LETTER
Preventing Rheumatic Heart Disease in Developing Countries
John D. Schwankhaus, MD
1 July 1994 | Volume 121 Issue 1 | Page 77
TO THE EDITOR:
I read with interest the article by Marcus and colleagues [1] on rheumatic mitral valve disease in developing countries. The enormity of this problem was obvious during a recent visit to the National Institute of Cardiology at Bach Mai Hospital in Hanoi, Vietnam. Patients with rheumatic heart disease accounted for 60% of those on a vastly overcrowded cardiology ward. There were so many patients that each of the 55 beds was occupied by two to three persons. Lack of a primary prevention program, scarcity of antibiotics to treat group A streptococcal pharyngitis, and a tendency for patients to seek medical assistance only when they were severely ill and unable to work were responsible for this sad problem. Rheumatic heart disease in Vietnam, with an estimated prevalence of 6.5 cases per 1000 persons, is overcrowding acute care hospitals, which lack the means to provide treatment. Because of a lack of equipment and supplies, only 10 open-heart surgeries per year can be done at this facility. Prevention must be a major emphasis of third-world countries and international organizations that provide aid. The effect of local educational programs in conjunction with benzathine penicillin to treat group A streptococcal pharyngitis and rheumatic fever in its early phases would be far more cost-effective than expensive surgical procedures for the late complications of the diseases [2].
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Author and Article Information
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Veterans Affairs Outpatient Clinic; Lubbock, TX 79410
1. Marcus RH, Saredi P, Pocock WA, Barlow JB. The spectrum of severe rheumatic mitral valve disease in a developing country: correlations among clinical presentation, surgical pathologic findings, and hemodynamic sequelae. Ann Intern Med. 1994; 120:177-83.
2. Massell BF, Chute CG, Walker AM, Kurland GS. Penicillin and the marked decrease in morbidity and mortality from rheumatic fever in the United States. N Engl J Med. 1988; 318:280-6.
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