Effectiveness of Systematic Echocardiographic Screening for Rheumatic Heart Disease in Nepalese Schoolchildren: A Cluster Randomized Clinical Trial

Rheumatic heart disease (RHD) continues to be responsible for major cardiovascular morbidity and mortality in the developing world.  It constitutes a double tragedy because it disproportionately affects economically disadvantaged people and young people, thereby robbing them of the most productive years of life. Often, by the time it is diagnosed, RHD has resulted in substantial valvular damage.  This cluster randomized clinical trial investigates if school-based echocardiographic screening in combination with secondary antibiotic prophylaxis in children with evidence of latent rheumatic heart disease may be an effective strategy to reduce the prevalence of definite or borderline rheumatic heart disease in endemic regions.