The rheumatic heart disease healthcare paradox: disease persistence in slums despite universal healthcare coverage—a provider perspective qualitative study

Morberg, Daniel P; Lopez, Yeimi Alzate; Moreira, Sueli Aparecida; Prata, Ndola; Riley, Lee W.; Peña, Melissa S. Burroughs

doi:10.1016/j.puhe.2019.03.015

Cited by 4 publications

(6 citation statements)

References 57 publications

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“…The occurrence of RHD is common in the northern regions dominated by rural areas with limited socioeconomic resources. The findings concur with the reported association between social determinants of health and RHD in LMICs, mainly poor sanitation, overcrowding, and inequitable access to healthcare [ 11 , 29 , 30 ]. Improving living conditions and access to health care in the primordial prevention approach is recommended to reduce regional inequities [ 14 ].…”

Section: Discussionsupporting

confidence: 89%

“…Positive cases must receive Benzathine Penicillin intramuscular injection, as it is proven to have superior preventative serum levels compared to oral Penicillin VK [ 12 ]. Investigations of the barriers to the supply chains, access, and suboptimal compliance will be crucial to the prevention of avoidable complications for individuals with RHD at a lower cost compared to surgical interventions [ 30 , 40 , 41 ]. Another essential part in the prevention efforts will be continuous education, and task-shifting to use cardiac non-expert practitioners for time detection, treatment, and referral of ARF and RHD.…”

Section: Discussionmentioning

confidence: 99%

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Rheumatic heart disease prevalence in Namibia: a retrospective review of surveillance registers

Shimanda

Söderberg

Iipinge³

et al. 2022

BMC Cardiovasc Disord

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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.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Rheumatic heart disease prevalence in Namibia: a retrospective review of surveillance registers

Shimanda

Söderberg

Iipinge³

et al. 2022

BMC Cardiovasc Disord

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“…While South American countries have achieved considerable health coverage of their population, most LMICs lack such coverage, requiring substantial out‐of‐pocket payments by patients and their families 26,27 . However, despite such health coverage, RHD remains a common problem in South America, especially in slums and among poorer populations, giving rise to a healthcare paradox 28 …”

Section: Areas Of Concernmentioning

confidence: 99%

“…26,27 However, despite such health coverage, RHD remains a common problem in South America, especially in slums and among poorer populations, giving rise to a healthcare paradox. 28 2.4 | Infrastructure, equipment, disposables, devices, drugs, and logistics For newly developing programs, various health system and infrastructure requirements are critical to ensure sustainability and safe and quality care. 29 New centers in LMICs are often financially constrained given the high upfront costs associated with establishing new infrastructure and may consider the use of used equipment or lower-cost items from upper-middle-income countries with growing cardiac surgical industry, such as Brazil, India, and China.…”

Section: Financial Needsmentioning

confidence: 99%

Rheumatic heart disease: The role of global cardiac surgery

Vervoort

Antunes

Pezzella³

2021

Journal of Cardiac Surgery

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Rheumatic heart disease (RHD) remains a neglected disease of poverty. While nearly eradicated in high‐income countries due to timely detection and treatment of acute rheumatic fever, RHD remains highly prevalent in low‐ and middle‐income countries (LMICs) and among indigenous and disenfranchised populations in high‐income countries. As a result, over 30 million people in the world have RHD, of which approximately 300,000 die each year despite this being a preventable and treatable disease. In LMICs, such as in Latin America, sub‐Saharan Africa, and Southeast Asia, access to cardiac surgical care for RHD remains limited, impacting countries' population health and resulting economic growth. Humanitarian missions play a role in this context but can only make a difference in the long term if they succeed in training and establishing autonomous local surgical teams. This is particularly difficult because these populations are typically young and largely noncompliant to therapy, especially anticoagulation required by mechanical valve prostheses, while bioprostheses have unacceptably high degeneration rates, and valve repair requires considerable experience. Devoted and sustained leadership and local government and public health cooperation and support with the clinical medical and surgical sectors are absolutely essential. In this review, we describe historical developments in the global response to RHD with a focus on regional, international, and political commitments to address the global burden of RHD. We discuss the surgical and clinical considerations to properly manage surgical RHD patients and describe the logistical needs to strengthen cardiac centers caring for RHD patients worldwide.

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“…Nutritional issues were examined in 8.5% of the studies, mainly with regard to children (e.g., [63,64]). Non-communicable diseases (8.2% of all studies) that are examined most frequently are cardiovascular diseases (e.g., [65,66]) or diabetes (e.g., [67,68]). There were only a few studies on cervical cancer (e.g., [69]), confirming a statement in a recent report by the WHO [70] that urges researchers not to neglect cancer in studies on the health of slum dwellers.…”

Section: Analysis By Health Categoriesmentioning

confidence: 99%

Slums, Space, and State of Health—A Link between Settlement Morphology and Health Data

Friesen

Dietrich

et al. 2020

IJERPH

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Approximately 1 billion slum dwellers worldwide are exposed to increased health risks due to their spatial environment. Recent studies have therefore called for the spatial environment to be introduced as a separate dimension in medical studies. Hence, this study investigates how and on which spatial scale relationships between the settlement morphology and the health status of the inhabitants can be identified. To this end, we summarize the current literature on the identification of slums from a geographical perspective and review the current literature on slums and health of the last five years (376 studies) focusing on the considered scales in the studies. We show that the majority of medical studies are restricted to certain geographical regions. It is desirable that the number of studies be adapted to the number of the respective population. On the basis of these studies, we develop a framework to investigate the relationship between space and health. Finally, we apply our methodology to investigate the relationship between the prevalence of slums and different health metrics using data of the global burden of diseases for different prefectures in Brazil on a subnational level.

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The rheumatic heart disease healthcare paradox: disease persistence in slums despite universal healthcare coverage—a provider perspective qualitative study

Cited by 4 publications

References 57 publications

Rheumatic heart disease prevalence in Namibia: a retrospective review of surveillance registers

Rheumatic heart disease prevalence in Namibia: a retrospective review of surveillance registers

Rheumatic heart disease: The role of global cardiac surgery

Slums, Space, and State of Health—A Link between Settlement Morphology and Health Data

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