{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T17:18:02Z","timestamp":1778260682178,"version":"3.51.4"},"reference-count":22,"publisher":"BMJ","issue":"1","funder":[{"name":"Karp Family Foundation"},{"name":"Children\u2019s National Global Health Initiative"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Heart"],"accepted":{"date-parts":[[2018,7,3]]},"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Estimates of the prevalence of rheumatic heart disease (RHD) in many endemic countries are limited to samples of children attending schools, which generate an incomplete picture of disease burden in communities. The present study conducted household-based RHD screening in a representative community in Gulu district, Uganda.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Members of households identified through a two-stage cluster-sampling approach between the ages of 5 years and 50 years were invited to undergo limited cardiac testing with a handheld echocardiogram to assess for the presence of RHD. Suspicious cases underwent confirmatory echocardiogram with a fully functional machine.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of the 2453 community members screened, 2.45% (95% CI 1.87% to 3.14%) showed echocardiographic evidence of RHD with 1.26% (95% CI 0.860% to 1.79%) having definite RHD. The overall prevalence of RHD among participants &lt;20 years was 2.52% (95% CI 1.78% to 3.45%), with a borderline prevalence of 1.97% (95% CI 1.33% to 2.82%) and a definite prevalence of 0.544% (95% CI 0.235% to 1.07%). Prevalence rates among youth increased with age and peaked in the age group of 16\u201320 years. The overall adult prevalence (&gt;20 years) of RHD was 2.34% (95% CI 1.49% to 3.49%). The majority of definite cases were mild (81%) and marked by mitral regurgitation and associated morphological valve changes (71%).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Our data reveal a high prevalence of undiagnosed RHD within an endemic community and fill a critical gap in RHD epidemiology in African adults.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/heartjnl-2018-313171","type":"journal-article","created":{"date-parts":[[2018,8,1]],"date-time":"2018-08-01T12:15:18Z","timestamp":1533125718000},"page":"60-66","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":34,"title":["Community study to uncover the full spectrum of rheumatic heart disease in Uganda"],"prefix":"10.1136","volume":"105","author":[{"given":"Amy","family":"Scheel","sequence":"first","affiliation":[{"name":"Children\u2019s National Health System, Washington, District of Columbia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isaac","family":"Ssinabulya","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Uganda Heart Institute, Kampala, Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Twalib","family":"Aliku","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Uganda Heart Institute, Kampala, Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tyler","family":"Bradley-Hewitt","sequence":"additional","affiliation":[{"name":"Children\u2019s National Health System, Washington, District of Columbia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexa","family":"Clauss","sequence":"additional","affiliation":[{"name":"Children\u2019s National Health System, Washington, District of Columbia, 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USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marni","family":"Jacobs","sequence":"additional","affiliation":[{"name":"Children\u2019s National Health System, Washington, District of Columbia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Klein","sequence":"additional","affiliation":[{"name":"Children\u2019s National Health System, Washington, District of Columbia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teresa E","family":"Moore","sequence":"additional","affiliation":[{"name":"Children\u2019s National Health System, Washington, District of Columbia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emmy","family":"Okello","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Uganda Heart Institute, Kampala, Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janet","family":"Scheel","sequence":"additional","affiliation":[{"name":"Department of Cardiology, St. Louis Children\u2019s, St. Louis, Missouri, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebekah","family":"Shaw","sequence":"additional","affiliation":[{"name":"Children\u2019s National Health System, Washington, District of Columbia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Craig","family":"Sable","sequence":"additional","affiliation":[{"name":"Children\u2019s National Health System, Washington, District of Columbia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Lwabi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Uganda Heart Institute, Kampala, Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6341-9595","authenticated-orcid":false,"given":"David A","family":"Watkins","sequence":"additional","affiliation":[{"name":"Department of General Internal Medicine, University of Washington, Seattle, Washington, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Beaton","sequence":"additional","affiliation":[{"name":"Children\u2019s National Health System, Washington, District of Columbia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,8,1]]},"reference":[{"key":"2025091922174444000_105.1.60.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)61728-0"},{"key":"2025091922174444000_105.1.60.2","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1056\/NEJMoa1603693","article-title":"Global, Regional, and National Burden of Rheumatic Heart Disease, 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Kampala, Uganda: Uganda Bureau of Statistics, 2017."},{"key":"2025091922174444000_105.1.60.12","first-page":"98","article-title":"A simplified general method for cluster-sample surveys of health in developing countries","volume":"44","author":"Bennett","year":"1991","journal-title":"World Health Stat Q"},{"key":"2025091922174444000_105.1.60.13","doi-asserted-by":"publisher","DOI":"10.1038\/nrcardio.2012.7"},{"key":"2025091922174444000_105.1.60.14","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa065085"},{"key":"2025091922174444000_105.1.60.15","doi-asserted-by":"crossref","first-page":"e717","DOI":"10.1016\/S2214-109X(14)70310-9","article-title":"Active surveillance for rheumatic heart disease in endemic regions: a systematic review and meta-analysis of prevalence among children and adolescents","volume":"2","author":"Rothenb\u00fchler","year":"2014","journal-title":"Lancet Glob Health"},{"key":"2025091922174444000_105.1.60.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2015.07.005"},{"key":"2025091922174444000_105.1.60.17","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.117.029936"},{"key":"2025091922174444000_105.1.60.18","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2015-307444"},{"key":"2025091922174444000_105.1.60.19","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2012.10.090"},{"key":"2025091922174444000_105.1.60.20","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehu449"},{"key":"2025091922174444000_105.1.60.21","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s12872-016-0451-8","article-title":"Rheumatic heart disease in Uganda: predictors of morbidity and mortality one year after presentation","volume":"17","author":"Okello","year":"2017","journal-title":"BMC Cardiovasc Disord"},{"key":"2025091922174444000_105.1.60.22","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0043917","article-title":"Socioeconomic and environmental risk factors among rheumatic heart disease patients in Uganda","volume":"7","author":"Okello","year":"2012","journal-title":"PLoS One"}],"container-title":["Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/heartjnl-2018-313171","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,20]],"date-time":"2025-09-20T05:17:55Z","timestamp":1758345475000},"score":1,"resource":{"primary":{"URL":"https:\/\/heart.bmj.com\/lookup\/doi\/10.1136\/heartjnl-2018-313171"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,8,1]]},"references-count":22,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2018,12,12]]},"published-print":{"date-parts":[[2019,1]]}},"alternative-id":["10.1136\/heartjnl-2018-313171"],"URL":"https:\/\/doi.org\/10.1136\/heartjnl-2018-313171","relation":{},"ISSN":["1355-6037","1468-201X"],"issn-type":[{"value":"1355-6037","type":"print"},{"value":"1468-201X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,8,1]]}}}