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AFRICA
Cardiovascular Journal of Africa • ABSTRACTS – SA HEART
®
CONGRESS 2019
S30
Cardiac manifestations of congenital rubella syndrome
Davidzo Murigo-Shumba, Ebrahim Goolam Mahomed Hoosen, Andiswa Nzimela and Marelize Bosman
University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
Introduction:
Maternal rubella infection in early pregnancy may result in Congenital Rubella Syndrome (CRS). Among the birth defects encountered with
CRS are cardiac and eye malformations. CRS is a vaccine preventable condition. In South Africa, rubella containing vaccines (RCVs) are not included in the
Expanded Programme of Immunisation (EPI). The objective of the study was to describe the characteristics of CRS patients with congenital heart defects
(CHDs) at Inkosi Albert Luthuli Central Hospital (IALCH) over a 12-month period.
Methods:
Hospital records of all patients with CHD and diagnosis of CRS from May 2018 - April 2019 were reviewed.
Results:
Nine patients with CRS and a cardiac lesion were seen during the 12-month period. Two mothers reported a rash suggestive of rubella during
early pregnancy. Findings at birth included prematurity (6 patients) and microcephaly (6 patients). Cardiac abnormalities included patent arterial duct in
all patients. In addition, 3 had coarctation of the aorta, 2 had supravalvular pulmonary stenosis and 1 patient had a ventricular septal defect. Six patients
underwent cardiac surgical intervention. Of the 3 who did not have cardiac surgery, 2 did not require surgery while the other patient succumbed to septic
shock before surgery. Eye manifestations in 7 patients included: cataracts, microphthalmos, nanophthalmos and cornea opacification. Two patients demised,
1 before surgery and the other succumbed to ICU related complications post-surgery.
Conclusion:
CRS remains a significant cause of morbidity and mortality in KwaZulu-Natal. Further studies are necessary as the introduction of RCVs to the EPI
in South Africa, if feasible, could significantly reduce CRS cases.
Prevalence of rheumatic heart disease in Zambian school children
John Musuku
Ministry of Health, Lusaka, Zambia
Introduction:
In recent years, following robust epidemiologic studies, the large global burden of rheumatic heart disease (RHD) has come to light. As
an operational research component of a broader programme aimed at primary and secondary prevention of RHD, we sought to determine the current
prevalence of RHD in the country’s capital, Lusaka, using a modern imaging-based screening methodology. In addition, we evaluated the practicality of
training local radiographers in echocardiography screening methods.
Methods:
Utilising a previously validated, abbreviated screening protocol, echocardiography was conducted on a random sample of students in 15 schools.
Through a task-shifting scheme, and in the spirit of capacity-building to enhance local diagnostic and research skills, general radiographers based at Lusaka
University Teaching Hospital (UTH) were newly trained in the use of portable echocardiography devices. Students deemed screen-positive were referred
for comprehensive echocardiography and clinical examination at UTH. Cardiac abnormalities were classified according to standard World Heart Federation
criteria.
Results:
Of 1 102 students who consented and were screened, 53 were referred for confirmatory echocardiography. Of these, 3 students had definite RHD,
10 had borderline RHD and 29 were normal. Eleven students were lost to follow-up. The rates of definite, borderline, and total RHD were 2.7 per 1 000, 9.1 per
1 000, and 11.8 per 1 000, respectively. Anterior mitral valve leaflet thickening and chordal thickening were the most common morphological defects. The
pairwise kappa test showed good agreement between local radiographers and an echocardiographer quality assurance specialist.
Conclusion:
The prevalence of asymptomatic RHD in urban communities in Zambia is on par with that reported in other sub-Saharan African countries. Task-
shifting local radiographers to conduct echocardiography was feasible. The results of this study will be used to inform ongoing efforts in Zambia to control
and eventually eliminate RHD.
Teachers’ knowledge and attitudes regarding rheumatic heart disease
John Musuku
Ministry of Health, Lusaka, Zambia
Introduction:
Rheumatic heart disease (RHD) is a major public health problem in Africa, affecting 1% - 5% of school-aged children. Community and
school involvement is increasingly recognised as an essential component of national strategies to control RHD. Very little is however known about teachers’
knowledge and attitudes about the disease. For the first time, school-based screening using portable echocardiography was conducted on up to 3 000
children in Lusaka.
Methods:
A workshop was conducted for primary and secondary school teachers in February 2014. Participants also completed an 8-item multiple-choice
questionnaire before, and after, the course to evaluate basic knowledge regarding RHD.
Results:
Fifty-three teachers from more than 45 schools participated. Most were female and all but 3 had been teachers for at least 5 years. Approximately
half of the teachers also served as their school’s health officer. Only 55% had ever heard of RHD before the workshop, and 24% reported that they had known
a student with RHD. Forty-nine percent of teachers were unaware that RHD is caused by bacterial infection of the throat and few (less than 25%) knew that
children with RHD require regular antibiotics to prevent progression of their heart disease. Pre-post knowledge scores improved from 3.8/8 (SD 0.9) to
5.9/8 (SD 1.2; p<0.001). In the focus group discussion, teachers were overwhelmingly eager to help facilitate RHD screening programmes at their schools.
Conclusion:
Teachers’baseline awareness of RHD is poor and few have first-hand exposure to students with RHD, despite the high prevalence of the disease
in Africa. Notwithstanding, teachers were eager to learn about RHD and demonstrated significantly improved knowledge after the workshop. Teachers appear
poised to assume their role as vital partners in school-based screening programmes and may also play important roles in long-term efforts to control RHD.