By Dr. Rachel Kerubo
Your child’s simple sore throat -when left untreated- can gradually develop into a chronic heart condition requiring frequent hospitalization, lifetime medication and costly surgery to replace heart valves. Yet it could have been prevented in early childhood.
To make matters worse, the sore throat that worsens into Rheumatic Heart Disease mostly affects children from humble backgrounds whose parents are likely to ignore symptoms due to poor health-seeking behaviour aggravated by public health facilities being largely inaccessible to this population.
So, what is Rheumatic Heart Disease?
Well, it is a heart valve disease where one or more valves do not function properly. As earlier mentioned, it develops from a cascade of events like under-treatment or failure to treat either a sore throat or scarlet fever (characterized by fevers, bright red skin rashes that cover most of the body and a sore throat).
The bacterial infection that causes Strep Throat Infection when not properly treated with antibiotics leads to Rheumatic Fever two to four weeks after infection.
The undertreated sore throat progresses to Acute Rheumatic Fever characterized by inflammation and aching of the heart, multiple large joint pains, uncontrolled dance-like movements, and a skin rash that presents with a round lesion characterized by pale centres and pink margins, and deep-seated small swellings.
The minor signs and symptoms of Rheumatic Fever include running high fevers and temperatures of, give or take, 38.3 degrees Celsius, high blood infection markers, echocardiogram changes, and a positive history of early treatment of a sore throat and aching of one or more joints. Compliance with medication given for a sore throat or scarlet fever is of the essence. Acute Rheumatic Fever comes about after two to three spells of scarlet fever or sore throat infections that go untreated or under-treated.
The upside of it all is, that it is a preventable event if acted upon early by being vigilant in identifying a sore throat and aggressively treating Strep throat or scarlet fevers
About eight years later, Rheumatic Heart Disease develops into a deadly yet irreversible infective endocarditis-which is the infection of the inner lining of the heart and heart valves caused by bacteria-induced blood infection.
To comfortably label one as having Rheumatic Heart Disease one has to present with two major symptoms plus one minor sign/symptom or two minor signs/ symptoms with evidence of a sore throat or scarlet fever infection together with a positive throat culture.
Please note that signs and symptoms differ: While signs can be measured using medical instruments, symptoms depend on how a patient presents and how they’re feeling.
But those suffering from Rheumatic Heart Disease (RHD) have damaged heart valves which have problems opening and closing. This means the heart can’t pump blood sufficiently, thus causing heart failure, sudden cardiac arrest (when the heart stops beating) and death.
Rheumatic Heart Disease (RHD) develops at age 15-25 years usually as a result of irreversible heart valve damage or disease.
According to the World Heart Federation, the prevalence of Rheumatic Heart Disease in Kenya stands at 1.2 per cent and is on the higher side compared to other countries. While the mortality rate in Kenya stands at 0.14 per cent, in Namibia it is 0.11 per cent.
Why the emphasis on aggressive treatment of sore throats?
It is one of the preventable causes of death among many since strep throat and scarlet fever are curable. On the flip side, Acute Rheumatic Fever (ARF) is not curable, symptoms are treated with painkillers, antipyretics, and anti-inflammatory medications depending on the presentation. This menace can be curbed a hundred per cent (100%) if parents are vigilant from the onset.
Managing Rheumatic Heart Disease (RHD) is not an easy task, valvuloplasty per valve at Kenyatta National Hospital costs about Sh175,000. The defective valves can range from 1 to 4. Therefore, the cost of valvuloplasty ranges roughly from Sh175,000 to a whopping Sh700,000. Unfortunately, these prosthetic valves are prone to infective endocarditis. Generally, it is not cheap to manage the disease.
Rheumatic Heart Disease thus not only affect the mental health of those concerned but financial stability, as well, calling for a multifaceted approach to prevention and management.
Preventive measures must begin at the community level, where education and awareness are the first lines of defence. Parents should be in a position to recognize early symptoms and ensure children receive appropriate and timely medical care. Public health campaigns should be robust and persistent, targeting mainly the rural populations with tailored messages that resonate across different cultural contexts.
Healthcare systems must also be fortified to support early diagnosis and treatment. Equipping primary healthcare centres with the necessary tools and trained personnel. Affordable healthcare services can bridge the gap in remote areas ensuring accessibility to all. Additionally, healthcare providers should be continuously trained on the latest protocols. By monitoring the prevalence and outcomes of RHD, we can develop targeted interventions that address the root causes of the disease.
Finally, socioeconomic support for vulnerable families is essential, accessibility to community health insurance is particularly important in low-income settings, where the cost of healthcare can be a significant barrier to accessing essential services.
Dr Rachel Kerubo is the Resident Medical Officer – Department of Internal Medicine, Nyamira County Referral Hospital.
