Rheumatic heart disease, Pacific Islands

The prevalence of rheumatic heart disease (RHD) in the Pacific Islands is one of the highest in the world. Because they are isolated and few have the capacity to provide heart valve surgery domestically, most Pacific Islands countries spend between 4-12% of their total health budgets sending RHD patients abroad for life-saving heart valve surgery.

Helping countries strengthen rheumatic disease control

The World Heart Federation's Pacific Rheumatic Heart Disease control programme was established in 2005. It seeks to prevent disease progression and avoid or delay valve surgery by reducing the recurrence of rheumatic fever.  Working in collaboration with local health departments, the programme has established demonstration sites in Fiji and Samoa.  These demonstration models are being rolled out at the national level over three years.  

Focus on secondary prevention

The RHD programme focuses on secondary prevention of rheumatic fever, which has been identified by the World Health Organisation as the most cost-effective approach to rheumatic heart disease control and demonstrated to be feasible and effective in a number of low-resource settings. The WHF demonstration projects are based on these principles and draw from experience gained in register-based rheumatic heart disease control programmes around the world.

Rolling out to national level in Fiji

The demonstration project in Fiji began in mid-2005. It is based in Suva (Central region) and has been rolled out to include the Western and Northern Divisions.  A number of training workshops have been conducted for health staff in all Divisions and the RHD Programme is working with key staff in each area to identify and register people with rheumatic fever and rheumatic heart disease and improve clinical care and long-term treatment. 


The programme in Western in Samoa

The Western Samoa project began in December, 2006. One workshop for health staff has been conducted in the capital Apia, and the local RHD team have undertaken active surveillance for rheumatic heart disease across the country. Screening primary school children for early signs of rheumatic heart disease has been undertaken on both the main islands of Upolu and Savai'i.

Workshops to strengthen regional RHD control

Two World Heart Federation / World Health Organization workshops on rheumatic heart disease have been held in Nadi, Fiji; the first in October 2006 and the second in February 2008. Clinicians and public health officials from 18 Pacific Island Nations including Australia and New Zealand have participated in these workshops, along with representatives from several international organizations. The workshops' overarching aim was to develop a regional strategy around RHD control and prevention. They offered a much-needed chance to share information and update knowledge and skills.  They included training on use of register databases and echocardiography. Programme staff have also provided technical assistance to clinicians from Vanuatu, Nauru, Saipan and Tonga and helped them adapt databases to their own needs.   

At the first workshop, the group issued a Call to Action document highlighting the magnitude of the burden of RHD in the Pacific and calling on governments and international aid organizations to establish and maintain RHD control programmes. The Call to Action was endorsed by delegates present at the second workshop. A Pacific Committee was established to direct and inform on future strategies for developing a long-term regional RHD prevention programme. The Committee includes representatives from Fiji, Palau, Saipan, Tonga, Vanuatu and Western Samoa.