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

  • Amy Sims Sanyahumbi (a1), Craig A. Sable (a2), Melissa Karlsten (a1), Mina C. Hosseinipour (a3), Peter N. Kazembe (a4), Charles G. Minard (a5) and Daniel J. Penny (a1)...



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.


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


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.


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).


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.


Corresponding author

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:


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

  • Amy Sims Sanyahumbi (a1), Craig A. Sable (a2), Melissa Karlsten (a1), Mina C. Hosseinipour (a3), Peter N. Kazembe (a4), Charles G. Minard (a5) and Daniel J. Penny (a1)...


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