The burden of rheumatic heart disease and issues affecting the provision of care in Malawi: A scoping review
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Background
Rheumatic heart disease (RHD) is an autoimmune sequela of group A streptococcal (GAS) pharyngitis. Single or recurrent episodes of acute rheumatic fever (ARF), a complication arising 2-3 weeks after GAS infection, can cause damage to the valves of the heart and RHD. This trajectory towards severe disease is now rare in high-income countries. The appropriate use of antibiotics has contributed to this decline in RHD prevalence, but socio-economic factors have also had a profound impact. In Malawi, as in many low-income countries, RHD continues to pose a significant challenge. Limited access to healthcare and poor education likely contribute to the disease burden, and actionable solutions are needed to eradicate RHD in these communities.
Aim
To determine the present burden of GAS, ARF and RHD in Malawi, the issues affecting the provision of care and the solutions that have been proposed.
Design and setting
A scoping review encompassing four electronic databases from which relevant articles were drawn.
Method
A systematic search of ‘PubMed’, ‘EMBASE’, ‘Cochrane Library’ and ‘Clinicaltrials.gov’ was conducted to identify research related to the study objectives. Supplemental grey literature and internet searches were carried out and collaboration with experts in the field ensured a comprehensive review of the available data. The selected articles spanned from 2008 to October 2024 and addressed one or more of the diseases of interest. A scoping review was carried out according to the Arksey and O’Malley procedure.
Results
This scoping review includes thirty papers, which focus primarily on RHD burden, screening, treatment, and barriers to care in Malawi. There was significantly less research on ARF and GAS infections. A wide variety of study designs were employed (mostly descriptive, cross-sectional and retrospective studies) and the number of participants varied significantly across the different studies. Two government reports were also included. The primary findings included a shift in the focus of research towards solutions to the high burden of RHD in Malawi.
Conclusion
The significant morbidity and mortality associated with RHD are a major concern in the communities and healthcare systems of Malawi. As in many low-income countries, resource mobilisation and improved education are areas requiring attention. To address the high burden of disease in the country, ongoing research is largely focused on establishing a sufficiently large and appropriately trained workforce to diagnose and monitor RHD using the resources available within the constraints of the country’s socioeconomic context.
