The Relationship Between Active Case Finding Of Rheumatic Heart Disease Through Echocardiographic Screening And Nutritional Status In Children Aged 5 – 15 Years Old In Surabaya, Indonesia
DOI:
https://doi.org/10.52783/jns.v14.2875Keywords:
Rheumatic Heart Disease, Active Cases Finding, Screening, Echocardiography, School Age, Nutritional StatusAbstract
Rheumatic heart disease (RHD) is a sequel of acute rheumatic fever (ARF) caused by an autoimmune reaction to group A beta-hemolytic streptococcal (GAS) infection. Although RHD is a preventable disease, it remains a significant health issue, particularly in developing countries like Indonesia, which has the fourth highest prevalence globally with 1.18 million cases each year. Diagnosing ARF and RHD in tropical regions poses challenges, compounded by the limited number of trained screening operators capable of performing and interpreting echocardiograms. The highest incidence of ARF occurs in children aged 5 to 15 years, making this age group a primary target for secondary antibiotic prophylaxis to reduce recurrence and the progression of RHD. This study is expected to serve as an initial step in prophylactic strategies to hinder the development of RHD, improve early therapeutic management, and support Sustainable Development Goals (SDG) indicators in achieving good health and community well-being. This study is a cross-sectional research. The subjects of the study are school-aged children (5-15 years) from schools scattered throughout Surabaya. Data collection includes basic characteristic data and echocardiographic examinations conducted by trained general practitioners using portable transthoracic echocardiography. Screening is categorized into positive and negative screening according to the World Heart Federation guidelines 2023. A total of 403 children aged 5 to 15 years participated in the study, with 71.2% classified as negative and 28.8% as positive for rheumatic heart disease (RHD) based on screening. Younger children in elementary school had a significantly higher prevalence of positive screening results (36.4%) compared to junior high school students (18.6%, p < 0.001). Based on the Spearman test results, a p-value of 0.900 was obtained, which is > 0.05, indicating that there is no significant relationship between rheumatic heart disease screening and nutritional status.
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Carapetis et al 2016. Carapetis JR, Beaton A, Cunningham MW, Guilherme L, Karthikeyan G, Mayosi BM, et al.. Acute rheumatic fever and rheumatic heart disease. Nat Rev Dis Primers. (2016) 2:15084.10.1038/nrdp.2015.84
Kumar et al., 2020. Kumar, R.K. et al. (2020) ‘Contemporary diagnosis and management of rheumatic heart disease: Implications for closing the gap: A scientific statement from the American Heart Association’, Circulation, 142(20). doi:10.1161/cir.0000000000000921.
Utamayasa, I. K. A., Indriasatari, A., Hidayat, T., Prihaningtyas, R. A., Rahman, M., Ontoseno, T. 2021. Clinical Profile of Children with Rheumatic Heart Disease in Indonesia. Sri Lanka Journal of Child Health, 50(2);200-202
Soesanto, A.M. and Suastika, L.O. 2020 ‘Echocardiography screening for latent rheumatic heart disease: What can we do in Indonesia?’, Frontiers in Surgery, 7. doi:10.3389/fsurg.2020.00046.
Gewitz et al., 2015. Gewitz MH, Baltimore RS, Tani LY, Sable CA, Shulman ST, Carapetis J, Remenyi B, Taubert KA, Bolger AF, Beerman L, et al ; on behalf of the American Heart Association Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young. Revision of the Jones Criteria for the diagnosis of acute rheumatic fever in the era of Doppler echocardiography: a scientific statement from the American Heart Association [published correction appears in Circulation. 2020;142:e65].Circulation. 2015; 131:1806–1818. doi: 10.1161/CIR.0000000000000205
Lilyasari et al., 2020. Lilyasari O, Prakoso R, Kurniawati Y, Roebiono PS, Rahajoe AU, Sakidjan I, et al. Clinical Profile and Management of Rheumatic Heart Disease in Children and Young Adults at a Tertiary Cardiac Center in Indonesia. Front Surg [Internet]. 2020 Aug 12 [cited 2023 Dec 3];7. Available from: https://pubmed.ncbi.nlm.nih.gov/32903397/
Watkins DA, Johnson CO, et al. Global, Regional, and National Burden of Rheumatic Heart Disease, 1990-2015. N Engl J Med 2017; 377:713. https://www.nejm.org/doi/full/10.1056/NEJMoa1603693
Zühlke L, Karthikeyan G, Engel ME, Rangarajan S, Mackie P, Cupido-Katya Mauff B, Islam S, Daniels R, Francis V, Ogendo S, et al.Clinical outcomes in 3343 children and adults with rheumatic heart disease from 14 low- and middle-income countries: two- year follow-up of the Global Rheumatic Heart Disease Registry (the REMEDY Study).Circulation. 2016; 134:1456–1466. doi: 10.1161/CIRCULATIONAHA.116.024769
Beaton et al., 2017. Beaton A, Aliku T, Dewyer A, Jacobs M, Jiang J, Longenecker CT, et al.. Latent rheumatic heart disease; identifying the children at highest risk of unfavorable outcome. Circulation. 2017 136:2233–44. 10.1161/CIRCULATIONAHA.117.029936
Watkins, Dr & Daskalakis, A. 2015. The economic impact of rheumatic heart disease in developing countries. The Lancet Global Health. 3. S37. 10.1016/S2214- 109X(15)70156-7.
Rémonda M, Atkinson D, White A, Brown A, Carapetis J, Remenyi B, et al. 2015. Are minor echocardiographic changes associated with an increased risk of acute rheumatic fever or progression to rheumatic heart disease? Int J Cardiol. 198:117–22. 10.1016/j.ijcard.2015.07.005
Engelman D, Kado JH, Reményi B, Colquhoun SM, Carapetis JR, Wilson NJ, et al. 2016. Screening for rheumatic heart disease: quality and agreement of focused cardiac ultrasound by briefly trained health workers. BMC Cardiovasc Disord [Internet]. Feb 1 [cited 2023 Dec 3];16(1). Available from: https://pubmed.ncbi.nlm.nih.gov/26830341/
Francis JR, Fairhurst H, Yan J, Fernandes Monteiro A, Lee AM, Maurays J, et al. 2023. Abbreviated Echocardiographic Screening for Rheumatic Heart Disease by Nonexperts with and without Offsite Expert Review: A Diagnostic Accuracy Study. J Am Soc Echocardiogr [Internet]. 2023 Jul 1 [cited 2023 Dec 3];36(7):733–45. Available from: https://pubmed.ncbi.nlm.nih.gov/36806665/
Suastika, L. O. S., et al. 2023. Prevalence of rheumatic heart disease in Bali, Indonesia: A school-based echocardiographic screening. Poster presented at the conference on Rheumatic Heart Disease (RHD).
Rahmawaty, N. K., Iskandar, B., & Albar, H. 2012. Faktor risiko serangan berulang demam rematik/penyakit jantung rematik. Sari Pediatri, 14(3), 179-184. Diambil dari https://ppl-ai-file-upload.s3.amazonaws.com/web/direct-files/45184540/15e55589- 15d3-4989-a93c-4480bd8a51e5/SARI-PEDIATRI-TTG-RHD-DAN-GIZI.pdf
Sika-Paotonu, D. et al. 2017. ‘Acute Rheumatic Fever and Rheumatic Heart Disease Epidemiology of ARF and RHD Burden of Disease’, Streptococcus pyogenes Basic Biology to Clinical Manifestations, pp. 1–43)
Watkins, D.A. et al. 2017. ‘Global, Regional, and National Burden of Rheumatic Heart Disease, 1990–2015’, New England Journal of Medicine, 377(8), pp. 713–722. doi:10.1056/nejmoa1603693
Dass C, Kanmanthareddy A. Rheumatic Heart Disease. [Updated 2023 Jul 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538286/
Roth GA, Mensah GA, Johnson CO, et al. Global Burden of Cardiovascular Diseases and Risk Factors, 1990-2019: Update From the GBD 2019 Study. J Am Coll Cardiol 2020; 76:2982.
Watkins DA, Johnson CO, Colquhoun SM, et al. Global, Regional, and National Burden of Rheumatic Heart Disease, 1990-2015. N Engl J Med 2017; 377:713.
Zühlke LJ, Beaton A, Engel ME, et al. Group A Streptococcus, Acute Rheumatic Fever and Rheumatic Heart Disease: Epidemiology and Clinical Considerations. Curr Treat Options Cardiovasc Med 2017; 19:15.
Sari, SM. 2019. Hubungan Penyakit Jantung Rematik dengan Status Gizi Anak di Rumah Sakit Umum Haji Adam Malik Medan. http://repositori.usu.ac.id/handle/123456789/26194.
Zaman, MM. 2015. Childhood Nutrition and Prevention of Rheumatic Fever. GLOBAL HEART, VOL. 10, NO. 1, p83
Watkins, D.A. et al. 2017 ‘Global, Regional, and National Burden of Rheumatic Heart Disease, 1990–2015’, New England Journal of Medicine, 377(8), pp. 713–722. doi:10.1056/nejmoa1603693
Zühlke L, Engel ME, Lemmer CE, van de Wall M, Nkepu S, Meiring A, et al. The natural history of latent rheumatic heart disease in a 5 year follow-up study: A prospective observational study. BMC Cardiovasc Disord [Internet]. 2016;16(1):1–6. Available from: http://dx.doi.org/10.1186/s12872-016-0225-3
Engel ME, Haileamlak A, Zühlke L, et al. Prevalence of rheumatic heart disease in 4720 asymptomatic scholars from South Africa and Ethiopia. Heart 2015; 101:1389.
Yadeta D, Hailu A, Haileamlak A, et al. Prevalence of rheumatic heart disease among school children in Ethiopia: A multisite echocardiography-based screening. Int J Cardiol 2016; 221:260.
Lennon D, Wilson N, Sharpe N, et al. New Zealand Guidelines for Rheumatic Fever, Diagnosis, Management and Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease: 2014 Update. Heart Foundation of New Zealand.
Zühlke, L. J., Engel, M. E., Nkepu, S., & Mayosi, B. M. 2016. Evaluation of a focussed protocol for hand-held echocardiography and computer-assisted auscultation in detecting latent rheumatic heart disease in scholars. Cardiology in the Young, 26, 1097– 1106. doi:10.1017/S1047951115001857
Francis, J. R., et al. 2023. Abbreviated echocardiographic screening for rheumatic heart disease by nonexperts with and without offsite expert review: A diagnostic accuracy study. Journal of the American Society of Echocardiography, 36(7), 733- 745. https://doi.org/10.1016/j.echo.2023.02.007
Gewitz MH, Baltimore RS, Tani LY, et al. Revision of the Jones Criteria for the diagnosis of acute rheumatic fever in the era of Doppler echocardiography: A scientific statement from the American Heart Association. Circulation 2015; 131:1806.
Ali, S., et al 2018. Echocardiographic screening for rheumatic heart disease in 4515 Sudanese school children: marked disparity between two communities. Cardiovascular Journal of Africa, 29(5), 273-277. https://doi.org/10.5830/CVJA-2018-022
Par'i, H.M., et al. 2017.Penilaian Status Gizi : Bahan Ajar Gizi Buku Ajar Penilaian Status Gizi. Jakarta: Kementerian Kesehatan Republik Indonesia; 2017
Kemenkes. 2020. Peraturan Menteri Kesehatan Republik Indonesia Nomor 2 Tahun 2020 tentang Standar Antropometri Anak. Jakarta: Kementerian Kesehatan Republik Indonesia. Diambil dari : https://yankes.kemkes.go.id/unduhan/fileunduhan_1660187306_961415.pdf
Gewitz MH, Baltimore RS, Tani LY, Sable CA, et al. Revision of the Jones Criteria for the Diagnosis of Acute Rheumatic Fever in the Era of Doppler Echocardiography A Scientific Statement From the American Heart Association. Circulation. 2015;131:1806- 18.
World Health Organization. 2008. Training Course on Child Growth Assessment: Measuring a Child's Growth. Geneva: WHO. Retrieved from https://ppl-ai-file- upload.s3.amazonaws.com/web/direct-files/45184540/61acb885-58b2-44d0-8c66- fcedf428b8bb/WHO-Measuring-a-child-s-growth.pdf
Lennon D, Wilson N, Sharpe N, et al. New Zealand Guidelines for Rheumatic Fever, Diagnosis, Management and Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease: 2014 Update. Heart Foundation of New Zealand.
Okello E, Ndagire E, Muhamed B, et al. Incidence of acute rheumatic fever in northern and western Uganda: a prospective, population-based study. Lancet Glob Health 2021; 9:e1423.
Zühlke L, Engel ME, Karthikeyan G, et al. Characteristics, complications, and gaps in evidence-based interventions in rheumatic heart disease: the Global Rheumatic Heart Disease Registry (the REMEDY study). Eur Heart J 2015; 36:1115.
Zühlke L, Karthikeyan G, Engel ME, et al. Clinical Outcomes in 3343 Children and Adults With Rheumatic Heart Disease From 14 Low- and Middle-Income Countries: Two-Year Follow-Up of the Global Rheumatic Heart Disease Registry (the REMEDY Study). Circulation 2016; 134:1456.
Shobha K L, Kusumakshi, Prasad V, RamachanARF L. Group A, G and C β- hemolytic Streptococci. International Journal of Medicine, 2015; 3(1): 8-11
Rwebembera, J., Marangou, J., Mwita, J.C. et al. 2023 World Heart Federation guidelines for the echocardiographic diagnosis of rheumatic heart disease. Nat Rev Cardiol 21, 250–263 (2024). https://doi.org/10.1038/s41569-023-00940-9
Irianto, P. 2017. Pedoman Gizi Lengkap Keluarga dan Olahragawan. Yogyakarta: CV. Andi Offset.
Arisman. 2014. Obesitas, Diabetes Melitus dan Dislipidemia. Jakarta : ECG
CDC.2022. CDC Growth charts. https://www.cdc.gov/growthcharts/cdc_charts.htm
Badan Pusat Statistik Provinsi Jawa Timur. 2024. Persentase Penduduk Usia 5 Tahun ke Atas di Jawa Timur Dirinci Menurut Kabupaten/Kota, Jenis Kelamin dan Status Pendidikan,2023. https://jatim.bps.go.id/id/statistics-table/1/MzEwNiMx/persentase- penduduk-usia-5-tahun-ke-atas-di-jawa-timur-dirinci-menurut-kabupaten-kota--jenis- kelamin-dan-status-pendidikan-2023.html
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