AIM:
Rheumatic heart disease poses a huge burden for developing countries, with Pacific Island nations having among the highest prevalence reported in the world. It is recognised that echocardiography is much more sensitive than clinical examination for detection of rheumatic heart disease, but resource and cost limitations are delaying implementation of screening programmes in developing nations. Rapid echocardiography using low-cost portable machines and a non-expert operator may be a useful compromise, allowing widespread screening and control of rheumatic heart disease in developing countries.

METHODS:
In-school echocardiography and clinical examination was carried out on primary school children (aged five to 14) in Lautoka, Fiji. All of the children with abnormal findings were then recalled for complete in-hospital clinical and echocardiographic assessment by a paediatrician with expertise in rheumatic heart disease and echocardiography.

RESULTS:
Using screening echocardiography averaging less than 4 min per patient, the prevalence of definite rheumatic heart disease detected by echocardiogram screening was 55.2 per 1000 compared with 11 per 1000 detected by clinical examination (P < 0.001). It was demonstrated that echocardiography is five times more sensitive at detecting rheumatic heart disease compared with clinical examination. A comprehensive screening programme is estimated to cost less than US$40 per patient detected.

CONCLUSION:
This study confirms that Fiji has the highest documented prevalence of rheumatic heart disease in the world. Rapid echocardiography has the potential to screen large numbers of patients by non-specialist operators, which encourages its use in larger scale screening and prevention strategies in developing countries.