IMPORTANCEEchocardiographic screening allows for early detection of subclinical stages of rheumatic heart disease among children in endemic regions.OBJECTIVE To investigate the effectiveness of systematic echocardiographic screening in combination with secondary antibiotic prophylaxis on the prevalence of rheumatic heart disease.DESIGN, SETTING, AND PARTICIPANTS This cluster randomized clinical trial included students 9 to 16 years of age attending public and private schools in urban and rural areas of the Sunsari district in Nepal that had been randomly selected on

Background With an aging global population comes significant non-communicable disease burden, especially in low- and middle-income countries (LMICs). An unknown proportion of this burden is treatable with surgery. For health system planning, this study aimed to estimate the surgical needs of individuals over 50 years in Nepal. Methods A two-stage, cluster randomized, community-based survey was performed in Nepal using the validated Surgeons OverSeas Assessment of Surgical Need (SOSAS) tool. SOSAS collects household demographics, randomly selects household members for verbal head-to-toe examinations for surgical conditions and completes a verbal autopsy for deaths in the preceding year. Only respondents older than 50 years were included in the analysis. Results The survey sampled 1,350 households, totaling 2,695 individuals (97% response rate). Of these, 273 surgical conditions were reported by 507 persons ages ≥50 years. Extrapolating, there are potentially 2.1 million people over age 50 with surgically treatable conditions needing care in Nepal (95%CI 1.8 – 2.4 million; 46,000 – 62,6000 per 100,000 persons). One in five deaths were potentially treatable or palliated by surgery. Though a growth or mass (including hernias and goiters) was the most commonly reported surgical condition (25%), injuries and fractures were also common and associated with the greatest disability. Literacy and distance to secondary and tertiary health facilities were associated with lack of care for surgical conditions (p<0.05). Conclusion There is a large unmet surgical need among the elderly in Nepal. Low literacy and distance from a capable health facility are the greatest barriers to care. As the global population ages, there is an increasing need to improve surgical services and strengthen health systems to care for this group.

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Background: The present study aimed to quantify the burden of structural heart disease in Nepali children. Methods: We performed a school-based cross-sectional echocardiographic screening study with cluster random sampling among children 5–16 years of age. Results: Between December 2012 and January 2019, 6573 children (mean age 10.6 ± 2.9 years) from 41 randomly selected schools underwent echocardiographic screening. Structural heart disease was detected in 14.0 per 1000 children (95% CI 11.3–17.1) and was congenital in 3.3 per 1000 (95% CI 2.1–5.1) and rheumatic in 10.6 per 1000 (95% CI 8.3–13.4). Rates of rheumatic heart disease were higher among children attending public as compared to private schools (OR 2.8, 95% CI 1.6–5.2, p = 0.0001). Conclusion: Rheumatic heart disease accounted for three out of four cases of structural heart disease and was more common among children attending public as compared to private schools.