Acute Rheumatic Fever and Rheumatic Heart Disease Workshops in Lilongwe, Malawi
Project Team: Amy Sanyahumbi, MD, Patricia Chiromo, NMT, Msandeni Chiume, MD

Last year, the RHD Action Small Grants Program funded five projects in low-and-middle income countries across the globe to support groups who are already addressing the work of RHD and to bring the work of key RHD stakeholders under the RHD Action banner. Successful applicants were awarded $2,000 each to complete a small-scale project. Dr Amy Sanyahumbi’s project based in Lilongwe, Malawi is the last of the five 2017 winners profiled here on our website.
 
Rheumatic heart disease (RHD) is a major public health problem in Malawi with an estimated burden of 169,000 prevalent cases in a country of almost 18 million people. With no in-country cardiac surgery services or reliable access to anticoagulation medication, people in Malawi with advanced RHD are left with substantial and life-threatening disability. This small grant from RHD Action was used to support the design and piloting of an RHD educational program for health workers which is intended to serve as the educational backbone of the future Ministry of Health RHD prevention program.
   
An acute rheumatic fever (ARF) and rheumatic heart disease (RHD) education curriculum was designed by the project team. Sessions included RHD modules from WIRED International; Benzathine Penicillin (BPG) Safety and Allergy adapted from a presentation given by Aiden Long, MD, who is widely known for his work on BPG administration; safety and adherence for primary prevention of RHD, and ARF and RHD in Malawi.
 
Three half-day workshops were conducted on the grounds of Kamuzu Central Hospital at the Baylor College of Medicine Clinic in Lilongwe, Malawi.  The workshops were presented by Dr Sanyahumbi, a paediatric cardiologist, and Ms Patricia Chiromo, a paediatric nurse.  The workshops included pre-tests and post-tests, as well as questionnaires and evaluations to gauge the impact of their work.

Sixty-five total participants, primarily nurses, doctors and clinical officers, were trained in these sessions.  The pre- and post-test scores of ARF and RHD knowledge showed significant improvement among the participants attending the workshop – encouraging the project developers that they were on the right track and successfully connecting with their audience.
    
A major concern identified through the pre-session questionnaires was the safety of benzathine penicillin administration. Fear and discomfort regarding patients experiencing adverse (allergic) reactions to benzathine penicillin injections were expressed on these questionnaires.  The project team made sure that the workshops included a session addressing issues of penicillin importance, safety, and allergy and used open discussions to voice and address these concerns.  Results from post-workshop questionnaires revealed that both nurse and clinician participants were much more comfortable prescribing or injecting benzathine penicillin after the workshop.  

The project team concluded that any future practical sessions on acute rheumatic fever and rheumatic heart disease in Malawi must address penicillin safety and administration.  Overall, the workshops received good feedback with a high overall rating from the participants.  

The Project Team remarks that a significant take-away lesson from the workshops is the importance of including sessions on increasing health worker comfort and knowledge surrounding BPG administration when designing future training sessions.  The Ministry of Health is currently in the early stages of developing a national rheumatic heart disease control program in Malawi and these workshops to train healthcare workers on ARF and RHD developed through this RHD Action grant will serve as the platform for the educational component of the RHD control program in Malawi.  

Congratulations to Dr Sanyahumbi and her team in Lilongwe for using their small grant to go a long way toward the development of an MOH-supported RHD control programme in Malawi.