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A meta-analysis using the hierarchical summary receiver operating characteristic model was conducted to produce summary results of sensitivity and specificity. Forest plots and scatter plots in receiver operating characteristic space in combination with subgroup analyses were used to investigate heterogeneity. Publication bias was not investigated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Six studies (N=4208) were included in the analysis. For any RHD detection, the pooled results from six studies were as follows: sensitivity: 81.56% (95% CI 76.52% to 86.61%) and specificity: 89.75% (84.48% to 95.01%). Meta-analytical results from five of the six included studies were as follows: sensitivity: 91.06% (80.46% to 100%) and specificity: 91.96% (85.57% to 98.36%) for the detection of definite RHD only and sensitivity: 62.01% (31.80% to 92.22%) and specificity: 82.33% (65.15% to 99.52%) for the detection of borderline RHD only.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>HAND displayed good accuracy for detecting definite RHD only and modest accuracy for detecting any RHD but demonstrated poor accuracy for the detection of borderline RHD alone. Findings from this review provide some evidence for the potential of HAND to increase access to echocardiographic screening for RHD in resource-limited and remote settings; however, further research into feasibility and cost-effectiveness of wide-scale screening is still needed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD42016051261.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-038449","type":"journal-article","created":{"date-parts":[[2020,10,29]],"date-time":"2020-10-29T17:11:38Z","timestamp":1603991498000},"page":"e038449","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":14,"title":["Standard echocardiography versus handheld echocardiography for the detection of subclinical rheumatic heart disease: a systematic review and meta-analysis of diagnostic accuracy"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8554-057X","authenticated-orcid":false,"given":"Lisa Helen","family":"Telford","sequence":"first","affiliation":[{"name":"Department of Medicine, Groote Schuur Hospital, University of Cape Town Faculty of Health Sciences, Cape Town, Western Cape, South Africa"},{"name":"Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town Faculty of Health Sciences, Cape Town, Western Cape, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leila Hussein","family":"Abdullahi","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town Faculty of Health Sciences, Cape Town, Western Cape, South Africa"},{"name":"Department of Policy and Research, African Institute for Development Policy (AFIDEP), Nairobi, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eleanor Atieno","family":"Ochodo","sequence":"additional","affiliation":[{"name":"Department of Global Health, Faculty of Medicine and Health Sciences, University of Stellenbosch Centre for Evidence-Based Health Care, Cape Town, Western Cape, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3961-2760","authenticated-orcid":false,"given":"Liesl Joanna","family":"Zuhlke","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town Faculty of Health Sciences, Cape Town, Western Cape, South Africa"},{"name":"Division of Cardiology, Department of Medicine, Groote Schuur Hospital, University of Cape Town Faculty of Health Sciences, Cape Town, Western Cape, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark Emmanuel","family":"Engel","sequence":"additional","affiliation":[{"name":"Department of Medicine, Groote Schuur Hospital, University of Cape Town Faculty of Health Sciences, Cape Town, Western Cape, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,10,29]]},"reference":[{"key":"2025121511423333000_10.10.e038449.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)61171-9"},{"key":"2025121511423333000_10.10.e038449.2","doi-asserted-by":"crossref","DOI":"10.1007\/s11936-017-0513-y","article-title":"Group A Streptococcus, acute rheumatic fever and rheumatic heart disease: epidemiology and clinical considerations","volume":"19","author":"Z\u00fchlke","year":"2017","journal-title":"Curr Treat Options Cardiovasc Med"},{"key":"2025121511423333000_10.10.e038449.3","unstructured":"World Heart Federation . 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