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Rheumatic heart disease prevalence in Namibia: a retrospective review of surveillance registers
Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Welwitchia Health Training Centre, Namibia.ORCID iD: 0000-0002-0899-2185
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.ORCID iD: 0000-0001-9225-1306
Welwitchia Health Training Centre, Namibia.
Cardiac Outpatient Clinic, Intermediate Hospital Oshakati, Oshakati, Namibia.
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2022 (English)In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 22, no 1, article id 266Article in journal (Refereed) Published
Abstract [en]

 Background:  Rheumatic heart disease (RHD) is the most commonly acquired heart disease in children and young people in low and middle-income settings. Fragile health systems and scarcity of data persist to limit the understanding of the relative burden of this disease. The aims of this study were to estimate the prevalence of RHD and to assess the RHD-related health care systems in Namibia.

 Methods:  Data was retrieved from outpatient and inpatient registers for all patients diagnosed and treated for RHD between January 2010 to December 2020. We used descriptive statistics to estimate the prevalence of RHD. Key observations and engagement with local cardiac clinicians and patients helped to identify key areas of improvement in the systems.

 Results:  The outpatient register covered 0.032% of the adult Namibian population and combined with the cumulative incidence from the inpatient register we predict the prevalence of clinically diagnosed RHD to be between 0.05% and 0.10% in Namibia. Young people (< 18 years old) are most affected (72%), and most cases are from the north-eastern regions. Mitral heart valve impairment (58%) was the most common among patients. We identified weaknesses in care systems i.e., lack of patient unique identifiers, missing data, and clinic-based prevention activities.

Conclusion:  The prevalence of RHD is expected to be lower than previously reported. It will be valuable to investigate latent RHD and patient follow-ups for better estimates of the true burden of disease. Surveillance systems needs improvements to enhance data quality. Plans for expansions of the clinic-based interventions must adopt the "Awareness Surveillance Advocacy Prevention" framework supported by relevant resolutions by the WHO.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2022. Vol. 22, no 1, article id 266
Keywords [en]
Acute rheumatic fever; Namibia; RF; RHD; Rheumatic heart disease
National Category
Cardiac and Cardiovascular Systems
Research subject
cardiovascular disease
Identifiers
URN: urn:nbn:se:umu:diva-196779DOI: 10.1186/s12872-022-02699-2ISI: 000811207600001Scopus ID: 2-s2.0-85132144539OAI: oai:DiVA.org:umu-196779DiVA, id: diva2:1672008
Funder
Familjen Erling-Perssons StiftelseFamiljen Erling-Perssons StiftelseAvailable from: 2022-06-17 Created: 2022-06-17 Last updated: 2024-04-02Bibliographically approved
In thesis
1. Rheumatic heart disease in Namibia: evaluating the burden and the cost-effectiveness of a preventive strategy
Open this publication in new window or tab >>Rheumatic heart disease in Namibia: evaluating the burden and the cost-effectiveness of a preventive strategy
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Rheumatic Heart Disease (RHD) is a neglected public health problem, which is most prevalent in low-and middle-income countries. It affects over 460 million people and causes about 390,000 deaths annually, predominantly children, young adults, and women. This thesis aimed to assess the burden of Rheumatic Heart Disease in Namibia and to evaluate the cost-effectiveness of a preventive strategy.

Methods: Data was obtained from primary and secondary sources in four distinct studies. The first study analysed the RHD outpatient and inpatient data from 2010-2020. The second employed a cross-sectional survey, incorporating a questionnaire with the EQ-5D-5L tool, to assess the health-related quality of life and healthcare usage pre- and post-RHD diagnosis. A systematic review was conducted in the third study synthesising preventive interventions, while the fourth study used a Markov model to evaluate the cost-effectiveness of a secondary prevention strategy in Namibia.

Results: The clinical RHD prevalence was estimated at 28 per 100,000 cases. From the survey, 83 RHD patients participated, predominantly women (77%) and primarily young adults aged 20-29 (41%). The majority (84%) had received surgical treatment. Notably, there was a significant increase in mean QALY from 0.773 pre-diagnosis to 0.941 post-diagnosis (p<0.001). The systematic review underscored the effectiveness of school and nurse-led prevention programmes. The health economic evaluation demonstrated that echocardiographic RHD screening was cost-effective, with an Incremental Cost-Effectiveness Ratio of N$ 28,516.75 per QALY gained, which falls below Namibia’s GDP per capita.

Conclusions: The findings highlight a significant gap in RHD data, particularly in high-endemic regions like Sub-Saharan Africa, emphasising the need for enhanced data quality and surveillance. The effectiveness of school-based and community-led programmes is apparent, but the scarcity of data from diverse regions limits a comprehensive understanding of optimal prevention strategies. Echocardiographic screening is identified as a feasible component of RHD secondary prevention in Africa, pointing towards a policy need for improved surveillance and data quality. Future research should investigate the impact of various interventions on RHD incidence and prevalence.

Place, publisher, year, edition, pages
Umeå: Umeå University, 2024. p. 49
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2292
Keywords
Rheumatic Heart Disease, Prevention, Cost-effectiveness, Namibia
National Category
Cardiac and Cardiovascular Systems Public Health, Global Health, Social Medicine and Epidemiology
Research subject
cardiovascular disease; Public health; Epidemiology
Identifiers
urn:nbn:se:umu:diva-222916 (URN)978-91-8070-330-7 (ISBN)978-91-8070-331-4 (ISBN)
Public defence
2024-04-26, Universitetsledningshuset (ULED), Triple Helix, Umeå, 09:00 (English)
Opponent
Supervisors
Funder
Familjen Erling-Perssons Stiftelse
Available from: 2024-04-05 Created: 2024-04-02 Last updated: 2024-04-08Bibliographically approved

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Shimanda, Panduleni PenipawaSöderberg, StefanNorström, Fredrik

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