Latent rheumatic heart disease in West Africa: a pilot multi-country study
Medical Research Council
London School of Hygiene and Tropical Medicine
This trial development grant (TDG) aims at generating epidemiological and feasibility data data to inform the design of a multicentric trial in West Africa to test the efficacy of penicillin to prevent the progression of latent RHD towards overt clinical disease. This is urgently needed to formulate long awaited guidelines for the management of latent RHD. There is little information on the burden of RHD in West Africa as most of . This TDG will determine the prevalence of latent RHD in three West African countries (Senegal, The Gambia, Nigeria), by carrying out mass screening at community level using handheld EC (HHEC) by non expert users. Study activities are divided in two phases, i.e. a training phase (3 months) and a screening phase (4 months). Two trainees from each country (1 expert cardiologist +1 nurse/midwife) will follow a 2-week intensive training on HHEC in Uganda. Each pair of trainees will become trainer for 3 additional health staff in its own country and continue on-site practical training for 6-10 weeks under the supervision (online) of the Ugandan expert. At the end of the training, each study team should have four trained non-expert staff (including 1 nurse, 1 midwife, and 1 community health worker) with two operators scanning in parallel. In each site, a total of 3,000 school children (5-18y) and 3,000 adults aged 19-40 years (pregnant and non pregnant women and their partners/relative men) will be screened in a pre-defined peri-urban community. Each suspect RHD case identified by HHEC will be referred for standard EC by a cardiologist. Confirmed latent RHD will be referred for regular EC monitoring while symptomatic RHD will be referred for appropriate care at the nearest teaching hospital. Quantitative and qualitative data will be collected on the feasibility and acceptability of the proposed approach in each site through continuous engagement with stakeholders and end users.
4.2 Evaluation of markers and technologies / Research Grant