Empowering Local Providers and Scaling Impact Through Technology and Training

Cincinnati Children’s Andrea Beaton, MD, and her team have made it their mission to address rheumatic heart disease (RHD) worldwide, with new efforts in Uganda that are having a significant impact. By training local nurses to identify and treat RHD, introducing modern technology and closely managing patients, the team is making inroads in preventing disease progression.

Largely preventable, RHD is a chronic valvular heart disease caused by rheumatic fever, which develops from an untreated streptococcal infection. Globally, more than 55 million people—primarily living in densely populated areas in economically underdeveloped countries—are afflicted by this disease. RHD causes approximately 350,000 deaths annually.

In the U.S. and countries with modern healthcare systems, cases of streptococcal infection are typically treated with penicillin, hence avoiding serious complications. However, in countries with limited access to hygiene and healthcare, such as Uganda, where Beaton conducts her research, most children are diagnosed after the disease has progressed to cause heart damage.

New Project to Prevent Rheumatic Heart Disease

Beaton’s team is continuing to develop new strategies to bring evidence-based RHD interventions to people in Uganda who need them most. The goal is to identify individuals with RHD early and help them stay on antibiotics to prevent serious illness and death.

The program, Accelerating Delivery of Rheumatic Heart Disease Prevention in Northern Uganda (ADUNU), is one of several run by the RHD Research Collaborative in Uganda (RRCU). The RRCU is a network of clinicians, scientists and public health researchers committed to preventing, diagnosing and treating RHD. Cincinnati Children's is one of several RRCU network collaborators, and Beaton is a co-director and senior investigator with RRCU.

The ADUNU project in Uganda’s Kitgum District could have lasting significance. If the methods used here prove effective and affordable, the program could be replicated to serve other people in need.

Training Local Nurses to Perform Echocardiograms

Partnering with the Ugandan Ministry of Health, the team has trained more than 50 local, primary healthcare nurses to perform echocardiograms to diagnose RHD. People screened are typically ages 5 to 39. People in this age group have the highest risk for RHD and benefit the most from treatment.

The nurses have screened more than 17,000 people in the Kitgum District since May 2022. The team intends to screen up to half the target age population.

Patients who receive a positive screen are referred to an RHD care clinic (usually a health center or district hospital with more resources and staffing). These clinics can provide definitive RHD screenings, such as a comprehensive scan or echocardiogram. After diagnosis, clinics can also develop medical management plans and link patients to a primary health center for ongoing care. Referrals are made with the Active Community Case Management Tool (ACT), a mobile registry developed at Cincinnati Children’s.

Managing Care with Cincinnati Children’s Mobile Tool

Uganda clinicians use ACT to manage care for more than 3,500 children, adolescents, and young adults across eight regional sites. It is designed to address barriers to delivering high-quality RHD care in low-resource settings by providing real-time data and support throughout the entire RHD journey from detection and treatment to recovery. Nurses use ACT at local health centers to ensure people with RHD get the care they need.

Adherence Exceeds Uganda's National Average

“We have identified more than 350 cases of RHD since May 2022,” says Beaton. These patients are placed on continuous antibiotic prophylaxis, or secondary prevention, which involves a monthly injection of penicillin or daily oral penicillin.

Penicillin helps reduce the risk of RHD progressing to severe or potentially fatal complications. “Our patients are achieving 92% adherence to prophylaxis, a far higher rate than the Uganda national average of 54%,” adds Beaton.

Beaton has been awarded grants totaling approximately $27 million to support her work. In the near future, Beaton’s team will be expanding the program to another district in Uganda and hopes it will eventually take hold beyond Uganda’s borders.

(Published December 2024)

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