• To determine if nurses can be trained in basic Rheumatic Heart Disease (RHD) echocardiography to undertake field echocardiography screening in remote settings
  • To determine the sensitivity and specificity of these trained nurses in detecting the presence of RHD by basic echocardiography when compared to an expert echocardiographer
  • To use this information to develop a fully tested training module for nurses to develop capacity and to undertake routine RHD screening in resource poor settings.
  • To ensure with simple training and supervised field experience, nurses will have high sensitivity in the identification of children with RHD when compared with expert echocardiographers (cardiologists). 

The study is a prospective study aimed at investigating the sensitivity and specificity of nurses trained in basic echocardiography in identifying cases of RHD when compared to echocardiographic diagnosis by a paediatric cardiologist.

Seven Fiji Ministry of Health nurses will be trained in the use of basic screening echocardiography using portable echocardiography machines. Guidelines recently developed by the International RHD Echocardiography Standardisation group will be used in this study.

The Fijian nurses will be trained to obtain a view of the mitral and aortic valves and assess for the presence of RHD, and to take two basic measurements of Doppler colour relevant to the diagnosis of RHD on echocardiography. The nurses will screen approximately 2,000 children in primary schools in Fiji.

In addition, all children will undergo an echocardiogram performed by an expert echocardiogram technician. All echocardiography films will be reviewed in Australia or New Zealand by a paediatric cardiologist. The nurses’ echocardiogram findings will be compared to the gold standard echocardiogram to determine the sensitivity and specificity of the nurses in detecting cases of RHD.

This study design is based on the successful pilot undertaken in 2009-10, with the addition of an extended field experience phase and a larger sample size that will allow us to fully test the module.(Colquhoun et al).

Implications for policy and practice:

This study aims to build capacity and skills in nurses employed by the Fiji Ministry of Health by teaching them basic valvular echocardiography. If the study is successful, then the program could be expanded, potentially to school health nurses.

This would represent a major capacity building activity. Early identification of RHD cases has a huge benefit for both the children identified and the Fiji Ministry of Health as these children will commence on benzathine penicillin prophylaxis to control their disease and prevent further morbidity in the future that may have otherwise required cardiac surgery.

This study is also a case-finding screening exercise and as such participants with previously unknown RHD may be diagnosed during the study and commenced on prophylaxis that may potentially be life-saving.

Our research has found: 

Preliminary results are detailed in this poster - front page, back page.

Final results will be available in late 2013.

Chief investigators:
  • Samantha Colquhoun
  • Bo Remenyi
 Project manager:
  • Samantha Colquhoun
Contact information:
  • Samantha Colquhoun
Project dates:

The project commenced in 2011 and is due for completion in 2013.

  • Fiji Ministry of Health
  • Centre for International Child Health, University of Melbourne
  • Telethon Child Health Research Institute
  • Cardiology Department, Starship Hospital Auckland, New Zealand.
  1. Colquhoun, S.M., Carapetis, J.R., Kado, J.H., Reeves, B.M., Remenyi, B., May, W., et al. (2013). Pilot study of nurse-led rheumatic heart disease echocardiography screening in Fiji - a novel approach in a resource-poor setting. Cardiology in the Young, 23(4), 546-552.