Skip to main content Accessibility help

Pilot study of nurse-led rheumatic heart disease echocardiography screening in Fiji – a novel approach in a resource-poor setting

  • Samantha M. Colquhoun (a1) (a2), Jonathan R. Carapetis (a1), Joseph H. Kado (a3), Benjamin M. Reeves (a4), Boglarka Remenyi (a1) (a5), William May (a6), Nigel J. Wilson (a5) and Andrew C. Steer (a2)...


We designed a pilot study of a training module for nurses to perform rheumatic heart disease echocardiography screening in a resource-poor setting. The aim was to determine whether nurses given brief, focused, basic training in echocardiography could follow an algorithm to potentially identify cases of rheumatic heart disease requiring clinical referral, by undertaking basic two-dimensional and colour Doppler scans. Training consisted of a week-long workshop, followed by 2 weeks of supervised field experience. The nurses’ skills were tested on a blinded cohort of 50 children, and the results were compared for sensitivity and specificity against echocardiography undertaken by an expert, using standardised echocardiography definitions for definite and probable rheumatic heart disease. Analysis of the two nurses’ results revealed that when a mitral regurgitant jet length of 1.5 cm was used as the trigger for rheumatic heart disease identification, they had a sensitivity of 100% and 83%, respectively, and a specificity of 67.4% and 79%, respectively. This pilot supports the principle that nurses, given brief focused training and supervised field experience, can follow an algorithm to undertake rheumatic heart disease echocardiography in a developing country setting to facilitate clinical referral with reasonable accuracy. These results warrant further research, with a view to developing a module to guide rheumatic heart disease echocardiographic screening by nurses within the existing public health infrastructure in high-prevalence, resource-poor regions.


Corresponding author

Correspondence to: MS. Samantha Colquhoun, BA, RN, MPH (PhD Scholar), Centre for International Child Health, East Level 2 Royal Children's Hospital, Flemington Road, Parkville 3052, Australia. Tel:+61 3 9345 4977; Fax: +61 3 9345 6667; E-mail:


Hide All
1. Steer, AC, Kado, J, Jenney, AW, et al. Acute rheumatic fever and rheumatic heart disease in Fiji: prospective surveillence, 2005–2007. Med J Aust 2009; 190: 133135.
2. Reeves, BM, Kado, JH, Brook, M. High prevalence of rheumatic heart disease in Fiji detected by echocardiography screening. J Paediatr Child Health 2011; 47: 473478.
3. Paar, JA, Berrios, NM, Rose, JD, et al. Prevalence of rheumatic heart disease in children and young adults in Nicaragua. Am J Cardiol 2010; 105: 18091814.
4. Carapetis, JR, Hardy, M, Fakakovikaetau, T, et al. Evaluation of a screening protocol using auscultation and portable echocardiography to detect aysmtomatic rheumatic heart disease in Tongan school children. Nat Clin Pract Cardiovasc Med 2008; 5: 411417.
5. Webb, R, Wilson, NJ, Lennon, DR, et al. Optimising echocardiographic screening for rheumatic heart disease in New Zealand: not all valve disease is rheumatic. Cardiol Young 2011; 21: 436443.
6. Marijon, E, Ou, P, Celermajer, DS, et al. Prevalence of rheumatic heart disease detected by echocardiographic screening. N Engl J Med 2007; 357: 470476.
7. Bhaya, M, Panwar, S, Beniwal, R, Panar, PB. High prevalence of rheumatic heart disease detected by echocardiography in school children. Echocardiography 2010; 27: 448453.
8. WHO Expert Consultation on Rheumatic Fever and Rheumatic Heart Disease (2001: Geneva, Switzerland); Rheumatic fever and rheumatic heart disease: report of a WHO Expert Consultation, Geneva, 29 October – 1 November 2001. (WHO technical report series; 923 published 20030, p 112.)
9. Tompkins, DG, Boxerbaum, B, Liebman, J. Long-term prognosis of rheumatic fever patients receiving regular intramuscular benzathine penicillin. Circulation 1972; 45: 543551.
10. Stollerman, GH, Rusoff, JH, Hirschfeld, I. Prophylaxis against group A streptococci in rheumatic fever; the use of single monthly injections of benzathine penicillin G. N Engl J Med 1955; 252: 787792.
11. Feinstein, AR, Stern, EK, Spagnuolo, M. The prognosis of acute rheumatic fever. Am Heart J 1964; 68: 817834.
12. Sanyal, SK, Berry, AM, Duggal, S, Hooja, V, Ghosh, S. Sequelae of the initial attack of acute rheumatic fever in children from north India. A prospective 5-year follow-up study. Circulation 1982; 65: 375379.
13. Majeed, HA, Batnager, S, Yousof, AM, Khuffash, F, Yusuf, AR. Acute rheumatic fever and the evolution of rheumatic heart disease: a prospective 12 year follow-up report. J Clin Epidemiol 1992; 45: 871875.
14. Carapetis, JR, Paar, J, Cherian, T. Standardization of epidemiologic protocols for surveillence of post-streptococcal sequelae: acute rheumatic fever, rheumatic heart disease and acute post-streptococcal glomerulonephritis. In: Protocols for surveillance of Streptococcal pyogenes infections and their sequelae. National Institutes of Health, Bethesda, USA, 2010., accessed 10 September 2012.
15. Remenyi, B, Wilson, N, Steer, A, et al. World Heart Federation criteria for echocardiographic diagnosis of rheumatic heart disease – an evidence-based guideline. Nat Rev Cardiol 2012, 5: 297309.



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed