How Poverty Causes Heart Disease

Despite being one of the most unequal societies on the planet, South Africa should not have to struggle to address diseases that are a direct result of poverty.

One of these diseases is rheumatic heart disease. Globally, more than 300 000 children are estimated to die each year because of the disease.

South Africa’s statistics on causes of death are notoriously suspect but the “heart of Soweto” study reported in 2010 that a high of 25 incidents of rheumatic heart disease were recorded out of 100 000 people.

Rheumatic disease is incubated in poor living conditions and lack of access to medication, factors which South Africa ought to be able to address.

The World Health Organisation agreed last week to launch a co-ordinated response to rheumatic fever and rheumatic heart disease.

But does South Africa need an international campaign to show us how to protect our children when the resolution of the problem lies within our means?

Rheumatic fever is one of the most common causes of cardiac disease in children. The streptococcus bacteria (Group A) causes strep throat which, if untreated, can lead to rheumatic fever that, in turn, can cause inflammation damage to the heart and other parts of the body. In the heart, inflammation and scarring can result in permanent narrowing of the valve channel; the heart will not pump effectively and the valves’ performance will drop.

Strep throat usually exhibits as fever and sore throat, with white dots or redness on the throat. It is easily treated with penicillin or amoxicillin.

In the absence of treatment, however, life-threatening consequences can arise.

The most recent estimate – by – of rheumatic disease deaths in South Africa was two people per 100 000 of the population.

There is some research evidence pointing to a drop in South African incidence of rheumatic fever in children since democracy, as primary health care strategies have brought knowledge and medicine to poor communities. However, Prof Bongani Mayosi has noted that this “Mandela dividend” (which also reflects the rising socio-economic status of South Africans) must be balanced against the increased incidence of adults with heart failure.

Mayosi also noted that treating doctors must take on board guidelines to treat all instances of sore throat in children with penicillin, and also to register rheumatic fever, given that it is a notifiable disease.

Historically, the incidence of rheumatic heart disease has decreased in developed countries, with improved living conditions and the availability of penicillin. In developing countries including South Africa, however, rheumatic heart disease remains a major cause of deaths in children, with hundreds of thousands of children dying from this disease every year.

Without major efforts to correct recording of death, it will remain very difficult to have accurate “burden of disease” figures and to provide proper treatment to manage diseases such as rheumatic fever.

A study is currently underway to determine more accurately the incidence of rheumatic fever in our population. No interim findings have been released.

For more information on rheumatic heart disease, visit

How Poverty Causes Heart Disease
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