Active Case Finding for Rheumatic Fever in an Endemic Country

Emmy Okello, Emma Ndagire, Jenifer Atala, Asha C. Bowen, Marc P. DiFazio, Nada S. Harik, Chris T. Longenecker, Peter Lwabi, Meghna Murali, Scott A. Norton, Isaac Otim Omara, Linda Mary Oyella, Tom Parks, Jafesi Pulle, Joselyn Rwebembera, Rachel J. Sarnacki, Christopher F. Spurney, Elizabeth Stein, Laura Tochen, David WatkinsMeghan Zimmerman, Jonathan R. Carapetis, Craig Sable, Andrea Beaton

Research output: Contribution to journalArticlepeer-review

14 Citations (Scopus)


Background Despite the high burden of rheumatic heart disease in sub-Saharan Africa, diagnosis with acute rheumatic fever (ARF) is exceedingly rare. Here, we report the results of the first prospective epidemiologic survey to diagnose and characterize ARF at the community level in Africa. Methods and Results A cross-sectional study was conducted in Lira, Uganda, to inform the design of a broader epidemiologic survey. Key messages were distributed in the community, and children aged 3 to 17 years were included if they had either (1) fever and joint pain, (2) suspicion of carditis, or (3) suspicion of chorea, with ARF diagnoses made by the 2015 Jones Criteria. Over 6 months, 201 children met criteria for participation, with a median age of 11 years (interquartile range, 6.5) and 103 (51%) female. At final diagnosis, 51 children (25%) had definite ARF, 11 (6%) had possible ARF, 2 (1%) had rheumatic heart disease without evidence of ARF, 78 (39%) had a known alternative diagnosis (10 influenza, 62 malaria, 2 sickle cell crises, 2 typhoid fever, 2 congenital heart disease), and 59 (30%) had an unknown alternative diagnosis. Conclusions ARF persists within rheumatic heart disease-endemic communities in Africa, despite the low rates reported in the literature. Early data collection has enabled refinement of our study design to best capture the incidence of ARF and to answer important questions on community sensitization, healthcare worker and teacher education, and simplified diagnostics for low-resource areas. This study also generated data to support further exploration of the relationship between malaria and ARF diagnosis in rheumatic heart disease/malaria-endemic countries.

Original languageEnglish
Article numbere016053
JournalJournal of the American Heart Association
Issue number15
Publication statusPublished - 4 Aug 2020


Dive into the research topics of 'Active Case Finding for Rheumatic Fever in an Endemic Country'. Together they form a unique fingerprint.

Cite this