Novartis has launched an effort to eliminate rheumatic heart disease (RHD) in Zambia in collaboration with the Lusaka University Teaching Hospital (UTH), the Ministry of Health in Zambia, the Pan-African Cardiology Society and Massachusetts General Hospital (MGH).
RHD is a complication of untreated streptococcal infections in which the valves of the heart are scarred and eventually degenerate, leading to heart failure. Eliminated by antibiotic treatment in most developed nations, in the developing world an estimated 15 million children suffer from this debilitating and often fatal disease.
"The toll of heart failure in young children with RHD in Zambia is immense, for the patient, their families, and the nation," said Mark C Fishman, cardiologist and president of the Novartis Institutes for BioMedical Research (NIBR). "It is entirely preventable. For the past several years Novartis has been working with colleagues in Lusaka to help understand and treat asthma in young children. We are expanding the collaboration to raise awareness, educate, and provide antibiotic therapy to prevent RHD."
To measure RHD prevalence and identify those in need of secondary prophylaxis, teams of health care professionals from Lusaka UTH, the MGH, and Novartis will use portable echocardiography machines to evaluate 3,000 children, ages 9-10, in Lusaka-area public schools. Echocardiography screening is estimated to detect more than 10 times as many cases as clinical screening.
Images from the echocardiography screens will be analyzed in Zambia and at the MGH using a cloud-based electronic registry developed by Dimagi Inc, a Cambridge, MA-based company that designs open-source electronic healthcare systems for low resource environments.
Children identified as having RHD will be treated with monthly penicillin injections (termed secondary prophylaxis) to prevent recurrent streptococcal infections and additional valve damage.
Primary prevention, the treatment of children with streptococcal infection to prevent RHD, is key to elimination of the disease. To this end, all children diagnosed with strep throat will be treated with injectable penicillin in the community-based study sites. Prevalence of RHD and adherence to secondary prophylaxis will be determined via the mobile electronic registry.
"We have assembled an experienced team from MGH who are excited to bring the mobile heart imaging technology to Zambia," stated Michael H Picard, MD, director of Echocardiography at the Massachusetts General Hospital and a past president of the American Society of Echocardiography. "We are creating a model for country-wide screening through schools that will not only raise awareness of the magnitude of this disease but also offer a simple method to identify those who will benefit from a very simple and safe treatment. The MGH Cardiology Division and its Cardiac Ultrasound Laboratory are delighted to be a partner in this initiative."
The Pan-African Cardiology Society will assist with the development of the study protocol and ethics approval. Based on the experience of the initial Lusaka-based effort, Novartis plans to support the rollout of the RHD training and treatment effort to Provinces across Zambia, with the ultimate goal of eliminating RHD in Zambia.
"RHD is the most common acquired heart ailment in Zambian children, but statistics are spotty and the disease is certainly diagnosed late when damage to the heart valves has already reached advanced stage," said John Musuku, principal investigator and UTH paediatrician. "Our hope is that the collaboration with Novartis will lay the foundation to detect the disease early so preventative measures are instituted. This is an effort to eradicate the disease across Zambia in our life time."
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