Bridging Knowledge Gaps in Rheumatic Heart Disease Prevention: A Narrative Review of Educational Interventions Across Resource-Limited Settings.

Abstract

Background: Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) remain major public health challenges in low- and middle-income countries, where limited awareness, delayed care-seeking, and inadequate provider training contribute to preventable morbidity and mortality.

Methods: A narrative review was conducted using an integrative synthesis framework to examine educational and awareness strategies implemented between 2010 and 2025. Searches across MEDLINE, Scopus, CINAHL, DOAJ, and grey literature sources identified studies reporting educational interventions targeting community members, mothers, students, or healthcare workers. Seven eligible studies were synthesised thematically based on intervention type, delivery modality, and outcomes.

Result: Across the seven included studies, educational and awareness interventions consistently improved knowledge, attitudes, preventive practices, or clinical competencies related to ARF/RHD. Although study designs, target populations, and delivery modes varied widely, all interventions demonstrated positive short-term effects. Healthcare-worker programmes reported notable gains in clinical understanding and confidence, particularly regarding diagnosis and benzathine penicillin use. Maternal education improved awareness and preventive practices, while school-based sessions enhanced immediate understanding despite a gradual decline over time. Community-level mass-media campaigns achieved broad reach and generated substantial increases in both knowledge and seeking care for sore throat. Collectively, the evidence demonstrates clear beneficial trends, though long-term sustainability and comparative effectiveness remain insufficiently evaluated.

Conclusion: Educational and awareness interventions consistently improve ARF/RHD-related knowledge, behaviours, and clinical competencies. Sustained impact, however, depends on integrated, multi-level approaches that combine school-based reinforcement, maternal education, health-worker training, and community-wide communication.