Prevalent in Europe after World War II, RHD now affects primarily sub-Saharan Africa, the Middle East, South-East Asia, and the Western Pacific. RHD is often referred to as a disease of poverty, affecting low- to middle-income countries but also disadvantaged communities in high-income countries. Transmission is fueled by socioeconomic and environmental factors such as poor housing, undernutrition, and overcrowding.
More than 40 million people still suffer from RHD. Every year, the disease claims over 288,000 lives, and takes a toll on family livelihoods. Most patients do not reach their 40th birthday, often experiencing prolonged disability.
Like many respiratory tract infections, the bacterium Streptococcus pyogenes (group A streptococcus) that causes sore throat can pass easily from person to person. Untreated or inadequately treated streptococcal throat infection, referred to as streptococcal pharyngitis or “strep throat,” can lead to Rheumatic Fever (RF), which can inflame and scar heart valves and heart muscle. Girls and women face up to double the risk of RHD as men and boys. In fact, women are often only aware they are afflicted once they become pregnant. Increased blood volume puts additional pressure on already vulnerable heart valves, causing heart arrhythmias and heart failure, and leading to complications during pregnancy and delivery, or even death.
A MULTI-TIERED APPROACH
In 2018, the World Health Organisation (WHO) Global Resolution on Rheumatic Fever and Rheumatic Heart Disease was adopted by Member States. This has helped propel and consolidate awareness and action at the regional and global levels. Sustaining the momentum requires the pooling of resources and collaboration of partners in healthcare, policy-setting, and beyond.
Awareness campaigns to test, prevent and treat symptoms such as sore throat, joint pain and fever make up one pillar of activity in stemming RHD. They include programs advocating for antibiotics such as benzathine penicillin G, a long-acting form of penicillin, to be widely available and affordable, as well as for cardiac care for advanced cases. One such campaign, “Colours to Save Hearts”, is a partnership the WHF developed and started implementing in Mozambique, a country with an estimated 3% incidence of disease among school-aged children.
The campaign’s programme of work includes distribution of colouring books and crayons in 20 schools to children aged 6-13 years, to help them learn about RHD. Digital stethoscopes, portable ultrasound scanners, and penicillin as well as other antibiotics will be distributed throughout implementation to allow for consistent testing, diagnosis, and treatment. Annual screening campaigns will train around 600 teachers to administer “Strep A” tests to 2,000 children. Health professionals will also be trained in screening, early detection, and monitoring of symptoms and in using medical equipment. WHF will allocate a portion of funds raised through the partnership for surgeries to repair or replace damaged heart valves in patients.
Understanding obstacles and opportunities is a key strand in the fight to end RHD. To support the right strategy for each context, a first of its kind study examining the costs and benefits of investment in the prevention and management of RHD in the African Union has been published in Lancet Global Health. The study shows that mortality can be reduced by 30 per cent and 70,000 lives saved over the next decade by investing $100 million annually in care and treatment such as penicillin and cardiac surgery. The study estimates costs and benefits of different intervention levels and scenarios involving primary, secondary, and tertiary care while offering some eye-opening results.
AMPLIFYING THE VOICES OF RHD PATIENTS
The courage of those living with RHD is evident in the film RHD: The Beat of Change, winner of the special prize on the topic of health equity in the WHO Health for All Film Festival 2021. The experience is repeated in the stories of patients such as 29-year Katusiime Christine, a graduate in industrial and organisational psychology and volunteer chairperson of the RHD Support Group at the Uganda Heart Institute in Mulago, Kampala. As she said, “when my parents took me to local clinics, the diagnosis was always malaria, and the situation just kept worsening. I dropped out of school because my life was deteriorating. Frustrated, my parents also took me to the local churches for prayers and to traditional healers for herbal treatments.” At 13 years of age, Christine had to travel abroad to get the heart surgery needed to repair her heart valves.
RHD is detectable, preventable, and treatable. The fact that RHD remains prevalent in some parts of the world causes unnecessary suffering, and unfortunately, often stigmatisation. Local and global communities, clinics, policymakers and caregivers all have a role in ensuring that the supply of medicine is reliable, staff are trained, and patients and their families informed and equipped to survive—and thrive.