{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T02:23:52Z","timestamp":1784082232647,"version":"3.55.0"},"reference-count":37,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2023,6,1]],"date-time":"2023-06-01T00:00:00Z","timestamp":1685577600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100015777","name":"Division of Research Capacity Development","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/501100015777","id-type":"DOI","asserted-by":"publisher"}]},{"name":"UK Medical Research Council and UK Department for International Development","award":["MR\/S005242\/1"],"award-info":[{"award-number":["MR\/S005242\/1"]}]},{"name":"National Research Foundation of South Africa","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,5,22]]},"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Rheumatic heart disease (RHD) is responsible for a significant burden of cardiovascular morbidity and mortality, and remains the most common cause of acquired heart disease among children and young adults in low-income and middle-income countries. Additionally, the global COVID-19 pandemic has forced the emergency restructuring of many health systems, which has had a broad impact on health in general, including cardiovascular disease. Despite significant cost to the health system and estimates from 2015 indicating both high incidence and prevalence of RHD in South Africa, no cohesive national strategy exists. An updated review of national burden of disease estimates, as well as literature on barriers to care for patients with RHD, will provide crucial information to assist in the development of a national RHD programme.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>Using predefined search terms that capture relevant disease processes from Group A Streptococcal (GAS) infection through to the sequelae of RHD, a search of PubMed, Scopus, ISI Web of Science, Sabinet African Journals, SA Heart and Current and Completed Research databases will be performed. All eligible studies on RHD, acute rheumatic fever and GAS infection published from April 2014 to December 2022 will be included. Vital registration data for the same period from Statistics South Africa will also be collected. A standardised data extraction form will be used to capture results for both quantitative and qualitative analyses. All studies included in burden of disease estimates will undergo quality assessment using standardised tools. Updated estimates on mortality and morbidity as well as a synthesis of work on primary, secondary and tertiary prevention of RHD will be reported.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>No ethics clearance is required for this study. Findings will be disseminated in a peer-reviewed journal and submitted to national stakeholders in RHD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD42023392782.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-073300","type":"journal-article","created":{"date-parts":[[2023,6,1]],"date-time":"2023-06-01T10:38:12Z","timestamp":1685615892000},"page":"e073300","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Burden of disease and barriers to comprehensive care for rheumatic heart disease in South Africa: an updated systematic review protocol"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4075-5072","authenticated-orcid":false,"given":"Serini","family":"Murugasen","sequence":"first","affiliation":[{"name":"Division of Paediatric Cardiology, Department of Paediatrics and Child Health, University of Cape Town Faculty of Health Sciences, Rondebosch, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leyla H","family":"Abdullahi","sequence":"additional","affiliation":[{"name":"African Institute for Development Policy, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hlengiwe","family":"Moloi","sequence":"additional","affiliation":[{"name":"South African Medical Research Council, Tygerberg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3904-9269","authenticated-orcid":false,"given":"Rosemary","family":"Wyber","sequence":"additional","affiliation":[{"name":"The George Institute for Global Health, Newtown, New South Wales, Australia"},{"name":"Telethon Kids Institute, Nedlands, Western Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Abrams","sequence":"additional","affiliation":[{"name":"Division of Paediatric Cardiology, Department of Paediatrics and Child Health, University of Cape Town Faculty of Health Sciences, Rondebosch, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6341-9595","authenticated-orcid":false,"given":"David A","family":"Watkins","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1334-8829","authenticated-orcid":false,"given":"Mark E","family":"Engel","sequence":"additional","affiliation":[{"name":"Department of Medicine, Cape Heart Institute, University of Cape Town Faculty of Health Sciences, Observatory, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3961-2760","authenticated-orcid":false,"given":"Liesl Joanna","family":"Z\u00fchlke","sequence":"additional","affiliation":[{"name":"Division of Paediatric Cardiology, Department of Paediatrics and Child Health, University of Cape Town Faculty of Health Sciences, Rondebosch, South Africa"},{"name":"South African Medical Research Council, Tygerberg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,6,1]]},"reference":[{"key":"2025102702570030000_13.6.e073300.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.11.010"},{"key":"2025102702570030000_13.6.e073300.2","doi-asserted-by":"publisher","DOI":"10.1038\/nrcardio.2013.34"},{"key":"2025102702570030000_13.6.e073300.3","doi-asserted-by":"crossref","unstructured":"White A . 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