Rheumatic heart disease, Africa
Rheumatic heart disease affects millions in Africa
Rheumatic heart disease is almost forgotten in the wealthy countries where it has been almost eliminated, but it remains the most common heart disease among children and young people in developing countries. The condition affects over 15 million people around the world and kills hundreds of thousands of them a year. Africa has the largest number of children with the disease: in sub-Saharan Africa, where there is little access to the treatment that could enable them to survive and lead normal lives, over a million children are estimated to suffer from the debilitating and often fatal condition.
To reduce the recurrences of rheumatic fever that cause the debilitating heart damage of rheumatic heart disease, the World Heart Federation has established a rheumatic heart disease control programme in Africa. The programme is setting up demonstration sites in Egypt, Eritrea, Ethiopia, Ghana, Kenya, Mozambique, Nigeria, Rwanda, South Africa and Zambia.
African initiative for rheumatic heart disease (RHD) control
The project is based on an initiative developed in 2005 at a workshop on RHD organized by the Pan African Society of Cardiology (PASCAR). It draws from the World Heart Federation's experience with rheumatic heart disease control in the the Pacific. Its approach, called the ASAP model, has four pillars: Awareness-raising, Surveillance, Advocacy, and Prevention. Demonstration sites will develop models for comprehensive rheumatic disease control at the national level. Click here for more information on the ASAP model>
Focus on prevention
The programme in Africa is similar to the World Heart Federation Pacific Islands Rheumatic Heart Disease Control Programme. Children are screened for heart valve damage and those found to have RHD are provided the monthly penicillin injections that prevent the progression of the disease. This approach of secondary prevention has been identified by the World Health Organization as the most cost-effective way to control RHD in developing countries. Ministries of health in South Africa, Ghana and Ethiopia have shown their support of the programme. The World Heart Federation featured the Africa RHD project at the Clinton Global Initiative in October.
Demonstration sites to provide model for national programmes
In South Africa, demonstration sites have been set up in the Capetown townships of Langa and Bonteheuwel, where population surveys are in progress and awareness campaigns conducted by the Department of Medicine at the University of Cape Town with the Heart and Stroke Foundation South Africa. Over 5,000 school children will eventually be screened at these sites, with support from the South African Paediatric Society of Cardiology.
The project in Ethiopia is being conducted in conjunction with Jimma University, where some 150 children with rheumatic fever and rheumatic heart disease are already being tracked. The project will cover a population of 140,000 in Gilgel Gibe.
The project in Ghana is being carried out together with the University of Ghana. Three sites have been identified near Accra where project staff have begun school screenings.
In Egypt, the project will be affiliated with the University of Alexandria.
Workshops to foster regional approach
The programme plans regional workshops which will share materials developed and experiences gained in the demonstration sites with health professionals and public health officials in neighbouring countries. Sample databases, guidelines, curricula, training presentations and other rheumatic heart disease resources will also be made available through the World Heart Federation Rheumatic Heart Disease Network, an online clearinghouse for materials on the control of rheumatic heart disease.
