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Review
. 2024 Oct 30;3(12):101347.
doi: 10.1016/j.jacadv.2024.101347. eCollection 2024 Dec.

Rheumatic Heart Disease Burden in Africa and the Need to Build Robust Infrastructure

Isah Abubakar Aliyu  1   2   3 , Jamilu Abubakar Bala  1   2   3 , Ibrahim Yusuf  3   4 , Taiwo Gboluwaga Amole  1   3   5 , Baba Maiyaki Musa  1   3   6 , Garba Yahaya  2 , Peter Kojo Quashie  3   7 , Manfreddy Binyet  3   7 , Patrick Soon-Shiong  8 , Keeley Foley  9 , Mahmoud Umar Sani  3   6 , Hadiza Shehu Galadanci  1   3   10 , Jacques Kpodonu  11
Affiliations
Review

Rheumatic Heart Disease Burden in Africa and the Need to Build Robust Infrastructure

Isah Abubakar Aliyu et al. JACC Adv. .

Abstract

Rheumatic heart disease (RHD) is an important public health problem in Africa. Mapping the epidemiology of RHD involves elucidating its geographic distribution, temporal trends, and demographic characteristics. The prevalence of RHD in Africa varies widely, with estimates ranging from 2.9 to 30.4 per 1,000 population. Factors contributing to this burden include limited access to health care, poverty, lack of research interest, and genetic fragility. Studies have highlighted differences in group A Streptococcus (GAS) incidence among different African countries, emphasizing the importance of effective monitoring and intervention strategies. RHD epidemiological mapping in Africa indicates regional differences and socioeconomic determinants. The high prevalence among females in most studies and among children underscores the urgency for targeted interventions. Diagnosing RHD in Africa faces challenges of inaccessibility of health facilities and trained personnel. Efforts to develop cost-effective and accessible diagnostic tools, such as mobile/portable echocardiography machines, molecular biomarkers such as Tenascin-C and microRNA expression profile shows promise for accurate diagnosis of RHD, but their validation and utilization is limited due to resource constraints. Furthermore, lack of an effective licensed vaccine for GAS causes significant retardation in RHD control in Africa. Addressing the burden of RHD in Africa and other low- and middle-income countries requires robust RHD biomarkers and effective vaccines. This review provides a comprehensive overview of the landscape of RHD in Africa, covering the bacteriology of GAS, the burden of GAS infections, exploring diagnostic avenues, challenges, and opportunities in RHD biomarkers, diagnosis, effective prevention strategies, and RHD management in Africa.

Keywords: Africa; diagnosis; group A Streptococcus; rheumatoid heart disease.

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Conflict of interest statement

Patrick Soon-Shiong has a license for the development and sales and manufacturing of Nudge technology held in a company called NantDNA. Keeley Foley is an advisor for DNA Nudgebox. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Representative Examples of GAS Cell–Associated and Secreted Virulence Factors, including Hyaluronic Acid Capsules, M Proteins, S Proteins, Streptolysins O, Proteases, and Other Immunoglobulin-Degrading Enzymes The figure also highlights the interactions of these virulence factors with the innate and adaptive immune systems, complement fixation pathways, and the phagocytic cell system. GAS = group A Streptococcus.
Figure 2
Figure 2
A Map of Africa and Overlying the Most Recent Incidence Rate and Pattern of Rheumatic Heart Disease in Africa The red colors indicate countries with high burden of recorded cases while green showed the countries with low disease burden. brown and yellow shows a moderate and low cases respectively.
Figure 3
Figure 3
DNA Nudge Box Rapid Point of Care Device Demonstrating the Test Flow of the Strep a group A Streptococcus Test Screening, With Results in 90 minutes which Include Antimicrobial Resistance Targets
Central Illustration
Central Illustration
Infrastructure Needs Required for Effectively Managing and Mitigating the Impact of the Burden of Rheumatic Heart Disease on the Continent of Africa
See this image and copyright information in PMC

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