Early Implementation and Clinical Outcomes of an Integrated Rheumatic Heart Disease Screening and Treatment Program in Northern Uganda
BACKGROUND: The World Health Organization recommends echocardiographic screening and secondary prophylaxis for rheumatic heart disease (RHD), but evidence on how to implement these interventions within healthcare systems is limited. We report early implementation and clinical outcomes of an RHD program in northern Uganda. METHODS: tests. Time-to-event analysis was conducted to assess the probability of receiving an injection over time since enrollment. RESULTS: Health workers screened about 1% of the district's target population each month. Over 18 months, 25 358 people were screened, including 1213 (4.8%) positive screens and 333 (1.3%) confirmed RHD cases. Among those screened, 16 406 (64%) were female, and 10 746 (42%) and 7333 (28%) were children (aged 5 years-14 years) and adolescents (aged 15 years-24 years), respectively. Of those with positive screens, 972 (80%) received confirmatory echocardiograms. Confirmed cases were relatively young (mean age 28 years), and 224 (67%) were female. Overall, 220 (75%) individuals achieved at least acceptable adherence. Among those who defaulted, 79% did so within 6 months of enrollment. CONCLUSIONS: An integrated RHD program in Uganda achieved successful delivery of echocardiographic screening within primary healthcare and acceptable early outcomes. The care cascade framework can be used to monitor similar RHD programs and identify opportunities for improvement.
Authors
- Joselyn Rwebembera (ORCID: https://orcid.org/0000-0001-8453-818X)
- Isaac Omara Otim (ORCID: https://orcid.org/0000-0001-8000-9483)
- Jafesi Pulle (ORCID: https://orcid.org/0000-0001-7955-3481)
- Nelson Kaulukusi Sewankambo (ORCID: https://orcid.org/0000-0001-9362-053X)
- Allison R. Webel (ORCID: https://orcid.org/0000-0002-7538-5780)
- Mucunguzi Atukunda (ORCID: https://orcid.org/0000-0003-4762-0728)
- Chris Todd Longenecker (ORCID: https://orcid.org/0000-0002-9468-0179)
- Doreen Nakagaayi (ORCID: https://orcid.org/0000-0003-4010-9951)
- James Kayima (ORCID: https://orcid.org/0000-0002-4676-7819)
- M Garcia Pardo (ORCID: https://orcid.org/0009-0000-3819-8567)
- Rachel Sarnacki (ORCID: https://orcid.org/0000-0001-9137-7476)
- Scott Wirth (ORCID: https://orcid.org/0000-0003-3901-2669)
- Kenneth Sherr (ORCID: https://orcid.org/0000-0002-2963-0829)
- Kristen Danforth (ORCID: https://orcid.org/0000-0002-7409-6661)
- Nanhua Zhang (ORCID: https://orcid.org/0000-0001-5796-3404)
- Charles Akiya Oyoo
- Francis Odong
- Emmy Okello
- Evaline Ayaa
- Ronald Ogwanh
- Sarah deLoizaga
- Craig Sable
- David A Watkins
- Andrea Beaton
Institutions
- Cincinnati Children's Hospital Medical Center (US)
- Children's National (US)
- University of Washington (US)
- Ochsner Medical Center (US)
- Ministry of Health (UG)
- Children's Hospital of New Orleans (US)
- National Heart Institute (MY)
- Department of Health (ZA)
- Seattle University (US)
- Makerere University (UG)
- University of Cincinnati Medical Center (US)
Publication Details
- Journal
- Circulation Population Health and Outcomes
- Published
- 2026-05-01
- DOI
- https://doi.org/10.1161/circoutcomes.125.012831
- Primary Topic
- Streptococcal Infections and Treatments
- Type
- article
- Field-Weighted Citation Impact
- 0.00