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Rheumatic fever and rheumatic heart disease in Bangladesh: A review
A K M Monwarul Islam1, A A S Majumder2
1Assistant Professor, Department of Cardiology, Jessore Medical College, Jessore, Bangladesh.
Insights
Rheumatic fever (RF) and rheumatic heart disease (RHD) significantly impact young people globally and in Bangladesh. While acute RF is controlled, chronic RHD remains a prevalent public health concern requiring further research and policy development.
Area of Science:
- Cardiovascular Medicine
- Public Health
- Epidemiology
Background:
- Rheumatic fever (RF) and rheumatic heart disease (RHD) are leading cardiovascular diseases in individuals under 25 globally.
- Historically, poverty, overcrowding, and poor healthcare fueled high RF/RHD incidence in Bangladesh.
- Improvements in socioeconomic factors, healthcare, and antibiotic prophylaxis have controlled acute RF.
Purpose of the Study:
- To analyze the current burden and challenges of rheumatic heart disease (RHD) in Bangladesh.
- To highlight the need for evidence-based national policies to address RHD prevalence.
- To underscore the ongoing public health significance of RHD.
Main Methods:
- Review of historical and current epidemiological data on RF and RHD in Bangladesh.
- Analysis of factors contributing to the control of acute RF.
- Assessment of the persistent prevalence and impact of chronic RHD.
Main Results:
- Acute rheumatic fever (RF) incidence has decreased due to socioeconomic and healthcare advancements.
- Chronic rheumatic heart disease (RHD) remains prevalent, with its full burden potentially underestimated.
- RHD disproportionately affects young adults, leading to significant disability, delayed diagnosis, and complex management.
Conclusions:
- Despite progress in controlling acute RF, chronic RHD continues to pose a substantial public health challenge in Bangladesh.
- Effective management of RHD is hampered by delayed diagnosis, protracted illness, and palliative, costly treatments.
- Large-scale epidemiological and clinical research is crucial for developing effective national policies to combat RHD.
Abstract:
Rheumatic fever (RF) and rheumatic heart disease (RHD) are the most-common cardiovascular disease in young people aged <25 years, globally. They are important contributors to cardiovascular morbidity and mortality in Bangladesh. Classical risk factors, i.e. poverty, overcrowding, ignorance, and insufficient health care services were responsible for the high incidence and prevalence of these diseases over the last century. In concert with the progresses in socioeconomic indicators, advances in health sectors, improved public awareness, and antibiotic prophylaxis, acute RF came into control. However, chronic RHD continues to be prevalent, and the actual disease burden may be much higher. RHD predominantly affects the young adults, seriously incapacitates them, follows a protracted course, gets complicated because of delayed diagnosis and is sometimes maltreated. The treatment is often palliative and expensive. Large-scale epidemiological and clinical researches are needed to formulate evidence-based national policy to tackle this important public health issue in future.
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