Prevention and control of rheumatic heart disease: Overcoming core challenges in resource-poor environments

Abstract

Rheumatic heart disease (RHD) has long receded as a significant threat to public health in high-income countries. In low-resource settings, however, the specter of RHD remains unabated, as exemplified by recent data from the Global Burden of Diseases Study. There are many complex reasons for this ongoing global disparity, including inadequate data on disease burden, challenges in effective advocacy, ongoing poverty and inequality, and weak health systems, most of which predominantly affect developing nations. In this review, we discuss how each of these acts as a core challenge in RHD prevention and control. We then examine key lessons learnt from successful control programs in the past and highlight resources that have been developed to help create strong national RHD control programs.

Trends in Deaths from Rheumatic Heart Disease in the Eastern Mediterranean Region: Burden and Challenges

“…The latter is probably an underestimation, since, in the Watkins study, the estimate of deaths in Pakistan alone was 18,900. Also our data estimate the number of deaths from SEAR to be 126,907, while the Watkins study group [ 16 ] estimated that the numbers of deaths due to RHD in India and China alone (119,100 and 72,600 deaths respectively) were much higher than those reported by the WHO for the region. Other contributors [ 9 ] to the journal in which the study of the Watkins team was published argue that the calculations may be an underestimate.…”

“…The crowding index, which is closely linked to TFR, has been closely linked with higher prevalence of streptococcal disease [ 4 , 5 , 6 ]. This might explain the high correlation with the limited social indicators reported in our study, but nonetheless warrants further investigation [ 16 ].…”

“…The Watkins team estimated that the global prevalence of RHD was 33.4 million cases worldwide, which is really only the tip of the iceberg, as expressed by Marijon [ 10 ], and is more than twice that calculated by a systematic evaluation of the literature [ 15 ]. The estimate was based on modeling due to a lack of data; for instance, 15 out of 53 countries in Africa lack primary sources of data on deaths from RHD [ 16 ].…”

“…This is in agreement with the findings of other workers [ 15 ], who reported that the disease is more prevalent among females. Possible causes include late detection, exposure to social discrimination, stigma from the disease interfering with prospects of marriage (especially in females living in socially deprived areas), illiteracy, and disempowerment [ 15 , 16 ].…”

“…Several investigators [ 16 ] have discussed the fact that the many challenges to the prevention and control of RF/RHD can be helped by estimating the true global burden of the disease. They emphasize that although registries with good quality of data are important, this has been limited to countries such as Australia, New Zealand, Pacific Islands, South Africa, and Tunisia, and is lacking in many other countries inflicted with this disease.…”