Ending RHD is a challenge due to a combination of low awareness, lack of healthcare access and treatment, inadequate diagnosis and inadequate medical training.
While rheumatic heart disease can easily be prevented by effective management of strep throat, treatment at this early stage is often not achieved. Families may not have the means to access a healthcare facility or may not seek care due to low awareness of the potential risk of untreated strep throat. Healthcare workers may also not have the necessary knowledge to appropriately diagnose and manage a strep throat. Currently, a large proportion of those suffering rheumatic heart disease are not diagnosed or are diagnosed at a late stage when damage to the heart is very severe.
When long-term treatment is required, access to care becomes an even greater issue, as it can be costly and challenging for patients to regularly visit a healthcare facility.
A steady supply of benzathine penicillin G is an essential prerequisite for treatment of sore throat and to prevent recurrent infection. However, the antibiotic is prone to global shortages. While demand for the drug is rising, high manufacturing costs and low purchase prices have pushed some manufacturers out of the market. When the medication is not available, necessary long-term treatment regimens are disrupted.
Finally, in many rheumatic heart disease-endemic countries there is little or no access to life-saving heart valve surgery, 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.