Cardiology in the Young

Original Articles

Pilot study of nurse-led rheumatic heart disease echocardiography screening in Fiji – a novel approach in a resource-poor setting

Samantha M. Colquhouna1a2 c1, Jonathan R. Carapetisa1, Joseph H. Kadoa3, Benjamin M. Reevesa4, Boglarka Remenyia1a5, William Maya6, Nigel J. Wilsona5 and Andrew C. Steera2

a1 International Health Division, Menzies School of Health Research, Darwin, Australia

a2 Centre for International Child Health, University of Melbourne, Melbourne, Australia

a3 Department of Paediatrics, Fiji Ministry of Health, Suva, Fiji

a4 Department of Paediatric Cardiology, Cairns Base Hospital, Cairns, Australia

a5 Paediatric and Congenital Cardiac Services, Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand

a6 College of Medicine, Nursing and Health Sciences, Fiji National University, Lautoka, Fiji


We designed a pilot study of a training module for nurses to perform rheumatic heart disease echocardiography screening in a resource-poor setting. The aim was to determine whether nurses given brief, focused, basic training in echocardiography could follow an algorithm to potentially identify cases of rheumatic heart disease requiring clinical referral, by undertaking basic two-dimensional and colour Doppler scans. Training consisted of a week-long workshop, followed by 2 weeks of supervised field experience. The nurses’ skills were tested on a blinded cohort of 50 children, and the results were compared for sensitivity and specificity against echocardiography undertaken by an expert, using standardised echocardiography definitions for definite and probable rheumatic heart disease. Analysis of the two nurses’ results revealed that when a mitral regurgitant jet length of 1.5 cm was used as the trigger for rheumatic heart disease identification, they had a sensitivity of 100% and 83%, respectively, and a specificity of 67.4% and 79%, respectively. This pilot supports the principle that nurses, given brief focused training and supervised field experience, can follow an algorithm to undertake rheumatic heart disease echocardiography in a developing country setting to facilitate clinical referral with reasonable accuracy. These results warrant further research, with a view to developing a module to guide rheumatic heart disease echocardiographic screening by nurses within the existing public health infrastructure in high-prevalence, resource-poor regions.

(Received March 20 2012)

(Accepted July 20 2012)

(Online publication October 08 2012)


  • Developing countries;
  • screening;
  • public health


c1 Correspondence to: MS. Samantha Colquhoun, BA, RN, MPH (PhD Scholar), Centre for International Child Health, East Level 2 Royal Children's Hospital, Flemington Road, Parkville 3052, Australia. Tel:+61 3 9345 4977; Fax: +61 3 9345 6667; E-mail: