heart disease in children
At the recent World Congress of Cardiology
held in Melbourne two new studies were presented showing 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, rheumatic heart
disease (RHD). Middle East Health reports.
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. RHD is not only a neglected disease, it
is also easily prevented and controlled; acute rheumatic fever can
mostly be avoided by treating acute throat infections caused by group A
streptococcus (GAS) with a simple, short course of antibiotics. For
those who have had rheumatic fever, monthly injections of long-acting
penicillin can prevent recurrent attacks of rheumatic fever which can
lead to further heart valve damage.
On the same day a unique new
handbook to support the development of RHD control programmes is
launched, new research puts a spotlight on the steps two countries are
taking to better manage RHD and improve the lives of thousands of
children at risk of developing the condition.
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 atrisk communities in New
Zealand’s North Island, working together with partners to find
innovative solutions. As part of these solutions, improvements to the
surveillance system to support programme planning and monitoring have
been introduced and a revised patient management system to prevent
recurrences of rheumatic fever is 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 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
Professor Diana Lennon, Department of Paediatrics: Child & Youth Health,
The University of Auckland.
Finding and preventing the burden of RHD in
RHD continues to be a problem in India, but despite this it is
overlooked as a public health priority. A study organised 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.
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.
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
Lead author, Dr Rosemary Wyber, Rheumatic Heart Disease
Program Manager at RhEACH describes: “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 under 25 years by 2025.
It is also well aligned with WHF CVD “roadmaps” for implementing
national targets around CVD. The TIPs Toolkit
of upload: 14th July 2014