Browsing by Subject "Rheumatic heart disease"

Now showing 1 - 10 of 10
  • Thumbnail Image
    Item
    Open Access
    A proposal for the eradication of rheumatic fever in our lifetime
    (2006) Mayosi, Bongani M
    The Pan African Society of Cardiology (PASCAR) convened the 1st All Africa Workshop on Rheumatic Fever (RF) and Rheumatic Heart Disease (RHD) on 15 - 16 October 2005 at the Champagne Sports Resort, Drakensberg, South Africa. The purpose of the Workshop was to formulate an action plan for the prevention of RF and RHD in Africa. The gathering was a response to the new guideline on the control of RF and RHD by the World Health Organization (WHO) in 2004.1 The meeting (and this supplement) was made possible by the generous sponsorship of the national Department of Health of South Africa, the Medical Research Council of South Africa, the WHO Regional Office for Africa (WHO-AFRO) and the World Heart Federation, and endorsed by the Heart Foundation of South Africa, the Paediatric Cardiac Society of South Africa, and the South African Heart Association. The other organisations represented at the meeting included the Africa Heart Network, the Nigerian Heart Foundation, and academics from the universities of Alexandria, Cape Town, Ghana, Ibadan, KwaZulu-Natal, Libreville, Limpopo, Nairobi, Pretoria, and Eduardo Mondlane University.
  • Thumbnail Image
    Item
    Open Access
    Data-independent acquisition mass spectrometry in severe rheumatic heart disease (RHD) identifies a proteomic signature showing ongoing inflammation and effectively classifying RHD cases
    (2022-03-22) Salie, M T; Yang, Jing; Ramírez Medina, Carlos R; Zühlke, Liesl J; Chishala, Chishala; Ntsekhe, Mpiko; Gitura, Bernard; Ogendo, Stephen; Okello, Emmy; Lwabi, Peter; Musuku, John; Mtaja, Agnes; Hugo-Hamman, Christopher; El-Sayed, Ahmed; Damasceno, Albertino; Mocumbi, Ana; Bode-Thomas, Fidelia; Yilgwan, Christopher; Amusa, Ganiyu A; Nkereuwem, Esin; Shaboodien, Gasnat; Da Silva, Rachael; Lee, Dave C H; Frain, Simon; Geifman, Nophar; Whetton, Anthony D; Keavney, Bernard; Engel, Mark E
    Background Rheumatic heart disease (RHD) remains a major source of morbidity and mortality in developing countries. A deeper insight into the pathogenetic mechanisms underlying RHD could provide opportunities for drug repurposing, guide recommendations for secondary penicillin prophylaxis, and/or inform development of near-patient diagnostics. Methods We performed quantitative proteomics using Sequential Windowed Acquisition of All Theoretical Fragment Ion Mass Spectrometry (SWATH-MS) to screen protein expression in 215 African patients with severe RHD, and 230 controls. We applied a machine learning (ML) approach to feature selection among the 366 proteins quantifiable in at least 40% of samples, using the Boruta wrapper algorithm. The case–control differences and contribution to Area Under the Receiver Operating Curve (AUC) for each of the 56 proteins identified by the Boruta algorithm were calculated by Logistic Regression adjusted for age, sex and BMI. Biological pathways and functions enriched for proteins were identified using ClueGo pathway analyses. Results Adiponectin, complement component C7 and fibulin-1, a component of heart valve matrix, were significantly higher in cases when compared with controls. Ficolin-3, a protein with calcium-independent lectin activity that activates the complement pathway, was lower in cases than controls. The top six biomarkers from the Boruta analyses conferred an AUC of 0.90 indicating excellent discriminatory capacity between RHD cases and controls. Conclusions These results support the presence of an ongoing inflammatory response in RHD, at a time when severe valve disease has developed, and distant from previous episodes of acute rheumatic fever. This biomarker signature could have potential utility in recognizing different degrees of ongoing inflammation in RHD patients, which may, in turn, be related to prognostic severity.
  • Thumbnail Image
    Item
    Open Access
    Epidemiology of pharyngitis as reported by Zambian school children and their families: implications for demand-side interventions to prevent rheumatic heart disease
    (BioMed Central, 2017-07-06) Musuku, John; Lungu, Joyce C; Machila, Elizabeth; Jones, Catherine; Colin, Laurence; Schwaninger, Sherri; Musonda, Patrick; Tadmor, Brigitta; Spector, Jonathan M; Engel, Mark E; Zühlke, Liesl J
    Background: Prompt and appropriate treatment of streptococcal pharyngitis decreases the risk of acute rheumatic fever and rheumatic heart disease (RHD). Understanding public perceptions and behaviors related to sore throat is fundamental to inform health programs aimed at eliminating new cases of RHD in endemic regions. We sought to describe the epidemiology of pediatric pharyngitis and its treatment, as reported by children and their parents or guardians in Lusaka, Zambia. Methods: This was a cross-sectional investigation using interviews and written surveys, nested in a school-based RHD prevalence study. Students and their parents were asked to report number of sore throats in the previous 12 months, treatment received, and type and place of treatment. A focused history and physical examination to detect pharyngitis was conducted and children were referred for follow-up as indicated. Results: A total of 3462 students from 47 schools participated in the study, along with their parents or guardians. Six hundred and fifty eight (19%) parents/guardians reported their child had at least one sore throat in the previous year, and 835 (24%) of students reported at least one sore throat in the same time period. Girls were reported to have pharyngitis 50% more often than boys, and also made up two-thirds of the total students treated. Approximately two-thirds of children who had at least one episode of pharyngitis during the previous year were also reported to have received some form of treatment. The majority of treatments were received in government clinics (36.6%) and at home (26.3%). Half of treatments included an antibiotic. Nineteen students (0.5%) had clinically-apparent pharyngitis at screening. Conclusion: Pharyngitis is common among school-aged children and adolescents in Zambia, with females reporting significantly more sore throat episodes than males. Parents/guardians have variable knowledge about the frequency of sore throat in their children, and management of pharyngitis may be suboptimal for many children since more than a quarter were reported to have received treatment without skilled assessment. These results provide insight into current perceptions and practices related to sore throat in Zambia and will be used to design public awareness activities aimed at reducing RHD.
  • Thumbnail Image
    Item
    Open Access
    Health education interventions to raise awareness of rheumatic fever: a systematic review protocol
    (BioMed Central Ltd, 2013) Ramsey, Laura; Watkins, Lauren; Engel, Mark E
    BACKGROUND:There is a significant global health burden associated with acute rheumatic fever (ARF) and rheumatic heart disease (RHD), especially in developing countries. ARF and RHD most often strike children and young adults living in impoverished settings, where unhygienic conditions and lack of awareness and knowledge of streptococcal infection progression are common. Secondary prophylactic measures have been recommended in the past, but primary prevention measures have been gaining more attention from researchers frustrated by the perpetual prevalence of ARF and RHD in developing countries. Health education aims to empower people to take responsibility for their own well-being by gaining control over the underlying factors that influence health. We therefore conducted a review of the current best evidence for the use of health education interventions to increase awareness and knowledge of streptococcal pharyngitis and ARF.METHODS AND DESIGN:This article describes the protocol for a systematic review of the effectiveness of health education interventions aimed at increasing awareness and knowledge of the symptoms, causes and consequences of streptococcal pharyngitis, rheumatic fever and/or rheumatic heart disease. Studies will be selected in which the effect of an intervention is compared with either a pre-intervention or a control, targeting all possible audience types. Primary and secondary outcomes of interest are pre-specified. Randomized controlled trials, quasi-randomized trials, controlled before-after studies and controlled clinical trials will be considered. We will search several bibliographic databases (for example, PubMed, EMBASE, World Health Organization Library databases, Google Scholar) and search sources for gray literature. We will meta-analyze included studies. We will conduct subgroup analyses according to intervention subtypes: printed versus audiovisual and mass media versus training workshops.DISCUSSION:This review will provide evidence for the effectiveness of educational components in health promotion interventions in raising public awareness in regard to the symptoms, causes and consequences of streptococcal pharyngitis, ARF and/or RHD. Our results may provide guidance in the development of future intervention studies and programs.
  • Thumbnail Image
    Item
    Open Access
    Health system costs of rheumatic heart disease care in South Africa
    (2021-07-03) Hellebo, Assegid G.; Zuhlke, Liesl J.; Watkins, David A.; Alaba, Olufunke
    Background Rheumatic Heart Disease (RHD) is a disease of poverty that is neglected in developing countries, including South Africa. Lack of adequate evidence regarding the cost of RHD care has hindered national and international actions to prevent RHD related deaths. The objective of this study was to estimate the cost of RHD-related health services in a tertiary hospital in the Western Cape, South Africa. Methods The primary data on service utilisation were collected from a randomly selected sample of 100 patient medical records from the Global Rheumatic Heart Disease Registry (the REMEDY study) - a registry of individuals living with RHD. Patient-level clinical data, including, prices and quantities of medications and laboratory tests, were collected from the main tertiary hospital providing RHD care. All annual costs from a health system perspective were estimated in 2017 (base year) in South African Rand (ZAR) using a combination of ingredients and step-down costing approaches and later converted to United States dollars (USD). Step-down costing was used to estimate provider time costs and all other facility costs such as overheads. A 3% discount rate was also employed in order to allow depreciation and opportunity cost. We aggregated data to estimate the total annual costs and the average annual per-patient cost of RHD and conducted a one-way sensitivity analysis. Results The estimated total cost of RHD care at the tertiary hospital was USD 2 million (in 2017 USD) for the year 2017, with surgery costs accounting for 65%. Per-patient, average annual costs were USD 3900. For the subset of costs estimated using the ingredients approach, outpatient medications, and consumables related to cardiac catheterisation and heart valve surgery were the main cost drivers. Conclusions RHD-related healthcare consumes significant tertiary hospital resources in South Africa, with annual per-patient costs higher than many other non-communicable and infectious diseases. This analysis supports the scaling up of primary and secondary prevention programmes at primary health centers in order to reduce future tertiary care costs. The study could also inform resource allocation efforts and provide cost estimates for future studies of intervention cost-effectiveness.
  • Thumbnail Image
    Item
    Open Access
    Mitral valve replacement for rheumatic heart disease in Southern Africa
    (BioMed Central Ltd, 2013) Zilla, Peter; Koshy, J; Brink, J; Human, P
    Background: Threshold countries like South Africa provide cardiac surgery to a largely indigent population with rheumatic heart disease. Although repairs are a preferred treatment modality many rheumatic mitral valves can only be replaced. In view of significantly improved primary health care and broad access of the indigent population to communication technology we revisited the efficacy of mitral valve replacement (MVR) at the interface of the developing and developed world. Methods: A cohort of 280 patients (mean age 40.7±13.7y/range 12-80y/median 41y; 76.4% female) with rheumatic heart disease (21% MR; 11% MS; 68% mixed) undergoing mitral valve replacement (MVR) (88.2% mechanical versus 11.8% tissue valves) was analyzed.
  • Thumbnail Image
    Item
    Open Access
    Prevalence of rheumatic heart disease in Zambian school children
    (BioMed Central, 2018-07-03) Schwaninger, Sherri; Musuku, John; Engel, Mark E; Musonda, Patrick; Lungu, Joyce C; Machila, Elizabeth; Mtaja, Agnes; Mulendele, Evans; Kavindele, Dorothy; Spector, Jonathan; Tadmor, Brigitta; Gutierrez, Marcelo M; Van Dam, Joris; Colin, Laurence; Long, Aidan; Fishman, Mark C; Mayosi, Bongani M; Zühlke, Liesl J
    Background The large global burden of rheumatic heart disease (RHD) has come to light in recent years following robust epidemiologic studies. As an operational research component of a broad program aimed at primary and secondary prevention of RHD, we sought to determine the current prevalence of RHD in the country’s capital, Lusaka, using a modern imaging-based screening methodology. In addition, we wished to evaluate the practicality of training local radiographers in echocardiography screening methods. Methods Echocardiography was conducted on a random sample of students in 15 schools utilizing a previously validated, abbreviated screening protocol. Through a task-shifting scheme, and in the spirit of capacity-building to enhance local diagnostic and research skills, general radiographers based at Lusaka University Teaching Hospital (UTH) were newly trained to use portable echocardiography devices. Students deemed as screen-positive were referred for comprehensive echocardiography and clinical examination at UTH. Cardiac abnormalities were classified according to standard World Heart Federation criteria. Results Of 1102 students that were consented and screened, 53 students were referred for confirmatory echocardiography. Three students had definite RHD, 10 had borderline RHD, 29 were normal, and 11 students were lost to follow-up. The rates of definite, borderline, and total RHD were 2.7 per 1000, 9.1 per 1000, and 11.8 per 1000, respectively. Anterior mitral valve leaflet thickening and chordal thickening were the most common morphological defects. The pairwise kappa test showed fair agreement between the local radiographers and an echocardiographer quality assurance specialist. Conclusion The prevalence of asymptomatic RHD in urban communities in Zambia is within the range of results reported in other sub-Saharan African countries using the WHF criteria. Task-shifting local radiographers to conduct echocardiography was feasible. The results of this study will be used to inform ongoing efforts in Zambia to control and eventually eliminate RHD. Trial registration The study was registered on clinicaltrials.gov ( #NCT02661763 ).
  • Thumbnail Image
    Item
    Open Access
    Protocols for antibiotic use in primary and secondary prevention of rheumatic fever
    (2006) Mayosi, Bongani M
    Several guidelines and studies that address the issue of ‘best practice’ in the primary and secondary prevention of rheumatic fever (RF) have been published recently.1-4 Here I present a summary of the latest recommendations for the prevention of RF that have been distilled from these sources.
  • Thumbnail Image
    Item
    Open Access
    The Drakensberg Declaration on the Control of Rheumatic Fever and Rheumatic Heart Disease in Africa
    (2006) Mayosi, Bongani; Robertson, Kate; Volmink, Jimmy; Adebo, Wole; Akinyore, Kingsley; Amoah, Albert; Bannerman, Charles; Biesman-Simons, Shan; Jonathan, Carapetis; Cilliers, Antoinette; Commerford, Patrick; Croasdale, Anne; Damasceno, Albertino; Dean, Jenny; Dean, Michael; de Souza, Robert; Filipe, Antonio; Hugo-Hamman, Chris; JurgensClur, Sally-Ann; Kombila-Koumba, Pierre; Kotzenberg, Christelle; Lawrenson, John; Manga, Pravin; Matenga, Jonathan; Mathivha, Tshimbi; Mntla, Phindile; Mocumbi, Ana; Mokone, Tiny; Ogola, Elijah; Omokhodion, Samuel; Palweni, Chapman; Pearce, Adrian; Salo, Avril; Thomas, Baby; Walker, Kathie; Wiysonge, Charles; Zaher, Salah
    This paper reviews some research studies on tillage methods influencing soil and moisture conservation in the eastern African countries of Kenya, Tanzania, Malawi and Ethiopia during the past four decades. Most of these studies were conducted in marginal rainfall (semi arid ) areas and on shallow soils of various textures (sandy clay loam, sandy clay, clay and loam). The studies were meant to establish the effects of tillage and residue management practices on physico-chemical soil properties (i.e. structure, bulk density, soil moisture and organic matter contents), runoff and infiltration. This review emphasizes the importance of appropriate tillage and residue management methods (contour bunds and terraces, minimum tillage, tied ridging, mulching and conventional tillage) in providing soil conditions favourable for soil moisture conservation and subsequent crop performance and yield on smallholder farms
  • Thumbnail Image
    Item
    Open Access
    Towards a uniform plan for the control of rheumatic fever and rheumatic heart disease in Africa - the Awareness Surveillance Advocacy Prevention (ASAP) Programme
    (2006) Robertson, Kate A; Volmink, Jimmy A; Mayosi, Bongani M
    Over the last 150 years the developed world has experienced a dramatic decline in the incidence and prevalence of rheumatic fever and rheumatic heart disease (RF/RHD) through improved living conditions and the widespread use of penicillin for the treatment of streptococcal pharyngitis. Despite the proven effectiveness and availability of penicillin for both primary and secondary prevention of RF, developing countries continue to face unacceptably high rates of the disease.1 RF/RHD is the most common cardiovascular disease in children and young adults in the world, because 80% of the world’s population live in developing countries where the disease is still rampant. Recent research estimates that RF/RHD affects about 15.6 million people worldwide, with 282 000 new cases and 233 000 deaths each year. There are 2.4 million affected children between 5 and 14 years of age in developing countries, 1 million of whom live in sub-Saharan Africa, making the continent the major RF/RHD hotspot.2