Medics Urge For More Efforts To Combat Rheumatic Heart Disease In Children

Henry Neondo, CNS Correspondent, Kenya
Medics at the World Congress of Cardiology 2014 have urged governments to put in more efforts to reduce Rheumatic Heart Disease (RHD) among children. RHD, a chronic heart condition caused by acute rheumatic fever (ARF), is the most common acquired heart disease amongst children in developing countries and affects over 15 million people.

Yet, according to Dr Bongani Mayosi of Cape Town, South Africa, RHD is a neglected disease despite being easily prevented and controlled. ARF can mostly be avoided by treating acute throat infections caused by group A streptococcus (GAS) with a simple, short course of antibiotics.

Two new studies presented today (7th May) show the importance of collecting comprehensive patient information nationally and providing timely access to health services in tackling one of the world’s most neglected and easily prevented diseases in children—the rheumatic heart disease.

Dr Bongani said that examples from Tunisia, South Africa and elsewhere show that national plans are needed to coordinate a war against RHD which affects children of all ages up to 15 years, becoming more acute when sore throats are neglected in the early childhood. These plans can then feed into educating the population, and help in effective surveillance, notification and treatment.

New Zealand: a country tackling RHD head on 
The New Zealand government has put a priority target in place to reduce rheumatic fever by two thirds by 2017 and is investing in education and prevention work in at-risk communities in New Zealand’s North Island, working together with partners to find innovative solutions. As part of these solutions, improvements in the surveillance system to support programme planning and monitoring have been introduced and a revised patient management system to prevent recurrences of rheumatic fever has been planned.

In addition,  the Department of Paediatrics at the University of Auckland and epidemiological experts from across the country have independently undertaken a large scale audit of different RHD surveillance processes in Auckland to better understand their strengths and weaknesses, as well as identify children with (or at risk of) developing RHD.   As a result of this audit, over 500 children with definite or probable ARF were identified in Auckland through a range of these complementary methods.  There is a necessity to have high quality and all-encompassing processes to identify as many cases as possible of ARF, which can prevent the deaths of hundreds of children every year.  

“Rheumatic heart disease is responsible for the deaths of thousands of young people under the age of 25 years each day around the world and cannot be ignored.  New Zealand is at the forefront when it comes to RHD prevention and our study shows the important role that efficient surveillance tools can play to avoid the devastating consequences of acute rheumatic fever being left untreated,” said Prof Diana Lennon, Department of Paediatrics, Child & Youth Health, The University of Auckland.

India:finding and preventing the burden of RHD

RHD continues to be a problem in India, and is overlooked as a public health priority.  A study by the Indian Council of Medical Research (ICMR) established 10 registries between 2000 and 2010 to look at a range of factors, which contribute to RHD, including biology and the existing health infrastructure. In addition, the registries undertook a wide range of prevention activities across India, including community health education campaigns, additional training for medical teams and prescription of oral antibiotics. The results of this large study show that the use of this registry-based prevention programme in existing healthcare settings works well and is a practical and achievable means of preventing and controlling RHD, which can ultimately lead to fewer deaths in children across India. The study also illustrates the challenges in obtaining representative data from large countries with great geographic and socio-economic diversity.  Additionally, sustaining the effort over several years will require robust long term policies based on the experience of the registry.

“Too many children die each year from this preventable disease and we have shown how surveillance tools and secondary prevention techniques delivered through existing healthcare structures can help prevent the onset of rheumatic heart disease and reduce the burden of heart disease amongst children.  Our research demonstrates that it is not only possible to make a difference, but that it needn’t be a difficult process,” said Meenakshi Sharma of ICMR. Dr Krishna Kumar added that there is need to integrate RHD programmes with the existing health facilities' systems.

The burden of RHD in Australia
In Australia, Aboriginal and Torres Strait Islander people are 8 times more likely to be hospitalised for ARF/RHD and 20 times more likely to die from rheumatic heart disease than any other group. The Heart Foundation’s National Cardiovascular Health Director Dr Robert Grenfell said that heart disease was the greatest single contributor to the gap in life expectancy between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians. 

“Many people may think that rheumatic heart disease is a thing of the past, something that happened in the 1950s, but that isn’t the case. Many young indigenous people, in Australia and around the world, are living with the burden of this disease, and are dying early because of it.  The Heart Foundation is passionate about supporting research and projects to address this serious problem and give more young Indigenous Australians the chance to live a full and healthy life,” said Dr Grenfell.

Tools for implementing RHD programmes: TIPs toolkit

Based on 60 years of experience in RHD prevention and control around the world, the TIPs handbook compiles interviews, case studies, unpublished reports and peer reviewed publications into an accessible format for the very first time. Topics include burden of disease data, fundraising, development of RHD registries and the interface with cardiac surgery. TIPs will be distributed to clinicians and policy makers tackling RHD in endemic countries.

Lead author, Dr Rosemary Wyber, Rheumatic Heart Disease Programme Manager at RhEACH (The Rheumatic heart disease. Evidence. Advocacy. Communication. Hope.) Programme said that, “TIPs provides a foundation to describe, design and implement comprehensive RHD control programmes in the areas of greatest global need. Collating and disseminating lessons from around the world will help make the delivery of RHD control programmes more effective, efficient and sustainable.”

The TIPs handbook is designed to build health system capacity to reach the World Heart Federation’s goal to achieve a 25% reduction in premature deaths from rheumatic fever and RHD among individuals aged below 25 years by 2025.  It is also well aligned with World Heart Foundation CVD “roadmaps” for implementing national targets around CVD.

Henry Neondo, Citizen News Service - CNS
6 May 2014