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Introduction Asthma is the most common paediatric chronic disease. (1) In 2006, approximately 14% of the world's children experienced asthma symptoms. (2,3) In African countries, the prevalence of asthma ranges [...], Problem In 2008, the prevalence of paediatric asthma in Zambia was unknown and the national treatment guideline was outdated. Approach We created an international partnership between Zambian clinicians, the Zambian Government and a pharmaceutical company to address shortcomings in asthma treatment. We did two studies, one to estimate prevalence in the capital of Lusaka and one to assess attitudes and practices of patients. Based on the information obtained, we educated health workers and the public. The information from the studies was also used to modernize government policy for paediatric asthma management. Local setting The health-care system in Zambia is primarily focused on acute care delivery with a focus on infectious diseases. Comprehensive services for noncommunicable diseases are lacking. Asthma management relies on treatment of acute exacerbations instead of disease control. Relevant changes Seven percent of children surveyed had asthma (255/3911). Of the 120 patients interviewed, most (82/120,68%) used oral short-acting [[beta].sub.2]-agonists for symptom control; almost half (59/120,49%) did not think the symptoms were preventable and 43% (52/120) thought inhalers were addictive. These misconceptions informed broad-based educational programmes. We used a train-the- trainer model to educate health-care workers and ran public awareness campaigns. Access to inhalers was Increased and the Zambian standard treatment guideline for paediatric asthma was revised to include steroid Inhalers as a control treatment. Lessons learnt Joint activities were required to change paediatric asthma care in Zambia. Success will depend on local sustainability, and it may be necessary to shift resources to mirror the disease burden. Probleme En 2008, la prevalence de l'asthme chez les enfants en Zambie etait Inconnue et les recommandations nationales en matiere de traitement etaient obsoletes. Approche Nous avons mis en place un partenariat international entre des medecins zambiens, le gouvernement du pays et une societe pharmaceutique afin de remedier aux manques dans le traitement de l'asthme. Nous avons mene deux etudes, une pour estimer la prevalence de la maladie dans la capitale, Lusaka, et l'autre pour evaluer les comportements et les pratiques des patients. Les informations obtenues nous ont permis de sensibiliser les professionnels de sante ainsi que le grand public Elles ont egalement contribue a moderniser la politique du. gouvernement concernant la prise en charge pediatrique de l'asthme. Environnement local Le systeme de sante en Zambie est essentiellement axe sur la prestation de soins de courte duree, notamment pourtraiter les maladies infectieuses. Il n'offre pas de services complets pour le traitement des maladies non transmissibles. La prise en charge de l'asthme repose sur le traitement des exacerbations aigues plutot que sur le controle de la maladie. Changements significatifs Sept pour cent des enfants de l'etude avaient de l'asthme (255/3911). Sur les 120 patients interroges, la plupart (82/120,68%) utilisaient des [[beta].sub.2]-stimulants a action breve par vole orale pour soulager les symptomes; pres de la moitie (59/120, 49%) ne pensaient pas que les symptomes etaient evitables et 43% (52/120) pensaient que les inhalateurs creaient une dependance. Ces idees fausses ont oriente la conception de vastes programmes de sensibilisation. Nous avons utilise un modele de formation des formateurs a l'intention des professionnels de sante et mene des campagnes de sensibilisation a destination du public. L'acces aux inhalateurs a ete elargi et les recommandations de la Zambie quant au traitement standard de l'asthme ont ete revisees afin d'inclure les Inhalateurs de steroides comme traitement de fond. Lecons tirees Des activites conjointes ont ete requises pour modifier la prise en charge pediatrique de l'asthme en Zambie. Leur succes dependra de leur durabilite au niveau local; il pourra aussi etre necessaire de reaffecter des ressources en fonction de la charge de morbidite. Situacion En 2008, se desconocia la prevalencia del asma infantil en Zambia y las directrices nacionales sobre el tratamiento estaban obsoletas. Enfoque Con el objetivo de poner remedio a las deficiencias en el tratamiento del asma, se creo una alianza internacional entre los medicos zambianos, el Gobierno de Zambia y una compania farmaceutica. Se llevaron a cabo dos estudios, uno para obtener una estimacion de la prevalencia en Lusaka, la capital, y otro para evaluarlos comportamientos y consultas con los pacientes. En base a la informacion obtenida, se educo tanto al personal sanitario como al publico general. La informacion obtenida de los estudios tambien se utilizo para modernizar la politica del gobierno sobre la gestion del asma infantil. Marco regional El sistema sanitario de Zambia se centra principalmente en una rigurosa prestacion de asistencia sanitaria, con el punto de mira puesto en las enfermedades infecciosas. Hay una falta de servicios integrales para las enfermedades no contagiosas. La gestion del asma radica en el tratamiento de la exacerbacion aguda en lugar del control de la enfermedad. Cambios importantes El siete por ciento de los ninos encuestados han tenido asma (255/3.911). De los 120 pacientes entrevistados, la mayoria (82/120, un 68%) utilizaron agonistas [[beta].sub.2] de accion corta por via oral para controlar los sintomas; casi la mitad (59/120, un 49%) consideraron que los sintomas no se podian prevenir y un 43% (52/120) pensaron que los inhaladores eran adictivos. Estas ideas equivocadas sirvieron para informar a los programas educativos de amplio espectro. Se utilizo un modelo para formara los instructores para educar al personal sanitario y se llevaron a cabo campanas de sensibilizacion de los ciudadanos. Aumento el acceso a los inhaladores y se revisaron los estandares de las directrices sobre el tratamiento del asma infantil en Zambia para incluir esteroides inhalados como parte del tratamiento de control. Lecciones aprendidas Hizo falta unirfuerzas para cambiarei cuidado del asma infantil en Zambia. El exito dependera de la sostenibilidad del lugar y puede quesea necesario hacer un intercambio de recursos para asi poder reflejar la carga de la enfermedad.

The use of broad consent for genomics research raises important ethical questions for the conduct of genomics research, including relating to its acceptability to research participants and comprehension of difficult scientific concepts. To explore these and other challenges, we conducted a study using qualitative methods with participants enrolled in an H3Africa Rheumatic Heart Disease genomics study (the RHDGen network) in Zambia to explore their views on broad consent, sample and data sharing and secondary use. In-depth interviews were conducted with RHDGen participants (n = 18), study staff (n = 5) and with individuals who refused to participate (n = 3). In general, broad consent was seen to be reasonable if reasons for storing the samples for future research use were disclosed. Some felt that broad consent should be restricted by specifying planned future studies and that secondary research should ideally relate to original disease for which samples were collected. A few participants felt that broad consent would delay the return of research results to participants. This study echoes findings in other similar studies in other parts of the continent that suggested that broad consent could be an acceptable consent model in Africa if careful thought is given to restrictions on re-use. [ABSTRACT FROM AUTHOR]

Background: The large global burden of rheumatic heart disease (RHD) has come to light in recent years following robust epidemiologic studies. As an operational research component of a broad program aimed at primary and secondary prevention of RHD, we sought to determine the current prevalence of RHD in the country's capital, Lusaka, using a modern imaging-based screening methodology. In addition, we wished to evaluate the practicality of training local radiographers in echocardiography screening methods.Methods: Echocardiography was conducted on a random sample of students in 15 schools utilizing a previously validated, abbreviated screening protocol. Through a task-shifting scheme, and in the spirit of capacity-building to enhance local diagnostic and research skills, general radiographers based at Lusaka University Teaching Hospital (UTH) were newly trained to use portable echocardiography devices. Students deemed as screen-positive were referred for comprehensive echocardiography and clinical examination at UTH. Cardiac abnormalities were classified according to standard World Heart Federation criteria.Results: Of 1102 students that were consented and screened, 53 students were referred for confirmatory echocardiography. Three students had definite RHD, 10 had borderline RHD, 29 were normal, and 11 students were lost to follow-up. The rates of definite, borderline, and total RHD were 2.7 per 1000, 9.1 per 1000, and 11.8 per 1000, respectively. Anterior mitral valve leaflet thickening and chordal thickening were the most common morphological defects. The pairwise kappa test showed fair agreement between the local radiographers and an echocardiographer quality assurance specialist.Conclusion: The prevalence of asymptomatic RHD in urban communities in Zambia is within the range of results reported in other sub-Saharan African countries using the WHF criteria. Task-shifting local radiographers to conduct echocardiography was feasible. The results of this study will be used to inform ongoing efforts in Zambia to control and eventually eliminate RHD.Trial Registration: The study was registered on clinicaltrials.gov ( #NCT02661763 ). [ABSTRACT FROM AUTHOR]

Importance: Rheumatic heart disease (RHD) remains a public health issue in low- and middle-income countries (LMICs). However, there are few large studies enrolling individuals from multiple endemic countries., Objective: To assess the risk and predictors of major patient-important clinical outcomes in patients with clinical RHD., Design, Setting, and Participants: Multicenter, hospital-based, prospective observational study including 138 sites in 24 RHD-endemic LMICs., Main Outcomes and Measures: The primary outcome was all-cause mortality. Secondary outcomes were cause-specific mortality, heart failure (HF) hospitalization, stroke, recurrent rheumatic fever, and infective endocarditis. This study analyzed event rates by World Bank country income groups and determined the predictors of mortality using multivariable Cox models., Results: Between August 2016 and May 2022, a total of 13 696 patients were enrolled. The mean age was 43.2 years and 72% were women. Data on vital status were available for 12 967 participants (94.7%) at the end of follow-up. Over a median duration of 3.2 years (41 478 patient-years), 1943 patients died (15% overall; 4.7% per patient-year). Most deaths were due to vascular causes (1312 [67.5%]), mainly HF or sudden cardiac death. The number of patients undergoing valve surgery (604 [4.4%]) and HF hospitalization (2% per year) was low. Strokes were infrequent (0.6% per year) and recurrent rheumatic fever was rare. Markers of severe valve disease, such as congestive HF (HR, 1.58 [95% CI, 1.50-1.87]; P < .001), pulmonary hypertension (HR, 1.52 [95% CI, 1.37-1.69]; P < .001), and atrial fibrillation (HR, 1.30 [95% CI, 1.15-1.46]; P < .001) were associated with increased mortality. Treatment with surgery (HR, 0.23 [95% CI, 0.12-0.44]; P < .001) or valvuloplasty (HR, 0.24 [95% CI, 0.06-0.95]; P = .042) were associated with lower mortality. Higher country income level was associated with lower mortality after adjustment for patient-level factors., Conclusions and Relevance: Mortality in RHD is high and is correlated with the severity of valve disease. Valve surgery and valvuloplasty were associated with substantially lower mortality. Study findings suggest a greater need to improve access to surgical and interventional care, in addition to the current approaches focused on antibiotic prophylaxis and anticoagulation.

Background: The genetics of rheumatic heart disease (RHDGen) Network was developed to assist the discovery and validation of genetic variations and biomarkers of risk for rheumatic heart disease (RHD) in continental Africans, as a part of the global fight to control and eradicate rheumatic fever/RHD. Thus, we describe the rationale and design of the RHDGen study, comprising participants from 8 African countries., Methods: RHDGen screened potential participants using echocardiography, thereafter enrolling RHD cases and ethnically-matched controls for whom case characteristics were documented. Biological samples were collected for conducting genetic analyses, including a discovery case-control genome-wide association study (GWAS) and a replication trio family study. Additional biological samples were also collected, and processed, for the measurement of biomarker analytes and the biomarker analyses are underway., Results: Participants were enrolled into RHDGen between December 2012 and March 2018. For GWAS, 2548 RHD cases and 2261 controls (3301 women [69%]; mean age [SD], 37 [16.3] years) were available. RHD cases were predominantly Black (66%), Admixed (24%), and other ethnicities (10%). Among RHD cases, 34% were asymptomatic, 26% had prior valve surgery, and 23% had atrial fibrillation. The trio family replication arm included 116 RHD trio probands and 232 parents., Conclusions: RHDGen presents a rare opportunity to identify relevant patterns of genetic factors and biomarkers in Africans that may be associated with differential RHD risk. Furthermore, the RHDGen Network provides a platform for further work on fully elucidating the causes and mechanisms associated with RHD susceptibility and development.

Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) remain major causes of heart failure, stroke and death among African women and children, despite being preventable and imminently treatable. From 21 to 22 February 2015, the Social Cluster of the Africa Union Commission (AUC) hosted a consultation with RHD experts convened by the Pan-African Society of Cardiology (PASCAR) in Addis Ababa, Ethiopia, to develop a 'roadmap' of key actions that need to be taken by governments to eliminate ARF and eradicate RHD in Africa. Seven priority areas for action were adopted: (1) create prospective disease registers at sentinel sites in affected countries to measure disease burden and track progress towards the reduction of mortality by 25% by the year 2025, (2) ensure an adequate supply of high-quality benzathine penicillin for the primary and secondary prevention of ARF/RHD, (3) improve access to reproductive health services for women with RHD and other non-communicable diseases (NCD), (4) decentralise technical expertise and technology for diagnosing and managing ARF and RHD (including ultrasound of the heart), (5) establish national and regional centres of excellence for essential cardiac surgery for the treatment of affected patients and training of cardiovascular practitioners of the future, (6) initiate national multi-sectoral RHD programmes within NCD control programmes of affected countries, and (7) foster international partnerships with multinational organisations for resource mobilisation, monitoring and evaluation of the programme to end RHD in Africa. This Addis Ababa communiqué has since been endorsed by African Union heads of state, and plans are underway to implement the roadmap in order to end ARF and RHD in Africa in our lifetime.