{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T22:13:10Z","timestamp":1775945590871,"version":"3.50.1"},"reference-count":18,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2022,9,23]],"date-time":"2022-09-23T00:00:00Z","timestamp":1663891200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Italian Ministry of Health-Ricerca Corrente to Centro Cardiologico Monzino IRCCS"},{"name":"Italian Society of Cardiology (SIC)"},{"name":"Fondazione Piero e Lucille Corti, Onlus"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Rheumatic heart disease (RHD) is a major cause of cardiovascular disease in developing nations, leading to more than 230,000 deaths annually. Most patients seek medical care only when long-term structural and hemodynamic complications have already occurred. Echocardiographic screenings ensure the early detection of asymptomatic subjects who could benefit from prophylaxis, monitoring and intervention, when appropriate. The aim of this study is to assess the feasibility of a screening program and the prevalence of RHD in a Ugandan orphanage. Methods: We performed an RHD-focused echocardiogram on all the children (5\u201314 years old) living in a north Ugandan orphanage. Exams were performed with a portable machine (GE Vivid-I). All the time intervals were recorded (minutes). Results: A total of 163 asymptomatic children were screened over 8 days (medium age 9.1; 46% male; 17% affected by severe motor impairment). The feasibility rate was 99.4%. An average of 20.4 exams were performed per day, with an average of 15.5 images collected per subject. Pathological mitral regurgitation (MR) was found in 5.5% of subjects, while at least two morphological features of RHD were found in 4.3%, leading to 1 \u201cdefinite RHD\u201d (0.6%) case and 13 \u201cborderline RHD\u201d cases (8.1%). Six congenital heart defects were also noted (3.7%): four atrial septal defects, one coronary artery fistula and one Patent Ductus Arteriosus. Conclusions: We demonstrated the feasibility of an echocardiographic screening for RHD in an orphanage in Uganda. A few factors, such as good clinical and hygienic care, the availability of antibiotics and closeness to a big hospital, may account for the low prevalence of the disease in our population.<\/jats:p>","DOI":"10.3390\/children9101451","type":"journal-article","created":{"date-parts":[[2022,9,25]],"date-time":"2022-09-25T21:14:28Z","timestamp":1664140468000},"page":"1451","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Echocardiographic Screening for Rheumatic Heart Disease in a Ugandan Orphanage: Feasibility and Outcomes"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9985-7407","authenticated-orcid":false,"given":"Massimo","family":"Mapelli","sequence":"first","affiliation":[{"name":"Centro Cardiologico Monzino, IRCCs, Via Parea 4, 20138 Milan, Italy"},{"name":"Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paola","family":"Zagni","sequence":"additional","affiliation":[{"name":"Terapia Intensiva Neonatale, Ospedale Fatebenefratelli P.O. Macedonio Melloni, Via Macedonio Melloni 52, 20129 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valeria","family":"Calbi","sequence":"additional","affiliation":[{"name":"San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy"},{"name":"Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0309-6231","authenticated-orcid":false,"given":"Laura","family":"Fusini","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino, IRCCs, Via Parea 4, 20138 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aliku","family":"Twalib","sequence":"additional","affiliation":[{"name":"Division of Paediatric Cardiology Uganda Heart Institute, Mulago Hospital and Complex, Kampala P.O. Box 37392, Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberto","family":"Ferrara","sequence":"additional","affiliation":[{"name":"Molecular Immunology Unit, Medical Oncology Department\u2014Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, 20132 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7781-1691","authenticated-orcid":false,"given":"Irene","family":"Mattavelli","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino, IRCCs, Via Parea 4, 20138 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0246-4805","authenticated-orcid":false,"given":"Laura","family":"Alberghina","sequence":"additional","affiliation":[{"name":"Department of Neurorehabilitation Sciences, Istituto Auxologico Italiano, IRCCS, 20132 Milan, Italy"},{"name":"Hospital Lacor, Gulu P.O. Box 180, Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisabetta","family":"Salvioni","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino, IRCCs, Via Parea 4, 20138 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cyprian","family":"Opira","sequence":"additional","affiliation":[{"name":"Hospital Lacor, Gulu P.O. Box 180, Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jackson","family":"Kansiime","sequence":"additional","affiliation":[{"name":"Hospital Lacor, Gulu P.O. Box 180, Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gloria","family":"Tamborini","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino, IRCCs, Via Parea 4, 20138 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mauro","family":"Pepi","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino, IRCCs, Via Parea 4, 20138 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Piergiuseppe","family":"Agostoni","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino, IRCCs, Via Parea 4, 20138 Milan, Italy"},{"name":"Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,9,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2095","DOI":"10.1016\/S0140-6736(12)61728-0","article-title":"Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: A systematic analysis for the Global Burden of Disease Study 2010","volume":"380","author":"Lozano","year":"2012","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1038\/nrcardio.2012.157","article-title":"Screening for rheumatic heart disease: Current approaches and controversies","volume":"10","author":"Roberts","year":"2013","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Okello, E., Longenecker, C.T., Beaton, A., Kamya, M.R., and Lwabi, P. (2017). Rheumatic heart disease in Uganda: Predictors of morbidity and mortality one year after presentation. BMC Cardiovasc. Disord., 17.","DOI":"10.1186\/s12872-016-0451-8"},{"key":"ref_4","first-page":"S9","article-title":"The Changing Pattern of Cardiac disease in Africa: The Ugandan Experience","volume":"22","author":"Kayima","year":"2011","journal-title":"Cardiovasc. J. Afr."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"80","DOI":"10.5830\/CVJA-2013-004","article-title":"Cardiovascular complications in newly diagnosed rheumatic heart disease patients at Mulago Hospital, Uganda","volume":"24","author":"Okello","year":"2013","journal-title":"Cardiovasc. J. Afr."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"836","DOI":"10.1161\/01.CIR.4.6.836","article-title":"Rheumatic fever and rheumatic heart disease. A twenty-year report on 1000 patients followed since childhood","volume":"4","author":"Bland","year":"1951","journal-title":"Circulation"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1161\/01.CIR.45.3.543","article-title":"Long-term prognosis of rheumatic fever patients receiving regular intramuscular benzathine penicillin","volume":"1972","author":"Tompkins","year":"1972","journal-title":"Circulation"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1038\/nrcardio.2012.7","article-title":"World Heart Federation criteria for echocardiographic diagnosis of rheumatic heart disease--an evidence-based guideline","volume":"9","author":"Wilson","year":"2012","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1953","DOI":"10.1161\/CIRCULATIONAHA.113.003495","article-title":"Echocardiographic screening for rheumatic heart disease in high and low risk Australian children","volume":"129","author":"Roberts","year":"2014","journal-title":"Circulation"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1093\/eurheartj\/ehu449","article-title":"Characteristics, complications, and gaps in evidence-based interventions in rheumatic heart disease: The Global Rheumatic Heart Disease Registry (the REMEDY study)","volume":"36","author":"Engel","year":"2015","journal-title":"Eur. Heart J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1136\/hrt.2004.042762","article-title":"Long term follow up of rheumatic fever and predictors of severe rheumatic valvar disease in Brazilian children and adolescents","volume":"91","author":"Meira","year":"2005","journal-title":"Heart"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"39","DOI":"10.4103\/0974-2069.197051","article-title":"Rheumatic heart disease screening: Current concepts and challenges","volume":"10","author":"Dougherty","year":"2017","journal-title":"Ann. Pediatr. Cardiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1024","DOI":"10.1093\/ehjci\/jes077","article-title":"Screening for rheumatic heart disease: Evaluation of a simplified echocardiography-based approach","volume":"13","author":"Mirabel","year":"2012","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1093\/ehjci\/jeu296","article-title":"The utility of handheld echocardiography for early rheumatic heart disease diagnosis: A field study","volume":"16","author":"Beaton","year":"2015","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1016\/j.echo.2015.01.001","article-title":"Simplified rheumatic heart disease screening criteria for handheld echocardiography","volume":"28","author":"Lu","year":"2015","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1017\/S1047951112001321","article-title":"Pilot study of nurse-led rheumatic heart disease echocardiography screening in Fiji\u2014A novel approach in a resource-poor setting","volume":"23","author":"Colquhoun","year":"2013","journal-title":"Cardiol. Young"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e002324","DOI":"10.1161\/CIRCIMAGING.114.002324","article-title":"Screening for rheumatic heart disease: Evaluation of a focused cardiac ultrasound approach","volume":"8","author":"Mirabel","year":"2015","journal-title":"Circ. Cardiovasc. Imaging"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1136\/heartjnl-2015-308236","article-title":"Handheld echocardiographic screening for rheumatic heart disease by non-experts","volume":"102","author":"Ploutz","year":"2016","journal-title":"Heart"}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/9\/10\/1451\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:37:55Z","timestamp":1760143075000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/9\/10\/1451"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,23]]},"references-count":18,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2022,10]]}},"alternative-id":["children9101451"],"URL":"https:\/\/doi.org\/10.3390\/children9101451","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,23]]}}}