A cause for 60% of all the cardiovascular disease in children and young adults:Rheumatic Fever [Archives:2005/842/Health]

Compiled by Amal Mohammed al-Ariqi
Yemen Times Staff
Rheumatic Heart Disease (RHD), which is considered a major health problem in developing countries is a consequence of rheumatic Fever (RF), once common as Acute Inflammatory Disease. This fever (RF) is characterized by fever and pain, tenderness, redness, and swelling of the joints. According to WHO reports, RF is a preventable disease yet, it is still present in many parts of the world and particularly in developing countries of Africa, Asia, India, South America and Australia. It affects yearly a total of 15 million individuals all over the world.

Socio-Economic Burden of Rheumatic Fever and Rheumatic Heart Disease

According to WHOs reports that socioeconomic and environmental factors play an indirect, but important, role in the magnitude and severity of RF/RHD. Factors such as a shortage of resources for providing quality health care, inadequate expertise of health-care providers, and a low level of awareness of the disease in the community can all impact the expression of the disease in populations.

On the other hand RF/RHD has a very deleterious effect on the socioeconomic status of every country with this health problem. In many developing countries, and our region is one of these, RF/RHD accounts for up to 60% of all the cardiovascular disease in children and young adults and it passively affects the national productivity. In addition many school-aged patients drop out of school due to RHD.

Moreover, large percentage of RHD children are physically handicapped, they are not regular at school, some have limitation in their social life and may not get an occupation easily. This will lead to loss of manpower and source of income to their families.

It is well known that the burden of RF/RHD on the socio-economic status of any country in the region includes the following items:

Thus the burden of managing RF/RHD puts additional pressure on the economies of these countries, which are already complaining of low national product and low national income. The already added burden of the disease is similar to a continuous blood loss to an already anemic person.

We can not ignore in this issue adding to the burden on health systems of developing countries are the costs of outside referrals that are often required during the course of treatment.

Prevention of Rheumatic Fever

Rheumatic fever and rheumatic heart disease (RF/RHD) are considered a major cause of morbidity and mortality in most developing countries. In some of these countries it is responsible for about one-third of deaths from cardiovascular diseases.

Rheumatic fever prevention and rheumatic heart disease control programs are cost-effective and inexpensive. Their designation, implementation and extension in the community are essential and an important objective to be achieved.

Both primary and secondary prevention of RF and RHD have been proved to be safe, feasible, and effective in both developed and developing countries. The overall goal of a national programs should be to reduce morbidity, disabilities and mortality from RF and RHD.

An approach to the problem of RF must be guided by a plan which coordinate medical and non-medical community leaders for mass primary prevention, providing care for high-risk group of susceptible children and for checking the accuracy of secondary prevention.

The objective of screening children of rheumatic families will involve physicians, families and the community in the preventive programs.

Prevention programs

. There should be a strong commitment at policy-maker level, particularly in the ministries of health and education. A national advisory committee (National Organization for RF Prevention and Control of RHD in each country of the Region) should be formed, with broad representation from all stakeholders, including representatives from a wide spectrum of professional organizations (e.g. cardiologists, pediatricians, family physicians, internal medicine specialists, epidemiologists and nurses).

. Program implementation should be stepwise. For example, start in one or more defined areas to test whether the methods and procedures are appropriate for the local situation (phase I) and then gradually extend the program to provincial (phase II), and then national coverage (phase III). A microbiology laboratory is essential with intermediate and peripheral level branches.

There is lack of emphasis given to this issue in many countries and globally. It will be necessary to make this problem a higher priority for ministries of health and official agencies.

More attention must be given to optimizing diagnosis and therapy of streptococcal infections, education of the general population, of school children and medical and public health professionals is required.

New approaches are needed to identify risky groups of children who are vulnerable to get the diseases. Moreover, new methods are needed to discover and apply genetic markers for disease susceptibility.
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