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Rheumatic Heart Disease: from Molecules to the Global Community - Summary Day 4

26 January 2017

On the final day of the conference ‘Rheumatic Heart Disease: from Molecules to the Global Community’, the focus of sessions turned to existing global, regional and national initiatives tackling RHD. The morning session also featured speakers discussing their experiences of using databases in RHD control programmes, and a keynote lecture from Salim Yusuf, Professor at McMaster University and Immediate Past President of the World Heart Federation (WHF). The conference – held in Cairo, Egypt – was organized by the Aswan Heart Centre and the Pan-African Society of Cardiology (PASCAR).

Awareness and Databases
The day kicked off with a number of presentations on databases, a vital component of effective RHD control programmes. In their presentations, speakers compared the merits and drawbacks of using different systems, such electronic or paper-based registries and hospital-based or population-based registries.
 
Acknowledging the challenges of both systems Professor Mark Engel – of the University of Cape Town – said that electronic registries were not widely accepted, that the technology was not always available and that an initial investment cost was necessary, while paper-based systems required a significant amount of time-consuming administration. However he noted that these challenges could be mitigated by making use of user-friendly technology, citing the CommCare App used to process data in the REMEDY study.

Keynote Lecture
The morning session concluded with a keynote lecture from Prof. Salim Yusuf, who highlighted the importance of tackling the socio-economic determinants of RHD. Noting that the prevalence of RHD had peaked in the United States and Western Europe in the 19th century – at the height of industrialization and urbanization – he said that sustainable economic development could play a significant role in eliminating RHD as a public health issue.

He also drew attention to the “market vulnerabilities” and regular shortages of Benzathine Penicillin G (BPG) – the essential antibiotic for secondary prevention of rheumatic fever and RHD – that continue to occur worldwide. Dr Yusuf set out supra-national, national and local actions that could help to reduce these shortages, and also highlighted health systems strengthening and clinical and policy research as essential components for effective RHD prevention and control. However, ‘elimination is possible’, said Prof. Yusuf, concluding his lecture by setting a target of eliminating RHD by 2040.

Global & Regional Initiatives
Policy and partnerships represented the main theme of the afternoon sessions. Professor Ana Olga Mocumbi, of the Ministry of Health for Mozambique, presented the WHF Roadmap on rheumatic heart disease. Prof. Mocumbi described the roadmap as a “dynamic tool” that should be “adapted to local needs”, and that it was designed to translate existing knowledge of best practices, barriers and solutions into practical strategies to effectively tackle RHD in endemic countries.

Meeting Co-Director Professor Bongani Mayosi – of PASCAR and UCT – then presented the seven key actions of the AU Communiqué – a continental declaration endorsed by all African Heads of State – and noted that this had “involved the engagement from people in various sectors”.
 
His presentation was followed by Dr. Oyere Onuma, Medical Office for Cardiovascular Disease at the World Health Organization (WHO), who spoke on WHO’s plans to increase their technical support and update guidelines on the prevention and control of RHD. Echoing Prof. Yusuf’s emphasis on the social determinants of the disease, Dr Onuma said that RHD was “a major public health & medical problem stratified by socio-economic and Indigenous status”.

Jeremiah Mwangi – Director of Policy and Advocacy at the WHF – concluded the session, providing an overview of the partners and demonstration projects that make up RHD Action, and outlined its priority areas for tackling rheumatic fever and rheumatic heart disease. He placed particular emphasis on engaging people living with RHD, saying “we want to include them in priority-setting and to empower them to tell their own story”.
 
National Programmes
The final session of the conference focused on national prevention programmes to tackle RHD around the world. This began with a presentation from Professor Alain Carpentier, who spoke on his experience of helping to establish a cardiac centre of excellence in Vietnam; the centre now conducts 4,000 operations a year in five sites throughout the country.
 
Professor Diana Lennon of the University of Auckland gave a summary of New Zealand’s comprehensive prevention programme for RF and RHD. In her presentation she stressed some of the key ingredients for a successful programme, which included strong professional support, political commitment to reduce socio-economic disparities, and forming community partnerships. Acknowledging the greater resources the government of New Zealand allocates to its health budget, she nevertheless stressed that progress could be made through cost-effective interventions and successful advocacy: “secondary prevention became a nationwide issue”.
 
Dr Alaa El Ghamrawy – speaking on the Egyptian National Programme for the prevention of RF and RHD – stressed the need for an effective referral process, with dedicated RHD centres integrated within the national health system. Tracing the history of the development of Namibia’s RHD prevention programme, Dr. Christopher Hugo-Hamman underlined the importance of the first Namibian national registry for RHD in leading to the scale-up of activities, saying “research empowers advocacy”. Marvin Allen, meanwhile, focused on the importance of educational and promotional tools in the prevention programme in Samoa, where he and his colleagues had used puppet shows, posters and local rugby players to raise awareness of RF and RHD.

Closing Ceremony
In the final session of the conference, Meeting Directors Prof. Mayosi and Sir Magdi Yacoub announced the winner of the best abstract at the conference, which was awarded to a study entitled ‘Staging trainees’ participation in mitral valve surgery produces less inferior operative outcomes: a single centre series’.

Stating that one outcome of the conference would be the Cairo Accord, Prof. Yacoub thanked participants for attending, and said he was “overwhelmed by the amount of knowledge” that had been shared at the meeting.

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