CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
158
AFRICA
Background:
Dilated cardiomyopathy (DCM) is an important cause
of heart failure in children and carries a high risk of mortality and
morbidity. In adults with heart failure moderate to low health-related
quality of life (HRQoL) has been reported. Information on HRQoL
in children is lacking. Therefore, in this multicentre study we evalu-
ated the HRQoL in children with DCM.
Methods:
HRQoL was measured with international standardised
QoL questionnaires: the Infant–Toddler Parental QoL questionnaire
(age 0–3 years); Child Health questionnaire (CHQ) Parental Form
50 (age 4–17 years) and the CHQ Child Form 87 (children aged
10–17 years). Results were compared with Dutch normative data. A
subgroup analysis was done to evaluate the parent–child agreement.
Results:
Parent reports of children aged 0–3 years (
n
=
19) showed
significantly poorer scores on ‘physical functioning’, ‘general
health’ and ‘growth and development’ compared to normative data
(
p
<
0.05). In contrast, on subscales ‘general behaviour’, ‘getting
along’ and family cohesion’, significantly better scores were found.
Parents of children aged 4–17 years (
n
=
33) reported impairments
(significantly reduced scale scores) on nearly all subscales, except for
‘general behaviour’ and ‘family cohesion’. On self reports, patients
with DCM (aged 10–17 years,
n
=
24) also scored significantly lower
on half of the subscales. Remarkably, they reported better ‘general
behaviour’ (
p
<
0.05) and their scores for ‘bodily pain’ and ‘mental
health’ were comparable to normative data. Strong parent–child
agreement was found for most physical subscales (
r
2
=
0.5–0.8;
p
<
0.01). To a lesser degree we observed agreement between parents’
and children’s reports on the psychosocial scales as ‘mental health’
and ‘self esteem’ (
r
2
=
0.2,
p
<
0.05).
Conclusion:
In children with DCM, HRQoL is considerably
impaired. Low scores were specifically found on physical subscales,
in which strong parent–child agreement was found. Interestingly, our
results showed better psychosocial and family functioning in families
with young children with DCM.
346: RESOURCE UTILISATION AND OUTCOMES OF
INFECTIVE ENDOCARDITIS IN CHILDREN: A MULTI-
CENTRE STUDY
Shaji Menon
1
, AdamWare
2
, Cindy Weng
2
, Jacob Wilkes
2
, Lloyd Tani
2
1
Division of Paediatric Cardiology, University of Utah, Salt Lake
City, Utah, USA
2
Department of Paediatrics, University of Utah, Salt Lake City, Utah,
USA
Background
: The objective of this study was to evaluate the resource
utilisation and outcomes of IE in children with and without pre-
existing heart disease (HD vs NHD).
Methods
: Children
<
19 years old without chronic non-cardiac
conditions hospitalised from 2004 to 2010 with IE at one of 37 US
children’s hospitals in the Paediatric Health Information Systems
database were included. Comparisons were made between HD and
NHD cohorts. Regression analysis was used to evaluate factors asso-
ciated with poor outcomes (mortality, mechanical cardiac support,
renal failure or stroke).
Results:
Of
1 033 IE cases, 663 had HD and 370 had NHD. Factors
associated with poor outcome in the HD cohort: higher risk of
mortality score (OR
=
7.9), mechanical ventilation (OR
=
3.1),
anti-arrhythmic use (OR
=
2.7) and vasoactive medication use (OR
=
3.8) and in the NHD cohort: renal failure (OR
=
19.3), higher risk
of mortality score (OR
=
4.2), anti-arrhythmic use (OR
=
3.8) and
mechanical ventilation (OR
=
3.2).
Conclusions:
Compared to IE in NHD, IE associated with HD
was more likely to occur in younger patients, less often related to
Staphylococcus
and more often related to
Streptococcus
, and was
associated with higher mortality, greater likelihood of needing
cardiac surgery, but a lower risk of stroke.
Factors associated with
poor outcome in the entire group included mechanical ventilation,
higher risk of mortality score at admission and anti-arrhythmic use.
In addition, renal failure in the NHD and vasoactive medication use
in the HD cohort were associated with poor outcomes.
363: EPIDEMIOLOGY OF RHEUMATIC HEART DISEASE
IN TUVALU
Maliesi Latasi
1
, Stephen Homasi
1
, Lafoe Mosese
1
, Liz Kennedy
2
,
Samantha Colquhoun
2,3
, Bo Remenyi
2
, Benjamin Reeves
5
, Frances
Matanatabu
4
, Jonathan Carapetis
2,6
1
Ministry of Health, Republic of Tuvalu, Pacific Islands
2
Menzies School of Health Research, Darwin, Australia
3
Centre for International Child Health, University of Melbourne,
Melbourne, Australia
4
Ministry of Health, Fiji Islands
5
Department of Health, Queensland, Australia
6
Telethon Institute for Child Health Research, Centre for Child
Health Research,
University of Western Australia, Perth, Australia
Background:
The World Heart Federation, Menzies School of
Health Research and Tuvalu Ministry of Health conducted the first
school-based echocardiographic screening in Tuvalu in 2012. The
aim of the screening was to detect cases of rheumatic heart disease
among school-aged children and to determine the burden of rheu-
matic heart disease in this Pacific Island nation.
Methods:
A technical team from Australia and the Fiji Islands trav-
elled to Tuvalu for 10 days to conduct the school-based screening.
Screening was undertaken in three schools. A local radiographer
assisted the team. The visiting paediatric cardiologist conducted 1:1
training in echo screening with the local radiographer and doctors.
Results:
A total of 571 children between the ages of six and 15
years were screened on the main island of Funafuti. This represents
approximately 50% of the age-eligible Funafuti population and 25%
of the national age-eligible population. Of the 571 children screened,
a total of 26 definite and probable cases of rheumatic heart disease
(RHD) were detected using the recently published World Heart
Federation criteria for echocardiographic screening, 65% of the cases
detected were female. RHD prevalence in Tuvalu is estimated at 31.5
per 1 000. The majority of those affected had mild disease. Four cases
of congenital heart disease were detected. All children who were
found to have either definite or probable RHD were counselled with
their parents/guardians, registered with the programme and second-
ary prophylaxis was commenced. Probable cases of RHD will be
reviewed after one year when the technical team returns to Tuvalu.
Conclusion:
The RHD prevalence in Tuvalu is consistent with rates
found in nearby Pacific nations of Tonga 33 per 1 000 and Fiji 32
per 1 000. Funafuti is densely populated, with poor living conditions.
Further work is required to determine risk factors and to estimate the
burden in outlying islands of Tuvalu.
364: SCHOOL-BASED SCREENING FOR RHEUMATIC
HEART DISEASE IN NAURU
Godfrey Waidubu
1
, Bo Remenyi
2
, Alani Tangitau
1
, Gano Mwareow
1
,
Febrina Buramen
1
, Laisiana Matatolu
4
, Michelle Gallant
2
, Liz
Kennedy
2
, Samantha Colquhoun
1,3
,Jonathan Carapetis
1,5
1
Ministry of Health, Republic of Nauru, Pacific Islands
2
Menzies School of Health Research, Darwin, Australia
3
Centre for International Child Health, University of Melbourne,
Melbourne, Australia
4
Ministry of Health, Fiji Islands
5
Telethon Institute of Child Health Research, Centre for Child Health
Research, University of Western Australia, Australia
Background:
Nauru, a Pacific nation with an estimated population
of just 10 000, commenced a rheumatic heart disease (RHD) preven-
tion programme in 2006. In 2012, the Ministry of Health with the
support of an international team conducted their first school-based
screening for RHD. The aims of the screening were to estimate
disease burden to enable for the prioritisation of RHD-related
activities and to identify children with RHD early, to allow for timely
enrolment into secondary prophylaxis programmes.
Methods:
School-based screening of grades 3, 6 and 9 students at
all four schools was undertaken using portable echocardiography.
