Managing the Growing Burden of Rheumatic Heart Disease in Low-Income Countries: A Primary Healthcare Approach in Ethiopia

Rheumatic fever and rheumatic heart disease continue to be the most common form of cardiovascular disease in low-income countries. Poor diagnostic and treatment capacity and limited patient understanding of disease etiology have kept both disease recognition and patient adherence to treatment low. In rural and remote areas, this is worsened as a result of poorer access to health facilities for diagnosis, treatment and monitoring. As recommended by the World Health Organization, to treat the chronic effects of rheumatic heart disease, patients must adhere to strict monthly treatment regimes of secondary prophylaxis with penicillin. However, adherence to treatment remains difficult for poor populations who struggle to meet the travel, economic and opportunity costs associated with seeking care. To address these challenges, lessons from Ethiopia suggest that a community-based primary healthcare approach that offers follow-up treatment and care through satellite health centres with health officers can be a sustainable and effective strategy for rheumatic fever and rheumatic heart disease management.