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Preventive interventions to reduce the burden of rheumatic heart disease in populations at risk: a systematic review protocol
Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Clara Barton School of Nursing, Welwitchia Health Training Centre, Windhoek, Namibia.ORCID iD: 0000-0002-0899-2185
University of Namibia.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.ORCID iD: 0000-0002-7054-0905
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.ORCID iD: 0000-0001-9225-1306
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2021 (English)In: Systematic Reviews, E-ISSN 2046-4053, Vol. 10, no 1, article id 200Article in journal (Refereed) Published
Abstract [en]

Background: Rheumatic heart disease is preventable, yet associated with significant health burden, mostly in low-resourced settings. It is prevalent among children and young adults living in impoverished areas. Primordial, primary, and secondary preventive measures have been recommended through health interventions and comprehensive programmes, although most implemented interventions are the high-resourced settings. The proposed review aims to synthesise the evidence of prevention effectiveness of implemented health interventions for the prevention of rheumatic heart disease.

Methods and design: This article describes a protocol for a systematic review. A predefined search strategy will be used to search for relevant literature published from the year 2000 to present. Electronic databases Medline, Web of Science, Scopus, and Cochrane Central Register of Controlled Trials will be searched for the studies, as well as reference lists of relevant studies included. Risk of bias and quality appraisal will be done for the included studies using ROBINS-I tool and Cochrane tool for assessing risk of bias in randomised control trials. Findings will be analysed in subgroups based on the level of intervention and prevention strategy implemented. We will present the findings in descriptive formats with tables and flow diagrams.

Discussion: This review will provide evidence on the prevention effectiveness of interventions or strategies implemented for the prevention of RHD. The findings of this will be significant for policy, practice, and research in countries planning to implement interventions.

Registration: PROSPERO ID: CRD42020170503.

Place, publisher, year, edition, pages
BioMed Central, 2021. Vol. 10, no 1, article id 200
Keywords [en]
Acute Rheumatic Fever, Rheumatic Heart Disease, Intervention, Prevention, Systematic Review
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health; cardiovascular disease
Identifiers
URN: urn:nbn:se:umu:diva-185872DOI: 10.1186/s13643-021-01748-9ISI: 000674358500003PubMedID: 34238388Scopus ID: 2-s2.0-85110511031OAI: oai:DiVA.org:umu-185872DiVA, id: diva2:1579423
Available from: 2021-07-09 Created: 2021-07-09 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 PenipawaBrunström, MattiasSöderberg, StefanLindholm, LarsNorström, Fredrik

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