By  CHIOMA OBINNA

Gabriel 5 was brilliant.  At age 2, he was already in Kindergarten 2. His parents cherish him. Every morning, his mother, a full time house wife takes him to school along with his sibling. One morning, she noticed Gabriel was running temperature. As the day went by, he started coughing and wheezing.  His mother took him to the hospital where he was treated for malaria.

Days later, he developed sore throat and the parents continued to manage him in one of the private hospitals around their community.  But as time went by, his situation worsened.  Further medical investigations revealed that he had developed an acute Rheumatic Heart Disease, RHD. It could immediately have been prevented or stopped by administration of Penicillin.

Rheumatic Heart Disease is caused by an infection with streptococcal bacteria, responsible for strep throat infections. For some reason, after the streptococcal infection, the immune system mistakenly attacks normal tissue and inflammation occurs in multiple.

Medical experts say streptococcal bacteria caused more damage on his heart apparently due to late presentation and the inability of the physician who initially handled his case to diagnose him properly.

Although, he could have been helped, Gabriel never lived to tell his story as the doctors lamented that surgery could do little or nothing to save him. Gabriel died as a result of a disease that could be simply prevented and treated if surgery or drugs were readily available.

Few weeks before his death, he was having regular palpitation, wheezing, coughing, and often losing concentration and sometimes fatigued. His beautiful skin gave way for pale looks.

His condition required early diagnosis, prevention and intervention.  If there had been greater efforts aimed at detecting the first signs of the disease which include; chest pain palpitations, shortness of breath, wheezing, cough, leg swelling, foot swelling, faintness, fainting excessive sweating and fatigue, in Gabriel, his case would have not been progressed.

According to the experts, all Gabriel required was a monthly dosage of penicillin and adequate clinical monitoring.  But for the fact that Gabriel lives in a country where Rheumatic Heart Disease has been forgotten, there was no hope. Yet the disorder continues to wreck havoc on the population.

Gabriel case is one out of the three deaths in the world today as a result of cardiovascular diseases. Studies have shown that one in five children with RHD will die by the age of 15 and almost 4-in-5 will die by age 25 in most Africa countries.
Neglected disease of poverty.

Nearly forgotten in developed countries where it has been almost entirely eliminated, RHD, according to the World Heart Federation, WHF, remains the most common cardiovascular disease of children and young people in developing countries like Nigeria. But unfortunately, the awareness about the disease remains poor.  Although, the disease has continued to be the agony of Africans, little or nothing is being done to eliminate the disease.

Reports from WHF show that: “It affects over 15 million people around the world and kills hundreds of thousands every year. Africa has the largest number of children with the disease in sub-Saharan Africa, where there is little access to the treatment that could enable them to survive and live normal lives; over a million children are estimated to suffer from the debilitating and often fatal condition”.

Kanu Nwankwo and some children that survived heart diseases

Investigations have shown a sharp rise in the incidence of heart related ailment. Many have blamed it on dietary factors, stress, pollution, and smoking, diseases such as hypertension, obesity, and diabetes mellitus.

New preliminary findings presented at the just- concluded 2012 World Congress of Cardiology, WCC, in Dubai, revealed that RHD is significantly under-treated in Africa and Nigeria inclusive. The study showed that across the African and Indian regions that patients are not receiving the surgery they need, secondary prevention with penicillin – to prevent further attacks of rheumatic fever – is being under-utilized and many patients are unaware of their target anti-coagulation levels.

Across the African and Indian regions included in the study it was revealed that patients are not receiving the surgery they need, secondary prevention with penicillin – to prevent further attacks of rheumatic fever – is being under-utilized and many patients are unaware of their target anti-coagulation levels.

In the study, only 41 per cent of patients enrolled in the study had received surgery. More than 85 per cent of the enrolling centres do not have surgery available on a regular basis for RHD patients.

Nearly one-quarter of all patients (22 per cent) were in atrial fibrillation and of these patients, only 65 per cent were receiving necessary anti-coagulant therapy.

The study results further showed that only 36 per cent of patients with moderate or severe disease and only 20 per cent of those that have undergone valve replacement surgery are receiving secondary prophylaxis with penicillin.

Crises of CVDs
However, the increasing global crisis in Non-Communicable Diseases  such as heart disease, stroke, cancer, diabetes, etc according to experts pose a major threat to UN development goals including poverty reduction, health equity, economic stability, and human security. In Africa, cardiovascular diseases are the second leading cause of mortality and the first under the age of 50 years.

Statistics have shown that RHD is a major cause of heart failure in Nigeria and other African countries.  According to experts, CVDs have reached near epidemic with RHD still major causes of mortality and morbidity in Nigeria and other African countries.  For instance, of the estimated 16.6 million deaths attributed to CVDs worldwide, 80 per cent is in developing countries like Nigeria. Studies have also found that RHD is worst in pregnant women as it increases the risk of maternal and fetal complications.

In Nigeria it is said to be another factor fueling maternal mortality in the country.  Another study in Senegal reports that 47 per cent of pregnant women with Mitral stenosis died in the peri- partum period. The mortality rate for the total group was 34 per cent and foetal loss was 33 per cent

However, the crisis situation of RHD took centre stage at the just concluded 2012 World Congress of Cardiology, WCC, organised by the World Heart Federation, WHF, in Dubai last week. The World Congress of Cardiology is the international platform for the cardiology community.

From the numerous scientific sessions on the various cardiovascular diseases, the 10,500 delegates that attended the congress from the latest scientific developments in the cardiology field agreed that the time to act was now.

However, the hope of Nigerians including other African countries that are currently being ravaged by RHD was risen with the new target by the world to reduce premature cardiovascular deaths by 25 per cent in 2025.

The targets, tagged; “2525”, includes reduction of RHD in African countries. President of the World Heart Federation, WHF, Sydney Smith said that the WHF is uniting the CVD community to reach the World Health Organization mortality target.

The “2525” tends to achieve the target through raising the priority of CV health on global agenda; global advocacy and leadership, heart healthy diet and physical activity for all, improve recognition & control of high blood pressure globally as well as advance a tobacco-free world amongst others.

Reeling out global statistics on CVD, he said: “Cardiovascular disease and stroke is the leading cause of deaths in the world today, particularly in the developing countries. By “By 2020 there will be slight rise of six million deaths in developed countries while more than doubling by 19 million in developing countries.”

Smith who lamented that 80 per cent will occur in developing countries reiterated that the United Nations recently adopted Non Communicable diseases as a special focus said the time to act is now.

Gaps in treatment
However, some of the cardiologists who spoke Sunday Vanguard blamed the crises states of the disease in Africa on gaps in recommended treatment guidelines.

According to a Paediatric Cardiologist, Red Cross Children’s Hospital, University of Cape Town, South Africa, Dr. Liesl Züklhe, who noted poor commitments on the part of African leaders, said only 30 per cent of patients in Africa has access to the secondary prophylaxis, penicillin used to prevent the disease from spreading.

According to her, “To tackle the disease, there is need to address these gaps by detect the first signs of  the disease,  investigations should be done properly,  need to establish RHD surveillance system for better documentation, screening programmes must be performed among elementary school children by echocardiography.

Other remedies she offered include; great efforts should be done to implement primary and secondary prevention programmes for rheumatic fever and RHD including establishing health educational programmes through different media.  Advanced cardiac centers must be established throughout the country to facilitate accessibility to appropriate management including interventional therapies with less effort and free of charge.”

Without doubt, appropriate public health control programmes and optimal medical care reduce the burden of disease. WHF has launched a project to strengthen the prevention and control of rheumatic fever and rheumatic heart disease (RF/RHD) in Africa. It is setting up demonstration sites in Egypt, Ethiopia, Ghana and South Africa.

It has also established a global Centre of Excellence for the control of rheumatic heart disease. Meant to be a resource for health practitioners and policy-makers in countries like Nigeria where the disease is still common, the web-based centre makes available tools and training materials developed in its demonstration projects.