scholarly journals Examining the Ugandan health system’s readiness to deliver rheumatic heart disease-related services

2021 ◽  
Vol 15 (2) ◽  
pp. e0009164
Author(s):  
Emma Ndagire ◽  
Yoshito Kawakatsu ◽  
Hadija Nalubwama ◽  
Jenifer Atala ◽  
Rachel Sarnacki ◽  
...  
Keyword(s):  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
Diagnostic Tests ◽  
Health Workers ◽  
District Level ◽  
Essential Medicines ◽  
World Health ◽  
World Health Assembly ◽  
The World ◽  
Rheumatic Heart

Background In 2018, the World Health Assembly mandated Member States to take action on rheumatic heart disease (RHD), which persists in countries with weak health systems. We conducted an assessment of the current state of RHD-related healthcare in Uganda. Methodology/Principal findings This was a mixed-methods, deductive simultaneous design study conducted in four districts of Uganda. Using census sampling, we surveyed health facilities in each district using an RHD survey instrument that was modeled after the WHO SARA tool. We interviewed health workers with experience managing RHD, purposively sampling to ensure a range of qualification and geographic variation. Our final sample included 402 facilities and 36 health workers. We found major gaps in knowledge of clinical guidelines and availability of diagnostic tests. Antibiotics used in RHD prevention were widely available, but cardiovascular medications were scarce. Higher levels of service readiness were found among facilities in the western region (Mbarara district) and private facilities. Level III health centers were the most prepared for delivering secondary prevention. Health worker interviews revealed that limited awareness of RHD at the district level, lack of diagnostic tests and case management registries, and absence of clearly articulated RHD policies and budget prioritization were the main barriers to providing RHD-related healthcare. Conclusions/Significance Uganda’s readiness to implement the World Health Assembly RHD Resolution is low. The forthcoming national RHD strategy must focus on decentralizing RHD diagnosis and prevention to the district level, emphasizing specialized training of the primary healthcare workforce and strengthening supply chains of diagnostics and essential medicines.

scholarly journals African leaders take action on RHD: The 4th All-Africa Workshop on Acute Rheumatic Fever and Rheumatic Heart Disease & African Union RHD Communiqué

2016 ◽  
Vol 2016 (2) ◽  
Author(s):  
Shanti Nulu ◽  
Robert C Neely ◽  
Zeina Tawakol ◽  
Magdi Yacoub
Keyword(s):  
Heart Disease ◽  
Rheumatic Fever ◽  
Rheumatic Heart Disease ◽  
Acute Rheumatic Fever ◽  
Addis Ababa ◽  
World Health ◽  
African Union ◽  
African Countries ◽  
The World ◽  
Rheumatic Heart

The 4th All-Africa Workshop on Acute Rheumatic Fever and Rheumatic Heart Disease (RHD) was held in Addis Ababa from March 4-6, 2016, hosted by the Pan-African Society of Cardiology (PASCAR) and the African Union Commission (AUC). This was a conference of expert cardiologists and cardiac surgeons who are leading RHD efforts, and included delegates from 22 African countries (Figure 1). There were also representatives from major international stakeholders, such as the World Health Organization (WHO), the World Heart Federation (WHF), as well as the philanthropic arms of the Novartis and Medtronic, both of which have active programs targeting RHD. 

scholarly journals The American Heart Association’s Call to Action for Reducing the Global Burden of Rheumatic Heart Disease: A Policy Statement From the American Heart Association

Circulation ◽  
2020 ◽  
Vol 142 (20) ◽  
Author(s):  
Andrea Beaton ◽  
Flavia B. Kamalembo ◽  
James Dale ◽  
Joseph H. Kado ◽  
Ganesan Karthikeyan ◽  
...  
Keyword(s):  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
American Heart Association ◽  
American Heart ◽  
Heart Association ◽  
World Health ◽  
Policy Statement ◽  
World Health Assembly Resolution ◽  
Worker Education ◽  
Rheumatic Heart

Rheumatic heart disease (RHD) affects ≈40 million people and claims nearly 300 000 lives each year. The historic passing of a World Health Assembly resolution on RHD in 2018 now mandates a coordinated global response. The American Heart Association is committed to serving as a global champion and leader in RHD care and prevention. Here, we pledge support in 5 key areas: (1) professional healthcare worker education and training, (2) technical support for the implementation of evidence-based strategies for rheumatic fever/RHD prevention, (3) access to essential medications and technologies, (4) research, and (5) advocacy to increase global awareness, resources, and capacity for RHD control. In bolstering the efforts of the American Heart Association to combat RHD, we hope to inspire others to collaborate, communicate, and contribute.

scholarly journals Accuracy of focussed cardiac ultrasound screening for rheumatic heart disease by health workers with limited training

2015 ◽  
Vol 24 ◽  
pp. S423
Author(s):  
D. Engelman ◽  
J. Kado ◽  
B. Remenyi ◽  
S. Colquhoun ◽  
J. Carapetis ◽  
...  
Keyword(s):  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
Health Workers ◽  
Ultrasound Screening ◽  
Cardiac Ultrasound ◽  
Rheumatic Heart

scholarly journals The personal and clinical impact of screen-detected maternal rheumatic heart disease in Uganda: a prospective follow up study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Sonia Voleti ◽  
Emmy Okello ◽  
Meghna Murali ◽  
Rachel Sarnacki ◽  
Albert Majwala ◽  
...  
Keyword(s):  
Heart Disease ◽  
Social Determinants Of Health ◽  
Rheumatic Heart Disease ◽  
Social Determinants ◽  
Determinants Of Health ◽  
World Health ◽  
Medical Decision ◽  
Rheumatic Heart

Abstract Background Pre-existing maternal cardiac disease is a significant contributor to adverse maternal, fetal, and neonatal outcomes. In 2015–2017, our team conducted the first community-based study of maternal rheumatic heart disease (RHD) in sub-Saharan Africa and identified RHD in 88% of those with pre-existing heart disease. Here we conducted a follow up investigation of women previously identified with RHD, describing clinical and echocardiographic outcomes, identifying barriers to medical adherence and evaluating the personal impact of RHD. Methods A 2 week prospective follow up was completed at sites in Central and Eastern Uganda. Participants underwent a three-step mixed methods study comprising of 1) direct structured interview targeting clinical history and medication adherence, 2) echocardiogram to evaluate left-sided heart valves, and 3) semi-structured guideline interview to elicit personal impacts of RHD. Results The team evaluated 40 (80%) of the original 51 mothers with RHD at a median post-partum time of 2.5 years after delivery (IQR 0.5). Echocardiographic data showed improvement in nine women with the remaining 31 women showing stable echocardiographic findings. Adherence to Benzathine penicillin G (BPG) prophylaxis was poor, with 70% of patients either poorly adherent or non-adherent. Three major themes emerged from interviews: 1) social determinants of health (World Health Organization, Social determinants of health, 2019) negatively affecting healthcare, 2) RHD diagnosis negatively affecting female societal wellbeing, 3) central role of spouse in medical decision making. Conclusions Screening echocardiography can identify women with pre-existing rheumatic heart disease during pregnancy, but long-term follow-up in Uganda reveals adherence to medical care following diagnosis, including BPG, is poor. Additionally, mothers diagnosed with RHD may experience unintended consequences such as social stigmatization. As identification of occult RHD is critical to prevent adverse pregnancy outcomes, further research is needed to determine how to best support women who face a new diagnosis of RHD, and to determine the role of screening echocardiography in high-risk settings.

The World Heart Federation criteria raise the threshold of diagnosis for mild rheumatic heart disease: Three reviewers are better than one

2019 ◽  
Vol 291 ◽  
pp. 112-118 ◽  
Author(s):  
Nicola Culliford-Semmens ◽  
Ross Nicholson ◽  
Elizabeth Tilton ◽  
John Stirling ◽  
Karishma Sidhu ◽  
...  
Keyword(s):  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
The World ◽  
Rheumatic Heart ◽  
Better Than

scholarly journals Cost analysis of treating cardiovascular diseases in a super-specialty hospital

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0262190
Author(s):  
Atul Kumar ◽  
Vijaydeep Siddharth ◽  
Soubam Iboyaima Singh ◽  
Rajiv Narang
Keyword(s):  
Heart Disease ◽  
Cardiovascular Diseases ◽  
Cost Analysis ◽  
Rheumatic Heart Disease ◽  
World Health ◽  
Inpatient Cost ◽  
Cardiac Care ◽  
Specialty Hospital ◽  
Cardiac Care Unit ◽  
Rheumatic Heart

Cardiovascular care is expensive; hence, economic evaluation is required to estimate resources being consumed and to ensure their optimal utilization. There is dearth of data regarding cost analysis of treating various diseases including cardiac diseases from developing countries. The study aimed to analyze resource consumption in treating cardio-vascular disease patients in a super-specialty hospital. An observational and descriptive study was carried out from April 2017 to June 2018 in the Department of Cardiology, Cardio-Thoracic (CT) Centre of All India Institute of Medical Sciences, New Delhi, India. As per World Health Organization, common cardiovascular diseases i.e. Coronary Artery Disease (CAD), Rheumatic Heart Disease (RHD), Cardiomyopathy, Congenital heart diseases, Cardiac Arrhythmias etc. were considered for cost analysis. Medical records of 100 admitted patients (Ward & Cardiac Care Unit) of cardiovascular diseases were studied till discharge and number of patient records for a particular CVD was identified using prevalence-based ratio of admitted CVD patient data. Traditional Costing and Time Driven Activity Based Costing (TDABC) methods were used for cost computation. Per bed per day cost incurred by the hospital for admitted patients in Cardiac Care Unit, adult and pediatric cardiology ward was calculated to be Indian Rupee (INR) 28,144 (US$ 434), INR 22,210 (US$ 342) and INR 18,774 (US$ 289), respectively. Inpatient cost constituted almost 70% of the total cost and equipment cost accounted for more than 50% of the inpatient cost followed by human resource cost (28%). Per patient cost of treating any CVD was computed to be INR 2,47,822 (US $ 3842). Cost of treating Rheumatic Heart Disease was the highest among all CVDs followed by Cardiomyopathy and other CVDs. Cost of treating cardiovascular diseases in India is less than what has been reported in developed countries. Findings of this study would aid policy makers considering recent radical changes and massive policy reforms ushered in by the Government of India in healthcare delivery.

P3133Single parasternal long axis echocardiography by briefly trained health workers using handheld devices for detection of rheumatic heart disease: a prospective study of diagnostic accuracy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Francis ◽  
H Fairhurst ◽  
A Kaethner ◽  
G Whalley ◽  
C Ryan ◽  
...  
Keyword(s):  
Heart Disease ◽  
Diagnostic Accuracy ◽  
Rheumatic Heart Disease ◽  
Health Workers ◽  
Pilot Project ◽  
Handheld Devices ◽  
Practical Training ◽  
Index Test ◽  
Detection Rates ◽  
Rheumatic Heart

Abstract Introduction Echocardiographic screening can detect rheumatic heart disease (RHD) in high-risk populations,but is limited by reliance on highly-trained experts and equipment. We sought to determine the diagnostic utility of an ultra-abbreviated single parasternal-long-axis-sweep of the heart (SPLASH) echocardiography protocol to detect RHD, performed by briefly-trained health workers. Methods In Timor-Leste and Northern Australia, individuals aged 5–20y were offered school-based echocardiographic screening. Health workers completed online modules followed by one-week of practical training, logging 50 echocardiograms prior to study. The index test was SPLASH, performed and reported by health workers using handheld GE V-scan devices. The index test was abnormal if any mitral or aortic regurgitation was detected. The reference test was a comprehensive echocardiogram, performed by an echocardiographers or cardiologist on a GE Vivid-Q, reported according to World Heart Federation criteria. The diagnostic accuracy of the index test was determined. Results 2590 subjects underwent index and reference tests. Prevalence of definite RHD was 3.2% (83/2590). Sensitivity and specificity of index test were 0.75 (95% CI 0.64–0.83) and 0.77 (95% CI 0.75–0.78) respectively for detection of any definite RHD, and 0.91 (95% CI 0.74–0.98) and 0.76 (95% CI 0.74–0.78) respectively for detection of moderate or severe RHD. Conclusion Health workers using SPLASH detected the vast majority of moderate and severe RHD cases, but lacked sensitivity for detection of mild RHD. Further analysis is underway to evaluate the learning curve and other performance indicators of health workers performing and interpreting echocardiograms. This will allow refinement of SPLASH protocol and augmentation of health worker training to increase detection rates and accuracy for future population screening initiatives. Acknowledgement/Funding Heart Foundation Australia Vanguard Grant, Menzies HOT-NORTH pilot project grant, Snow Foundation, Rotary, Bawinanga Aboriginal Corporation, Mala'la

A rapid echocardiographic screening protocol for rheumatic heart disease in Samoa: a high prevalence of advanced disease

2017 ◽  
Vol 27 (8) ◽  
pp. 1599-1605 ◽  
Author(s):  
Marvin Allen ◽  
John Allen ◽  
Take Naseri ◽  
Rebecca Gardner ◽  
Dennis Tolley ◽  
...  
Keyword(s):  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
Advanced Disease ◽  
Valve Disease ◽  
Severe Aortic Regurgitation ◽  
Time Period ◽  
High Prevalence ◽  
The World ◽  
Screening Protocol ◽  
Rheumatic Heart

AbstractBackgroundEchocardiography has been proposed as a method to screen children for rheumatic heart disease. The World Heart Federation has established guidelines for echocardiographic screening. In this study, we describe a rapid echocardiogram screening protocol according to the World Heart Federation guidelines in Samoa, endemic for rheumatic heart disease.MethodsWe performed echocardiogram screening in schoolchildren in Samoa between 2013 and 2015. A brief screening echocardiogram was performed on all students. Children with predefined criteria suspicious for rheumatic hear diseases were referred for a more comprehensive echocardiogram. Complete echocardiograms were classified according to the World Heart Federation guidelines and severity of valve disease.ResultsEchocardiographic screening was performed on 11,434 children, with a mean age of 10.2 years; 51% of them were females. A total of 558 (4.8%) children underwent comprehensive echocardiography, including 49 students who were randomly selected as controls. Definite rheumatic heart disease was observed in 115 students (10.0 per 1000): 92 students were classified as borderline (8.0 per 1000) and 23 with CHD. Advanced disease was identified in 50 students (4.4 per 1000): 15 with severe mitral regurgitation, five with severe aortic regurgitation, 11 with mitral stenoses, and 19 with mitral and aortic valve disease.ConclusionsWe successfully applied a rapid echocardiographic screening protocol to a large number of students over a short time period – 28 days of screening over a 3-year time period – to identify a high prevalence of rheumatic heart disease. We also reported a significantly higher rate of advanced disease compared with previously published echocardiographic screening programmes.

Sign in / Sign up

Export Citation Format

Share Document