Basin. Int J Cardiol 2022; 352:115-122. [PMID: 35065154 DOI: 10.1016/j.ijcard.2022.01.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 01/04/2022] [Accepted: 01/14/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Rheumatic heart disease (RHD) continues to be a burden in low- and middle-income countries and prevalence estimates are lacking from South America. We aimed to determine the prevalence of RHD in the Brazilian Amazon Basin. METHODS We examined a random sample of adults (≥18 years) from the general population, who underwent echocardiographic image acquisition by a medical doctor. All images were analyzed according to (i) the 2012 World Heart Federation criteria and (ii) a simplified algorithm for RHD from a previously validated risk score (categories: low-, medium-, high-risk) which involved assessment of the mitral valve (leaflet thickening and excessive motion, regurgitation jet length) and aortic valve (thickening and any regurgitation). RESULTS A total of 488 adults were screened (mean age 40 ± 15 years, 38% men). The prevalence of RHD was 39/1000 adults (n = 17 definite and n = 2 borderline). Fourteen (74%) had pathological mitral regurgitation, four (21%) mitral stenosis, 0 (0%) pathological aortic regurgitation and six (32%) both mitral and aortic valve disease. None had a prior diagnosis of RHD, 10 (53%) had positive cardiac auscultation and two (11%) reported a history of rheumatic fever. The simplified algorithm identified four (21%) adults as low-risk, six (32%) as intermediate, and nine (47%) as high-risk. CONCLUSIONS The prevalence of RHD was 39/1000 in adults from the Brazilian Amazon Basin, indicating the need for screening programs in remote areas. A simplified model was only able to categorize every second case of RHD as high-risk. External validation of simplified screening models to increase feasibility in clinical practice are encouraged.
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Affiliation(s)
- Alma Wegener
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil; Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
| | - Anna Engell Holm
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil; Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
| | - Laura C Gomes
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Karine O Lima
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
| | - Molly D Kaagaard
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil; Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
| | - Luan O Matos
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
| | - Isabelle V M Vieira
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
| | - Rodrigo Medeiros de Souza
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
| | | | - Bruno R Nascimento
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Departamento de Clínica Médica Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark; Faculty of Biomedical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Odilson M Silvestre
- Health and Sport Science Center, Federal University of Acre, Rio Branco, Acre, Brazil
| | - Philip Brainin
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil; Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark.
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7
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Davis K, de Oliveira LN, da Silva Almeida I, Noronha M, Martins J, Dos Santos M, Monteiro A, Brewster D, Horton A, Remenyi B, Francis JR. Morbidity and mortality of rheumatic heart disease and acute rheumatic fever in the inpatient setting in Timor-Leste. J Paediatr Child Health 2021; 57:1391-1396. [PMID: 33825269 DOI: 10.1111/jpc.15476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 03/25/2021] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Kimberly Davis
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | | | | | - Mario Noronha
- Department of Paediatrics, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Joao Martins
- Department of Paediatrics, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Milena Dos Santos
- Department of Paediatrics, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Andre Monteiro
- Department of Paediatrics, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - David Brewster
- Department of Paediatrics, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Ari Horton
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,East Timor Hearts Fund, Melbourne, Victoria, Australia
| | - Bo Remenyi
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Joshua R Francis
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
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Strasserking F, Davila-Roman VG. Making a SPLASH for Rheumatic Heart Disease. Circ Cardiovasc Imaging 2021; 14:e013232. [PMID: 34384234 DOI: 10.1161/circimaging.121.013232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Fiona Strasserking
- Cardiovascular Division, Vanderbilt University Medical Center, Nashville, TN (F.S.)
| | - Victor G Davila-Roman
- Cardiovascular Imaging and Clinical Research Core Laboratory, Cardiovascular Division, Department of Medicine, and Global Health Center, Institute of Public Health, Washington University School of Medicine, St. Louis, MO (V.G.D.-R.)
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Francis JR, Whalley GA, Kaethner A, Fairhurst H, Hardefeldt H, Reeves B, Auld B, Marangou J, Horton A, Wheaton G, Robertson T, Ryan C, Brown S, Smith G, Dos Santos J, Flavio R, Embaum K, da Graca Noronha M, Lopes Belo S, Madeira Santos C, Georginha Dos Santos M, Cabral J, do Rosario I, Harries J, Francis LA, Draper ADK, James CL, Davis K, Yan J, Mitchell A, da Silva Almeida I, Engelman D, Roberts KV, Ralph AP, Remenyi B. Single-View Echocardiography by Nonexpert Practitioners to Detect Rheumatic Heart Disease: A Prospective Study of Diagnostic Accuracy. Circ Cardiovasc Imaging 2021; 14:e011790. [PMID: 34384239 PMCID: PMC8373443 DOI: 10.1161/circimaging.120.011790] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Echocardiographic screening can detect asymptomatic cases of rheumatic heart disease (RHD), facilitating access to treatment. Barriers to implementation of echocardiographic screening include the requirement for expensive equipment and expert practitioners. We aimed to evaluate the diagnostic accuracy of an abbreviated echocardiographic screening protocol (single parasternal-long-axis view with a sweep of the heart) performed by briefly trained, nonexpert practitioners using handheld ultrasound devices. Methods: Participants aged 5 to 20 years in Timor-Leste and the Northern Territory of Australia had 2 echocardiograms: one performed by an expert echocardiographer using a GE Vivid I or Vivid Q portable ultrasound device (reference test), and one performed by a nonexpert practitioner using a GE Vscan handheld ultrasound device (index test). The accuracy of the index test, compared with the reference test, for identifying cases with definite or borderline RHD was determined. Results: There were 3111 enrolled participants; 2573 had both an index test and reference test. Median age was 12 years (interquartile range, 10–15); 58.2% were female. Proportion with definite or borderline RHD was 5.52% (95% CI, 4.70–6.47); proportion with definite RHD was 3.23% (95% CI, 2.61–3.98). Compared with the reference test, sensitivity of the index test for definite or borderline RHD was 70.4% (95% CI, 62.2–77.8), specificity was 78.1% (95% CI, 76.4–79.8). Conclusions: Nonexpert practitioners can be trained to perform single parasternal-long-axis view with a sweep of the heart echocardiography. However, the specificity and sensitivity are inadequate for echocardiographic screening. Improved training for nonexpert practitioners should be investigated.
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Affiliation(s)
- Joshua R Francis
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Australia (J.R.F., H.F., J.M., J.Y., A.P.R., B.R.).,Department of Pediatrics, Royal Darwin Hospital, Australia (J.R.F., H.H., A.H., L.A.F., K.D., J.Y., K.V.R., B.R.).,Maluk Timor, Timor-Leste (J.R.F., J.D.S., R.F., K.E.)
| | - Gillian A Whalley
- Dunedin School of Medicine, University of Otago, New Zealand (G.A.W.)
| | | | - Helen Fairhurst
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Australia (J.R.F., H.F., J.M., J.Y., A.P.R., B.R.)
| | - Hilary Hardefeldt
- Department of Pediatrics, Royal Darwin Hospital, Australia (J.R.F., H.H., A.H., L.A.F., K.D., J.Y., K.V.R., B.R.)
| | | | - Benjamin Auld
- Department of Cardiology, Queensland Children's Hospital, Australia (B.A.)
| | - James Marangou
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Australia (J.R.F., H.F., J.M., J.Y., A.P.R., B.R.).,NT Cardiac, Australia (A.K., J.M., B.R.)
| | - Ari Horton
- Department of Pediatrics, Royal Darwin Hospital, Australia (J.R.F., H.H., A.H., L.A.F., K.D., J.Y., K.V.R., B.R.)
| | - Gavin Wheaton
- Department of Cardiology, Women's and Children's Hospital, Australia (G.W., T.R.)
| | - Terry Robertson
- Department of Cardiology, Women's and Children's Hospital, Australia (G.W., T.R.)
| | - Chelsea Ryan
- Maningrida Health Center (C.R., S.B., G.S.), Top End Health Services, Australia
| | - Shannon Brown
- Maningrida Health Center (C.R., S.B., G.S.), Top End Health Services, Australia
| | - Greg Smith
- Maningrida Health Center (C.R., S.B., G.S.), Top End Health Services, Australia
| | | | | | | | - Mario da Graca Noronha
- Department of Pediatrics, Hospital Nacional Guido Valadares, Timor-Leste (M.d.G.N., S.L.B., C.M.S., M.G.d.S., J.C., I.d.R., I.d.S.A.)
| | - Sonia Lopes Belo
- Department of Pediatrics, Hospital Nacional Guido Valadares, Timor-Leste (M.d.G.N., S.L.B., C.M.S., M.G.d.S., J.C., I.d.R., I.d.S.A.)
| | - Carla Madeira Santos
- Department of Pediatrics, Hospital Nacional Guido Valadares, Timor-Leste (M.d.G.N., S.L.B., C.M.S., M.G.d.S., J.C., I.d.R., I.d.S.A.)
| | - Maria Georginha Dos Santos
- Department of Pediatrics, Hospital Nacional Guido Valadares, Timor-Leste (M.d.G.N., S.L.B., C.M.S., M.G.d.S., J.C., I.d.R., I.d.S.A.)
| | - Jose Cabral
- Department of Pediatrics, Hospital Nacional Guido Valadares, Timor-Leste (M.d.G.N., S.L.B., C.M.S., M.G.d.S., J.C., I.d.R., I.d.S.A.)
| | - Ivonia do Rosario
- Department of Pediatrics, Hospital Nacional Guido Valadares, Timor-Leste (M.d.G.N., S.L.B., C.M.S., M.G.d.S., J.C., I.d.R., I.d.S.A.)
| | | | - Laura A Francis
- Department of Pediatrics, Royal Darwin Hospital, Australia (J.R.F., H.H., A.H., L.A.F., K.D., J.Y., K.V.R., B.R.).,Center for Disease Control (L.A.F., A.D.K.D., C.L.J.), Top End Health Services, Australia
| | - Anthony D K Draper
- Center for Disease Control (L.A.F., A.D.K.D., C.L.J.), Top End Health Services, Australia
| | - Christian L James
- Center for Disease Control (L.A.F., A.D.K.D., C.L.J.), Top End Health Services, Australia
| | - Kimberly Davis
- Department of Pediatrics, Royal Darwin Hospital, Australia (J.R.F., H.H., A.H., L.A.F., K.D., J.Y., K.V.R., B.R.)
| | - Jennifer Yan
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Australia (J.R.F., H.F., J.M., J.Y., A.P.R., B.R.).,Department of Pediatrics, Royal Darwin Hospital, Australia (J.R.F., H.H., A.H., L.A.F., K.D., J.Y., K.V.R., B.R.)
| | | | - Ines da Silva Almeida
- Department of Pediatrics, Hospital Nacional Guido Valadares, Timor-Leste (M.d.G.N., S.L.B., C.M.S., M.G.d.S., J.C., I.d.R., I.d.S.A.)
| | - Daniel Engelman
- Tropical Diseases, Murdoch Children's Research Institute, Australia (D.E.)
| | - Kathryn V Roberts
- Department of Pediatrics, Royal Darwin Hospital, Australia (J.R.F., H.H., A.H., L.A.F., K.D., J.Y., K.V.R., B.R.)
| | - Anna P Ralph
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Australia (J.R.F., H.F., J.M., J.Y., A.P.R., B.R.).,Division of Medicine, Royal Darwin Hospital, Australia (A.P.R.)
| | - Bo Remenyi
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Australia (J.R.F., H.F., J.M., J.Y., A.P.R., B.R.).,Department of Pediatrics, Royal Darwin Hospital, Australia (J.R.F., H.H., A.H., L.A.F., K.D., J.Y., K.V.R., B.R.).,NT Cardiac, Australia (A.K., J.M., B.R.).,Department of Pediatrics, Cairns Base Hospital, Australia (B.R.)
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10
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Paratz ED, Mock N, Gutman SJ, Horton A, Creati L, Appelbe A, Eggleton S, Kushwaha V, da Silva Almeida IT, Monteiro A, Bayley N. Taking the pulse of Timor-Leste's cardiac needs: a 10-year descriptive time-trend analysis. Intern Med J 2021; 50:838-845. [PMID: 31237730 DOI: 10.1111/imj.14411] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/13/2019] [Accepted: 06/16/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Timor-Leste is one of the poorest countries in the world. The East Timor Hearts Fund is a charitable organisation involving Australian cardiologists providing outreach screening and access to cardiac interventions. AIMS To assess ten years of clinical volume, demographics and patient outcomes. Our intention was to identify existing limitations to facilitate planning for further capacity building over the next decade. METHODS The East Timor Hearts Fund database was sectioned into 2-year intervals (2009/2010, 2011/2012, 2013/2014, 2015/2016 and 2017/2018). Demographics and clinical outcomes of patients were compared, with subgroup analysis of adult (>18 years old), paediatric and interventional patients. RESULTS Over 10 years, 2050 patient encounters have occurred; 1119 (54.6%) encounters occurred in 2017/2018; 73.6% of patients were assessed in the capital Dili. Rheumatic and congenital cardiac diseases remain very common (39.1% of adult new patients and 74.2% of paediatric new patients), with 1.4% of new patients exhibiting both pathologies. The number of new patients with rheumatic or congenital heart disease tripled in 2017/2018 compared to 2009/2010 (99 vs 34 patients, P < 0.0001). Paediatric case volume increased over 10-fold over 10 years (288 new patients in 2017/2018 vs 24 in 2009/2010, P < 0.0001), with corresponding increase in proportion of paediatric interventions (59.4% in 2017/2018 vs 25.0% in 2009/2010, P = 0.027). For patients undergoing intervention (n = 87), post-procedural complications and mortality are extremely low (3.4% and 1.1%, respectively), with all eligible patients attending at least one post-procedure appointment. CONCLUSION Demand for cardiac services in Timor-Leste is rising exponentially, with inequitable geographic coverage. Rheumatic and congenital cardiac diseases remain priorities for assessment, and paediatric case volume is increasing. Patients undergoing intervention experience good medical outcomes.
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Affiliation(s)
- Elizabeth D Paratz
- East Timor Hearts Fund, Melbourne, Victoria, Australia.,Cardiology Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Cardiology Department, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Nicki Mock
- East Timor Hearts Fund, Melbourne, Victoria, Australia
| | - Sarah J Gutman
- East Timor Hearts Fund, Melbourne, Victoria, Australia.,Cardiology Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Cardiology Department, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Ari Horton
- East Timor Hearts Fund, Melbourne, Victoria, Australia.,Paediatric Cardiology, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Louise Creati
- East Timor Hearts Fund, Melbourne, Victoria, Australia.,Cardiology Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Alan Appelbe
- East Timor Hearts Fund, Melbourne, Victoria, Australia.,Cardiology Department, Geelong Hospital, Geelong, Victoria, Australia
| | - Simon Eggleton
- East Timor Hearts Fund, Melbourne, Victoria, Australia.,Cardiology Department, Eastern Heart Clinic, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Virag Kushwaha
- East Timor Hearts Fund, Melbourne, Victoria, Australia.,Cardiology Department, Eastern Heart Clinic, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Inez T da Silva Almeida
- Internal Medicine, Hospital Nacional Guido Valdares, Dili, Timor-Leste.,Valdares Cardiology, Warrnambool Base Hospital, Warrnambool, Victoria, Australia
| | - Andre Monteiro
- Internal Medicine, Hospital Nacional Guido Valdares, Dili, Timor-Leste.,Valdares Cardiology, Warrnambool Base Hospital, Warrnambool, Victoria, Australia
| | - Noel Bayley
- East Timor Hearts Fund, Melbourne, Victoria, Australia.,Valdares Cardiology, Warrnambool Base Hospital, Warrnambool, Victoria, Australia
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11
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Matthews A, Le B, Amaral S, Arkell P, Monteiro M, Clarke N, Barros T, de Jesus Mendonça J, Gusmão SME, Dos Reis Seixas LM, da Piedade JHA, Engelman D, Steer AC, Fancourt NSS, Yan J, Kaldor J, Francis JR, Nery SV. Prevalence of scabies and impetigo in school-age children in Timor-Leste. Parasit Vectors 2021; 14:156. [PMID: 33722285 PMCID: PMC7962383 DOI: 10.1186/s13071-021-04645-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 02/16/2021] [Indexed: 11/23/2022] Open
Abstract
Background Scabies and impetigo are endemic in many tropical, low- and middle-income countries. Mass drug administration (MDA) with ivermectin has emerged as a control strategy for these conditions. In 2019, Timor-Leste Ministry of Health planned to implement MDA including ivermectin for the control of lymphatic filariasis, so we undertook a baseline assessment of scabies and impetigo to better understand local epidemiology and contribute to future surveys assessing the impact of MDA. Methods A cross-sectional school survey was conducted in April–May 2019 at six primary schools in a semi-urban (Dili) and two rural (Ermera and Manufahi) settings. Children under 19 years of age present at school on survey days were eligible to participate, of whom we enrolled 1183. Trained health workers interviewed and examined 1043 participants to clinically diagnose scabies using the 2020 International Alliance for the Control of Scabies (IACS) diagnostic criteria, as well as impetigo. Prevalence was adjusted for age and sex. Mixed-effects logistic regression models were used to analyse odds of scabies and impetigo infection. All models accounted for clustering at the school level through the use of random effect terms. Population attributable risk of scabies as a cause of impetigo was also estimated. Results The overall weighted prevalence of scabies was 30.6%. Children in rural Manufahi were more likely to have scabies than those in semi-urban Dili (53.6% vs 28.2%, adjusted odds ratio [AOR] 3.5). Most cases of scabies were mild (3 to 10 lesions), and lesions were usually distributed on more than one body region. Scabies prevalence was lower among 10 to 14 year olds compared to 5 to 9 year olds. Overall weighted prevalence of impetigo was 11.3%. Relative to Dili, children in rural Ermera and Manufahi were twice as likely to have impetigo. Impetigo was twice as common in children with scabies than in those without, corresponding to an attributable risk of scabies as a cause of impetigo of 22.7%. Conclusions Scabies and impetigo prevalence in Timor-Leste is among the highest reported globally, particularly in rural areas. Scabies infestation was strongly associated with impetigo. Comprehensive control strategies are urgently needed in Timor-Leste.![]()
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Affiliation(s)
| | - Brandon Le
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Salvador Amaral
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Paul Arkell
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | | | - Naomi Clarke
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | | | | | | | | | | | - Daniel Engelman
- Tropical Diseases, Murdoch Children's Research Institute, Melbourne, Australia
| | - Andrew C Steer
- Tropical Diseases, Murdoch Children's Research Institute, Melbourne, Australia
| | - Nicholas S S Fancourt
- Royal Darwin Hospital, Darwin, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Jennifer Yan
- Royal Darwin Hospital, Darwin, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - John Kaldor
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Joshua R Francis
- Royal Darwin Hospital, Darwin, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Susana Vaz Nery
- The Kirby Institute, University of New South Wales, Sydney, Australia
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12
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Talley NJ. A New Year, the top research articles, and a call to deliver a "net zero" Australian health care system by 2040. Med J Aust 2021; 214:17-19. [PMID: 33454973 DOI: 10.5694/mja2.50896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 11/27/2020] [Indexed: 11/17/2022]
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13
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Kang K, Chau KWT, Howell E, Anderson M, Smith S, Davis TJ, Starmer G, Hanson J. The temporospatial epidemiology of rheumatic heart disease in Far North Queensland, tropical Australia 1997-2017; impact of socioeconomic status on disease burden, severity and access to care. PLoS Negl Trop Dis 2021; 15:e0008990. [PMID: 33444355 PMCID: PMC7840049 DOI: 10.1371/journal.pntd.0008990] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 01/27/2021] [Accepted: 11/16/2020] [Indexed: 11/21/2022] Open
Abstract
Background The incidence of rheumatic heart disease (RHD) among Indigenous Australians remains one of the highest in the world. Many studies have highlighted the relationship between the social determinants of health and RHD, but few have used registry data to link socioeconomic disadvantage to the delivery of patient care and long-term outcomes. Methods A retrospective study of individuals living with RHD in Far North Queensland (FNQ), Australia between 1997 and 2017. Patients were identified using the Queensland state RHD register. The Socio-Economic Indexes for Areas (SEIFA) Score–a measure of socioeconomic disadvantage–was correlated with RHD prevalence, disease severity and measures of RHD care. Results Of the 686 individuals, 622 (90.7%) were Indigenous Australians. RHD incidence increased in the region from 4.7/100,000/year in 1997 to 49.4/100,000/year in 2017 (p<0.001). In 2017, the prevalence of RHD was 12/1000 in the Indigenous population and 2/1000 in the non-Indigenous population (p<0.001). There was an inverse correlation between an area’s SEIFA score and its RHD prevalence (rho = -0.77, p = 0.005). 249 (36.2%) individuals in the cohort had 593 RHD-related hospitalisations; the number of RHD-related hospitalisations increased during the study period (p<0.001). In 2017, 293 (42.7%) patients met criteria for secondary prophylaxis, but only 73 (24.9%) had good adherence. Overall, 119/686 (17.3%) required valve surgery; the number of individuals having surgery increased over the study period (p = 0.02). During the study 39/686 (5.7%) died. Non-Indigenous patients were more likely to die than Indigenous patients (9/64 (14%) versus 30/622 (5%), p = 0.002), but Indigenous patients died at a younger age (median (IQR): 52 (35–67) versus 73 (62–77) p = 0.013). RHD-related deaths occurred at a younger age in Indigenous individuals than non-Indigenous individuals (median (IQR) age: 29 (12–58) versus 77 (64–78), p = 0.007). Conclusions The incidence of RHD, RHD-related hospitalisations and RHD-related surgery continues to rise in FNQ. Whilst this is partly explained by increased disease recognition and improved delivery of care, the burden of RHD remains unacceptably high and is disproportionately borne by the socioeconomically disadvantaged Indigenous population. Rheumatic heart disease (RHD), a disease of poverty and disadvantage, is almost completely preventable. It is now extremely rare in wealthy countries, but in Far North Queensland in tropical Australia, the incidence of RHD, RHD-related hospitalisations and RHD-related surgery is continuing to rise, with the burden of disease borne almost entirely by the region’s Indigenous population. While the increasing incidence of RHD and its complications may be partly explained by improvements in local service delivery, the disease remains inextricably linked to socioeconomic disadvantage. In this study, not only were patients living in socioeconomically disadvantaged areas more likely to have RHD, but they were also paradoxically less likely to receive valve surgery. The current local model of care—which is centralised, medical and emphasises disease monitoring and secondary prophylaxis—appears to be having a limited impact on morbidity. Strategies must evolve—in partnership with Indigenous communities—to have a greater focus on disease prevention by addressing the personal, community and environmental factors that increase the risk of the disease. This is likely to not only reduce the incidence of RHD, but will also tend to reduce the burden of the many other diseases that result from socioeconomic disadvantage and that disproportionately affect Indigenous Australians.
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Affiliation(s)
- Katherine Kang
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia
| | - Ken W. T. Chau
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia
| | - Erin Howell
- Rheumatic Heart Disease Program, Tropical Public Health Unit, Cairns, Queensland, Australia
| | - Mellise Anderson
- Rheumatic Heart Disease Program, Tropical Public Health Unit, Cairns, Queensland, Australia
| | - Simon Smith
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia
| | - Tania J. Davis
- Department of Cardiology, Cairns Hospital, Cairns, Queensland, Australia
| | - Greg Starmer
- Department of Cardiology, Cairns Hospital, Cairns, Queensland, Australia
| | - Josh Hanson
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- * E-mail:
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14
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Hempenstall A, Howell E, Kang K, Chau KWT, Browne AL, Kris E, Wapau H, Pilot P, Smith S, Reeves B, Hanson J. Echocardiographic Screening Detects Rheumatic Heart Disease and Missed Opportunities in the Treatment of Group A Streptococcal Infections in Australian Torres Strait Islander Children. Am J Trop Med Hyg 2021; 104:1211-1214. [PMID: 33432909 DOI: 10.4269/ajtmh.20-0846] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 11/25/2020] [Indexed: 12/17/2022] Open
Abstract
Rheumatic heart disease (RHD) is almost entirely preventable, but the incidence in indigenous Australians remains one of the highest in the world. A community-based echocardiogram screening program of 862 Torres Strait Islander children identified 25 (2.9%) new cases of RHD. Among these 25 children, 5/7 (71%) prior acute rheumatic fever presentations had not been recognized. There was a history of microbiologically confirmed group A Streptococcus infection in 17/25 (68%) children with RHD compared with 9/25 (36%) controls (odds ratio [OR] [95% CI]: 3.78 [1.17-12.19], P = 0.03). This was more likely to be a skin swab (16/25 [64%] cases versus 6/25 [24%] controls) than a throat swab (1/25 [4%] cases versus 3/25 [12%] controls) (OR [95% CI]: 5.33 [1.51-18.90] [P = 0.01]), supporting a role for skin infection in RHD pathogenesis. Household crowding and unemployment were common in the cohort, emphasizing the need for prioritizing strategies that address the social determinants of health. This study explores the burden of rheumatic heart disease diagnosed during an echocardiogram screening program in the Torres Strait Islands in tropical Australia and highlights the importance of primordial and primary prevention.
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Affiliation(s)
- Allison Hempenstall
- James Cook University, Cairns, Australia.,Torres and Cape Hospital and Health Service, Thursday Island, Australia
| | - Erin Howell
- Cairns Hospital and Hinterland Health Service, Cairns, Australia
| | - Katherine Kang
- Cairns Hospital and Hinterland Health Service, Cairns, Australia
| | - Ken W T Chau
- Cairns Hospital and Hinterland Health Service, Cairns, Australia
| | - Amy-Lou Browne
- Torres and Cape Hospital and Health Service, Thursday Island, Australia
| | - Ella Kris
- James Cook University, Cairns, Australia.,Torres and Cape Hospital and Health Service, Thursday Island, Australia
| | - Hylda Wapau
- Torres and Cape Hospital and Health Service, Thursday Island, Australia
| | - Pelista Pilot
- Torres and Cape Hospital and Health Service, Thursday Island, Australia
| | - Simon Smith
- Cairns Hospital and Hinterland Health Service, Cairns, Australia
| | - Benjamin Reeves
- Cairns Hospital and Hinterland Health Service, Cairns, Australia
| | - Josh Hanson
- The Kirby Institute, Sydney, Australia.,Cairns Hospital and Hinterland Health Service, Cairns, Australia
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15
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Kumar RK, Antunes MJ, Beaton A, Mirabel M, Nkomo VT, Okello E, Regmi PR, Reményi B, Sliwa-Hähnle K, Zühlke LJ, Sable C. Contemporary Diagnosis and Management of Rheumatic Heart Disease: Implications for Closing the Gap: A Scientific Statement From the American Heart Association. Circulation 2020; 142:e337-e357. [PMID: 33073615 DOI: 10.1161/cir.0000000000000921] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The global burden of rheumatic heart disease continues to be significant although it is largely limited to poor and marginalized populations. In most endemic regions, affected patients present with heart failure. This statement will seek to examine the current state-of-the-art recommendations and to identify gaps in diagnosis and treatment globally that can inform strategies for reducing disease burden. Echocardiography screening based on World Heart Federation echocardiographic criteria holds promise to identify patients earlier, when prophylaxis is more likely to be effective; however, several important questions need to be answered before this can translate into public policy. Population-based registries effectively enable optimal care and secondary penicillin prophylaxis within available resources. Benzathine penicillin injections remain the cornerstone of secondary prevention. Challenges with penicillin procurement and concern with adverse reactions in patients with advanced disease remain important issues. Heart failure management, prevention, early diagnosis and treatment of endocarditis, oral anticoagulation for atrial fibrillation, and prosthetic valves are vital therapeutic adjuncts. Management of health of women with unoperated and operated rheumatic heart disease before, during, and after pregnancy is a significant challenge that requires a multidisciplinary team effort. Patients with isolated mitral stenosis often benefit from percutaneous balloon mitral valvuloplasty. Timely heart valve surgery can mitigate the progression to heart failure, disability, and death. Valve repair is preferable over replacement for rheumatic mitral regurgitation but is not available to the vast majority of patients in endemic regions. This body of work forms a foundation on which a companion document on advocacy for rheumatic heart disease has been developed. Ultimately, the combination of expanded treatment options, research, and advocacy built on existing knowledge and science provides the best opportunity to address the burden of rheumatic heart disease.
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16
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Francis JR, Fairhurst H, Hardefeldt H, Brown S, Ryan C, Brown K, Smith G, Baartz R, Horton A, Whalley G, Marangou J, Kaethner A, Draper ADK, James CL, Mitchell AG, Yan J, Ralph A, Remenyi B. Hyperendemic rheumatic heart disease in a remote Australian town identified by echocardiographic screening. Med J Aust 2020; 213:118-123. [DOI: 10.5694/mja2.50682] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 04/23/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Joshua R Francis
- Menzies School of Health ResearchCharles Darwin University Darwin NT
- Royal Darwin Hospital Darwin NT
| | - Helen Fairhurst
- Menzies School of Health ResearchCharles Darwin University Darwin NT
| | | | - Shannon Brown
- Top End Health ServiceManingrida Health Centre Maningrida NT
| | - Chelsea Ryan
- Top End Health ServiceManingrida Health Centre Maningrida NT
| | - Kurt Brown
- Top End Health ServiceManingrida Health Centre Maningrida NT
| | - Greg Smith
- Top End Health ServiceManingrida Health Centre Maningrida NT
| | - Roz Baartz
- Top End Health ServiceManingrida Health Centre Maningrida NT
| | | | | | | | | | - Anthony DK Draper
- Centre for Disease ControlNorthern Territory Department of Health Darwin NT
| | - Christian L James
- Centre for Disease ControlNorthern Territory Department of Health Darwin NT
| | - Alice G Mitchell
- Menzies School of Health ResearchCharles Darwin University Darwin NT
| | - Jennifer Yan
- Menzies School of Health ResearchCharles Darwin University Darwin NT
- Royal Darwin Hospital Darwin NT
| | - Anna Ralph
- Menzies School of Health ResearchCharles Darwin University Darwin NT
| | - Bo Remenyi
- Royal Darwin Hospital Darwin NT
- NT Cardiac Darwin NT
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17
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Hao EY, Rhodes JEJ, Nixon RL, Saunderson RB. A cross-sectional study of dermatological conditions in rural and urban Timor-Leste. Australas J Dermatol 2020; 61:e395-e398. [PMID: 32542648 DOI: 10.1111/ajd.13347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is limited information about the type of skin disease in Timor-Leste. In order to determine the type and magnitude of skin disease in Timor-Leste, we conducted a cross-sectional point prevalence study of 271 patients from rural and urban Timor-Leste. The aim of the study was to estimate the magnitude and burden of dermatological disease. METHODS Two Australian-trained dermatologists conducted clinics in the city of Dili (urban) and village of Manusae (rural) in Timor-Leste between the period of June and July 2016. They independently recorded all patient presentations and diagnoses. RESULTS A total of 271 patients were reviewed over two months, of whom 37% were seen in an urban setting and 63% in a rural setting. Scabies accounted for 96% of all presentations in the rural setting, which was significantly higher than its presentation in the urban setting (8%), P < 0.001. Scabies also accounted for the majority of presentations in the paediatric population aged 10 years or younger. Fungal and bacterial skin and soft tissue infections were both more common in urban areas (P < 0.001). CONCLUSIONS Scabies infection remains the most prevalent dermatological condition encountered in the Timor-Leste rural population and has hopefully been addressed by a recent mass drug administration. It is important to raise awareness of the systemic problems that can arise from untreated skin infections.
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Affiliation(s)
- Evelyn Y Hao
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | | | | | - Rebecca B Saunderson
- Northern Clinical School, University of Sydney, Sydney, NSW, Australia.,Department of Dermatology, Royal North Shore Hospital, Sydney, NSW, Australia.,Department of Dermatology, Prince of Wales Hospital, Randwick, NSW, Australia
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18
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Francis JR, Fairhurst H, Whalley G, Kaethner A, Ralph A, Yan J, Cush J, Wade V, Monteiro A, Remenyi B. The RECARDINA Study protocol: diagnostic utility of ultra-abbreviated echocardiographic protocol for handheld machines used by non-experts to detect rheumatic heart disease. BMJ Open 2020; 10:e037609. [PMID: 32467256 PMCID: PMC7259846 DOI: 10.1136/bmjopen-2020-037609] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Rheumatic heart disease (RHD) causes significant morbidity and mortality in young people from disadvantaged populations. Early detection through echocardiography screening can facilitate early access to treatment. Large-scale implementation of screening could be feasible with the combination of inexpensive standalone ultrasound transducers and upskilling non-expert practitioners to perform abbreviated echocardiography. METHODS AND ANALYSIS A prospective cross-sectional study will evaluate an abbreviated echocardiography screening protocol for the detection of latent (asymptomatic) RHD in high-risk populations. The study will evaluate the diagnostic accuracy of health worker conducted single parasternal long axis view with a sweep using handheld devices (SPLASH) (Philips Lumify S4-1 phased array transducer). Each participant will have at least one reference test performed on the same day by an expert echocardiographer. Diagnosis of RHD will be determined by a panel of three experts, using 2012 World Heart Federation criteria. Sensitivity and specificity of the index test will be calculated with 95% CIs, to determine diagnostic accuracy of a screen-and-refer approach to echocardiography screening for RHD. Remote review of SPLASH images obtained by health workers will facilitate evaluation of the sensitivity and specificity of an alternative approach, using external review of health worker obtained SPLASH images to decide onward referral. ETHICS AND DISSEMINATION Ethics approval was obtained from the Human Research Ethics Committee of the Northern Territory Department of Health and Menzies School of Health Research, for the project to be carried out in Timor-Leste (HREC 2019-3399), and in Australia, following review by the Aboriginal Ethics subcommittee (HREC 2019-334). Ethical and technical approval was granted in Timor-Leste, by the Institute National of Health Research Ethics and Technical Committee (1073-MS-INS/GDE/VII/2019). Study results will be disseminated in the communities involved in the study, and through peer-reviewed publications and conference abstracts. TRIAL REGISTRATION NUMBER The Australia New Zealand Clinical Trials Registry (ACTRN12620000122954).
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Affiliation(s)
- Joshua Reginald Francis
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Helen Fairhurst
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Gillian Whalley
- Department of Medicine, University of Otago Dunedin School of Medicine, Dunedin, New Zealand
| | | | - Anna Ralph
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Infectious Diseases, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Jennifer Yan
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - James Cush
- Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Vicki Wade
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Andre Monteiro
- Internal Medicine, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Bo Remenyi
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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19
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Vaughan G, Dawson A, Peek MJ, Carapetis JR, Sullivan EA. Standardizing clinical care measures of rheumatic heart disease in pregnancy: A qualitative synthesis. Birth 2019; 46:560-573. [PMID: 31150150 DOI: 10.1111/birt.12435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/24/2019] [Accepted: 04/25/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND Rheumatic heart disease (RHD) is a preventable cardiac condition that escalates risk in pregnancy. Models of care informed by evidence-based clinical guidelines are essential to optimal health outcomes. There are no published reviews that systematically explore approaches to care provision for pregnant women with RHD and examine reported measures. The review objective was to improve understanding of how attributes of care for these women are reported and how they align with guidelines. METHODS A search of 13 databases was supported by hand-searching. Papers that met inclusion criteria were appraised using CASP/JBI checklists. A content analysis of extracted data from the findings sections of included papers was undertaken, informed by attributes of quality care identified previously from existing guidelines. RESULTS The 43 included studies were predominantly conducted in tertiary care centers of low-income and middle-income countries. Cardiac guidelines were referred to in 25 of 43 studies. Poorer outcomes were associated with higher risk scores (detailed in 36 of 41 quantitative studies). Indicators associated with increased risk include anticoagulation during pregnancy (28 of 41 reported) and late booking (gestation documented in 15 of 41 studies). Limited access to cardiac interventions was discussed (19 of 43) in the context of poorer outcomes. Conversely, early assessment and access to regular multidisciplinary care were emphasized in promoting optimal outcomes for women and their babies. CONCLUSIONS Despite often complex care requirements in challenging environments, pregnancy provides an opportunity to strengthen health system responses and address whole-of-life health for women with RHD. A standard set of core indicators is proposed to more accurately benchmark care pathways, outcomes, and burden.
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Affiliation(s)
- Geraldine Vaughan
- Faculty of Health, Australian Centre for Public and Population Health Research (ACPPHR), University of Technology Sydney, Sydney, New South Wales, Australia
| | - Angela Dawson
- Faculty of Health, Australian Centre for Public and Population Health Research (ACPPHR), University of Technology Sydney, Sydney, New South Wales, Australia
| | - Michael J Peek
- The Australian National University and Centenary Hospital for Women and Children, The Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Jonathan R Carapetis
- Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia.,Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Elizabeth A Sullivan
- Faculty of Health, Australian Centre for Public and Population Health Research (ACPPHR), University of Technology Sydney, Sydney, New South Wales, Australia.,Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
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Abstract
BACKGROUND The aim of this study is to investigate the prevalence of subclinical rheumatic heart disease in schoolchildren aged 5-18 by using portable echocardiography in Ankara, Turkey. METHODS The portable echocardiography screening was performed by a paediatric cardiologist for all of the cases. The mean age of 2550 healthy students was 11.09 ± 2.91 years (1339 females, 1211 males) in three private and three public schools. Echocardiographic studies were assessed according to 2012 World Heart Federation criteria for rheumatic heart disease. RESULTS After reviewing the echocardiographic images, 73 students were reevaluated by an advanced echocardiography device in the university hospital. Evidence of definite subclinical rheumatic heart disease was found in 39 students (15/1000) and borderline rheumatic heart disease in 20 students (8/1000). No children had any clinical symptoms. The mean age of children diagnosed with rheumatic heart disease and borderline rheumatic heart disease is 12.4 and 11.4 years, respectively. The risk of rheumatic heart disease was found to be increased sevenfold in girls between 14 and 18 years. We surprisingly observed that the prevalence of definite rheumatic heart disease in private schools located in high-income areas of Ankara was higher than that in public schools. CONCLUSIONS This is the first and largest single-centred echocardiographic screening study for subclinical rheumatic heart disease in Turkish schoolchildren. The frequency of rheumatic heart disease has been found to be 15/1000. This finding is similar to those of recent echocardiographic screening studies performed in middle and high-risk populations. We conclude that to decrease the burden of rheumatic heart disease, echocardiographic screening studies are necessary, and long-term follow-up of children with echocardiographically diagnosed subclinical rheumatic heart disease is needed.
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21
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Remenyi B, Davis K, Draper A, Bayley N, Paratz E, Reeves B, Appelbe A, Wheaton G, da Silva Almeida IT, Dos Santos J, Carapetis J, Francis JR. Single Parasternal-Long-Axis-View-Sweep Screening Echocardiographic Protocol to Detect Rheumatic Heart Disease: A Prospective Study of Diagnostic Accuracy. Heart Lung Circ 2019; 29:859-866. [PMID: 31320258 DOI: 10.1016/j.hlc.2019.02.196] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 01/28/2019] [Accepted: 02/05/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Echocardiographic screening in school-aged children can detect rheumatic heart disease (RHD) prior to the manifestation of symptoms of heart failure. The challenge is making this practical and affordable on a global scale. This study aims to evaluate the diagnostic utility of an ultra-abbreviated echocardiographic screening protocol involving a single parasternal-long-axis-view-sweep of the heart (SPLASH) in two dimensional (2D) and colour Doppler imaging (index test). METHODS This prospective study of diagnostic accuracy compared the diagnostic utility of the index screening test with a comprehensive reference test (standard echocardiographic screening protocols) as per World Heart Federation (WHF) echocardiographic criteria. School students in Timor-Leste aged 5-20 years were enrolled. Both index and reference test images were acquired by cardiologists on Vivid I or Q machines (GE Healthcare, Marlborough, MA, USA). RESULTS A total of 1,365 participants were screened; median age was 11 years. The estimated prevalence of definite and borderline RHD was 35.2 per 1,000. Congenital heart disease was identified in 11 children (0.8%) with two needing cardiac surgery. Abnormal SPLASH views were found in 109/1365 (7.99%). No cases of RHD or significant congenital heart disease were missed. Sensitivity and specificity of the abbreviated protocol for detecting RHD were 1.0 and 0.95 respectively. CONCLUSIONS A simplified echocardiography screening protocol using SPLASH is highly sensitive and specific and could significantly improve the efficiency of RHD screening. It has the potential to expedite training of health workers whilst protecting the modesty of students.
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Affiliation(s)
- Boglarka Remenyi
- Royal Darwin Hospital, Darwin, NT, Australia; Menzies School of Health Research, Darwin, NT, Australia.
| | - Kimberly Davis
- Royal Darwin Hospital, Darwin, NT, Australia; Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Anthony Draper
- Centre for Disease Control, Darwin, Darwin, NT, Australia
| | | | | | | | | | - Gavin Wheaton
- Women's and Children's Hospital, Adelaide, SA, Australia
| | | | | | - Jonathan Carapetis
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia; Perth Children's Hospital, Perth, WA, Australia
| | - Joshua R Francis
- Royal Darwin Hospital, Darwin, NT, Australia; Menzies School of Health Research, Darwin, NT, Australia
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22
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Talley Ac NJ. From the curious case of Patient K to TOP GEAR and Bond. Med J Aust 2018; 209:468-471. [PMID: 30521432 DOI: 10.5694/mja18.01086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 10/22/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Nicholas J Talley Ac
- Editor-in-Chief, the Medical Journal of Australia, on behalf of the MJA Editorial team
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