Findings from the last major systematic review of the global
Findings from the last major systematic review of the global prevalence of echocardiographic rheumatic Rimonabant disease showed that the highest calculated regional prevalence was in sub-Saharan Africa (5·7 cases per 1000 people), indigenous people in the Pacific islands, Australia, and New Zealand (3·5 cases per 1000 people), and south central Asia (2·2 cases per 1000 people). By contrast, the additional studies included in the present review show that southeast Asia is the new hot spot for echocardiographic rheumatic heart disease (28·0 cases per 1000 people, 95% CI 16·6–49·9), followed by Oceania (14·0 per 1000 people, 7·7–25·5), and Africa (7·9 per 1000 people, 2·9–21·4). The dramatic revival of rheumatic heart disease in the former Soviet republics of central Asia since the fall of the Berlin Wall in 1989 is consistent with the location of the epicentre of rheumatic heart disease in Asia reported in the present systematic review. The changing pattern of rheumatic heart disease in different regions of the world emphasises the importance of improving social conditions and access to primary health care for the control of rheumatic heart disease.
The pooled prevalence of clinical rheumatic heart disease (ie, presence of pathological murmur) seemed to be comparable whether it was measured by auscultation only (2·9 per 1000 people, 95% CI 1·7–5·0) or by echocardiography and auscultation (2·7 per 1000 people, 1·6–4·4), which is remarkable. Consensus is emerging that this group of people with asymptomatic but clinically evident rheumatic heart disease should be considered for secondary antibiotic prophylaxis with penicillin to prevent progression to symptomatic disease, although there is no randomised evidence to support this recommendation. However, the challenge is how to manage treatment in children and adolescents with clinically silent rheumatic heart disease, whose prevalence was substantially higher than the cases of clinically manifest rheumatic heart disease in this systematic review. There is limited information on the natural history and virtually no evidence upon which to base the management of children and adolescents with asymptomatic subclinical rheumatic heart disease that is detected on active surveillance. The time has come to launch large-scale prospective studies of the natural history of latent rheumatic heart disease and trials to assess the efficacy of penicillin prophylaxis to prevent progression of disease.
The most important message of this systematic review and meta-analysis is that rheumatic heart disease remains a major public health problem in developing countries. The disease causes the highest number of disability-adjusted life-years of all listed cardiovascular diseases among 10–14-year-olds (516·6 per 100 000 people, 95% CI 425·3–647·0) and the second highest number among children aged 5–9 years (362·0 per 100 000 people, 294·6–462·0). WHO has set a target of reducing premature mortality from rheumatic heart disease and other non-communicable disease by 25% by the year 2025. This target can be achieved and exceeded through the establishment of national rheumatic heart disease programmes that implement a comprehensive strategy for primary and secondary prevention of the disease, such as the Stop Rheumatic Heart Disease A.S.A.P. Programme, which has been launched in Africa.
Pneumonia is the leading killer of children younger than 5 years, and the greatest risk of mortality from pneumonia in childhood is in the neonatal period. Substantial reductions in childhood pneumonia deaths have been hindered by a lack of progress in addressing neonatal mortality. Deaths in the neonatal period constitute 41·6% of the 6·3 million children who die annually before their fifth birthday. In 2010, there were an estimated 1·7 million cases of neonatal sepsis and 510 000 cases of neonatal pneumonia. On Nov 12, World Pneumonia Day, we focus on prevention of pneumonia in these youngest and most susceptible victims.