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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 26, No 6, November/December 2015
AFRICA
251
Cardio News
National Advisory Committee for the Prevention and Control of
Rheumatic Fever and Rheumatic Heart Disease in Namibia
InWindhoek, Namibia, Thursday 23April
2015 marked a historic milestone for the
Pan-African campaign to arrest the march
of rheumatic fever (RF) and rheumatic
heart disease (RHD) throughout our
continent. Under the authority of the
Minister of Health and Social Services,
Dr Bernard Haufiku, the first meeting
of the National Advisory Committee on
Rheumatic Fever and Rheumatic Heart
Disease began to elaborate on a plan for
the prevention and control of a heart
disease, which, it is estimated, claims the
lives of 1.4 million people in less well-
resourced countries globally every year.
The prevalence in Africa is as high as 30/1
000 among school children.
Amongsurvivors,RHDisamajorcause
of morbidity through heart failure, atrial
fibrillation and cerebrovascular accidents.
RHD results in school absenteeism in
about two-thirds of affected learners, and
because the disease progresses during early
adulthood and causes chronic disability, it
has the potential to undermine national
productivity. The economic impact of
RHD in the African region is profound
and was estimated at US$791 million to
2.37 billion in 2010.
Significantly, Namibia is the first
African country to tackle the prevention
and control of RHD in this manner at a
national level. The national programme
was launched in March 2014 by Dr
Richard Kamwi, the health minister
at that time. Advocacy for the national
programme had been informed by
research conducted by the Namibian
National Registry of RF and RHD,
which is an important partner in the
Global Registry of RF and RHD.
The campaign to eliminate RHD in
our lifetime has its origins in the first
all-Africa workshop on rheumatic fever
and rheumatic heart disease, which was
supported by the Pan-African Society
of Cardiology (PASCAR) and the
World Health Organisation African
region (WHO-AFRO), and held in the
Drakensberg, South Africa in 2005.
At that meeting, four actions were
recommended as part of any programme:
awareness-raising for both the public
and health workers, surveillance (of
incidence and prevalence), advocacy for
funding and implementing treatment and
prevention programmes, and prevention
(primary and secondary). From this
conversation, the ‘Stop Rheumatic Heart
Disease ASAP Programme’, described
in the Drakensberg Declaration, was to
emerge.
Clinicians in 12 countries in Africa
took up the surveillance challenge and
participated in the Global Registry
for RHD (REMEDY), which in 2012
collected robust data on 3 066 children
and adults (including 266 Namibian
patients) with RHD. A strong coalition
for RF and RHD prevention developed
over this period. Both the knowledge
gathered and the collaboration itself
established a powerful platform through
which the coalition has been able to
influence public policy and advocate for
the prevention and control of the most
common non-communicable disease
affecting the heart in our continent.
These intentions were consolidated at
the second all-Africa workshop on RF
and RHD at Livingstone, Zambia in
2014 and expressed through the ‘Mosi-o-
Tunya (the smoke that thunders) Call to
Action’ (2014). This call from PASCAR
was endorsed by the WHO-AFRO and
called for the elimination of acute RF and
control of RHD in Africa in our lifetime.
Persistent in-country advocacy over
four years, together with the momentum
created by the Pan-African coalition, led
to the creation of the National Advisory
Committee on Rheumatic Fever and
Rheumatic Heart Disease in Namibia.
RHD is the end result of acute RF,
a consequence of untreated pharyngitis
caused by group A
Streptococcus
(GrAS).
Overcrowding, poor housing conditions,
under-nutrition and lack of access to
penicillin for sore throat are determinants
of RHD.
With adequate medical care, RHD is
preventable, and it is therefore a litmus
test for the efficacy of primary healthcare
systems. Penicillin prevents rheumatic
fever and is the cornerstone of both
primary and secondary prevention.
Penicillin supply is dependent on health
system infrastructure. Penicillin delivery
depends on awareness among healthcare
providers of the importance of this
strategy.
Recognising these realities, Namibia
has adopted the ‘ASAP’ strategies and
will incorporate them into the national
programme. The advisory committee
will work with the Minister to design
the details of the programme, namely
raising awareness through public and
professional education, establishing a
well-tested surveillance system, advocacy
work to improve the availability of health
services for patients, and promoting
adherence to effective measures for the
prevention of RF.
Dr Christopher Hugo-Hamman
Centre for Paediatric and Congenital
Heart Disease, Namibia
Dr Norbert Forster
Deputy Permanent Secretary
Ministry of Health and Social Services,
Namibia
Delegates of the National Advisory
Committee on RF and RHD