Okello Emmy, Longenecker Chris T, Scheel Amy, Aliku Twalib, Rwebembera Joselyn, Mirembe Grace, Sable Craig, Lwabi Peter, Beaton Andrea
Uganda Heart Institute, Kampala, Uganda.
School of Medicine, Makerere University, Kampala, Uganda.
Heart Asia. 2018 Jan 13;10(1):e010981. doi: 10.1136/heartasia-2017-010981. eCollection 2018.
Rheumatic heart disease (RHD) remains a major driver of cardiovascular morbidity and mortality in low-resource settings. Registry-based care for RHD has been advocated as a powerful tool to improve clinical care and track quality metrics. Data collected through an RHD registry may also reveal epidemiological and geospatial trends, as well as insight into care utilisation. Uganda established a central RHD registry at the country's only tertiary cardiac centre in 2010. In 2014 RHD care and registry enrolment expanded to the Western region and in 2015 to the North. Here, we examine the geographical distribution of RHD cases in Uganda and the impact of registry expansion.
A retrospective search of the Ugandan national RHD registry was preformed to capture all cases of acute rheumatic fever or clinical RHD from January 2010 through July 2016. A geospatial analysis revealed that the density of detected cases (cases/100 000 district residents) reflected proximity to an RHD registry enrolment centre. Regionalisation improved the number of cases detected in the regions of expansion and improved retention of patients in care.
RHD appears to have uniform distribution throughout Uganda with geographical clustering surrounding RHD registry enrolment centres reflecting access to care, rather than differences in prevalence. Higher rates of case detection and improved retention in care with regionalisation highlight the urgent need for decentralisation of cardiovascular services. Future studies should examine sustainable models for cardiovascular care delivery, including task shifting of clinical care and echocardiography and use of telemedicine.
在资源匮乏地区，风湿性心脏病（RHD）仍是心血管疾病发病和死亡的主要原因。基于登记系统的RHD护理被认为是改善临床护理和跟踪质量指标的有力工具。通过RHD登记系统收集的数据还可以揭示流行病学和地理空间趋势，以及对医疗利用情况的洞察。乌干达于2010年在该国唯一的三级心脏中心建立了中央RHD登记系统。2014年，RHD护理和登记注册扩展到西部地区，2015年扩展到北部地区。在此，我们研究了乌干达RHD病例的地理分布以及登记系统扩展的影响。
对乌干达国家RHD登记系统进行回顾性检索，以获取2010年1月至2016年7月期间所有急性风湿热或临床RHD病例。地理空间分析表明，检测到的病例密度（病例数/10万地区居民）反映了与RHD登记注册中心的距离。区域化增加了扩展地区检测到的病例数量，并提高了患者接受护理的持续性。
RHD在乌干达各地的分布似乎较为均匀，RHD登记注册中心周围的地理聚集反映了获得医疗服务的情况，而非患病率的差异。区域化提高了病例检测率，并改善了护理持续性，凸显了心血管服务去中心化的迫切需求。未来的研究应探讨心血管护理提供的可持续模式，包括临床护理和超声心动图的任务转移以及远程医疗 的使用。
