Congenital heart disease in elementary school children in rural Thailand: the role of the trained noncardiologist

Background: Congenital heart diseases (CHD) comprise about one-third of all major birth defects. Children with delayed diagnosis and improper treatment are at a high risk of morbidity and mortality. Objective: To determine the prevalence of unrecognized congenital heart disease among elementary school students and study the types and frequency of congenital heart disease in Phitsanulok, Pichit, and Kampangpetch provinces of Thailand using trained nurses and other health care personnel. Methods: Between September 2008 and September 2010, 138,529 students from 1,243 elementary schools were screened for abnormal heart conditions by trained nurses or health care workers. The students who were suspected to have CHD were referred to a pediatric cardiologist for complete evaluation and identification of the lesions. Results: Five hundred forty eight students were suspected to have heart diseases and 102 students were diagnosed as CHD. The average prevalence of unrecognized CHD in Phitsanulok, Pichit, and Kampangpetch was 0.74 per 1,000. Simple acyanotic lesions (ventricular septal defect, atrial septal defect, and pulmonary stenosis) were common in this study (32.35%, 16.67%, and 11.76%, respectively). Conclusion: Qualified nurses or health care workers can be useful for identifying patients with CHD. The role of these personnel in the national heart screening program should be further clarified.