EGYPT: Time for action on “heart disease of the poor”
Ayman Mahdi Saleh, 32, has Rheumatic Heart Disease
CAIRO, 11 May 2010 (IRIN) - Ayman Mahdi Saleh, 32, started to feel pain in his chest soon after he was diagnosed with Rheumatic Heart Disease (RHD). “I started to experience eye blurring, chest pain and dizziness last year but the symptoms have started to become more serious now,” he told IRIN at the National Heart Institute (NHI) in Cairo where he was seeking treatment.
RHD is one of the most common heart diseases in Egypt, putting at risk the lives of thousands of people, especially in poor areas, doctors say.
The disease is a complication of rheumatic fever, an inflammatory disease that usually affects children aged 5-15 and damages the heart valves. It is caused by an infection with the Group A streptococcus bacterium that begins with strep throat.
“It is the heart disease of the poor. It is widely spread in impoverished, congested areas that lack proper ventilation, making the infection spread faster,” said Alaa al-Ghamrawi, director of the Ministry of Health’s Rheumatic Heart Programme in the northern governorate of Gharbya.
“In addition, poor people usually lack strong immunity with the absence of proper nutrition, and they lack awareness on health issues,” he said.
The Rheumatic Heart Programme is educating primary health doctors on how to diagnose rheumatic fever, and training community leaders in the villages to spread awareness on the importance of proper ventilation, nutrition as well as treatment, he said.
Lack of research
There is a lack of up-to-date information on the prevalence of RHD, said Hosam Fawzy, a cardiologist at the NHI.
“The latest study we have is on the prevalence among schoolchildren and it goes back to 2001. It shows that there were 9.4 cases per 1,000,” he said. “We have about 20 million schoolchildren in the country. This means that 188,000 of them have RHD.”
Fawzy believes actual prevalence is much higher. “This study was for schoolchildren only. There are many children who are not in school and those usually live in miserable conditions [which makes them more prone to catching rheumatic fever],” he said, adding that prevalence could be four times as much, exceeding 700,000 cases.
“Funding usually comes from pharmaceutical companies. The problem is that medicine for the fever is very cheap which does not encourage these companies to fund research. But the cost goes up when there is a need to manufacture valves and filters [at a later stage of the disease],” Fawzy said.
Photo: Dana Hazin/IRIN
|Rheumatic fever is common in poor areas where houses lack proper ventilation
To get a clearer picture of the disease, and in a bid to eradicate it, the Egypt Heart Society, in collaboration with the NHI and a number of universities, launched a study to determine the prevalence of rheumatic fever and RHD, as well as the risk factors associated with it.
Eleven governorates were selected to represent different geographical areas: Giza, Qualioubia, Alexandria, Dakahlya, Menoufya, Gharbya, Port-Said, al-Arish, Fayoum, Souhag, and Luxor.
Although the study has not been completed yet, “results obtained after examining children in Qualioubia and Alexandria were quite high,” said Nashwa al-Hagrasy, head of Egypt Hearts, a local NGO that provides care for poor heart-disease patients.
“It showed that the prevalence of the disease among schoolchildren in Qualioubia Governorate is 7.6 per 1,000 and in Alexandria 10.8 per 1,000,” she said.
Doctors say workers with RHD are particularly vulnerable: “The problem with this disease is that people keep using their cardiac reserve and when they start to complain, it is already too late,” said Fawzy.
“A labourer who is supposed to work 7-8 hours per day starts to feel he cannot work more than three, which affects his income,” he said. “Also, those who undergo valve replacement or repair need to take blood thinners, which means they cannot do much muscular effort, as any small injury can lead to severe bleeding.”
The disease may also put pressure on the health budget if the number of RHD patients continues to increase. “Valve replacement for one patient costs the state 32,000 Egyptian pounds [US$5,700], while open heart surgery costs 10,000 Egyptian pounds [$1,784],” al-Hagrasy said, adding that further efforts were needed on prevention.
Fawzy said a new approach was needed to combat the disease: “We need to diagnose cases as early as possible and at the same time study the microbe that causes the fever and kill it… This is what countries in Europe and America did to completely eradicate it,” he said.
“A vaccine was produced in Europe for rheumatic fever. We are waiting here for research to produce a vaccine that is suitable for the type of bacterium we have here in Egypt,” al-Ghamrawi said.