For those outside the medical field, chronic heart disease is often assumed to be a condition affecting only the elderly. However, those who are closely involved with these cases know that it tragically affects many young lives. The most strategic aspect is that this disease can be prevented through pharmacological means. While most chronic diseases are preventable by addressing modifiable risk factors (often non-pharmacological), the situation is different for the specific disease I am about to discuss.
What Is It Exactly?
Chronic rheumatic heart disease is a condition that impacts the heart valves. It is the long-term consequence of acute rheumatic fever, which occurs due to the body’s autoimmune response to group A streptococcal pharyngitis. Streptococcal skin infections have also been implicated in the disease process. Socioeconomic and environmental factors, such as poor housing, undernutrition, overcrowding, and poverty, significantly contribute to the incidence, magnitude, and severity of rheumatic heart disease.
What Makes It Unique?
It predominantly affects the young population. - Globally, RHD remains the most-common cardiovascular disease in young people aged <25 years.
In developing and low-income countries, it stands as the leading cause of morbidity and mortality among children and young adults. -The 2004 World Health Organization (WHO) report and 2005 publication on the global burden of group A streptococcal disease estimated the global prevalence of RHD to be 15.6 million, which included approximately 1.01 million children in sub-Saharan Africa [1]. This estimate of the global RHD population has doubled to 32.9 million according to the 2013 Global Burden of Disease (GBD) study [2], which accounts for at least 345,000 annual deaths [3]. - The prevalence of rheumatic heart disease in East Africa is very high, affecting about one in seven people [4].
The causative and risk factors are well-established, making them the most significant avoidable risk factors.
Rheumatic heart disease profoundly impacts individuals’ physical, financial, and psychological well-being.
How Can We Prevent It?
Prevention strategies can be classified into three segments:
Primary Prevention: Properly treating Group A streptococcal infections with antibiotics, using the right dosage for the appropriate duration of time.
Secondary Prevention: Administering intramuscular injections of benzathine Penicillin G (BPG) to prevent the recurrence of Rheumatic Fever and the development of Rheumatic heart disease.
Fig .1[5]
Tertiary Prevention: Providing optimal medical care for those who have already developed Rheumatic heart disease.
Where We Stand: Data from Some Countries
Although RHD is the most-common cardiovascular disease among young people (age <25 years) worldwide [6], just 0.1% of global health research funding for neglected diseases was targeted towards RF between 2007 and 2010, which equated to US$1,736,877 in 2010[7].
Numerous studies conducted in developing countries have consistently highlighted a concerning lack of awareness among parents and children regarding the primary prevention of rheumatic heart disease.
For instance, a study conducted in Kenya reported:
The participants had a poor level of knowledge on primary prevention of RHD. However, the majority had practiced sore throat management in their children and had preferred hospital treatment for that episode [8].
Another study from Egypt reported:
In a cross-sectional survey of 6958 subjects, our findings revealed that a strikingly low proportion of participants correctly identified the cause of RHD, as well as a prevalent reliance on self/peer-prescribed medications. Interestingly, females were more likely to consult physicians and were more knowledgeable about the association between sore throat and RHD. Moreover, younger individuals (highest risk category) scored the lowest in terms of knowledge and were the least likely to consult a physician [9].
What Must Be Done?
Position statement of the World Heart Federation (WHF) on the prevention and control of rheumatic heart disease published on 2013 affirms WHF commitments to five key strategic targets [10]:
comprehensive register-based control programmes
global access to benzathine penicillin G,
identification and development of public figures as 'RHD champions',
expansion of RHD training hubs,
and support for vaccine development.
Here are some straightforward steps to address this critical issue:
Improve Socioeconomic and Environmental Factors: Prioritize efforts to enhance socioeconomic conditions and environmental factors in a cost-effective manner. These improvements can significantly impact the incidence and severity of rheumatic heart disease.
Vigilance for Sore Throats: Pay attention to children around you who experience sore throats. Encourage them to seek medical attention promptly. Early diagnosis and treatment are crucial in preventing complications.
Support Initiatives: Get involved in initiatives aimed at raising awareness about rheumatic heart disease. Whether through advocacy, education, or community programs, every effort counts.
Let’s protect our children and adults by spreading awareness! 🌟
REFERENCES
1. World Health Organization. The Current Evidence for the Burden of Group A Streptococcal Diseases . World Health Organization; 2005. [Google Scholar]
2. Vos T., Barber R. M., Bell B., et al. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet . 2015;386(9995):743–800. doi: 10.1016/S0140-6736(15)60692-4. [PMC free article] [PubMed] [CrossRef] [Google Scholar] [Ref list]
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4. Mebrahtom G, Hailay A, Aberhe W, Zereabruk K, Haile T. Rheumatic Heart Disease in East Africa: A Systematic Review and Meta-Analysis. Int J Rheumatol. 2023 Sep 19;2023:8834443. doi: 10.1155/2023/8834443. PMID: 37767221; PMCID: PMC10522432.
5. PPT - The Prevention of Rheumatic Fever and Rheumatic Heart Disease PowerPoint Presentation - ID:227296 (slideserve.com)
6. Murray, C. J. & Lopez, A. D. Global Health Statistics (Harvard University Press, 1996).
7. Moran, M. et al. G-Finder: Global Funding of Innovation for Neglected Diseases. Neglected disease research and development: is innovation under threat? Policy Cures [online], (2011).
8. Ismail, Mukraish. Knowledge and Practice of Primary Prevention of Rheumatic Heart Disease in Parents of Children with Acute Pharyngitis at Kenyatta National Hospital. http://erepository.uonbi.ac.ke/handle/11295/160715
9. Sayed, A.K.; Se’eda, H.; Eltewacy, N.K.; El Sherif, L.; Ghalioub, H.S.; Sayed, A.; Afifi, A.M.; Almoallim, H.S.; Alharbi, S.A.; Abushouk, A.I. Awareness of Rheumatic Heart Disease in Egypt: A National Multicenter Study. J. Cardiovasc. Dev. Dis. 2021, 8, 108. https://doi.org/10.3390/jcdd8090108
10. Remenyi, B., Carapetis, J., Wyber, R. et al. Position statement of the World Heart Federation on the prevention and control of rheumatic heart disease. Nat Rev Cardiol 10, 284–292 (2013). https://doi.org/10.1038/nrcardio.2013.34
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