Cardiovascular Journal of Africa: Vol 28 No 5 (September/October 2017)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 5, September/October 2017 292 AFRICA
Adams gave expert advice regarding the echocardiographic techniquies. We
also sincerely thank Josh Goldberg and Egidia Rugwizangoga for their dedi-
cation and assistance.
The authors gratefully acknowledge the assistance of Agnes Binagwaho,
MD, PhD, then Minister of Health of the Republic of Rwanda. Dr Vincent
Biruta, then Minister of Education of the Republic of Rwanda, gave advice.
The Departments of Health and Education of Gasabo district were helpful in
their suggestions for and facilitation of health education and parent education.
We also express our appreciation to the Medical Director and the supervisory
team of Kibagabaga Hospital, as well as the volunteer nurses from Gasabo
District Health Centres for their participation in carrying out this investigation.
We thank the Medtronic Foundation, Minneapolis, Minnesota, for
significant financial support. Studycast, Core Sound Imaging, Inc, Raleigh,
NC, provided in-kind assistance in formatting images, data storage and shar-
ing. The SonoSite Company (Bothell, Washington) generously provided the
majority of the echocardiographic equipment during this project. Additional
funding was provided by Team Heart, Inc, Boston, MA.
Drs Mucumbitsi and Bulwer are both first authors and put in equal
amounts of work. Dr Kaplan is corresponding author. His address is
Department of Pediatrics, University of Minnesota Medical School, MMC
296, 420 Delaware Str SE, Minneapolis, MN 55422, USA. Tel: 612-624-4455;
Fax: 612-625-7859; e-mail:
References
1. Kaplan EL. T Duckett Jones memorial lecture: Global assessment of
rheumatic fever and rheumatic heart disease at the close of the century.
Influences and dynamics of populations and pathogens: a failure to real-
ize prevention? Circulation 1993; 88: 1964–1972.
2. Carapetis JR, Steer AC, Mulholland EK, Weber M. The global burden
of group A streptococcal disease. Lancet Infect Dis 2005; 5: 685–694.
3. Tibazarwa, KB, Volmink JA, Mayosi, BM. Incidence of acute rheumatic
fever in the world: a systematic review of population based studies. Heart
2008; 94: 1534–1540.
4. Veasy LG, Wiedmeier SE, Orsmond GS, Ruttenberg HD, Boucek MM,
Roth SJ, et al. Resurgence of acute rheumatic fever in the intermountain
area of the United States. N Engl J Med 1987; 316: 421–427.
5. Paar JA, Berrios NM, Rose JD, Caceres M, Pena R, Perez W, et al.
Prevalence of rheumatic heart disease in children and young adults in
Nicaragua. Am J Cardiol 2010; 105: 1809–1814.
6. Essop MR, Nkomo VT. Rheumatic and non-rheumatic valvular
heart disease: epidemiology, management, and prevention in Africa.
Circulation 2005; 112: 3584–3591.
7. Engle ME, Haileamlak A, Zuhlke L, Lemmer CE, Nkepu S, van der Wall
M, et al. Prevalence of rheumatic heart disease in 4720 asymptomatic
scholars from South Africa and Ethiopia. Heart 2015; 101: 1389-1394.
8. Kaplan EL, Mendis S, Bisno A, Butchart EG, Ganguly NK, Ghebrehiwet
T, et al. Rheumatic fever and rheumatic heart disease – Report of a
World Health Organization Expert Consultation. WHO Technical
Report Series 923. World Health Organization, Geneva, Switzerland,
2004.
9. Atatoa-Carr P, Lennon D, Wilson N. Rheumatic fever. Diagnosis,
management, and secondary prevention: a New Zealand guideline. N Z
Med J 2008; 121: 59–69.
10. The Australian guideline for prevention, diagnosis, and management of
acute rheumatic fever and rheumatic heart disease. 2012. http://www.
11. Remenyi B, Wilson N, Steer A, Ferreira B, Kado J, Kumar K, et al.
World Heart Federation criteria for echocardiographic diagnosis of
rheumatic heart disease – an evidence-based guideline. Nat Rev Cardiol
2012; 9: 297–309.
12. Gewitz MH, Baltimore RS, Tani L, Sable CM, Shulman ST, Carapetis J,
et al. Revision of the Jones criteria for the diagnosis of acute rheumatic
fever in the era of Doppler echocardiography: A scientific statement
from the American Heart Association Committee on Rheumatic Fever,
Endocarditis, and Kawasaki Disease of the Council on Cardiovascular
Disease in the Young. Circulation 2015; 122; 1806–1818.
13. Marijon E, Celermajer DS, Ferriera B, Mocumbi AO, Jani D, Paquet
C, et al. Prevalence of rheumatic heart disease detected by echocardio-
graphic screening. New Eng J Med 2007; 357: 470–476.
14. Anabwani GM, Bonhoeffer P. Prevalence of heart disease in school
children in rural Kenya using colour-flow echocardiography. E Afr Med
J 1996; 73: 215–217.
15. Beaton A, Okello E, Lwabi P, Mondo C, McCarter R, Sable C.
Echocardiographic screening for rheumatic heart disease in Ugandan
schoolchildren. Circulation 2012; 125: 3127–3132.
16. Bingawaho A, Farmer PE, Nsanzimana S, et al. Rwanda 20 years on:
investing in life. Lancet 2014; 384: 371-375.
17. Clark BC, Krishnan A, McCarter R, Scheel J, Sable C, Beaton A. Using
a low-risk population to estimate the specificity of the World Heart
Federation criteria for the diagnosis of rheumatic heart disease. J Am
Society Echocard 2016; 29: 253–258.
18. Zühlke L, Mayosi BM. Echocardiographic screening for subclinical rheu-
matic heart disease remains a research tool pending studies of impact on
prognosis. Cur Cardiol Rep 2013; 15: 343.
19. Remenyi B, Carapetis J, Wyber R, Taubert K, Mayosi B. Position state-
ment of the World Heart Federation on the prevention and control of
rheumatic heart disease. Nat Rev Cardiol 2013; 10: 284–292.