CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 2, May/June 2023 AFRICA 67 From the Editor’s Desk I acknowledge it is perhaps unusual to start an editor’s comment with remarks about a case report. I offer no apologies for bringing the case report of Naidoo and colleagues (page 117) to your attention in this issue for two reasons. Firstly, it is a disgrace that diphtheria, a condition that is completely preventable by adequate childhood immunisation, is once again killing young people in South Africa. The authors point out that until the recent outbreaks, diphtheria had been practically eliminated in South Africa, with only three sporadic cases reported between 2008 and 2015. These cases and recently reported outbreaks of measles indicate that the childhood immunisation programme in South Africa is woefully inadequate at present and considerably less effective than in past years. Secondly, it is a reminder that despite the major advances in management of cardiovascular diseases there remain some that were once mainly of historical interest but sadly need to be borne in mind when healthcare systems fail. The authors are to be congratulated for reminding us of this. Namuyonga and co-authors (page 89) address another illness that should have been eliminated by socio-economic intervention rather than immunisation. Recognising that training health workers in high-risk settings to detect acute rheumatic fever/ rheumatic heart disease (ARF/RHD) is a key strategy in preventing ARF, these authors assessed frontline health workers from selected health facilities in Uganda. They were assessed for their knowledge on the clinical features and role of benzathine penicillin G (BPG) in the treatment and prevention of recurrence of ARF. Using the RHD Action Needs assessment tool, they generated and administered a pre-test, then conducted training and re-administered a post-test. Eight months later, health workers were again assessed for knowledge retention and change in practices. During the initial phase, 31% of health workers passed the pre-test, indicating familiarity with clinical features of ARF. The level of knowledge of BPG use in ARF was very poor in all the health units (22.6%), but improved after training to 80%. However, retention of this knowledge waned after eight months and was not significantly different compared to pre-training. This study, which carefully trained, evaluated and, importantly, re-evaluated healthcare workers, identified a critical knowledge gap among health workers, both in awareness and treatment of ARF, and calls for repetitive training as a priority strategy in prevention. Abdelgawad and colleagues’ report (page 82) included 90 consecutive patients admitted to the Cardiology Department in a tertiary-care university hospital in Egypt with a diagnosis of infective endocarditis. In common with the reported experience from other developing countries, the patients were young, with underlying valvular heart disease and intravenous drug abuse being common. Culture-negative endocarditis was common, as was heart failure. Cardiac surgery was considered to be indicated in the majority of patients but was only performed in a minority. Many died before surgery could be performed. The in-hospital mortality rate was high. The above-mentioned articles are a sobering reflection of the state of cardiovascular care in Africa. Success in this area is often measured in the number of high-profile operations or technically complex procedures performed. But the content of these articles indicates that there is still scope for much improvement in very basic levels of care. Pat Commerford Editor-in-Chief Professor PJ Commerford
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