Cardiovascular Journal of Africa: Vol 27 No 3 (May/June 2016)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 3, May/June 2016

AFRICA

185

the reduction of mortality 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 ultrasound of the

heart), (5) establish national and regional centres of excel-

lence for essential cardiac surgery for the treatment of affect-

ed 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 multinational

organsations for resource mobilisation, monitoring and eval-

uation of the programme to end RHD in Africa.

This Addis Ababa communiqué has since been endorsed

by African Union heads of state, and plans are underway to

implement the roadmap in order to end ARF and RHD in

Africa in our lifetime.

Keywords:

rheumatic heart disease, prevention

Submitted 8/10/15, accepted 14/11/15

Published online 12/1/16

Cardiovasc J Afr

2016;

: 184–187

www.cvja.co.za

DOI: 10.5830/CVJA-2015-090

While acute rheumatic fever (ARF) essentially vanished from

industrialised countries during the latter half of the 20th

century,

the condition and its major sequel, rheumatic heart

disease (RHD) remain important public health concerns in

Africa. Poverty and inadequate primary healthcare systems

are major contributors to the persistence of ARF/RHD in

Africa.

On the other hand, improving economic conditions and

enhanced health system investments during the HIV/AIDS era

offer an opportunity to address this neglected disease of poverty

in a co-ordinated fashion.

3,4

Over the past decade, there has been a renewed global interest

in RHD as well as a proliferation of scientific and public health

work led by African investigators and practitioners.

At the same

time, the World Heart Federation (WHF) non-communicable

disease action plan, developed for the World Health Assembly

in 2013, called for a 25% reduction in premature mortality from

RHD by the year 2025 (‘25 by 25’).

Prior to 2015, two workshops on ARF/RHD in Africa were

held, with resultant position statements on the necessary steps

to address ARF/RHD on the continent. The first statement, the

‘Drakensberg Declaration on the Control of Rheumatic Fever

and Rheumatic Heart Disease in Africa’, was issued in 2005

after the meeting in South Africa,

and the second, the ‘Mosi-

o-tunya Call to Action’, was issued in 2014 after the meeting in

Zambia.

This was followed by the publication of a key dataset,

enumerating key characteristics, gaps in implementation of

evidence-based practices and shortfalls in the management of

RHD in African communities.

From 21 to 22 February 2015, the Social Cluster of the

African Union Commission (AUC) hosted the Third All-Africa

Workshop on ARF and RHD, which was an expert consultation

of RHD clinicians and researchers affiliated with the Pan-African

Society of Cardiology (PASCAR). This meeting was intended to

develop a roadmap that could be adopted by ministries of health

and governments in order to eliminate ARF and control RHD

in their home countries. This article outlines the Addis Ababa

communiqué that emerged from the consultative meeting, and

also provides a brief report of the objectives and proceedings of

the meeting, as well as the outcomes of the meeting in the first

six months thereafter.

The Addis Ababa communiqué on eradication

of RHD in Africa

Motivation

The communiqué began by recalling that RHD is both preventable

and common in Africa, affecting 1.5 to 3% of school-aged

children.

10,11

Because severe RHD is lethal in the absence of surgical

treatment,

the total economic cost of premature mortality

in Africa is staggering,

and hampers the achievement of the

Millennium Development Goals and forthcoming Sustainable

Development Goals on health. The problem has been made worse

by a lack of comprehensive, integrated prevention and control

programmes in most African Union (AU) member states that

carry a heavy burden of ARF/RHD.

The AU recognised several mandates to convene this meeting

and discuss a roadmap for ARF/RHD in Africa. These included

the following:

•

The 6th ordinary session of the Conference of AU Ministers

of Health (CAMH6; 22–26 April 2013), adopted under the

AU Executive Council Declaration

EX.CL/Dec.795(

XXIV):

this requested the AU commission (AUC) to develop a mech-

anism to control NCDs in Africa.

•

The first joint AU and World Health Organisation (WHO)

ministerial meeting, convened under AU Assembly Decision

Assembly/AU/Dec.506(XXII): this pledged action towards

controlling NCDs in Africa under the AUC–WHO joint work

plan (14–17 April 2014).

•

The Drakensberg Declaration and the Mosi-o-Tunya Call to

Action, mentioned above, which were endorsed by the WHO

Regional Office for Africa and called for the eradication of

ARF/RHD ‘in our lifetime’.

Barriers to action

The foundation of the recommendations of the communiqué

was a recent publication of baseline characteristics of patients

with RHD from 12 African countries.

Several of the key barriers

to control of RHD in Africa are listed in Table 1. Notably,

despite the lack of progress on RHD control in Africa, there are

several examples of countries, such as Cuba,

Costa Rica,

and

Tunisia,

that have realised the eradication of ARF and control

of RHD over several years by implementing co-ordinated and

comprehensive public health programmes.

Meeting objectives and proceedings

The objectives of the Third All-Africa Workshop on ARF and

RHD were as follows:

•

develop approaches on how to eradicate RHD in Africa

•

develop milestones for the eradication of RHD