Screening and Diagnostic Measures Impact on RHD Burden in Australia

This project evaluates the impact of various screening and diagnostic measures on the burden of Rheumatic Heart Disease (RHD) in Australia, focusing on children aged 5-17 years in the Northern Territory and Central Australia. The study employs a cross-sectional and cohort design, utilizing data collected from public hospitals and schools, with a sample size of 3500 children and a control group of 1700. Data collection relies on questionnaires, and statistical analysis involves univariate analysis and x2 analysis. Ethical considerations include obtaining consent, ensuring confidentiality, and securing ethical clearance. The study aims to provide recommendations for appropriate RHD screening and diagnostic tools, contributing to improved management of the disease in Australia and globally, while acknowledging potential biases due to the study population.

Running Head: PUBLIC HEALTH AND EPIDEMIOLOGY
Public Health and Epidemiology
Name
Institution

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Public Health and Epidemiology
Table of Contents
Table of Contents.............................................................................................................................2
Title of the Project...........................................................................................................................4
Study Duration.................................................................................................................................4
Project Summary.............................................................................................................................4
Background......................................................................................................................................5
Study Goals and Objectives.........................................................................................................7
Study Design and Methods..............................................................................................................8
Study Design and Setting.............................................................................................................8
Sample Population.......................................................................................................................8
Sample Selection......................................................................................................................9
Sample Size..................................................................................................................................9
Data Collection..........................................................................................................................10
Statistical Analysis.....................................................................................................................10
Ethical Considerations...............................................................................................................11

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Consent.......................................................................................................................................11
Confidentiality...........................................................................................................................11
Access to Medical Record and RHD Register...........................................................................12
Ethical Clearance.......................................................................................................................12
Study Limitations...........................................................................................................................12
Impacts of the Study......................................................................................................................12
Project Management Arrangements..............................................................................................13
Conclusion.....................................................................................................................................13
References......................................................................................................................................15

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Title of the Project
Assessment of impact of various screening and diagnostic measure on Rheumatic heart
disease (RHD) burden in Australia
Study Duration
120 months
Project Summary
RHD is among the primary causes of cardiovascular death plus morbidity in many
nations in the world in children and adolescents in disadvantaged populaces. Australia is among
the countries globally impacted by rheumatic heart diseases and several screening and diagnosis
methods have been advanced to manage the condition. The advent of echocardiographic
screening offers the prospect of untimely illness, as well as intervention. In the last decades,
several groups globally have carried out populace-based screening for rheumatic heart disease
utilizing portable echocardiography, displaying its feasibility in diverse backgrounds (Steeret et
al., 2009).
The study aims to assess the impact of various screenings and diagnostic measure on the
rheumatic disease burden on Australia. The proposed study is planned to be carried out in the
Northern Territory of Australia and Central Australia that will be carried out in public hospitals
because the target population will be children aged between 5 and 17 years in schools in
Australia. The study will start in November 1, 2018 and end in November 2, 2019. The data that

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will be collected from the study will be analysed through computing the relative of RHD
amongst children in the study area that will represent the entire population in Australia. The
study will use cross-sectional and cohort study to collect the needed data needed to evaluate the
influence of different screening and diagnosis measure of RHD in Australia. The main
implication of the study is anticipated to play a leading role in advancing screening and
diagnostic measures for RHD among the Australians towards managing this condition in
Australia and globally (Roberts et al., 2013).
Background
RHD, the only long-standing result of acute rheumatic fever (ARF), is prevalent amongst
middle-income, as well as low-income nations, as well as in some indigenous societies in
developed societies, like Australia. It is estimated that at least 30 million persons are affected by
RHD globally and causes more 345,000 deaths on a yearly basis. The majority of the patients in
resource-restricted environments present with complex disease burden along with complications,
as well as thus prediction at the moment of diagnosis are deprived. RHD for many decades has
been the main object of public health screen where the World Health Organization (WHO)
carries on recommending screening as constituent of RHD control in high incidence parts in the
world. During the last decade, several groups globally have carried out populace-based diagnosis
and screening for RHD utilizing convenient echocardiography confirming its feasibility in many
backgrounds (Roberts et al., 2014).
According to Roberts, Maguire and Brown (2014), screening for RHD offers a prospect
to accurately define the present illness burden and to identify children with illness not diagnosed

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who might profit from early medication. Many researches have demonstrated that heart
auscultation is devoid of sensitivity along with specificity needed for screening the rheumatic
heart disease plus must no longer be employed for screening purposes to diagnose RHD.
Marijon, Tafflet and Jouven (2008) argue that echocardiography has demonstrated to be effective
and highly sensitive screening instrument for RHD, increasing the likelihood that a populace-
oriented screening program would identify cases earlier, as well as enhance disease outcomes via
secondary antibiotic prophylaxis. In addition, the creation of proper screening guidelines need a
consideration of the history of echocardiagraphic modifications in a given period of time and the
way these modifications associated with the threat of advancing clinical obstacles. Thus,
convenient echocardiography has become a more important instrument, as well as its
significance was improved by the issuance of the World Heart Foundation (WHF) principles for
the echocardiographic diagnosis of rheumatic heart disease in 2012 (Marijon, Tafflet & Jouven,
2008).
Saxena, Zuhlke and Wilson (2013) argues that the WHF principle for echocardiographic
diagnosis of the disease has offered standardization, as well as enhanced specificity, as well as
the efficacy of these principles in screening situation is currently extensively acknowledged by
the cardiology society. In this regard, rheumatic heart disease is shifting nearer to satisfying the
principles for an illness appropriate for screening. There is as well a “latent” phase, which may
be noticed (by echocardiography utilizing WHF principles) plus though conjuncture remains
regarding the account of WHF’s “borderline” group, there is a growing agreement that screen-
sensed “explicit rheumatic heart disease” embodies real illness plus is a sign for regimen
benzathine penicillin G(BPG) prophylaxis (Saxena, Zuhlke & Wilson, 2013). In many

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environments, people with the borderline rheumatic heart disease have not been put on
prophylaxis. Hence, if a huge populace of the borderline faction certainly has true, dormant
rheumatic heart disease, then the case for screen could be more convincing.
Conventionally, rheumatic heart disease was diagnosed by auscultation for a heart mutter
in those with account of acute rheumatic fever. It was not until the last few years, the stethoscope
tool was the only non-invasive diagnostic instrument accessible to health professionals in low-
income nations, as well as in distant areas in which RHD and ARF are mainly widespread.
Nonetheless, the discovery rates were much low. Thus, the echocardiography has confirmed to
be more responsive in addition to explicit that auscultation. Rheumatic heart disease detected on
echocardiography without a linked pathological heart hum is called subclinical RHD. With the
development of portable tech, echocardiography may at the present be carried out at a
comparatively economical, and to the isolated surroundings (Godown et al., 2015).
Study Goals and Objectives
The primary goal of the research proposal will be to assess the impact of different
screening and diagnostic measure on Rheumatic heart disease (RHD) burden in Australia
towards recommending an appropriate screening and diagnostic tool to be used. The assessment
is designed to provide a tool that will be used to screen and diagnose the Australians believed to
be having RHD especially children in public schools in Australia. The primary objective of the
research proposal is to carry out research to assess the impact of diverse screening along with a
diagnostic measure on RHD burden amongst the Australians. Another objective of the research
proposal is to provide recommendation on the appropriate screening and diagnostic tool that will
be used to measure RHD among school-aged children schools in Australia (Zachariah &

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Samnaliev, 2015). The Health Ministry of Australia will fund the project from the start to the
conclusion. The study may have some biases because of the population taking part in the study.
Study Design and Methods
This part will examine the methodology that will be used to collect the data needed to
establish the impact of various screening and diagnostic measure on rheumatic heart disease
(RHD) burden in Australia. The study will be divided into the study design, research population,
the size of the sample, data collection techniques, data analysis and ethical considerations.
Study Design and Setting
The study will adopt cross-sectional and cohort study that will be appropriate for the
study to collect the needed results to establish the health issue in question. The study will sample
different schools in the Northern Territory of Australia and Central Australia that will represent
the entire population. The design of the study is meant to ensure that the cohort study is the
representative of the entire population. The children in the study will be evaluated prospectively
for the advance of progressive valve anomalies, as well as retrospectively for the prevalence of
ARF. In this study, the comparator will be sex, age, as well as ethnicity-equaled controls that
have formerly had a standard screening echocardiogram (Yardley & Marks, 2003).
Sample Population
This study will recruit participants who are mainly a subset of kids that had an
echocardiogram during the previous screening study. This population has historically been the
target group for RHD screening and diagnosing. The participants live in 28 remote communities
across northern, as well as central Australia. Utilizing a school-based strategy has feasible

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advantages of screening several children in a single location, and detection of younger
participants has the highest impact on the outcome once preventative measures have been started.
Thus, this population will be vital in the evaluation of influence of screening plus a diagnostic
measure of RHD (Colquhoun, Kado, & Remenyi, 2014). The inclusion criterion is that children
in the study will be between 5 and 17 years and they should identify as Aboriginal Australian
and/or Torres Strait Islander and reside in distant sites. In addition, the children should be
attending school because the study will target school. The exclusion criterion is that children that
have had diagnosis of congenital valvular heart disease will not take part in the study.
Sample Selection
All kids between 5 and 17 years (inclusive) will be eligible for the study, comprising
children with identified record of rheumatic heart disease or congenital heart disease (CHD).
Children will be recognized by the enrolment record schools taking part in the study. In
consultation with school authorities and students, study information and consent forms will be
distributed to all families of eligible children.
Sample Size
The sample size approximations for the study should be based on estimated rates of ARF
founded on the yearly occurrence of ARF in persons with the identified rheumatic heart disease,
along with the background yearly occurrence of ARF in children amid 5 and 17 years of age. The
sample size will be calculated founded on the Northern Territory and Central Australia register
approximations, which the point prevalence of RHD in those children aged between 5 and 17
years. 3500 children in the participating schools will be selected for the study to collect the
needed data for the study (Zuhlke & Mayosi, 2013). The control group will be important for this

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study in ensuring valid and reliable data is collected. The control group will be crucial in this
study because it will provide a basis for comparison and ensure that the analysis is done in an
effective manner. The control group will comprise of 1700 children in selected schools with no
history of ARF/RHD (Chambers & Skinner, 2003).
Data Collection
Questionnaires will be the most appropriate for the study towards the collection of the
appropriate data needed. Well-organized questionnaire is cost-effective tool for collecting data
because it has the advantage of providing the needed responses to the questions of the study. The
interview will not be appropriate for this kind of study because the cohort is too large and it will
be cumbersome to undertake interview sessions, which implies that questionnaires would be
appropriate for the study (Presser, 2004). For this study, self-administered or self-completion
will be selected as the primary tool because it is quick to manage and perhaps has a higher
percentage of return rate when organized well. Given that the population under study are school
children, questionnaire will be appropriate. The study will use semi-structured questionnaire that
will use both open-ended and closed-ended questions to elicit response from the participants of
the study (MacDonald, 2012).
Statistical Analysis
The principal analysis would be founded on univariate analysis that comares the different
cases plus matched controls. The analysis will comprise x2 analysis that will be used to compare
the number of kids with an incident of RHD (stratified by distinct, probable, as well as latent in
the follow-up process plus those who have shown development of a valve injury (Parnaby &
Carapetis, 2010). In addition, more comprehensive analysis of the collected data from the

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questionnaire will be used through the use of logistic regression because of the nature of the
study to establish the relationship regarding the impact of screening and diagnostic measures of
RHD among children in the sample (Presser, 2004).
Ethical Considerations
Studies that entail epidemiology are in most cases subjected to ethical issues since they
are primarily touches human beings and there is normally the likelihood to harm the participants
either mentally or physically. In the current study, there is the need to consider ethical issues
because the population under study are mainly school children. Therefore, these children demand
that ethics be observed to avoid legal implications afterward (Shamoo & Resnik, 2009).
Consent
Written consent for the population under study will be necessary to be obtained from the
parents and guardians of the children before they are enrolled in the study. Furthermore, written
consent will be sought from kids with 13 years and above following an explanation utilizing flip-
charts, as well as culturally educational resource.
Confidentiality
All the children that will be taking part in then study will be registered into the study
enrolment log by study number, name, as well as the date of birth. Thus, the study enrolment log
will be maintained exclusively by the study coordinator for the study areas where all paperwork
with identifiable details will be stored in a separate and locked facility. Accordingly, all the data
has been collected and analysed will be use only study number rather than the names of the

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participants. This will guarantee the confidentiality of the personal information of the
participants (Roberts, Colquhoun, Steer, Remenyi & Carapetis, 2013).
Access to Medical Record and RHD Register
When the child will be founded to have anomaly on the echocardiogram, the medical
record along with RHD register will be accessed to verify whether this will be a novel finding.
The two records will be checked occasionally all through the study period to make sure that
children who had been referred for specialist review will complete a follow-up process.
Ethical Clearance
Ethical clearance will be accrued by the pertinent committee that include: Central
Australian Human Research Ethics Committee, and Western Australian Aboriginal Health
Information and Ethics Committee.
Study Limitations
The study entails a long cohort study that is the primary limitation, whereby 120 months
is a long period. This period makes it hard to make a follow-up because of the different
population dynamics that include migration and education. In addition, the long duration of the
study will make the study to be more expensive. Another restraint of the research is the large
number of participants that will make it hard to undertake data collection and to make analysis,
which will increase the biasness of the study in the long-term (MacDonald, 2012).
Impacts of the Study