PS296 Task Shifting: Proficiency of General Radiography Technicians in Detecting Rheumatic Heart Disease

Zühlke, Liesl; Machila, Elizabeth; Lungu, J.C.; Schwaninger, Sherri; Dam, Joris van; Spector, J. Michael; Tadmor, Brigitta; Musuku, John

doi:10.1016/j.gheart.2016.03.230

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“…Six general radiographers from UTH were recruited to participate in the school screening study, and three ultimately completed training and remained part of the study team throughout the study period. Training comprised classroom-style and hands-on workshops involving actual RHD patients at UTH and supportive supervision during school screening [ 28 ]. Training activities took place periodically over 12 months beginning May 2014.…”

Section: Methodsmentioning

confidence: 99%

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Prevalence of rheumatic heart disease in Zambian school children

Musuku

Engel

Musonda

et al. 2018

BMC Cardiovasc Disord

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BackgroundThe large global burden of rheumatic heart disease (RHD) has come to light in recent years following robust epidemiologic studies. As an operational research component of a broad program 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 wished to evaluate the practicality of training local radiographers in echocardiography screening methods.MethodsEchocardiography was conducted on a random sample of students in 15 schools utilizing a previously validated, abbreviated screening protocol. 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 to use portable echocardiography devices. Students deemed as screen-positive were referred for comprehensive echocardiography and clinical examination at UTH. Cardiac abnormalities were classified according to standard World Heart Federation criteria.ResultsOf 1102 students that were consented and screened, 53 students were referred for confirmatory echocardiography. Three students had definite RHD, 10 had borderline RHD, 29 were normal, and 11 students were lost to follow-up. The rates of definite, borderline, and total RHD were 2.7 per 1000, 9.1 per 1000, and 11.8 per 1000, respectively. Anterior mitral valve leaflet thickening and chordal thickening were the most common morphological defects. The pairwise kappa test showed fair agreement between the local radiographers and an echocardiographer quality assurance specialist.ConclusionThe prevalence of asymptomatic RHD in urban communities in Zambia is within the range of results reported in other sub-Saharan African countries using the WHF criteria. 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.Trial registrationThe study was registered on clinicaltrials.gov (#NCT02661763).

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Section: Methodsmentioning

confidence: 99%

“…The opportunity of this study was also used to build local echocardiographic capabilities that could be applied to subsequent clinical and research activities in Zambia [ 28 ]. Data from this investigation were anticipated to inform health programs combating RHD and to support advocacy for RHD patients.…”

Section: Introductionmentioning

confidence: 99%