{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T15:09:54Z","timestamp":1781104194026,"version":"3.54.1"},"reference-count":24,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2021,4,6]],"date-time":"2021-04-06T00:00:00Z","timestamp":1617667200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Paediatrics Child Health"],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:sec><jats:title>Aim<\/jats:title><jats:p>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\u2010Leste.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This prospective study documented cases of ARF and RHD in children aged 14\u2009years 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 <jats:italic>Streptococcus<\/jats:italic>. Clinical and echocardiographic findings, comorbidities and discharge outcomes are reported.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 63 patients were admitted with ARF or RHD; 54 were diagnosed with RHD for the first time. Median age was 11\u2009years (range 3\u201314); 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Community echocardiography screening has reported a high prevalence of undetected mild to moderate cases of RHD in Timor\u2010Leste, 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\u2010Leste and improved recognition and diagnosis, as well as effective delivery of treatment and follow\u2010up are imperative.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jpc.15476","type":"journal-article","created":{"date-parts":[[2021,4,7]],"date-time":"2021-04-07T06:59:21Z","timestamp":1617778761000},"page":"1391-1396","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Morbidity and mortality of rheumatic heart disease and acute rheumatic fever in the inpatient setting in <scp>Timor\u2010Leste<\/scp>"],"prefix":"10.1111","volume":"57","author":[{"given":"Kimberly","family":"Davis","sequence":"first","affiliation":[{"name":"Department of Paediatrics Royal Darwin Hospital  Darwin Northern Territory Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lidia NL","family":"de Oliveira","sequence":"additional","affiliation":[{"name":"Department of Paediatrics Hospital Nacional Guido Valadares  Dili Timor\u2010Leste"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ines","family":"da Silva Almeida","sequence":"additional","affiliation":[{"name":"Department of Paediatrics Hospital Nacional Guido Valadares  Dili Timor\u2010Leste"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Noronha","sequence":"additional","affiliation":[{"name":"Department of Paediatrics Hospital Nacional Guido Valadares  Dili Timor\u2010Leste"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joao","family":"Martins","sequence":"additional","affiliation":[{"name":"Department of Paediatrics Hospital Nacional Guido Valadares  Dili Timor\u2010Leste"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milena","family":"dos Santos","sequence":"additional","affiliation":[{"name":"Department of Paediatrics Hospital Nacional Guido Valadares  Dili Timor\u2010Leste"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andre","family":"Monteiro","sequence":"additional","affiliation":[{"name":"Department of Paediatrics Hospital Nacional Guido Valadares  Dili Timor\u2010Leste"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Brewster","sequence":"additional","affiliation":[{"name":"Department of Paediatrics Hospital Nacional Guido Valadares  Dili Timor\u2010Leste"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ari","family":"Horton","sequence":"additional","affiliation":[{"name":"Department of Paediatrics Royal Darwin Hospital  Darwin Northern Territory Australia"},{"name":"East Timor Hearts Fund  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Remenyi","sequence":"additional","affiliation":[{"name":"Department of Paediatrics Royal Darwin Hospital  Darwin Northern Territory Australia"},{"name":"Menzies School of Health Research Charles Darwin University  Darwin Northern Territory Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9302-4543","authenticated-orcid":false,"given":"Joshua R","family":"Francis","sequence":"additional","affiliation":[{"name":"Department of Paediatrics Royal Darwin Hospital  Darwin Northern Territory Australia"},{"name":"Menzies School of Health Research Charles Darwin University  Darwin Northern Territory Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,4,6]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1603693"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrdp.2015.84"},{"key":"e_1_2_8_4_1","unstructured":"General Directorate of Statistics.2015 Timor\u2010Leste Population and Housing Census \u2013 Data Sheet: Statistics Timor\u2010Leste. 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