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Task shifting to clinical officer-led echocardiography screening for detecting rheumatic heart disease in Malawi, Africa

Published online by Cambridge University Press:  19 December 2016

Amy Sims Sanyahumbi ,
Craig A. Sable ,
Melissa Karlsten ,
Mina C. Hosseinipour ,
Peter N. Kazembe ,
Charles G. Minard  and
Daniel J. Penny
Amy Sims Sanyahumbi*
Affiliation:
Department of Cardiology, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, United States of America
Craig A. Sable
Affiliation:
Department of Cardiology, Children’s National Medical Center, Washington, District of Columbia, United States of America
Melissa Karlsten
Affiliation:
Department of Cardiology, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, United States of America
Mina C. Hosseinipour
Affiliation:
University of North Carolina Project, Lilongwe, Malawi
Peter N. Kazembe
Affiliation:
Baylor International Pediatric AIDS Initiative, Lilongwe, Malawi
Charles G. Minard
Affiliation:
Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas, United States of America
Daniel J. Penny
Affiliation:
Department of Cardiology, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, United States of America
*
Correspondence to: A. S. Sanyahumbi, MD, Department of Cardiology, Baylor College of Medicine, Texas Children’s Hospital, 6621 Fannin St, Houston, TX 77030, United States of America. Tel: 832 826 5600; E-mail: aesims@bcm.edu
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Abstract

Background

Echocardiographic screening for rheumatic heart disease in asymptomatic children may result in early diagnosis and prevent progression. Physician-led screening is not feasible in Malawi. Task shifting to mid-level providers such as clinical officers may enable more widespread screening.

Hypothesis

With short-course training, clinical officers can accurately screen for rheumatic heart disease using focussed echocardiography.

Methods

A total of eight clinical officers completed three half-days of didactics and 2 days of hands-on echocardiography training. Clinical officers were evaluated by performing screening echocardiograms on 20 children with known rheumatic heart disease status. They indicated whether children should be referred for follow-up. Referral was indicated if mitral regurgitation measured more than 1.5 cm or there was any measurable aortic regurgitation. The κ statistic was calculated to measure referral agreement with a paediatric cardiologist. Sensitivity and specificity were estimated using a generalised linear mixed model, and were calculated on the basis of World Heart Federation diagnostic criteria.

Results

The mean κ statistic comparing clinical officer referrals with the paediatric cardiologist was 0.72 (95% confidence interval: 0.62, 0.82). The κ value ranged from a minimum of 0.57 to a maximum of 0.90. For rheumatic heart disease diagnosis, sensitivity was 0.91 (95% confidence interval: 0.86, 0.95) and specificity was 0.65 (95% confidence interval: 0.57, 0.72).

Conclusion

There was substantial agreement between clinical officers and paediatric cardiologists on whether to refer. Clinical officers had a high sensitivity in detecting rheumatic heart disease. With short-course training, clinical officer-led echo screening for rheumatic heart disease is a viable alternative to physician-led screening in resource-limited settings.

Keywords

Rheumatic heart diseaseechocardiographyscreeningglobal cardiologytask shiftingpaediatric cardiology
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 6 , August 2017 , pp. 1133 - 1139
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Copyright
© Cambridge University Press 2016 

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