Rheumatic heart disease in Samoa and the Pacific Nations

Abstract

Acute rheumatic fever (ARF) and its longterm sequela chronic rheumatic heart disease (RHD) remain a massive problem around the world, especially in the developing world. ARF is an inflammatory disease that can develop after a pharyngitis caused by Group A streptococcal infection, usually during childhood.' RHD is the result of valvular damage caused by this inflammatory disease. It is manifested by inflammation causing thickening of the valves, leaking of the valves as a result of lengthening of the valve chords, failure of coaption of the valves, annulus dilatations, or stenosis of the valves from scarring and tethering of the valve leaflets or valve chords. RHD remains a massive problem in Pacific nations, including Samoa, Tonga, Fiji, and others.^"'' RHD prevalence remains high in the indigenous populations of New Zealand (Maori) and Australia (Aborigines), and the Pacific nations' migrant populations in New Zealand and Australia.^ RHD remains a major cause of morbidity and premature death. The prevalence of RHD imposes a significant burden on health care systems in the Pacific nations, which have very limited budgets. Since 2003, the Government of Samoa has sent between 25 and 30 young people every year for RHD surgery in New Zealand.^ This has an enormous impact on the overseas treatment budget of NZ$10 million per year. None of the Pacific nations can afford the escalating costs of RHD surgery and, therefore, there should be a strong focus on primordial, primary and secondary prevention of ARF and RHD.