Umeå University's logo

umu.sePublications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Preventive interventions to reduce the burden of rheumatic heart disease in populations at risk: a systematic review
Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.ORCID iD: 0000-0002-0899-2185
Department of Occupational Therapy and Physiotherapy University of Namibia Windhoek Namibia.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.ORCID iD: 0000-0002-7054-0905
Clara Barton School of Nursing, Welwitchia Health Training Centre Windhoek Namibia.
Show others and affiliations
2024 (English)In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, E-ISSN 2047-9980, Vol. 13, no 5, article id e032442Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Rheumatic heart disease (RHD) is a devastating yet preventable condition that disproportionately affects low-middle-income countries and indigenous populations in some high-income countries. Various preventive interventions have been implemented across the globe, but evidence for the effectiveness of these measures in reducing the incidence or prevalence of acute rheumatic fever and RHD is scattered. This systematic review aims to assess the effectiveness of preventive interventions and identify the strategies used to reduce the burden of RHD.

METHODS AND RESULTS: A comprehensive search was conducted to identify relevant studies on RHD prevention interventions including interventions for primordial, primary, and secondary prevention. Effectiveness measures for the interventions were gathered when available. The findings indicate that school-based primary prevention services targeting the early detection and treatment of Group A Streptococcus pharyngitis infection with penicillin have the potential to reduce the incidence of Group A Streptococcus pharyngitis and acute rheumatic fever. Community-based programs using various prevention strategies also reduced the burden of RHD. However, there is limited evidence from low-middle-income countries and a lack of rigorous evaluations reporting the true impact of the interventions. Narrative synthesis was performed, and the methodological quality appraisal was done using the Joanna Briggs Institute critical appraisal tools.

CONCLUSIONS: This systematic review underscores the importance of various preventive interventions in reducing the incidence and burden of Group A Streptococcus pharyngitis, acute rheumatic fever, and RHD. Rigorous evaluations and comprehensive analyses of interventions are necessary for guiding effective strategies and informing public health policies to prevent and reduce the burden of these diseases in diverse populations.

REGISTRATION: URL: https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42020170503.

Place, publisher, year, edition, pages
American Heart Association , 2024. Vol. 13, no 5, article id e032442
Keywords [en]
RHD prevention, acute rheumatic fever, rheumatic heart disease, systematic review
National Category
Health Sciences Public Health, Global Health, Social Medicine and Epidemiology
Research subject
cardiovascular disease; Public health; Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-221473DOI: 10.1161/JAHA.123.032442PubMedID: 38390809Scopus ID: 2-s2.0-85187199895OAI: oai:DiVA.org:umu-221473DiVA, id: diva2:1840501
Funder
Familjen Erling-Perssons StiftelseAvailable from: 2024-02-23 Created: 2024-02-23 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

Open Access in DiVA

fulltext(375 kB)610 downloads
File information
File name FULLTEXT01.pdfFile size 375 kBChecksum SHA-512
ee694c81c2040b2583c8b68fc29ea5781ab5db0f38e66c28984cbb5a6a2d5532578191a4dae6cd4975fa6fc1167905946d447302022565413cf1f85655193274
Type fulltextMimetype application/pdf

Other links

Publisher's full textPubMedScopus

Authority records

Shimanda, Panduleni PenipawaBrunström, MattiasSöderberg, StefanLindholm, LarsNorström, Fredrik

Search in DiVA

By author/editor
Shimanda, Panduleni PenipawaBrunström, MattiasSöderberg, StefanLindholm, LarsNorström, Fredrik
By organisation
Department of Epidemiology and Global HealthCardiology
In the same journal
Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
Health SciencesPublic Health, Global Health, Social Medicine and Epidemiology

Search outside of DiVA

GoogleGoogle Scholar
Total: 610 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 679 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf