Rheumatic heart disease: a forgotten killer in low-income countries

RHD is a type of heart disease caused by a bacterial (streptococcal) throat infection acquired in childhood.  Although this type of infection is common and widespread, a small proportion of children so affected go on to develop an inflammatory condition that leads to scarring and narrowing of the heart valves and, in time, heart failure.  Although rare now in the Western world, it remains an important public health problem in many low and middle income countries.

Particularly prevalent in sub-Saharan Africa, the disease typically affects children and young adults. There it carries a grim prognosis due to the lack of specialised treatment. I will always remember the anxious face of Awal – a young boy of 14 years with very severe RHD – whom we encountered in Southern Ethiopia while making a film about RHD for the heart charity, Chain of Hope. Although we tried to arrange urgent referral for heart surgery, Awal died suddenly a couple of days later.

The disease has almost disappeared in high income countries, and as a result funding and research has been greatly neglected. The classical approach to preventing RHD has depended on the use of penicillin injections to treat sore throats especially in those with early signs of the disease but the notorious under-resourcing of health systems and the lack of qualified medical staff in many low income countries hinder this approach. Current worries about overusing antibiotics also highlight the need for new ideas.

In collaboration with Chain of Hope, THET have been studying RHD in Ethiopia. We have shown that the early signs of RHD can be detected in children and are surprisingly common among teenagers in remote rural areas. Our current work is focussed on trying to determine why the disease is so strongly linked with poverty. We are currently looking at a suggestion that the disease could be caused by domestic air pollution. Smoke pollution is the norm for many families living in sub-Saharan Africa as cooking is typically carried out on open fires and the resulting smoke permeates throughout the house. Infants and young children may be heavily exposed especially in poor families who tend to use the smokiest fuels such as crop waste or dung. We think that this could help explain the persistence of RHD in the many parts of the world where domestic air pollution is still common. It may be that something as simple as better ventilation of people’s houses could prevent this terrible disease.

To find out more about our work on RHD and Non-Communicable Diseases in Ethiopia and to see the film about RHD, please visit www.thena-ethiopia.org

[1] https://www.worldheartday.org/whdcvd/