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Objective: To estimate the echocardiography confirmed prevalence of rheumatic heart disease (RHD) in school children in Fiji., Design: Cross-sectional observational study., Setting: Ten primary schools in Fiji., Patients: School children aged 5-14 years., Interventions: Each child had an echocardiogram performed by an echocardiographic technician subsequently read by a paediatric cardiologist not involved with field screening, and auscultation performed by a paediatrician., Main Outcome Measures: Echocardiographic criteria for RHD diagnosis were based on those previously published by the National Institutes of Health (NIH) and World Health Organization (WHO), and data were also analyzed using the new World Heart Federation (WHF) criteria. Prevalence figures were calculated with binomial 95% confidence intervals., Results: Using the modified NIH/WHO criteria the prevalence of definite RHD prevalence was 7.2 cases per 1000 (95% CI 3.7-12.5), and the prevalence of probable RHD 28.2 cases per 1000 (95% CI 20.8-37.3). By applying the WHF criteria the prevalence of definite and borderline RHD was 8.4 cases per 1000 (95% CI 4.6-14.1) and 10.8 cases per 1000 (95% CI 6.4-17.0) respectively. Definite RHD was more common in females (OR 5.1, 95% CI 1.1-48.3) and in children who attended school in a rural location (OR 2.3, 95% CI 0.6-13.50). Auscultation was poorly sensitive compared to echocardiography (30%)., Conclusion: There is a high burden of undiagnosed RHD in Fiji. Auscultation is poorly sensitive when compared to echocardiography in the detection of asymptomatic RHD. The results of this study highlight the importance of the use of highly sensitive and specific diagnostic criteria for echocardiography diagnosis of RHD., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Rheumatic heart disease (RHD) is a leading cause of cardiac disease among children in developing nations, and in indigenous populations of some industrialized countries. In endemic areas, RHD has long been a target of screening programmes that, historically, have relied on cardiac auscultation. The evolution of portable echocardiographic equipment has changed the face of screening for RHD over the past 5 years, with greatly improved sensitivity. However, concerns have been raised about the specificity of echocardiography, and the interpretation of minor abnormalities poses new challenges. The natural history of RHD in children with subclinical abnormalities detected by echocardiographic screening remains unknown, and long-term follow-up studies are needed to evaluate the significance of detecting these changes at an early stage. For a disease to be deemed suitable for screening from a public health perspective, it needs to fulfil a number of criteria. RHD meets some, but not all, of these criteria. If screening programmes are to identify additional cases of RHD, parallel improvements in the systems that deliver secondary prophylaxis are essential.

Rheumatic heart disease (RHD) is an important cause of cardiac morbidity and mortality globally, particularly in the Pacific region. Susceptibility to RHD is thought to be due to genetic factors that are influenced by environmental factors, such as crowding and poverty. However, there are few data relating to these environmental factors in the Pacific region. We conducted a case-control study of 80 cases of RHD with age- and sex-matched controls in Fiji using a questionnaire to investigate associations of RHD with a number of environmental factors. There was a trend toward increased risk of RHD in association with poor-quality housing and lower socioeconomic status, but only one factor, maternal unemployment, reached statistical significance (OR 2.6, 95% confidence interval 1.2-5.8). Regarding crowding, little difference was observed between the two groups. Although our data do not allow firm conclusions, they do suggest that further studies of socioeconomic factors and RHD in the Pacific are warranted. They also suggest that genetic studies would provide an insight into susceptibility to RHD in this population.

This article outlines the impact of rheumatic heart disease for the individual, the international community and the Pacific region. It then appraises the three main strategies for control of rheumatic heart disease. Secondary prevention is the regular delivery of antibiotic prophylaxis to prevent further episodes of recurrent rheumatic fever and is the only prevention activity that is proven to be effective and cost effective at the individual and community level. The article explores the essential facets of a successful control program focussing upon health education and promotion, and then discusses previous experience with control programs for rheumatic heart disease. Finally it describes the current Pacific Rheumatic Heart Disease Control Program.