{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T14:40:26Z","timestamp":1791211226201,"version":"4.1.0"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"25","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2012,6,26]]},"abstract":"<jats:sec>\n                    <jats:title>Background\u2014<\/jats:title>\n                    <jats:p>Historically, sub-Saharan Africa has had the highest prevalence rates of clinically detected rheumatic heart disease (RHD). Echocardiography-based screening improves detection of RHD in endemic regions. The newest screening guidelines (2006 World Health Organization\/National Institutes of Health) have been tested across India and the Pacific Islands, but application in sub-Saharan Africa has, thus far, been limited to Mozambique. We used these guidelines to determine RHD prevalence in a large cohort of Ugandan school children, to identify risk factors for occult disease, and to assess the value of laboratory testing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and Results\u2014<\/jats:title>\n                    <jats:p>\n                      Auscultation and portable echocardiography were used to screen randomly selected schoolchildren, 5 to 16 years of age, in Kampala, Uganda. Disease likelihood was defined as definite, probable, or possible in accordance with the 2006 National Institutes of Health\/World Health Organization guidelines. Ninety-seven percent of eligible students received screening (4869 of 5006). Among them, 130 children (2.7%) had abnormal screening echocardiograms. Of those 130, secondary evaluation showed 72 (55.4%) with possible, probable, or definite RHD; 18 (13.8%) with congenital heart disease; and 40 (30.8%) with no disease. Echocardiography detected 3 times as many cases of RHD as auscultation: 72 (1.5%) versus 23 (0.5%;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001). Children with RHD were older (10.1 versus 9.3 years;\n                      <jats:italic>P<\/jats:italic>\n                      =0.002). Most cases (98%) involved only the mitral valve. Lower socioeconomic groups had more RHD (2.7% versus 1.4%;\n                      <jats:italic>P<\/jats:italic>\n                      =0.036) and more advanced disease (64% versus 26%;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001). Antistreptolysin O titers were elevated in children with definite RHD.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions\u2014<\/jats:title>\n                    <jats:p>This is one of the largest single-country childhood RHD prevalence studies and the first to be conducted in sub-Saharan Africa. Our data support inclusion of echocardiography in screening protocols, even in the most resource-constrained settings, and identify lower socioeconomic groups as most vulnerable. Longitudinal follow-up of children with echocardiographically diagnosed subclinical RHD is needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circulationaha.112.092312","type":"journal-article","created":{"date-parts":[[2012,5,25]],"date-time":"2012-05-25T20:28:50Z","timestamp":1337977730000},"page":"3127-3132","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":222,"title":["Echocardiography Screening for Rheumatic Heart Disease in Ugandan Schoolchildren"],"prefix":"10.1161","volume":"125","author":[{"given":"Andrea","family":"Beaton","sequence":"first","affiliation":[{"name":"From the Children's National Medical Center, Washington, DC (A.B., R.M., C.S.), and Uganda Heart Institute, Kampala, Uganda (E.O., P.L., C.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmy","family":"Okello","sequence":"additional","affiliation":[{"name":"From the Children's National Medical Center, Washington, DC (A.B., R.M., C.S.), and Uganda Heart Institute, Kampala, Uganda (E.O., P.L., C.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Lwabi","sequence":"additional","affiliation":[{"name":"From the Children's National Medical Center, Washington, DC (A.B., R.M., C.S.), and Uganda Heart Institute, Kampala, Uganda (E.O., P.L., C.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Mondo","sequence":"additional","affiliation":[{"name":"From the Children's National Medical Center, Washington, DC (A.B., R.M., C.S.), and Uganda Heart Institute, Kampala, Uganda (E.O., P.L., C.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"McCarter","sequence":"additional","affiliation":[{"name":"From the Children's National Medical Center, Washington, DC (A.B., R.M., C.S.), and Uganda Heart Institute, Kampala, Uganda (E.O., P.L., C.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig","family":"Sable","sequence":"additional","affiliation":[{"name":"From the Children's National Medical Center, Washington, DC (A.B., R.M., C.S.), and Uganda Heart Institute, Kampala, Uganda (E.O., P.L., C.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3156.2010.02670.x"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(05)70267-X"},{"key":"e_1_3_2_4_2","first-page":"329","article-title":"Socioeconomic factors in the etiology of rheumatic fever","volume":"32","author":"Adanja B","year":"1988","unstructured":"Adanja B, Vlajinac H, Jarebinski M . Socioeconomic factors in the etiology of rheumatic fever. J Hyg Epidemiol Microbiol Immunol. 1988;32:329\u2013335.","journal-title":"J Hyg Epidemiol Microbiol Immunol"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1177\/146642409011000107"},{"key":"e_1_3_2_6_2","first-page":"1503","article-title":"Epidemiology of streptococcal infection with reference to rheumatic fever","volume":"28","author":"Bhave SY","year":"1991","unstructured":"Bhave SY, Kinikar A, Sane S, Agarwal M, Amdekar YK . Epidemiology of streptococcal infection with reference to rheumatic fever. Indian Pediatr. 1991;28:1503\u20131508.","journal-title":"Indian Pediatr"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0167-5273(97)00311-2"},{"key":"e_1_3_2_8_2","first-page":"528","article-title":"Group a streptococcal sore throat in a periurban population of northern India: a one-year prospective study","volume":"79","author":"Nandi S","year":"2001","unstructured":"Nandi S, Kumar R, Ray P, Vohra H, Ganguly NK . Group a streptococcal sore throat in a periurban population of northern India: a one-year prospective study. Bull World Health Organ. 2001;79:528\u2013533.","journal-title":"Bull World Health Organ"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.2147\/CLEP.S12977"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.105.539775"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa065085"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(00)05134-5"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8175.2009.01055.x"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1754.2010.01997.x"},{"key":"e_1_3_2_15_2","unstructured":"Carapetis JP Paar J Cherian T . Standardization of epidemiologic protocols for surveillance of post-streptococcal sequelae: acute rheumatic fever rheumatic heart disease and acute post-streptococcal glomerulonephritis. National Institute of Allergy and Infectious Diseases. 2006. http:\/\/www.niaid.nih.gov\/topics\/strepThroat\/Documents\/groupasequelae.pdf."},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2011-300792"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1128\/CVI.00291-08"},{"key":"e_1_3_2_18_2","unstructured":"Statistics UBo. 2002 Uganda Population and Housing Census. 2006. http:\/\/www.ubos.org\/onlinefiles\/uploads\/ubos\/pdf%20documents\/2002%20CensusPopnSizeGrowthAnalyticalReport.pdf. Accessed May 31 2012."},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/0167-5273(89)90254-4"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1159\/000174993"},{"key":"e_1_3_2_21_2","first-page":"601","article-title":"Prevalence of rheumatic heart disease among school children in Addis Ababa","volume":"76","author":"Oli K","year":"1999","unstructured":"Oli K, Porteous J . Prevalence of rheumatic heart disease among school children in Addis Ababa. East Afr Med J. 1999;76:601\u2013605.","journal-title":"East Afr Med J"},{"key":"e_1_3_2_22_2","first-page":"213","article-title":"WHO programme for the prevention of rheumatic fever\/rheumatic heart disease in 16 developing countries: report from phase I (1986\u201390): WHO cardiovascular diseases unit and principal investigators","volume":"70","year":"1992","unstructured":"WHO programme for the prevention of rheumatic fever\/rheumatic heart disease in 16 developing countries: report from phase I (1986\u201390): WHO cardiovascular diseases unit and principal investigators. Bull World Health Organ. 1992;70:213\u2013218.","journal-title":"Bull World Health Organ"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1136\/heart.85.4.407"}],"container-title":["Circulation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCULATIONAHA.112.092312","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T03:15:04Z","timestamp":1715570104000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.112.092312"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2012,6,26]]},"references-count":22,"journal-issue":{"issue":"25","published-print":{"date-parts":[[2012,6,26]]}},"alternative-id":["10.1161\/CIRCULATIONAHA.112.092312"],"URL":"https:\/\/doi.org\/10.1161\/circulationaha.112.092312","relation":{},"ISSN":["0009-7322","1524-4539"],"issn-type":[{"value":"0009-7322","type":"print"},{"value":"1524-4539","type":"electronic"}],"subject":[],"published":{"date-parts":[[2012,6,26]]},"assertion":[{"value":"2012-02-16","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2012-04-24","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2012-05-24","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}