Task shifting to clinical officer-led echocardiography screening for detecting rheumatic heart disease in Malawi, Africa
| Autor: | Melissa Karlsten, Charles G. Minard, Mina C. Hosseinipour, Peter N. Kazembe, Daniel J. Penny, Craig Sable, Amy Sims Sanyahumbi |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty Malawi Clinical officer Referral Heart disease Adolescent 030204 cardiovascular system & hematology Asymptomatic 03 medical and health sciences 0302 clinical medicine Cardiologists Predictive Value of Tests medicine Humans Mass Screening 030212 general & internal medicine Child business.industry Incidence Rheumatic Heart Disease Reproducibility of Results General Medicine medicine.disease Confidence interval Echocardiography Doppler Color Paediatric cardiology Paediatric cardiologist ROC Curve Child Preschool Pediatrics Perinatology and Child Health Emergency medicine Physical therapy Female Task shifting medicine.symptom Cardiology and Cardiovascular Medicine business |
| Zdroj: | Cardiology in the young. 27(6) |
| ISSN: | 1467-1107 1047-9511 |
| Popis: | BackgroundEchocardiographic 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.HypothesisWith short-course training, clinical officers can accurately screen for rheumatic heart disease using focussed echocardiography.MethodsA 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.ResultsThe 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).ConclusionThere 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. |
| Databáze: | OpenAIRE |
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