Public Health Approaches to Rheumatic Heart Disease Prevention and Management

Abstract

Rheumatic heart disease (RHD) is a major public health problem because it continues to be very prevalent among the poor and marginalized populations and predominantly targets young adults with considerable mortality and disability. The prevalence of RHD and successful implementation of control programs are intimately linked to the availability of effective primary health care. For this reason, the RHD distribution mirrors human development. Much of the global decline in RHD burden has happened with improving access to health care and living standards and is not the result of specific RHD control strategies. RHD control has unique challenges because of absence of an effective vaccine, high dependence on penicillin, the long and protracted course of heart valve disease and high dependence on expensive tertiary cardiac care to treat established disease. For this reason, there is a need to thoughtfully integrate RHD control with non-communicable disease programs. Much needs to be done to implement key elements of RHD prevention and control that include creating robust and effective disease registries that are deeply integrated into primary health care, ensuring reliable availability and safe administration of penicillin, tailoring control strategies to regions with high disease burden and improving access to affordable tertiary care that includes heart surgery and catheter interventions. The international mandate on RHD that has been recently clearly spelled out by World Health Organization should serve as an impetus for a number of global organizations and governments to come together and collectively work towards reducing the RHD burden in affected populations.