Author: Nikil Chand (Umanand Prasad School of Medicine and Health Science - Year 3 student, 2020)
Rheumatic heart disease (RHD) is the result of an abnormal immune response to the bacteria Streptococcus pyogenes. The disease causes permanent scarring of the heart valves, which results in heart failure, stroke and early death. It primarily affects the world’s poorest and most disadvantaged populations and despite the availability of cheap and effective prevention strategies, receives little attention from policy-makers and funders .
Fiji and surrounding Pacific countries have the highest prevalence of RHD globally and that’s not a record that we should be proud of. RHD costs the country about 19 million dollars annually with the majority of the impact coming from the loss of productivity, hospitalization and surgical intervention . At least 60-70 deaths are being reportedly attributed to RHD in the south pacific island nation . RHD is the second leading cause of death in Fiji, second to drowning between the ages of 5-year old to 20-year-old in Fiji . Many children present late with valve damage (RHD) because many ARF presentations are not recognized in Fiji. The researchers found, patients presenting with potential features of ARF seldom had a diagnostic evaluation sufficient to exclude its diagnosis suggesting that many clinical staff working in the high incidence setting of Fijis are not familiar with the symptoms of ARF . Data on ARF and RHD were not recorded routinely until the establishment of a national RHD register and commencement of the World heart Federation control programme in 2005 .
Parental care has come under the spotlight as it is recognized as a major causative factor in the late diagnosis of RHD. Sometimes parents tend to regard their work more important than their children's health. “The young Navakai, Nadi lass, said the reality was that a few parents who had children suffering from Rheumatic Heart Disease (RHD) did not consider the pain children endured when given monthly Benza injections. Sometimes they don’t realize how much pain their kids go through when they are medically examined,” she said. RHD patients need more support from their family members. Sometimes when I go for my check-up and injection I usually go alone. Even though I couldn’t have gone through my journey with RHD without the support from my family” .
In June 2014, a five-year partnership project commenced with the aim of preventing and reducing the impact of rheumatic heart disease (RHD) in the Fiji Islands. Cure Kids is working collaboratively with the Fiji Ministry of Health and Medical Services, Auckland District Health Board, and the Centre for International Child Health at Murdoch Children’s Research Institute 
The goal is to:
Expand and strengthen the existing Fiji Rheumatic Heart Disease Control Programme to include developing new models of ARF/RHD care and prevention with the aim of reducing RHD related morbidity and mortality.
Fundamental to Project outputs is an effective national coordination structure for the Fiji RHD Control Programme (Fiji MOH).
Increasing capacity at this level will provide a governance model that can continue beyond the life of the Project .
In conclusion, to start reducing the number of cases of RHD in Fiji, we have to establish high quality and regularly maintained ARF/RHD, primary and secondary prevention strategies. Furthermore, registers are a vital component to primary data collection. Making ARF and RHD notifiable diseases seems to help increase case detection and establish disease burden. This has occurred in New Zealand and Australia, in many Pacific Islands, South Africa, and Tunisia. However, maintaining physicians' awareness of their legal obligation to notify and correctly implement the notification can be a significant barrier. It is also important that physicians remain up to date with the latest iteration of the Fiji Guidelines for Acute Rheumatic Fever and Rheumatic Heart Disease Diagnosis, Management and Prevention. Decentralizing diagnostic services through point-of-care technologies, such as portable echocardiography and rapid antigen detection test kits are therefore needed to further maximize case detection. Improvements in socioeconomic and environmental conditions can reduce Group A Strep infections and ARF.
Finally, understanding the clinical significance of asymptomatic RHD detected through echocardiographic screening (subclinical RHD) needs further clarification. Although there is a paucity of data regarding outcomes of these patients, recent evidence suggests that screening-detected RHD can progress significantly within 4–5 years with clinically-diagnosed RHD progressing the most rapidly [8, 9]. Some screening-detected RHD cases have progressed to require valve surgery, yet other studies have demonstrated a more stable course with over 90% of patients remaining only mildly affected.
Chambers, N.C. 2018. 60 To 70 Deaths Per Year From RHD, Nadi: Fiji Sun.https://fijisun.com.fj/2018/10/01/60-to-70-deaths-per-year-from-rhd/
Cure Kids Fiji. Retrieved from https://curekids.org.fj/rheumatic-heart-disease=RHD is a significant health, every classroom living with RHD.
Fiji Guidelines for Acute Rheumatic Fever and Rheumatic Heart Disease Diagnosis, Management and Prevention. 2020. pp. 3-4. Suva.
Fiji sees one of world's highest rates of Rheumatic Heart Disease. Retrieved from http://www.xinhuanet.com/english/2018-09/10/c_137458670.htm
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Rheumatic Heart Disease costs Fiji $19m annually. Retrieved from https://www.fnu.ac.fj/new/uncategorised/481-rheumatic-heart-disease-costs-fiji-19m-annually
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