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Abstract
Rheumatic heart disease (RHD) remains a significant cause of morbidity and mortality in Indigenous Australians. Echocardiographic screening in children potentially provides the opportunity to detect RHD in its mildest form, and instigation and regular delivery of secondary prophylaxis for detected cases should result in the majority avoiding severe RHD. Screening would also permit collection of accurate prevalence data, and quantify the burden of undiagnosed disease. However, evidence is needed for appropriate policy recommendations to be made.
This thesis aims to provide that evidence and is divided into three parts. The first describes RHD burden in Indigenous Australians and examines whether RHD fulfils standard public health screening criteria; the second presents the results of a large prospective echocardiographic screening survey of nearly 5000 children living in four regions of northern Australia; and the third is a cost effectiveness analysis of a proposed model of echocardiographic screening for RHD in Indigenous children in the Northern Territory.
The principal findings are:
The prevalence of Definite RHD in 3946 remote Indigenous children was 8.6 per 1000, compared with no cases detected in 1053 non-Indigenous children.
Half of the Definite RHD cases were previously undiagnosed, suggesting that the true burden of RHD is higher than surveillance data reports.
The prevalence of Definite RHD in Indigenous children from the Top End of the Northern Territory was 17 per 1000; more than double the prevalence in the other three study regions.
Cardiac auscultation is not a useful method of screening for RHD.
A proposed model of echocardiographic screening for RHD in Indigenous children is potentially cost-effective, but sensitive to a number of assumptions.
Echocardiographic screening for RHD in Indigenous Australian children is feasible and will detect new disease. However, if it is to be beneficial, it must be coupled with measures to improve the delivery of secondary prophylaxis.
