This partnership is working to eliminate rheumatic heart disease (RHD) in Zambia. RHD is caused by streptococcal pharyngitis, commonly known as strep throat. Strep throat is easily treated with penicillin. But untreated, some patients will eventually form scars on valves of the heart. Over time, this can lead to heart failure and, ultimately, early death. In sub-Saharan Africa, recent studies show that a staggering 1-3% of school-age children have early signs of disease. “BeatRHD Zambia” is tackling RHD through a multi-faceted effort involving research, health system strengthening, public awareness, and health policy activities.

(1) Research. New technology is revolutionizing the way doctors can identify children with RHD. Portable echocardio¬graphy machines create ultrasound images of the heart that can show tissue damage even before symptoms appear. Using this new technology, over 3,000 schoolchildren in Lusaka have been screened. Children diagnosed with RHD are offered monthly penicillin injections. The in-country stocks of penicillin have been supplemented by a product grant from Sandoz to help ensure availability. The results of the screening are being analyzed currently and will, for the first time, indicate the prevalence of RHD in a Zambian population using echocardiography. (2) Health system strengthening. The partnership supports efforts of the local doctors and nurses to strengthen health systems in Lusaka to help children with strep throat and RHD receive the treatment they need. Currently, 7 government clinics in Lusaka have been enrolled in this effort. All clinics completed an initial training workshop about RHD prevention and treatment and receive ongoing coaching by nurses from the university hospital. Free penicillin treatment is offered to patients, including medicine that was granted by Sandoz to the Ministry of Health. At the invitation of the health authorities in Zambia, the partnership plans to extend the rollout of the RHD training and treatment effort from the initial Lusaka scheme to multiple provinces across Zambia. (3) Public awareness. Public awareness is essential to RHD prevention and treatment. The partnership has distributed key messages through television and radio programs, and educational brochures and posters. Many of these activities took place during a nationally sponsored “RHD Week” in August 2015 that was launched with a televised address by Zambia’s Minister of Health. (4) Policy. The partnership has contributed to health policy work to support RHD elimination throughout Africa. Partners helped to sponsor meetings of technical experts from more than 10 countries on three occasions under the auspices of the Pan African Society of Cardiology, which ultimately helped seed an RHD Policy Roadmap developed by the African Union and agreed upon by African Ministers of Health and Heads of States in 2015.

(1) Capacity-Building: Echocardiography services. As part of the partnership’s research efforts we helped to develop local technical expertise to conduct echocardiographic screening suitable for resource-limited environments. This was necessary because few health workers in Lusaka are skilled in cardiac echocardiography. Rather than relying exclusively on experts from abroad, from the outset of the study we chose to use this effort to build local echocardiographic capabilities that could be applied to subsequent clinical and research activities in Zambia. (2) Technology transfer: “eRegister” for improved patient care. The clinical management of patients with RHD is complex. It requires monthly penicillin injections, regular clinical examinations, and echocardiography at least once or twice annually. A novel mobile, electronic patient register (“eRegister”) was developed and deployed to help doctors and nurses to track patient care. The partners are now providing support to facilitate rollout of this new electronic registry system in other African countries.

The initiative is coordinated by Dr. John Musuku, Chief of Paediatrics at University Teaching Hospital. The Zambia Ministry of Health approves all programs that take place in government clinics. The University of Zambia and the Zambia Paediatric Association provide technical expertise. Novartis provides strategic planning and project management assistance, along with technical expertise and some grants. The partners have teleconferences 2-4 times monthly to discuss planning, implementation, monitoring, and evaluation of program activities.

University Teaching Hospital (Lusaka, Zambia), Zambia Ministry of Health, University of Zambia, Zambia Paediatric Association, Sandoz, Novartis Institutes for BioMedical Research