Rheumatic heart disease prevalence in Namibia: a retrospective review of surveillance registers

Abstract

Background Rheumatic heart disease (RHD) is the most commonly acquired heart disease in children and young people in low and middle-income settings. Fragile health systems and scarcity of data persist to limit the understanding of the relative burden of this disease. The aims of this study were to estimate the prevalence of RHD and to assess the RHD-related health care systems in Namibia. Methods Data was retrieved from outpatient and inpatient registers for all patients diagnosed and treated for RHD between January 2010 to December 2020. We used descriptive statistics to estimate the prevalence of RHD. Key observations and engagement with local cardiac clinicians and patients helped to identify key areas of improvement in the systems. Results The outpatient register covered 0.032% of the adult Namibian population and combined with the cumulative incidence from the inpatient register we predict the prevalence of clinically diagnosed RHD to be between 0.05% and 0.10% in Namibia. Young people (< 18 years old) are most affected (72%), and most cases are from the north-eastern regions. Mitral heart valve impairment (58%) was the most common among patients. We identified weaknesses in care systems i.e., lack of patient unique identifiers, missing data, and clinic-based prevention activities. Conclusion The prevalence of RHD is expected to be lower than previously reported. It will be valuable to investigate latent RHD and patient follow-ups for better estimates of the true burden of disease. Surveillance systems needs improvements to enhance data quality. Plans for expansions of the clinic-based interventions must adopt the “Awareness Surveillance Advocacy Prevention” framework supported by relevant resolutions by the WHO.

Health-related quality of life and healthcare consultations among adult patients before and after diagnosis with rheumatic heart disease in Namibia

“…There is limited data available on the prevalence of RHD in Namibia. Overall, estimates suggest it affects about 1% of the population, but recent evidence suggest it may be as low as 0.05–0.1% of the population [ 31 ]. RHD is one of the top three causes of cardiovascular death in children ages 5–14, along with congenital heart disease [ 32 ].…”

“…It is more common among women and children in the northern regions of the country, particularly in socially disadvantaged vast rural areas with limited access to healthcare (Fig. 1 ) [ 31 , 32 ]. RHD patients need to travel to the nearest health facility at least once a month for medicine and prophylaxis injections, and they visit the cardiac clinic regularly for assessments with a cardiologist, and psychosocial support.…”