A recent publication in Global Heart documents the application of a systematic review protocol developed by the RHD Action team at the University of Cape Town to investigate RHD-related epidemiology, health systems and stakeholders in RHD Action Countries, Tanzania and Uganda.

The study was led by Hlengiwe Moloi, during her period as a research assistant at the Children’s Heart Disease Research Unit supervised by Dr Watkins and Professors Liesl Zühlke and Mark Engel.  The project entailed the development of the final protocol for a systematic review of PubMed, Embase, and grey literature for quantitative and qualitative studies on group A streptococcal disease (GAS), acute rheumatic fever (ARF), and RHD and was followed by the application of the protocol in Uganda and Tanzania.

Three sets of outcomes were pre-specified: (1) disease epidemiology, (2) barriers and facilitators to healthcare, and (3) stakeholder identification and engagement.  Methods included random-effects meta-analyses and a narrative synthesis of themes. No studies contained data on stakeholder identification and engagement (Objective 3). 

The query resulted in 293 records and 12 of them met inclusion criteria (nine for objective 1 and three for objective 2). The prevalence of RHD was estimated at 17.9 (95% confidence interval [CI]: 4.0 to 41.2) per 1000.  The most frequent nonfatal sequelae were found to be heart failure, pulmonary hypertension, and atrial fibrillation. Case-fatality rates in medical and surgical wards were 17% (95% CI: 13% to 21%) and 27% (95% CI: 18% to 36%), respectively. 

Barriers and facilitators to GAS and RHD care were identified in the domains of individual knowledge, family support, provider communication and knowledge, and system design. The research team concluded that RHD remains endemic in Tanzania and Uganda, and symptomatic RHD is associated with high rates of morbidity and mortality.  Critical data gaps in the areas of GAS and ARF epidemiology were identified, as well as healthcare utilization patterns and their determinants.

For more information:
Epidemiology, health systems and stakeholders in rheumatic heart disease in Africa: a systematic review protocol. BMJ Open. 
Rheumatic Heart Disease Epidemiology and Health Systems Barriers and Facilitators: A Systematic Review of Studies From Uganda and Tanzania. Global Heart