In March this year we returned on a mission to Tanzania to screen school children to pediatric and cardiology for rheumatic disease.
Rheumatic disease, manifested through rheumatic carditis, is one of the most frequent causes of jouth death in sub-Saharan countries. There are 1.78 million cases per year, the annual mortality rate is 12.5 percent with 70 percent of deaths occurring before the age of 26.
A team consisting of a pediatrician, a cardiologist, and two nurses, equipped with rapid pharyngeal swabs and a portable echocardiographic device, subjected children during school hours to pediatric examination with performance of rapid pharyngeal swab (SWAB) for detection of beta hemolytic streptococcus infection (primary cause of disease) and cardiologic examination with echocardiogram (2012 Task Force Criteria for Early Diagnosis of Rheumatic Disease)
From March 11 to 14, 2024, 315 half-male and half-female children aged 6 to 11 were screened, 150 in Tandala Primary School and 165 in Ikonda Primary School.
No symptomatic children or positive swabs were found in the Tandala school, and echocardiographic examinations also showed no rheumatic heart disease.
We found only one syndromic child with a phenotype suggestive for Holt-Oram syndrome, characterized by hypoplasia of the upper limbs and, as per ultrasound, non-restrictive apical ventricular septal defect and pervious ductus arteriosus.
In Ikonda Primary School, 8 positive swabs were found. For 2 two asymptomatic children no treatment, for 6 children with fever, sore throat and positive swabs we suggested 10 days of antibiotic therapy with amoxicillin 50 mg/kg/day. No echocardiographic signs of rheumatic heart disease were found in these children.
We also found “scimitar syndrome,” a rare congenital abnormality of venous drainage, and saw some children with restrictive PDA.
Our mission to Tanzania gives us further confirmation of the expected results, how cardiology screening in schools is important because it allows detection of rheumatic disease that has high prevalence in school-age children and symptomatic pauci.
