{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T16:12:32Z","timestamp":1787501552094,"version":"build-2736575974"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"15","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2020,8,4]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Despite the high burden of rheumatic heart disease in sub\u2010Saharan Africa, diagnosis with acute rheumatic fever (ARF) is exceedingly rare. Here, we report the results of the first prospective epidemiologic survey to diagnose and characterize ARF at the community level in Africa.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">A cross\u2010sectional study was conducted in Lira, Uganda, to inform the design of a broader epidemiologic survey. Key messages were distributed in the community, and children aged 3 to 17\u00a0years were included if they had either (1) fever and joint pain, (2) suspicion of carditis, or (3) suspicion of chorea, with ARF diagnoses made by the 2015 Jones Criteria. Over 6\u00a0months, 201 children met criteria for participation, with a median age of 11\u00a0years (interquartile range, 6.5) and 103 (51%) female. At final diagnosis, 51 children (25%) had definite ARF, 11 (6%) had possible ARF, 2 (1%) had rheumatic heart disease without evidence of ARF, 78 (39%) had a known alternative diagnosis (10 influenza, 62 malaria, 2 sickle cell crises, 2 typhoid fever, 2 congenital heart disease), and 59 (30%) had an unknown alternative diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">ARF persists within rheumatic heart disease\u2013endemic communities in Africa, despite the low rates reported in the literature. Early data collection has enabled refinement of our study design to best capture the incidence of ARF and to answer important questions on community sensitization, healthcare worker and teacher education, and simplified diagnostics for low\u2010resource areas. This study also generated data to support further exploration of the relationship between malaria and ARF diagnosis in rheumatic heart disease\/malaria\u2010endemic countries.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.120.016053","type":"journal-article","created":{"date-parts":[[2020,7,29]],"date-time":"2020-07-29T05:09:10Z","timestamp":1595999350000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Active Case Finding for Rheumatic Fever in an Endemic Country"],"prefix":"10.1161","volume":"9","author":[{"given":"Emmy","family":"Okello","sequence":"first","affiliation":[{"name":"Uganda Heart Institute Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Ndagire","sequence":"additional","affiliation":[{"name":"Uganda Heart Institute Kampala Uganda"},{"name":"Children\u2019s National Hospital Washington DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenifer","family":"Atala","sequence":"additional","affiliation":[{"name":"Uganda Heart Institute Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asha C.","family":"Bowen","sequence":"additional","affiliation":[{"name":"Telethon Kids Institute Perth Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc P.","family":"DiFazio","sequence":"additional","affiliation":[{"name":"Children\u2019s National Hospital Washington DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nada S.","family":"Harik","sequence":"additional","affiliation":[{"name":"Children\u2019s National Hospital Washington DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9468-0179","authenticated-orcid":false,"given":"Chris T.","family":"Longenecker","sequence":"additional","affiliation":[{"name":"Case Western Reserve University School of Medicine Cleveland OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2895-3626","authenticated-orcid":false,"given":"Peter","family":"Lwabi","sequence":"additional","affiliation":[{"name":"Uganda Heart Institute Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meghna","family":"Murali","sequence":"additional","affiliation":[{"name":"Children\u2019s National Hospital Washington DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott A.","family":"Norton","sequence":"additional","affiliation":[{"name":"Children\u2019s National Hospital Washington DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isaac Otim","family":"Omara","sequence":"additional","affiliation":[{"name":"Uganda Heart Institute Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda Mary","family":"Oyella","sequence":"additional","affiliation":[{"name":"Uganda Heart Institute Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Parks","sequence":"additional","affiliation":[{"name":"London School of Hygiene &amp; Tropical Medicine London United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jafesi","family":"Pulle","sequence":"additional","affiliation":[{"name":"Uganda Heart Institute Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8453-818X","authenticated-orcid":false,"given":"Joselyn","family":"Rwebembera","sequence":"additional","affiliation":[{"name":"Uganda Heart Institute Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel J.","family":"Sarnacki","sequence":"additional","affiliation":[{"name":"Children\u2019s National Hospital Washington DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher F.","family":"Spurney","sequence":"additional","affiliation":[{"name":"Children\u2019s National Hospital Washington DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Stein","sequence":"additional","affiliation":[{"name":"University of Washington Seattle WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Tochen","sequence":"additional","affiliation":[{"name":"Children\u2019s National Hospital Washington DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Watkins","sequence":"additional","affiliation":[{"name":"University of Washington Seattle WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7311-8278","authenticated-orcid":false,"given":"Meghan","family":"Zimmerman","sequence":"additional","affiliation":[{"name":"Children\u2019s National Hospital Washington DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan R.","family":"Carapetis","sequence":"additional","affiliation":[{"name":"Telethon Kids Institute Perth Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig","family":"Sable","sequence":"additional","affiliation":[{"name":"Children\u2019s National Hospital Washington DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4963-355X","authenticated-orcid":false,"given":"Andrea","family":"Beaton","sequence":"additional","affiliation":[{"name":"Cincinnati Children's Hospital Medical Center Cincinnati OH"},{"name":"Cincinnati University School of Medicine Cincinnati OH"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(14)70310-9"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1136\/heartasia-2017-010981"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3156.2009.02385.x"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1136\/adc.85.3.223"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000205"},{"key":"e_1_3_1_7_2","unstructured":"Statistics UBo . 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