The hidden burden of rheumatic heart disease in the Gambia

Rheumatic heart disease (RHD) remains the leading cause of cardiac death and disability in children and young adults worldwide, with global estimates of 34 million people affected and 345,000 deaths, mainly in sub-Saharan Africa. RHD occurs after cardiac valvular damage caused by an exaggerated immune response to group A streptococcus infections, usually during childhood and adolescence. Complications include heart failure, atrial fibrillation, stroke, infective endocarditis and adverse pregnancy outcomes. Although RHD can be prevented using penicillin, there are numerous poorly understood barriers to effective control programs. In the Gambia, the RHD burden is probably high and yet there is no reliable data available and there is no control activity currently in place.

We will generate baseline information on RHD among children (aged 5 to 19 years) and pregnant women. This baseline study will include a population-based study with echocardiographic screening of children and pregnant women, and a hospital-based review of all RHD cases currently managed by the health services.

This study will be a first step towards a much larger multidisciplinary research proposal whose results may be used for the formulation of a nationwide RHD control program, and it will foster regional research collaborations on RHD control.