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Seven Key Actions to Eradicate Rheumatic Heart Disease in Africa: the Addis Ababa Communiqué

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Seven Key Actions to Eradicate Rheumatic Heart Disease in Africa: the Addis Ababa Communiqué 184 CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 3, May/June 2016 AFRICA Seven key actions to eradicate rheumatic heart disease in Africa: the Addis Ababa communiqué David Watkins, Liesl Zuhlke, Mark Engel, Rezeen Daniels, Veronica Francis, Gasnat Shaboodien, Mabvuto Kango, Azza Abul-Fadl, Abiodun Adeoye, Sulafa Ali, Mohammed Al-Kebsi, Fidelia Bode- Thomas, Gene Bukhman, Albertino Damasceno, Dejuma Yadeta Goshu, Alaa Elghamrawy, Bernard Gitura, Abraham Haileamlak, Abraha Hailu, Christopher Hugo-Hamman, Steve Justus, Ganesan Karthikeyan, Neil Kennedy, Peter Lwabi, Yoseph Mamo, Pindile Mntla, Chris Sutton, Ana Olga Mocumbi, Charles Mondo, Agnes Mtaja, John Musuku, Joseph Mucumbitsi, Louis Murango, George Nel, Stephen Ogendo, Elijah Ogola, Dike Ojji, Taiwo Olabisi Olunuga, Mekia Mohammed Redi, Kamanzi Emmanuel Rusingiza, Mahmoud Sani, Sahar Sheta, Steven Shongwe, Joris van Dam, Habib Gamra, Jonathan Carapetis, Diana Lennon, Bongani M Mayosi Abstract a consultation with RHD experts convened by the Pan-African Society of Cardiology (PASCAR) in Addis Ababa, Ethiopia, Acute rheumatic fever (ARF) and rheumatic heart disease to develop a ‘roadmap’ of key actions that need to be taken by (RHD) remain major causes of heart failure, stroke and death governments to eliminate ARF and eradicate RHD in Africa. among African women and children, despite being preventable Seven priority areas for action were adopted: (1) create and imminently treatable. From 21 to 22 February 2015, the prospective disease registers at sentinel sites in affected coun- Social Cluster of the Africa Union Commission (AUC) hosted tries to measure disease burden and track progress towards Department of Medicine, Groote Addis Ababa University, Sefako Makgatho Health Federal Medical Centre, Schuur Hospital and University Ethiopia Sciences University, South Abeokuta, Nigeria of Cape Town, South Africa Dejuma Yadeta Goshu, MD Africa Taiwo Olabisi Olunuga, MB ChB David Watkins, MD, MPH Pindile Mntla, MB ChB Liesl Zuhlke, MB ChB, PhD Ministry of Health, Rheumatic Chris Sutton, MB BCh Common Market for Eastern Mark Engel, PhD Heart Disease Programme, and Southern Africa, Ethiopia NCDs, Egypt Instituto Nacional de Saúde, Rezeen Daniels Mekia Mohammed Redi Veronica Francis, BA Alaa Elghamrawy, MD Mozambique and PASCAR Vice Gasnat Shaboodien, PhD President South University of Rwanda, Rwanda Kenyatta National Hospital, Bongani M Mayosi, MB ChB, Ana Olga Mocumbi, MD, PhD Kenya Kamanzi Emmanuel Rusingiza, DPhil, [email protected] Bernard Gitura, MB ChB, MMed Mulago Hospital, Uganda MD University of Washington, USA (Int Med) Charles Mondo, MB ChB, PhD Bayero University Kano and David Watkins, MD Jimma University, Ethiopia University Teaching Hospital, Aminu Kano Teaching Hospital, African Union Commission, Abraham Haileamlak, MD Zambia Nigeria Ethiopia Mahmoud Sani, MBBS Mekelle University, Ethiopia Agnes Mtaja, MBBS Mabvuto Kango, MBBS John Musuku, MBBS, MMed Abraha Hailu, MB ChB Cairo University Children (Paeds) Association Friends of Hospital, Faculty of Medicine, Ministry of Health and Social Children with RHD, Egypt Rwanda Heart Foundation, Services, Namibia Egypt Azza Abul-Fadl, MD Rwanda Christopher Hugo-Hamman, Sahar Sheta, MD, MSc Joseph Mucumbitsi, MD University College Hospital, MB ChB WHO Regional Office in Africa, Ibadan, Nigeria East African Community, Touch Foundation, Tanzania Congo Abiodun Adeoye, MBBS Burundi Steve Justus, MD Steven Shongwe, MB ChB, MBA University of Khartoum and Louis Murango, BSc Sudan Heart Centre, Sudan All India Institute of Medical Novartis, USA Sciences, India PASCAR Secretariat, South Sulafa Ali, MD Africa Joris van Dam, PhD Ganesan Karthikeyan, DM University of Sana’a, Yemen George Nel, MSc African Heart Network, Tunisia Mohammed Al-Kebsi, MD, PhD College of Medicine, University Bongani M Mayosi, MB ChB, Habib Gamra, MD of Malawi, Malawi DPhil University of Jos, Nigeria Neil Kennedy, MB ChB Telethon Kids Institute, University of Nairobi, Kenya Fidelia Bode-Thomas, MBBS University of Western Australia, Uganda Heart Institute, Uganda Stephen Ogendo, MB ChB, Princess Margaret Hospital for Harvard Medical School/ Peter Lwabi, MB ChB, MMed (Int MMed (Surg) Children, Australia Partners in Health, USA Med) Elijah Ogola, MB ChB, MMed Gene Bukhman, MD, PhD (Int Med) Jonathan Carapetis, MBBS, PhD Technical Adviser, NCD Mozambican Heart Association directorate, Federal Ministry of University of Abuja Teaching University of Auckland, New (AMOCOR), Mozambique Health of Ethiopia, Ethiopia Hospital, Nigeria Zealand Albertino Damasceno, MD, PhD Yoseph Mamo, MD Dike Ojji, MBBS, PhD Diana Lennon, MD AFRICA CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 3, May/June 2016 185 of RHD clinicians and researchers affiliated with the Pan-African the reduction of mortality by 25% by the year 2025, (2) ensure Society of Cardiology (PASCAR). This meeting was intended to an adequate supply of high-quality benzathine penicillin for develop a roadmap that could be adopted by ministries of health the primary and secondary prevention of ARF/RHD, (3) and governments in order to eliminate ARF and control RHD improve access to reproductive health services for women with RHD and other non-communicable diseases (NCD), (4) in their home countries. This article outlines the Addis Ababa decentralise technical expertise and technology for diagnosing communiqué that emerged from the consultative meeting, and and managing ARF and RHD (including ultrasound of the also provides a brief report of the objectives and proceedings of heart), (5) establish national and regional centres of excel- the meeting, as well as the outcomes of the meeting in the first lence for essential cardiac surgery for the treatment of affect- six months thereafter. ed patients and training of cardiovascular practitioners of the future, (6) initiate national multi-sectoral RHD programmes The Addis Ababa communiqué on eradication within NCD control programmes of affected countries, of RHD in Africa and (7) foster international partnerships with multinational organsations for resource mobilisation, monitoring and eval- Motivation uation of the programme to end RHD in Africa. The communiqué began by recalling that RHD is both preventable This Addis Ababa communiqué has since been endorsed and common in Africa, affecting 1.5 to 3% of school-aged by African Union heads of state, and plans are underway to children.10,11 Because severe RHD is lethal in the absence of surgical implement the roadmap in order to end ARF and RHD in treatment,12 the total economic cost of premature mortality Africa in our lifetime. in Africa is staggering,13 and hampers the achievement of the Millennium Development Goals and forthcoming Sustainable Keywords: rheumatic heart disease, prevention Development Goals on health. The problem has been made worse by a lack of comprehensive, integrated prevention and control Submitted 8/10/15, accepted 14/11/15 programmes in most African Union (AU) member states that Published online 12/1/16 carry a heavy burden of ARF/RHD. Cardiovasc J Afr 2016; 27: 184–187 www.cvja.co.za The AU recognised several mandates to convene this meeting and discuss a roadmap for ARF/RHD in Africa. These included DOI: 10.5830/CVJA-2015-090 the following: • The 6th ordinary session of the Conference of AU Ministers of Health (CAMH6; 22–26 April 2013), adopted under the While acute rheumatic fever (ARF) essentially vanished from AU Executive Council Declaration EX.CL/Dec.795(XXIV): industrialised countries during the latter half of the 20th this requested the AU commission (AUC) to develop a mech- century,1 the condition and its major sequel, rheumatic heart anism to control NCDs in Africa. disease (RHD) remain important public health concerns in • The first joint AU and World Health Organisation (WHO) Africa. Poverty and inadequate primary healthcare systems ministerial meeting, convened under AU Assembly Decision are major contributors to the persistence of ARF/RHD in Assembly/AU/Dec.506(XXII): this pledged action towards Africa.2 On the other hand, improving economic conditions and controlling NCDs in Africa under the AUC–WHO joint work enhanced health system investments during the HIV/AIDS era plan (14–17 April 2014). offer an opportunity to address this neglected disease of poverty • The Drakensberg Declaration and the Mosi-o-Tunya Call to in a co-ordinated fashion.3,4 Action, mentioned above, which were endorsed by the WHO Over the past decade, there has been a renewed global interest Regional Office for Africa and called for the eradication of in RHD as well as a proliferation of scientific and public health ARF/RHD ‘in our lifetime’. work led by African investigators and practitioners.5 At the same time, the World Heart Federation (WHF) non-communicable disease action plan, developed for the World Health Assembly Barriers to action in 2013, called for a 25% reduction in premature mortality from The foundation of the recommendations of the communiqué RHD by the year 2025 (‘25 by 25’).6 was a recent publication of baseline characteristics of patients Prior to 2015, two workshops on ARF/RHD in Africa were with RHD from 12 African countries.9 Several of the key barriers held, with resultant position statements on the necessary steps to control of RHD in Africa are listed in Table 1. Notably, to address ARF/RHD on the continent. The first statement, the despite the lack of progress on RHD control in Africa, there are ‘Drakensberg Declaration on the Control of Rheumatic Fever several examples of countries,
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