This is an important paper that presents contemporary worldwide data on
fatal and non-fatal rheumatic heart disease (RHD) for the period from
1990 through 2015. The authors estimated that there were 319,400 (95%
uncertainty interval, 297,300 to 337,300) deaths due to rheumatic heart
disease in 2015. Global age-standardized mortality due to rheumatic
heart disease decreased by 47.8% from 1990 to 2015, but large
differences were observed across regions. In 2015, the highest
age-standardized mortality due to and prevalence of rheumatic heart
disease were observed in Pacific islands (Oceania), South Asia (Indian
subcontinent), and central sub-Saharan Africa. The prevalence of RHD was
estimated at 33.4 million (95% uncertainty interval, 29.7 million to
43.1 million) cases. An additional important measure of disease burden
that was estimated was the disability-adjusted life-years due to RHD.
This was 10.5 million (95% uncertainty interval,9.6 million to 11.5
million) globally.
The authors concluded that the estimated prevalence
of and mortality due to RHD has declined globally over a 25-year period,
but high rates of disease persist in some of the poorest regions in the
world.
RHD has progressively slipped out of the collective
consciousness of the global community of pediatricians, physicians and
cardiologists. This is perhaps because it is largely confined to
marginalized populations that have little access to health care. This
marginalization has contributed to the perception that RHD is on a sharp
decline. This perception among the medical community impacts policy
makers. The Global Burden of Disease (GBD) data are particularly
important for neglected diseases such as RHD that receive little
attention from health policy makers and governments because of erroneous
perceptions on disease prevalence and because of limited advocacy.
Global advocacy may have a greater impact on policy.
At least for India, if a credible international agency were to
publically report our national data, this is likely to translate into
some action.
Advocacy can accomplish the following objectives with
RHD control:
• Policies on penicillin manufacture,
distribution and administration given the huge problems that exist
globally with penicillin availability
• Delivering comprehensive cardiac care for the
marginalized
• Planning large-scale heart surgeries and
balloon mitral valvotomy through public health insurance
• Low-cost solutions for tertiary cardiac care