Moloi Annesinah H, Mall Sumaya, Engel Mark E, Stafford Renae, Zhu Zhang Wan, Zühlke Liesl J, Watkins David A
Department of Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Centre for Evidence Based Health Care, Faculty of Health Sciences, Stellenbosch University, Stellenbosch, South Africa; Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
Glob Heart. 2017 Mar;12(1):5-15.e3. doi: 10.1016/j.gheart.2016.12.002. Epub 2017 Mar 14.
Rheumatic heart disease (RHD) is an important and preventable cause of cardiovascular disease.
As part of a recent RHD initiative in Uganda and Tanzania, we systematically reviewed group A streptococcal disease (GAS), acute rheumatic fever (ARF), and RHD in these countries.
Using a systematic review and meta-analysis/meta-synthesis, we searched PubMed, Embase, and grey literature for quantitative and qualitative studies conducted in Uganda and Tanzania that included individuals affected by GAS, ARF, and RHD. We pre-specified 3 sets of outcomes: 1) disease epidemiology; 2) barriers and facilitators to health care; and 3) stakeholder identification and engagement. Study descriptors, outcomes, and interest, and quality assessments were recorded. For the first objective, we conducted random-effects meta-analyses. For the second objective, we produced a narrative synthesis of themes. No studies contained data on the third objective.
Of 293 records identified, 12 met our inclusion criteria (9 for objective 1 and 3 for objective 2). Most quantitative studies were at moderate or high risk of bias, and only 1 of 2 qualitative studies was high quality. We estimated the prevalence of RHD to be 17.9 (95% confidence interval [CI]: 4.0 to 41.2) per 1,000 individuals. The most frequent nonfatal sequelae were heart failure, pulmonary hypertension, and atrial fibrillation. Case-fatality rates in medical and surgical wards were 17% (95% CI: 13% to 21%) and 27% (95% CI: 18% to 36%), respectively. Barriers and facilitators to GAS and RHD care were identified in the domains of individual knowledge, family support, provider communication and knowledge, and system design.
RHD remains endemic in Tanzania and Uganda, and symptomatic RHD is associated with high rates of morbidity and mortality. We have identified critical data gaps in the areas of GAS and ARF epidemiology as well as health care utilization patterns and their determinants.
风湿性心脏病（RHD）是心血管疾病的一个重要且可预防的病因。
作为乌干达和坦桑尼亚近期风湿性心脏病倡议的一部分，我们系统回顾了这些国家的A组链球菌病（GAS）、急性风湿热（ARF）和风湿性心脏病。
我们采用系统回顾和荟萃分析/综合分析方法，在PubMed、Embase和灰色文献中检索在乌干达和坦桑尼亚开展的定量和定性研究，这些研究纳入了受GAS、ARF和RHD影响的个体。我们预先设定了3组结果：（一）疾病流行病学；（二）医疗保健的障碍和促进因素；（三）利益相关者的识别和参与。记录研究描述符、结果、兴趣点和质量评估。对于第一个目标，我们进行随机效应荟萃分析。对于第二个目标，我们对主题进行了叙述性综合分析。没有研究包含关于第三个目标的数据。
在识别出的293条记录中，12条符合我们的纳入标准（目标1为9条，目标2为3条）。大多数定量研究存在中度或高度偏倚风险，2条定性研究中只有1条质量较高。我们估计每1000人中风湿性心脏病的患病率为17.9（95%置信区间[CI]：4.0至41.2）。最常见的非致命后遗症是心力衰竭、肺动脉高压和心房颤动。内科和外科病房的病死率分别为17%（95%CI：13%至21%）和27%（95%CI：18%至36%）。在个人知识、家庭支持、医护人员沟通与知识以及系统设计等领域确定了GAS和RHD护理的障碍和促进因素。
风湿性心脏病在坦桑尼亚和乌干达仍然流行，有症状的风湿性心脏病与高发病率和高死亡率相关。我们已经确定了GAS和ARF流行病学以及医疗保健利用模式及其决定因素方面的关键数据空白。
