The Oxford Dictionary defines neglect as ‘fail to care properly’. It is this failure that is resulting in a high prevalence of rheumatic heart disease (RHD) prevalence among Samoa’s children. It is a preventable condition.

However, many parents are failing to recognise the symptoms that could lead to serious conditions where the child incurs life-threatening injuries to the heart. To understand how parents often neglect proper medical care and allow their children to develop RHD, we have to understand what this disease is.

Since we are not medical experts, we give you the definition of RHD as defined by the World Health Organisation.

According to WHO, rheumatic heart disease starts as a sore throat from a bacterium called Streptococcus pyogenes (group A streptococcus) which can pass easily from person to person in the same way as other upper respiratory tract infections. Strep infections are most common in childhood.

In some people, repeated strep infections cause the immune system to react against the tissues of the body including inflaming and scarring the heart valves. This is what is referred to as rheumatic fever. Rheumatic heart disease results then from the inflammation and scarring of heart valves caused by rheumatic fever.

Rheumatic fever mostly affects children and adolescents in low- and middle-income countries, especially where poverty is widespread and access to health services is limited. People who live in overcrowded and poor conditions are at greatest risk of developing the disease.

The practice in most Pacific countries including ours is that when children develop sore throat infections, there is no urgency to get them medical care. For the parents, it is a symptom of the common cold and will go away soon. This is the mistake that allows rheumatic fever to develop leading to rheumatic heart diseases.

Parents need to push for a RHD screening if they have access to these services for children between 10 and 13 years. Better still, something as small as a sore throat must be taken very seriously.

This is the reason why the Ministry of Health is concerned and stepped up its plans to conduct RHD screening among children as early as next year.

Acting Director General Atoa Dr. Glen Fatupaito said RHD remains a major health issue among children.

“There are two types of heart problems presented among Samoan children. Congenital heart problems

The most effective way of dealing with RHD is early detection.

Noted Cardiologist Professor Asiata Dr. Satupaitea Viali in a research paper wrote that RHD remained a major cause of morbidity and premature death in Samoa.

There is no cure for rheumatic heart disease and the damage to the heart valves are permanent. Patients with severe rheumatic heart disease will often require surgery to replace or repair the damages valve or valves.

Depending on the severity of disease, medication may also be needed to treat symptoms of heart failure or heart rhythm abnormalities. Medications which thin the blood to reduce the risk of blood clots may also be needed. In the case of serious disease surgery may be required to repair or replace the heart valves. This is often not available in low-income settings, or when it is available the costs may be too high if not covered as part of national health plans, putting families under increased financial strain.

Rheumatic heart disease is preventable. Since rheumatic heart disease results from rheumatic fever, an important strategy is to prevent rheumatic fever from occurring. Treatment of strep throat with appropriate antibiotics will prevent rheumatic fever.

Once a patient has been identified as having had rheumatic fever, it is important to prevent additional streptococcal infections as this could cause a further episode of rheumatic fever and additional damage to the heart valves. The strategy to prevent additional streptococcal infection is to treat the patient with antibiotics over a long period of time.

For countries like ours where rheumatic heart disease is endemic,  the main strategies for prevention, control and elimination include: improving standards of living; expanding access to appropriate care; ensuring a consistent supply of quality-assured antibiotics for primary and secondary prevention; and planning, developing and implementing feasible programmes for prevention and control of rheumatic heart disease, supported by adequate monitoring and surveillance, as an integrated component of national health systems responses.

Next time a child has a sore throat, get them properly accessed and hopefully medical personnel when treating sore throats in children do proper due diligence.

We hope that the planned rheumatic fever and RHD screening is a nationwide exercise.