{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T21:36:02Z","timestamp":1769204162868,"version":"3.49.0"},"reference-count":28,"publisher":"Cambridge University Press (CUP)","issue":"6","license":[{"start":{"date-parts":[[2016,12,19]],"date-time":"2016-12-19T00:00:00Z","timestamp":1482105600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["www.cambridge.org"],"crossmark-restriction":true},"short-container-title":["Cardiol Young"],"published-print":{"date-parts":[[2017,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S1047951116002511_abs1\" sec-type=\"general\"><jats:title>Background<\/jats:title><jats:p>Echocardiographic screening for rheumatic heart disease in asymptomatic children may result in early diagnosis and prevent progression. Physician-led screening is not feasible in Malawi. Task shifting to mid-level providers such as clinical officers may enable more widespread screening.<\/jats:p><\/jats:sec><jats:sec id=\"S1047951116002511_abs2\" sec-type=\"general\"><jats:title>Hypothesis<\/jats:title><jats:p>With short-course training, clinical officers can accurately screen for rheumatic heart disease using focussed echocardiography.<\/jats:p><\/jats:sec><jats:sec id=\"S1047951116002511_abs3\" sec-type=\"methods\"><jats:title>Methods<\/jats:title><jats:p>A total of eight clinical officers completed three half-days of didactics and 2 days of hands-on echocardiography training. Clinical officers were evaluated by performing screening echocardiograms on 20 children with known rheumatic heart disease status. They indicated whether children should be referred for follow-up. Referral was indicated if mitral regurgitation measured more than 1.5 cm or there was any measurable aortic regurgitation. The \u03ba statistic was calculated to measure referral agreement with a paediatric cardiologist. Sensitivity and specificity were estimated using a generalised linear mixed model, and were calculated on the basis of World Heart Federation diagnostic criteria.<\/jats:p><\/jats:sec><jats:sec id=\"S1047951116002511_abs4\" sec-type=\"results\"><jats:title>Results<\/jats:title><jats:p>The mean \u03ba statistic comparing clinical officer referrals with the paediatric cardiologist was 0.72 (95% confidence interval: 0.62, 0.82). The \u03ba value ranged from a minimum of 0.57 to a maximum of 0.90. For rheumatic heart disease diagnosis, sensitivity was 0.91 (95% confidence interval: 0.86, 0.95) and specificity was 0.65 (95% confidence interval: 0.57, 0.72).<\/jats:p><\/jats:sec><jats:sec id=\"S1047951116002511_abs5\" sec-type=\"conclusion\"><jats:title>Conclusion<\/jats:title><jats:p>There was substantial agreement between clinical officers and paediatric cardiologists on whether to refer. Clinical officers had a high sensitivity in detecting rheumatic heart disease. With short-course training, clinical officer-led echo screening for rheumatic heart disease is a viable alternative to physician-led screening in resource-limited settings.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s1047951116002511","type":"journal-article","created":{"date-parts":[[2016,12,19]],"date-time":"2016-12-19T03:49:27Z","timestamp":1482119367000},"page":"1133-1139","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":18,"title":["Task shifting to clinical officer-led echocardiography screening for detecting rheumatic heart disease in Malawi, Africa"],"prefix":"10.1017","volume":"27","author":[{"given":"Amy","family":"Sims Sanyahumbi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Craig A.","family":"Sable","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melissa","family":"Karlsten","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mina C.","family":"Hosseinipour","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter N.","family":"Kazembe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles G.","family":"Minard","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel J.","family":"Penny","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2016,12,19]]},"reference":[{"key":"S1047951116002511_ref19","doi-asserted-by":"publisher","DOI":"10.1017\/S1047951112001321"},{"key":"S1047951116002511_ref20","doi-asserted-by":"publisher","DOI":"10.2307\/2531248"},{"key":"S1047951116002511_ref8","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0145634"},{"key":"S1047951116002511_ref24","doi-asserted-by":"publisher","DOI":"10.1038\/nrcardio.2013.34"},{"key":"S1047951116002511_ref17","doi-asserted-by":"publisher","DOI":"10.1186\/1756-0500-6-53"},{"key":"S1047951116002511_ref22","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa065085"},{"key":"S1047951116002511_ref16","doi-asserted-by":"publisher","DOI":"10.2188\/jea.JE2008006"},{"key":"S1047951116002511_ref2","volume-title":"Streptococcus Pyogenes: Basic Biology to Clinical Manifestations","author":"Sims Sanyahumbi","year":"2016"},{"key":"S1047951116002511_ref7","unstructured":"Rheumatic fever and rheumatic heart disease. 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