Screening for Rheumatic Heart Disease among Peruvian Children: A Two-Stage Sampling Observational Study.

Area of Science:

• Cardiology
• Public Health
• Pediatrics

Background:

• Rheumatic heart disease (RHD) remains a significant global health concern, particularly in low-resource settings.
• Accurate prevalence estimation is crucial for effective public health interventions.
• Echocardiographic screening in schools offers a potential method for early detection.

Purpose of the Study:

• To evaluate how different RHD classification criteria impact prevalence estimates in Peruvian schoolchildren.
• To assess the significance of incidental findings, such as congenital heart disease, during RHD screening.

Main Methods:

• A cluster randomized observational survey was conducted using portable echocardiography.
• Schoolchildren aged 5-16 in Arequipa, Peru, were screened.
• RHD was defined using modified World Health Organization (WHO) and World Heart Federation (WHF) criteria.

Main Results:

• 1023 schoolchildren participated; RHD prevalence was 19.7/1000 (WHO criteria) and 3.9/1000 (WHF criteria).
• Prevalence varied by age, with higher rates in older children (13-16 years).
• Congenital heart disease was detected in 2.1% of students, with 8 requiring intervention.

Conclusions:

• RHD prevalence in Peru is lower than in highly endemic regions globally.
• Echocardiographic screening revealed a notable burden of congenital heart disease.
• Integrated strategies are needed to manage incidental findings within RHD surveillance programs.