Zühlke Liesl, Watkins David, Engel Mark E
Department of Paediatrics, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa Department of Medicine, Groote Schuur Hospital Cape Town, Cape Town, South Africa.
Department of Medicine, Groote Schuur Hospital Cape Town, Cape Town, South Africa Department of Medicine, University of Washington, Seattle, Washington, USA.
BMJ Open. 2014 Jun 10;4(6):e004844. doi: 10.1136/bmjopen-2014-004844.
Rheumatic heart disease (RHD) is the principal cause of acquired heart disease affecting people living largely in poverty and deprived conditions. Sub-Saharan Africa was long thought to be the hotspot of the disease but recent reports suggest that this is no longer the case. South Africa is the leading economic force within this region yet contends with continued extreme income disparities. It is of interest to ascertain whether the strides that have been made in healthcare since the democratic transition in South Africa have translated into decreased RHD burden. We therefore propose to review the current best estimates of incidence of newly diagnosed RHD and prevalence of existing RHD within the past two decades. We also propose to characterise the fatal and non-fatal outcomes of RHD and identify any trends in this period.
We plan to search electronic databases and reference lists of relevant articles published from April 1994 to April 2014. Studies will be included if they estimated one of the following epidemiological measures: incidence, prevalence, remission rate, relative risk of mortality or cause-specific mortality. For studies deemed eligible for inclusion, we will assess overall study quality, reliability and risk of bias using design-specific criteria. We will extract data using a standardised form and perform descriptive and quantitative analysis to assess RHD prevalence, mortality and morbidity. This review protocol is registered in the PROSPERO International Prospective Register of systematic reviews, registration number CRD42014007072.
Our planned review will provide healthcare providers, public health officials and policymakers with pooled contemporary data regarding RHD, in particular regarding the effect the new political dispensation has had on the burden of this preventable disease within South Africa. In addition, these important country-specific data could influence policy decisions regarding prevention, management and control of RHD.
风湿性心脏病（RHD）是后天性心脏病的主要病因，主要影响生活在贫困和匮乏条件下的人群。长期以来，撒哈拉以南非洲一直被认为是该病的高发地区，但最近的报告表明情况已不再如此。南非是该地区的主要经济力量，但仍存在持续的极端收入差距。确定自南非民主转型以来在医疗保健方面取得的进展是否已转化为RHD负担的减轻很有意义。因此，我们建议回顾过去二十年中最新诊断的RHD发病率和现有RHD患病率的最佳估计值。我们还建议描述RHD的致命和非致命结局，并确定这一时期的任何趋势。
我们计划检索1994年4月至2014年4月发表的相关文章的电子数据库和参考文献列表。如果研究估计了以下流行病学指标之一：发病率、患病率、缓解率、死亡相对风险或特定病因死亡率，则将其纳入。对于被认为符合纳入条件的研究，我们将使用特定设计标准评估总体研究质量、可靠性和偏倚风险。我们将使用标准化表格提取数据，并进行描述性和定量分析，以评估RHD的患病率、死亡率和发病率。本综述方案已在PROSPERO国际前瞻性系统评价注册库中注册，注册号为CRD42014007072。
我们计划进行的综述将为医疗保健提供者、公共卫生官员和政策制定者提供有关RHD的汇总当代数据，特别是关于新的政治体制对南非这种可预防疾病负担的影响。此外,这些重要的特定国家数据可能会影响有关RHD预防、管理和控制的政策决策。
