{"id":5252,"date":"2025-10-27T11:05:50","date_gmt":"2025-10-27T09:05:50","guid":{"rendered":"https:\/\/cvja.co.za\/journal\/?p=5252"},"modified":"2026-05-05T14:21:16","modified_gmt":"2026-05-05T12:21:16","slug":"cvja-2025-077","status":"publish","type":"post","link":"https:\/\/cvja.co.za\/journal\/cvja-2025-077\/","title":{"rendered":"A train-the-trainer curriculum to scale up artificial intelligence-supported echocardiography for rheumatic heart disease screening in a public health care system"},"content":{"rendered":"    <div id=\"article\">                                                                                                                        \r\n        <div id=\"title-container\">                                                                                                    \r\n        <div id=\"authors-title\">                                                                                                            \r\n        <!--Aurthors under Title-->                                                                                                            \r\n            \r\nDoreen Nakagaayi, Jafesi Pulle, Jenifer Atala, Linda M. Oyella, Sarah de Loizaga, Neema W. Minja, Nicholas J. Ollberding, Ndate Fall, Miriam Nakitto, Rachel Sarnacki, Joselyn Rwebembera, Emmy Okello, Andrea Beaton, Craig Sable\r\n        <\/div>        \r\n<\/div>                                                                                                                            \r\n            <div id=\"copyright\">\r\n        <strong>Copyright:<\/strong> Clinics Cardive Publishing (Pty) Ltd. publisher\r\n        of Cardiovascular Journal of Africa.<\/div>\r\n    <div style=\"clear: both;\"><\/div>                                                                                                                                \r\n        <div id=\"article-abstract\">                                                                                                            \r\n            <div id=\"abstract-title\">                                                                                                        \r\n                    Abstract                                                                                                                \r\n                <\/div>                                                                                                                        \r\n                                                                                                                                \r\n            <div id=\"abstract-content\">                                                                                                        \r\n            <!--Content of Abstract Article-->                                                                                                \r\n            <!--<strong>\"Abstract titles\":<\/strong>-->                                                                                        \r\n            <!--<br\/> at the end of each section!!-->                                                                                        \r\n                                                                                                                                            \r\n        <strong>Background:<\/strong>                                                                                                    \r\n                                                                                                                                                    \r\nThis study aimed to test a train-the-trainer model for scaling up echocardiographic screening for rheumatic heart disease (RHD).\r\n<br \/>                                                                                                                            \r\n                                                                                                                                                \r\n        <strong>Methods:<\/strong>                                                                                                    \r\n                                                                                                                                                    \r\nThis was a two-phased, prospective, pilot cohort study conducted in Lira, Uganda. In phase one, four nurse centres underwent a three-day training on echocardiographic screening for RHD. Thereafter, nurses integrated screening of patients aged 5-40 years into their routine clinic workflow. Echocardiograms were uploaded to a cloud-based server for review by an expert, who served as the gold standard for interpretation. In phase two, 12 nurses were trained by trainees included in phase one.\r\n<br \/>        \r\n                \r\n                <strong>Results:<\/strong>                                                                                                    \r\nA total of 16 nurses (four in phase one and 12 in phase two) were recruited. All nurses achieved the target of acquiring 100 echocardiograms, resulting in a total of 1620 screening echocardiograms (n = 406 in phase one and n = 1214 in phase two). Over 95% of the studies were of diagnostic quality. There were 44\/1473 (3%) screen-positive participants, 40 with RHD. There was a decline in sensitivity from 70% to 50% (p = 0.33) and an increase in specificity from 86% to 94% (p < 0.0001) between phases one and two. All four cases of moderate\/severe RHD were correctly identified. In phase one, 56 cases were incorrectly classified as left ventricular dysfunction using the auto ejection fraction function; this option was omitted for phase two.\r\n<br \/>\r\n                                                                                                                                                                                                                                                                        \r\n                                                                                                                                                \r\n        <strong>Conclusion:<\/strong>                                                                                                    \r\n                                                                                                                                                    \r\nThis pilot study showed that utilising a train-the- trainer model to implement echocardiographic screening for RHD into primary health care in a low-resource setting is feasible.\r\n<br \/>    \r\n                                                                                                        \r\n\r\n                                                                                                                                                \r\n            <\/div>                                                                                                                            \r\n        <\/div>                                                                                                                                    \r\n                                                                                                                                        \r\n                                                                                                                                                \r\n        <div id=\"keywords\">                                                                                                                    \r\n                                                                                                                                            \r\n            <strong>Keywords:<\/strong>                                                                                                        \r\n                                                                                                                                            \r\n            <strong>rheumatic heart disease, echocardiographic screening, train-the-trainer, artificial intelligence, primary health care<\/strong>                                                                                                                                                                                                                    \r\n                                                                                                                                                \r\n        <\/div>                                                                                                                                    \r\n                                                                                                                                                \r\n    <div id=\"publish-info\">                                                                                                                    \r\n                                                                                                                                \r\n    <strong>Submitted:<\/strong> June 20, 2024; <!--Month day, year; -->    \r\n    <strong>Accepted:<\/strong> July 14, 2025; <!--Month day, year; -->                                                                            \r\n    <strong>Published:<\/strong> October 27, 2025<!--Month day, year; -->                                                                                                                            <br \/>                                                            \r\n        <em>Cardiovasc J Afr 2025; <b>36<\/b>: 538-547<!--pg no. till pg no. \"eg. 4-7\"--><\/em>\r\n        <br \/><strong>Volume 36, Issue 4<\/strong> <br \/>                                                                            \r\n        <\/div>                                                                                                                            \r\n                                                                                                                                        \r\n    <div id=\"DOI\">                                                                                                                    \r\n            DOI Citation Reference: dx.doi.org\/10.5830\/CVJA-2025-077<!--DOI number-->                                                                \r\n        <\/div>                                                                                                                            \r\n                \r\n                <div id=\"author-affiliation\">                                                                                                \r\n\r\n<strong>Uganda Heart Institute, First Floor, Block C, Mulago Hospital Complex, Kampala, Uganda\r\n<\/strong>    <br \/>                                                                            \r\nDoreen Nakagaayi<br \/>\r\nJafesi Pulle<br \/>\r\nJenifer Atala<br \/>\r\nLinda M. Oyella<br \/>\r\nMiriam Nakitto<br \/>\r\nJoselyn Rwebembera<br \/>\r\nEmmy Okello\r\n\r\n<br \/><br \/>\r\n\r\n<strong>Heart Institute, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, USA\r\n<\/strong>    <br \/>                                                                            \r\nSarah de Loizaga<br \/>\r\nNdate Fall<br \/>\r\nAndrea Beaton\r\n\r\n<br \/><br \/>\r\n\r\n<strong>Department of Pediatrics, University of Cincinnati, Cincinnati\r\n<\/strong>    <br \/>                                                                            \r\nSarah de Loizaga<br \/>\r\nAndrea Beaton\r\n\r\n<br \/><br \/>\r\n\r\n<strong>Department of Global Health, University of Washington, USA; Kilimanjaro Clinical Research Institute, Moshi, Tanzania\r\n<\/strong>    <br \/>                                                                            \r\nNeema W. Minja\r\n\r\n<br \/><br \/>\r\n\r\n<strong>Division of Biostatistics and Epidemiology, Cincinnati Children\u2019s Hospital Medical Center, USA; University of Cincinnati College of Medicine, Cincinnati, USA\r\n<\/strong>    <br \/>                                                                            \r\nNicholas J. Ollberding\r\n\r\n<br \/><br \/>\r\n\r\n<strong>Children\u2019s National Hospital, Washington, District of Columbia, USA\r\n<\/strong>    <br \/>                                                                            \r\nRachel Sarnacki\r\n\r\n<br \/><br \/>\r\n\r\n<strong>Ochsner Children\u2019s Hospital, Xavier Ochsner College of Medicine (XOCOM), New Orleans, Louisiana, USA\r\n<\/strong>    <br \/>                                                                            \r\nCraig Sable\r\n\r\n<br \/><br \/>\r\n                                                                                                                                                                                                                                        \r\n\r\n                [soshsc hide=\"logged\"]\r\n                <strong>You need to be <a style=\"color: #c80c44;\" href=\"https:\/\/cvja.co.za\/journal\/member-login\/\" target=\"_blank\" rel=\"noopener\">logged in to view and download<\/a> the full text PDF version. <a style=\"color: #c80c44;\" href=\"https:\/\/cvja.co.za\/journal\/register\/\" target=\"_blank\" rel=\"noopener\">Register for a free account?<\/a><\/strong> <br \/><br \/>[\/soshsc]\r\n                \r\n                \r\n                \r\n                <\/div>\r\n    \r\n<\/div>","protected":false},"excerpt":{"rendered":"<p>This study aimed to test a train-the-trainer model for scaling up echocardiographic screening for rheumatic heart disease (RHD).<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[44,108],"tags":[],"class_list":["post-5252","post","type-post","status-publish","format-standard","hentry","category-cardiovascular-topics","category-volume-36-issue-4"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.0 - 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