Echo in Africa is now entering its third year. The ultimate aim of the programme is to develop a method of screening very large numbers of individuals (20,000 or more) at risk from rheumatic heart disease. This is a communicable illness that affects the young, with those who are poor or malnourished at much greater risk. The heart is involved in about half of all cases of acute rheumatic disease, and permanent valve damage arises after repeated attacks. The purpose of early detection is to then provide regular antibiotic prophylaxis, often given as a monthly depot injection, which then prevents the recurrent infection that leads to valvular heart disease.
The first stage of the programme is nearing completion – to scan a population at risk in Cape Town and establish the background frequency of the disease in susceptible populations over a 2 year period. These echocardiograms have been done by our accredited members on over 2150 school children from four different schools located in poorer districts of the city using Vivid-I machines. All screening has taken place in a purpose-renovated facility in Tygerberg Hospital, built to accommodate the safe and dignified screening of large numbers of scholars and part-funded by the donations from BSE members. During this phase, an abbreviated ‘target’ protocol has been trialled using hand-held V-scans performed by the local South African team, with the aim of comparing the rate of diagnosis to a full transthoracic echocardiogram according to the Minimum Dataset. These data are now being analysed, with the aim of producing evidence to support the use of the abbreviated scan on a hand-held device to identify rheumatic disease.
The next stage will be to broaden the horizons of the project and start screening in the wider community, to work towards the ultimate goal of a full and adaptable screening programme for large populations across South Africa. This will mean echocardiographers will leave the Department and go to community based screening projects in the West coast-, Cape Winelands- and Overberg educational districts of the Western Cape. Scanning will take place in selected schools in these districts. A school health outreach program currently exists, where a nurse specialist travels to schools in her area to provide a limited health screening service. EIA will attach to this existing system and utilise the infrastructure that this system provides. The project aims to screen a minimum of 10,000 secondary school children over this 2-year period at their respective schools. Apart from reaching out to and impacting an even larger population of school-age children, this experience will generate invaluable information regarding the prevalence of rheumatic disease in these districts and also will be used to gain information on the projected costs and needed infrastructure to run large scale screening projects of this kind further afield. All schools considered for screening will be visited prior to screening taking place to ensure that a safe and private working environment can be created at the specific school to accommodate the screening process.
The dates for 2016 are now available. I went to Cape Town last year and cannot speak highly enough of the team and the children being screened. Think about signing up – you will not regret it, ask any of us who have been!
Dr Rick Steeds, President of British Society of Echocardiography