Targeted investment needed to end rheumatic heart disease in Africa

Over the past decade, we have witnessed reinvigoration of research and advocacy to combat rheumatic heart disease, with much this work led from African continent. Among those achievements been a substantial increase in epidemiological data quantify burden largely through echocardiographic surveillance studies, registry-based studies that highlighted impact disease gaps exist continuum care, particular for living Union (AU).1Rothenbuhler M O'Sullivan CJ Stortecky S et al.Active endemic regions: systematic review meta-analysis prevalence among children adolescents.Lancet Glob Health. 2014; 2: e717-e726Summary Full Text PDF PubMed Scopus (92) Google Scholar, 2Zuhlke L Karthikeyan G Engel ME al.Clinical outcomes 3343 adults 14 low- middle-income countries: two-year follow-up global Rheumatic Heart Disease Registry (the REMEDY Study).Circulation. 2016; 134: 1456-1466Crossref (113) Scholar Above all, has shown is great prevention, diagnosis, care are wide. As result, tackling might seem like complex challenging task, countries faced questions what do first, or which investment will lead greatest gains. The study by Matthew Coates colleagues Lancet Global Health adds critical, potentially transformative, new information.3Coates MM Sliwa K Watkins DA al.An case prevention management 2021–30: modelling study.Lancet 2021; (published online May 10.)https://doi.org/10.1016/S2214-109X(21)00199-6Summary (4) authors use cohort state transitional model estimate compare scaling up primary secondary tertiary services disease. conclude scale all three approaches could avert 74 000 AU deaths next decade—a number probably underestimated due overall underestimation mortality region. Benefit–cost ratios time-to-impact were most favourable scale-up services, benefits outweighing costs decade. We found be powerful call action. To make difference, focus should on finding people initiating prevent progression, ensuring access interventional individuals who progressed advanced Improving achievable, but take improved diagnostics, namely ultrasound, at community level. Only small fraction receive timely miss period when prophylaxis can effective preventing progression.2Zuhlke Education capacity building frontline providers also best achieved integrated non-communicable clinics, such as PEN-Plus programme, tested Partners Rwanda.4Bukhman KA PIH guide chronic integration Rwanda edition cardiac, renal, diabetes, pulmonary, palliative care. Health, Boston, MA2011Google Scaling require multisector investment. Many moving direction, upfront needed establish maintain programmes, including direct funding training, infrastructure development, patient costs. One viable option coordinated regional centres excellence cardiac surgery catheter interventions target congenital strategy not first because it low benefit–cost ratio. However, model, assumptions around pharyngitis perhaps fungible. Epidemiological superficial group A streptococcal infection nearly non-existent AU. used very 10% contribution streptococcus sore throats continent, compared published data.5DeWyer Scheel Webel AR al.Prevalence beta-hemolytic throat carriage prospective pilot Ugandan school children.Int J Infect Dis. 2020; 93: 245-251Summary 6Oliver Malliya Wadu E Pierse N Moreland NJ Williamson Baker MG Group pharyngeal carriage: meta-analysis.PLoS Negl Trop 2018; 12e0006335Crossref (47) Furthermore, assume lower, less optimistic, treatment coverage other cost-effectiveness analyses, lowering potential intervention.7Watkins D Lubinga SJ Mayosi B Babigumira JB tool prioritization fever control nations.PLoS 10e0004860Crossref (15) Additionally, includes formal health-care evaluation provider charge each throat, practical feasible setting. truly understand ratio further improve our understanding test alternative models ultimately continue development an vaccine, good highest risk populations, Ultimately, WHO member states signed 2018 RHD Resolution, calling reprioritisation agenda, yet little national action occurred. In part, lack driven certainly where invest. detailed analyses now provide starting point. Begin know economic higher than costs, tens thousands lives saved over declare no competing interests. An studyIncreased manage accelerate progress towards eradication states. Gaps local components process create uncertainty level benefits. short term, lower accrue earlier. Full-Text Open Access