The Pacific region, including Fiji, has the highest reported prevalence of rheumatic heart disease (RHD) in the world. Urgent action is required to curb this disease.

The focus of global efforts currently is to enhance secondary prevention programmes (secondary prophylaxis refers to regular delivery of injectable long-acting penicillin to stop recurrent attacks of rheumatic fever and therefore prevent worsening of RHD – this is a proven and effective strategy). A RHD control and prevention programme has been in place since 2005.

An important part of bolstering these programmes is by identifying patients with mild disease because these patients stand to gain the most from preventive medication – this can be achieved by screening.

We now know that the best method of screening is by echocardiography of asymptomatic children in endemic areas. To undertake echocardiographic screening the availability of expert, skilled personnel is crucial – the problem is that in most remote and developing country settings, including Fiji, cardiologists or echocardiography technicians are not readily available.

A solution to overcome this resource gap is to train nurses to undertake basic echocardiography to flag cases that require further review by experts. Our proposed study will investigate whether this is feasible.

Based on a module developed in a successful pilot study undertaken in 2010, we will teach nurses the basics of echocardiography so that they can detect key features of RHD. We will then determine the sensitivity and specificity of nurses trained in basic echocardiography in identifying cases of RHD among 2000 schoolchildren in Fiji when compared to echocardiographic diagnosis by a cardiologist.

This study will be conducted in Fiji where RHD is a national health priority, and where our research team has established an internationally recognised research program. Our innovative study will be the first of its kind and will have major implications for RHD control, not just in Fiji, but also for many developing countries across the globe.

Menzies HREC-2011-1649