Cardiovascular Journal of Africa: Vol 29 No 6 (November/December 2018)

62 / 74

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 6, November/December 2018 394 AFRICA
The Pan-African Society of Cardiology position paper on
reproductive healthcare for women with rheumatic heart
disease
Ana Olga Mocumbi, Keila KF Jamal, Amam Mbakwem, Maylene Shung-King, Karen Sliwa
Abstract
This position paper summarises the current knowledge on the
epidemiology, diagnosis and management of women of child-
bearing age with rheumatic heart disease (RHD) in Africa, as
well as the available data on their use of reproductive health
services. The aim is to provide guidance to health profession-
als on aspects of sexual and reproductive health in women
with RHD. It reviews the diagnosis, management and coun-
selling of women with RHD throughout their reproductive
life. Additionally, this publication discusses potential ways
of integrating obstetric and cardiovascular care at peripheral
levels of the health systems, as a way of improving outcomes
and reducing maternal mortality rates related to cardiovascu-
lar disease in Africa. Finally, the article proposes responses to
fulfill the actual needs for better reproductive health services
and improvement in care for women with RHD.
Keywords: sexual and reproductive health, cardiovascular disease,
rheumatic heart disease
Submitted 19/2/18, accepted 21/7/18
Published online 18/9/18
Cardiovasc J Afr 2018; 29: 394–403
DOI: 10.5830/CVJA-2018-044
The social cluster of the African Union Commission hosted
a consultation with rheumatic heart disease (RHD) experts,
convened by the Pan-African Society of Cardiology (PASCAR)
in Addis Ababa, Ethiopia from 21 to 22 February 2015. 1 The
objective of this meeting was to develop a ‘roadmap’ of key
actions that need to be taken by governments to eliminate acute
rheumatic fever (ARF) and eradicate RHD in Africa, following
a call for action the previous year.2 Seven priority areas for
intervention were adopted: (1) create prospective disease registers
at sentinel sites in affected countries to measure disease burden
and track progress towards a reduction in mortality rate by 25%
by the year 2025; (2) ensure an adequate supply of high-quality
benzathine penicillin for the primary and secondary prevention of
ARF/RHD; (3) improve access to reproductive health services for
women with RHD and other non-communicable diseases (NCD);
(4) decentralise technical expertise and technology for diagnosing
and managing ARF and RHD (including cardiac ultrasound); (5)
establish national and regional centres of excellence for essential
cardiac surgery for the treatment of affected patients and
training of cardiovascular practitioners of the future; (6) initiate
national multi-sectoral RHD programmes within NCD control
programmes of affected countries; and (7) foster international
partnerships with multi-national organisations for resource
mobilisation, monitoring and evaluation of the programme to
end RHD in Africa. Since then, African Union heads of state
have endorsed this Addis Ababa communiqué.
Following the Mosi-o-Tunya Declaration in 2014.2 PASCAR
created seven taskforces as part of the plan to implement a
roadmap to end ARF and RHD in Africa. These PASCAR
technical groups aim to move forward each of these key areas
of intervention. We present the work of the taskforce on ‘Access
to reproductive health services for women with RHD and other
non-communicable diseases in Africa’ here, which emanated out
of face-to-face and virtual meetings.
This position paper reviews the current knowledge on
reproductive care for women with RHD, particularly during
their reproductive years. Its objective is to provide guidelines
for (1) the use of contraceptive methods by girls and women of
reproductive age with RHD; (2) antenatal care and counselling;
(3) diagnosis and management of pregnant women with RHD;
(4) post-delivery counselling and follow up for women with
RHD. Acknowledging that sexual and reproductive health
services do not function in isolation, but instead are nested
within the broader health system, consideration is given to health
system factors, by reflecting on what needs to be in place to
adequately provide equitable care to women with RHD.
Rationale
The Millennium Development Goal 5 of achieving a 75%
Division of Non-Communicable Diseases, Instituto
Nacional de Saúde; and Faculty of Medicine, Eduardo
Mondlane University, Maputo, Mozambique
Ana Olga Mocumbi, MD, PhD,
Mozambique Institute of Health Education and Research,
Maputo, Mozambique
Ana Olga Mocumbi, MD, PhD
Keila KF Jamal, BSc (Public Health)
Departments of Internal Medicine and Cardiology,
University of Lagos, Lagos, Nigeria
Amam Mbakwem, MD
Health Policy and Systems Division, School of Public
Health and Family Medicine, University of Cape Town,
Cape Town, South Africa
Maylene Shung-King, MB ChB, PhD
Hatter Institute for Cardiovascular Research in Africa,
Department of Medicine, Faculty of Health Sciences,
University of Cape Town; Soweto Cardiovascular Research
Group, University of the Witwatersrand, Johannesburg,
South Africa; and Mary McKillop Institute, ACU, Melbourne,
Australia
Karen Sliwa, MD, PhD