Addressing the challenge of rheumatic heart disease in Pakistan: A call to action

Dialogues in health Pub Date : 2025-05-28 DOI:10.1016/j.dialog.2025.100221

Abdul Hakeem , Masood Sadiq , Javerya Hassan , Isbaah Tejani , Ijaz Hussain , Jalil Khan , Mohammad Waleed , Sabha Bhatti , Sana Sheikh , Sobia Masood , Ali H. Mokdad , Aziz Sheikh , Zafar Mirza , Zainab Samad

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Abstract

Despite its high prevalence, Acute rheumatic fever (ARF) and Rheumatic heart disease (RHD) is underrepresented in Pakistan's national and federal health plans. To address this gap, we gathered multi-geographic and specialty perspectives from frontline clinicians in Pakistan'. Major challenges in RHD diagnosis and care include regional healthcare disparities, diagnostic limitations, scarcity of Benzathine Penicillin G (BPG) for prophylaxis, and lack of multidisciplinary RHD teams.

Our practitioner-informed recommendations emphasize community outreach, targeted screening, and surveillance, and comprehensive training for healthcare providers in the diagnosis and management of GAS infections and ARF. Strengthening multidisciplinary care and ensuring stable BPG supplies are essential, as is integrating RHD care into Universal Health Coverage (UHC) models currently being implemented to reduce patient financial burdens. Improving RHD management requires systemic changes to healthcare infrastructure, practitioner training, and coordinated policy efforts. Crucially, these proposals align with WHO's latest RHD guidelines on primary (treating GAS infections) and secondary prevention (antibiotic prophylaxis and screening). By translating local clinical wisdom into actionable policies, this viewpoint yields practical interventions tailored to Pakistan that are also adaptable to similar LMIC settings.

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应对巴基斯坦风湿性心脏病的挑战：行动呼吁

尽管急性风湿热（ARF）和风湿性心脏病（RHD）的发病率很高，但在巴基斯坦国家和联邦卫生计划中的代表性不足。为了解决这一差距，我们收集了来自巴基斯坦一线临床医生的多地域和专业观点。RHD诊断和治疗的主要挑战包括地区卫生保健差异、诊断局限性、缺乏用于预防的苄星青霉素G （BPG）以及缺乏多学科RHD团队。我们的医生知情建议强调社区外展，有针对性的筛查和监测，以及对医疗保健提供者进行GAS感染和ARF诊断和管理方面的全面培训。加强多学科护理和确保稳定的BPG供应至关重要，将RHD护理纳入目前正在实施的全民健康覆盖（UHC）模式也是如此，以减轻患者的经济负担。改善RHD管理需要对医疗保健基础设施、从业人员培训和协调的政策努力进行系统性改革。至关重要的是，这些建议符合世卫组织关于初级（治疗气体感染）和二级预防（抗生素预防和筛查）的最新RHD指南。通过将当地的临床智慧转化为可操作的政策，这一观点产生了适合巴基斯坦的实际干预措施，这些干预措施也适用于类似的中低收入国家环境。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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