Last week, more than 30 nurse practitioners and medical student volunteers converged in UR-Huye campus for a one-day training on rheumatic heart disease (RHD) eradication. The training was organised by Voluntary Based Rheumatic Heart Disease Action (VOBRA), a project of Rwanda Village Community Promoters (RVCP). The projects aimed at creating RHD action heroes’ community, which will innovatively catalyse a transformational change consigning RHD to history books of Rwanda. Through the workforce development workshop in Huye, the practitioners were empowered with skills in prevention, management of strep throat and acute rheumatic fever, as well as patient post-surgery follow-up. They are also expected to train others in the peer-to-peer learning program in health centres. Community health workers will be equipped with knowledge to raise RHD awareness through radio talks, TV, and monthly Umuganda teaching sessions. According to Dr Bienvenu Muvunyi, the director-general of Munini District Hospital, the training was to ensure evidence-based management at lower levels of the Rwandan healthcare system. He says the community will be fully informed on basic needed knowledge about RHD and what the role of an individual to eradicate the condition is — which lies in the prevention of strep throat spreading. HOW COMMON ARE HEART DISEASES? WHO envisions reducing non-communicable diseases’ overall mortality by 25 per cent by 2025, where RHD is the leading cardiovascular cause of death globally in the first five decades of life. Each year, more than 300,000 people die from rheumatic heart disease and more than 32 million people live with RHD globally. The burden is greatest in the most productive years of life for those who can least afford it. The absolute burden of disease, the social effect, economic cost and the abject inequality of RHD demand urgent global action. Meanwhile, WHO states that almost exclusively, the people who die of RHD live in low- and middle-income countries, or in vulnerable communities in high-income countries. However, their deaths are preventable with medical knowledge and antibiotics which have existed for more than half a century. Preventing, diagnosing and treating Acute Rheumatic fever and RHD remains a fitful struggle in low resource settings. In Rwanda, rheumatic heart disease and acute rheumatic fever remain a problem, an important medical, surgical and public health concern which is not the case in many developed countries. THE CONNECTION BETWEEN STREP THROAT AND HEART DISEASES Dr Joel Bahoza, a medical doctor at Kabutare District Hospital, and one of the trainers, says when strep throat caused by bacteria known as streptococcus group A is not treated, complications that could arise from it. He notes that it can lead to a sore throat, which can be caused by viruses or bacteria. When it is of bacterial origin, he says, it can develop into acute rheumatic fever and subsequently, rheumatic heart disease. “If the bacteria causing strep throat are not eradicated with available and cheap treatment, the body immune system can confuse them with body structure in the heart, joints, skin, and brain and attach them, resulting in heart, mental joints, and skin problems,” he warns. Dr Bahoza says that there is also a risk of infection of the inner layer of the valves, which can be a fatal condition. The medic further notes that portion of inflammatory deposits over the inner layer may break and pass on in bloodstream to the brain. Here, he says, it may block the blood supply to part of the brain, thus causing a stroke to the patient. He adds that one affected by rheumatic heart disease is bound to remain chronically sick with cardiac disease or related complications. Dr Nathan Ruhamya, a senior consultant cardiologist at King Faisal Hospital, says the signs of acute rheumatic fever are brought about by a reaction to the bacteria which is responsible for causing strep throat (group A streptococcus). He says although not all cases of strep throat result in rheumatic fever, this can be prevented with diagnosis and treatment of sore throat. Ruhamya, however, points out that a child or any adult with rheumatic fever manifests signs such as a sore throat and swollen lymph node, rashes that are red, problems in swallowing food, high fever, tonsils, a sore throat and headaches. “Sore throats appear in patients about 10 days or weeks later, which could lead to people developing acute rheumatic fever if not treated earlier,” he says. COMPLICATIONS Acute rheumatic fever can occur about four weeks following the sore throat. The fever usually affects children from 4 to 14 years but adults are not exempted. It is usually more common in vulnerable children living in slums. Dr Muvunyi says acute rheumatic fever can lead to rheumatic heart disease, disability, open heart surgery, and death, especially when recurrent episodes occur. He notes that acute rheumatic fever and rheumatic heart disease are prevalent in children and young adults in poor countries, especially in groups of people living in overcrowded settings. Dr Muvunyi says when this happens, all layers of the heart may be inflamed, causing an abnormal sound on examination. He says the person may develop acute cardiac failure manifesting as sudden breathlessness, rhythm disturbances and swelling over feet. Some years after acute rheumatic fever, he says there may be permanent damage to heart valves producing chronic heart failure. “There is breathlessness even during rest and lying down, swelling of feet and then the whole body,” he adds. On top of this, Bahoza says a person becomes asthenic and loses the capacity to work. Another complication, Bahoza says, is that fluid may develop in the coverings of the heart as they get inflamed, aggravating the symptoms. As cardiac failure progresses, he notes that the person may develop liver and kidney failure. TAKE CAUTION Christiane Mwamikazi, a Team Heart Rwanda nurse with experience in post-operative RHD patients’ follow-up care at King Faisal Hospital, points out the importance of a nurse in community awareness. She says that when the patient visits a health centre with such a case, they should first be treated on strep throat or rheumatic fever or referred to the hospital for further management. Claudette Shema, a nurse at Kinyamakara Health Centre, says it is common for health workers to routinely treat strep throat without being fully aware of its complications. Therefore, with this training, she says, such cases can be avoided and health practitioners can focus on how to manage the condition through an evidence-based practice. Mwamikazi says there are ways of preventing strep throat that the community should be aware of. She says they include properly covering the mouth while sneezing is infected with strep throat. Proper hand hygiene, washing hands regularly, especially before eating. Seeking medical help at the early stages of strep throat is important because this prevents the spread, Mwamikazi says.
