The personal and clinical impact of screen-detected maternal rheumatic heart disease in Uganda: a prospective follow up study
Abstract Background Pre-existing maternal cardiac disease is a significant contributor to adverse maternal, fetal, and neonatal outcomes. In 2015–2017, our team conducted the first community-based study of maternal rheumatic heart disease (RHD) in sub-Saharan Africa and identified RHD in 88% of thos...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-10-01
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| Series: | BMC Pregnancy and Childbirth |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12884-020-03189-z |
| _version_ | 1818218698569154560 |
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| author | Sonia Voleti Emmy Okello Meghna Murali Rachel Sarnacki Albert Majwala Renny Ssembatya Olivia Bakka Henriator Namisanvu Angela Njeri Alphonsus Matovu Kristen DeStigter Craig Sable Andrea Beaton |
| author_facet | Sonia Voleti Emmy Okello Meghna Murali Rachel Sarnacki Albert Majwala Renny Ssembatya Olivia Bakka Henriator Namisanvu Angela Njeri Alphonsus Matovu Kristen DeStigter Craig Sable Andrea Beaton |
| author_sort | Sonia Voleti |
| collection | DOAJ |
| description | Abstract Background Pre-existing maternal cardiac disease is a significant contributor to adverse maternal, fetal, and neonatal outcomes. In 2015–2017, our team conducted the first community-based study of maternal rheumatic heart disease (RHD) in sub-Saharan Africa and identified RHD in 88% of those with pre-existing heart disease. Here we conducted a follow up investigation of women previously identified with RHD, describing clinical and echocardiographic outcomes, identifying barriers to medical adherence and evaluating the personal impact of RHD. Methods A 2 week prospective follow up was completed at sites in Central and Eastern Uganda. Participants underwent a three-step mixed methods study comprising of 1) direct structured interview targeting clinical history and medication adherence, 2) echocardiogram to evaluate left-sided heart valves, and 3) semi-structured guideline interview to elicit personal impacts of RHD. Results The team evaluated 40 (80%) of the original 51 mothers with RHD at a median post-partum time of 2.5 years after delivery (IQR 0.5). Echocardiographic data showed improvement in nine women with the remaining 31 women showing stable echocardiographic findings. Adherence to Benzathine penicillin G (BPG) prophylaxis was poor, with 70% of patients either poorly adherent or non-adherent. Three major themes emerged from interviews: 1) social determinants of health (World Health Organization, Social determinants of health, 2019) negatively affecting healthcare, 2) RHD diagnosis negatively affecting female societal wellbeing, 3) central role of spouse in medical decision making. Conclusions Screening echocardiography can identify women with pre-existing rheumatic heart disease during pregnancy, but long-term follow-up in Uganda reveals adherence to medical care following diagnosis, including BPG, is poor. Additionally, mothers diagnosed with RHD may experience unintended consequences such as social stigmatization. As identification of occult RHD is critical to prevent adverse pregnancy outcomes, further research is needed to determine how to best support women who face a new diagnosis of RHD, and to determine the role of screening echocardiography in high-risk settings. |
| first_indexed | 2024-12-12T07:27:54Z |
| format | Article |
| id | doaj.art-4012bbd11fb845dcaa5a4415b2d91256 |
| institution | Directory Open Access Journal |
| issn | 1471-2393 |
| language | English |
| last_indexed | 2024-12-12T07:27:54Z |
| publishDate | 2020-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pregnancy and Childbirth |
| spelling | doaj.art-4012bbd11fb845dcaa5a4415b2d912562022-12-22T00:33:06ZengBMCBMC Pregnancy and Childbirth1471-23932020-10-0120111010.1186/s12884-020-03189-zThe personal and clinical impact of screen-detected maternal rheumatic heart disease in Uganda: a prospective follow up studySonia Voleti0Emmy Okello1Meghna Murali2Rachel Sarnacki3Albert Majwala4Renny Ssembatya5Olivia Bakka6Henriator Namisanvu7Angela Njeri8Alphonsus Matovu9Kristen DeStigter10Craig Sable11Andrea Beaton12Department of Cardiology, Children’s National Medical CenterThe Uganda Heart InstituteDepartment of Cardiology, Children’s National Medical CenterDepartment of Cardiology, Children’s National Medical CenterThe Uganda Heart InstituteImaging the World AfricaImaging the World AfricaImaging the World AfricaImaging the World AfricaMubende Regional Referral HospitalUniversity of Vermont Medical CenterDepartment of Cardiology, Children’s National Medical CenterCincinnati Children’s Hospital Medical CenterAbstract Background Pre-existing maternal cardiac disease is a significant contributor to adverse maternal, fetal, and neonatal outcomes. In 2015–2017, our team conducted the first community-based study of maternal rheumatic heart disease (RHD) in sub-Saharan Africa and identified RHD in 88% of those with pre-existing heart disease. Here we conducted a follow up investigation of women previously identified with RHD, describing clinical and echocardiographic outcomes, identifying barriers to medical adherence and evaluating the personal impact of RHD. Methods A 2 week prospective follow up was completed at sites in Central and Eastern Uganda. Participants underwent a three-step mixed methods study comprising of 1) direct structured interview targeting clinical history and medication adherence, 2) echocardiogram to evaluate left-sided heart valves, and 3) semi-structured guideline interview to elicit personal impacts of RHD. Results The team evaluated 40 (80%) of the original 51 mothers with RHD at a median post-partum time of 2.5 years after delivery (IQR 0.5). Echocardiographic data showed improvement in nine women with the remaining 31 women showing stable echocardiographic findings. Adherence to Benzathine penicillin G (BPG) prophylaxis was poor, with 70% of patients either poorly adherent or non-adherent. Three major themes emerged from interviews: 1) social determinants of health (World Health Organization, Social determinants of health, 2019) negatively affecting healthcare, 2) RHD diagnosis negatively affecting female societal wellbeing, 3) central role of spouse in medical decision making. Conclusions Screening echocardiography can identify women with pre-existing rheumatic heart disease during pregnancy, but long-term follow-up in Uganda reveals adherence to medical care following diagnosis, including BPG, is poor. Additionally, mothers diagnosed with RHD may experience unintended consequences such as social stigmatization. As identification of occult RHD is critical to prevent adverse pregnancy outcomes, further research is needed to determine how to best support women who face a new diagnosis of RHD, and to determine the role of screening echocardiography in high-risk settings.http://link.springer.com/article/10.1186/s12884-020-03189-zRheumatic heart diseaseMaternal healthUgandaHealth disparitiesEchocardiographyScreening |
| spellingShingle | Sonia Voleti Emmy Okello Meghna Murali Rachel Sarnacki Albert Majwala Renny Ssembatya Olivia Bakka Henriator Namisanvu Angela Njeri Alphonsus Matovu Kristen DeStigter Craig Sable Andrea Beaton The personal and clinical impact of screen-detected maternal rheumatic heart disease in Uganda: a prospective follow up study BMC Pregnancy and Childbirth Rheumatic heart disease Maternal health Uganda Health disparities Echocardiography Screening |
| title | The personal and clinical impact of screen-detected maternal rheumatic heart disease in Uganda: a prospective follow up study |
| title_full | The personal and clinical impact of screen-detected maternal rheumatic heart disease in Uganda: a prospective follow up study |
| title_fullStr | The personal and clinical impact of screen-detected maternal rheumatic heart disease in Uganda: a prospective follow up study |
| title_full_unstemmed | The personal and clinical impact of screen-detected maternal rheumatic heart disease in Uganda: a prospective follow up study |
| title_short | The personal and clinical impact of screen-detected maternal rheumatic heart disease in Uganda: a prospective follow up study |
| title_sort | personal and clinical impact of screen detected maternal rheumatic heart disease in uganda a prospective follow up study |
| topic | Rheumatic heart disease Maternal health Uganda Health disparities Echocardiography Screening |
| url | http://link.springer.com/article/10.1186/s12884-020-03189-z |
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