END RHD Campaign

END RHD Campaign, Nepal

An initiative of Nepal Heart Foundation to fight Rheumatic Heart Disease in Nepal

Background

Rheumatic Heart Disease(RHD) is a 100% preventable condition but it still remains a major public health problem in Nepal with high morbidity and mortality in children and young adults. Around 1 to 10 per 1,000 children within the age of 5-15 years representing mostly from the low socio-economic class suffer from this disease. More than 1,000 children die every year from RHD and around 1,500 patients undergo heart valve replacement surgery and intervention every year. RHD has been considered as a neglected heart disease of the poor by the World Health Organization (WHO). 

Nepal Heart Foundation (NHF), a not for profit organization has been primarily focusing on prevention and control of RHD since its establishment in 1988.NHF has pursued a diagonal approach to focus on RHD within the framework of the existing health care system. The RHD control program was initiated in partnership with the Government of Nepal which was in action from 2007 until 2013. Later in 2014 Government of Nepal changed its policy and started focusing on patients support for heart valve surgeries leaving behind the prevention part. In recent years NHF has extended its RHD prevention activities through the partnership with other organizations.

In December 2019, NHF launched the “End RHD Campaign, Nepal”as a credible new initiative to fight RHD. SGNHC joined in this noble venture in June, 2020. To support the sustainability of this campaign NHF announced establishment of a trust fund by the name RHD Research Fund in December 2019. Later in 2024 the trust fund was renamed as END RHD FUND (ERHDF).

Methods:  Implementing comprehensive RHD control program thatincludes Primary, Secondary and Tertiary prevention (in line with the 25 components outlined by the WorldHeart Federation (WHF).

Primary Prevention

1. Awareness raisingon link of bacterial sore throat and RHD
2. Make Oral Penicillin and other antibiotics available for treatment of sore throat
3. Facilitate treatment of bacterial sore throat with antibiotics

Secondary Prevention

1. Early detection through heart screenings
2. RHD Patient Registry
3. Make Inj. Benzathine Penicillin G (BPG) and Tab. Penicillin V easily available
4. Extend health facilities for safe delivery of injection BPG

Tertiary Prevention

1. Make Oral Anticoagulant (warfarin) easily available
2. Extend PT/INR testing facilities
3. Availability of Heart Valve Surgery facilities
4. Contact &tracing (Surveillance) of post valve surgery patients for PT/INR monitoring

Lead Organization: NHF

National RHD Prevention & Control Program Management Committee (proposed)

Chairperson               :   President, NHF Central Committee

Vice Chairperson      :   HoD, Department of Preventive Cardiology and Cardiac Rehabilitation, SGNHC

Executive Director   :   National Program Director of NHF

Members                    :   Representative of SGNHC (1)+ One representative from each Province of Nepal (7) + Cardiologists (2)

Advisors                       :  As needed

Work Plan Outlines:

Baseline Works: (completed)

1. Program Committee Formation (National level)
2. MoU with SGNHC and Nepal Pediatric society (NEPAS)
3. Production of awareness raising materials
4. Publication of health workers training materials and manuals
5. Publication of education materials for secondary level school education
6. Publication of RHD Patient Registers (electronic and paper based)
7. RHD patients Club Formation
8. Data collection (epidemiological survey of RHD). Burden evaluation.
9. Pilot Project of RHD prevention in Chandragiri Municipality, Kathmandu
10. Establishment of END RHD Fund
11. Procurement and storage of Inj BPG and Penicillin V
12. Production of RHD focused echocardiography training manual for Non-experts
13. Training of nurses on RHD focused Echocardiography

RHD Patient Registry and delivery of medicines and injections:(Ongoing)

1. Facilitate in making oral penicillin available for patients for treatment of sore throat,
2. Ensure easy availability of Inj. BPG to the needy patients,
3. Develop required health facilities for delivery of Inj. BPG for secondary prophylaxis,
4. Make oral anticoagulant Warfarin easily available,
5. Maintain RHD Patient Registry at all service outlets.

Monitoring and Evaluation: 5 years, 10 years

Scientific Data Presentation (Posters)