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Global epidemiology, prevention and control of rheumatic heart disease with a focus on the Pacific Islands region

Colquhoun, Samantha M. (2015). Global epidemiology, prevention and control of rheumatic heart disease with a focus on the Pacific Islands region. PhD Thesis, Charles Darwin University.

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Author Colquhoun, Samantha M.
Title Global epidemiology, prevention and control of rheumatic heart disease with a focus on the Pacific Islands region
Institution Charles Darwin University
Publication Date 2015
Thesis Type PhD
Abstract Rheumatic heart disease (RHD) is a leading cause of cardiac disease among children in developing nations and Indigenous populations in some industrialised countries. In 1990, there were 29,172,383 prevalent cases of RHD globally, which increased to 34,232,795 in 2010, with 8,593,116 deaths during this entire period. Mortality due to RHD in Australia disproportionately affects young Indigenous people, with deaths due to RHD 43.1 times more common among young Indigenous people than the general population.

Despite this, accurate documentation of the burden of RHD, particularly mortality, is lacking in many high-risk countries, and regional and global estimates of the disease require updating. In response, four studies were undertaken with the following aims:
1. to determine the prevalence of RHD in Fiji using echocardiography
2. to investigate the training of nurses in basic echocardiography to detect RHD
3. to estimate the global burden of RHD
4. to determine the mortality of RHD among Indigenous Australians.

The prevalence of RHD in 1,666 school-aged children in Fiji was measured using echocardiography. It was found to be high when using World Health Organization criteria (7.2 cases per 1,000), and higher when using the new World Heart Federation criteria (8.4 per 1,000). Two nurses trained in basic RHD echocardiography in Fiji had high sensitivity to detect RHD (83% and 100%).

The Global Burden of Disease Study estimates of RHD outlined in this thesis suggest a higher burden than previously reported, and support the contention that morbidity and mortality due to RHD have been underestimated globally. However, more robust epidemiologic data, such as those from Fiji and Indigenous Australia, are required to better inform these estimates. Novel approaches, such as the training of nurses in echocardiography, may enhance data collection in resource-poor settings. Better data will enhance advocacy to bring RHD control to those most in need.

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