{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T10:25:25Z","timestamp":1767176725336,"version":"build-2238731810"},"update-to":[{"DOI":"10.1371\/journal.pntd.0013400","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T00:00:00Z","timestamp":1756166400000}}],"reference-count":53,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T00:00:00Z","timestamp":1755561600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Rheumatic heart disease (RHD) is an autoimmune sequela of group A streptococcal (GAS) pharyngitis. Acute rheumatic fever (ARF), a complication arising 2\u20133 weeks after GAS infection, can cause damage to the valves of the heart and, ultimately, RHD. This trajectory towards severe disease is now rare in high-income countries. In Malawi, as in many low-income countries, RHD continues to pose a significant challenge. Limited access to healthcare and poor education likely contribute to the disease burden. This scoping review aims to determine the present burden of GAS, ARF and RHD in Malawi, the issues affecting the provision of care and the solutions that have been proposed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>A search was conducted of \u2018PubMed\u2019, \u2018EMBASE\u2019, \u2018Cochrane Library\u2019 and \u2018Clinicaltrials.gov\u2019 to identify research published between 1995 and 2024 according to the Arksey and O\u2019Malley framework. The PRISMA extension for Scoping Review (PRISMA-ScR) Checklist guided the search (Supplementary File 3).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Data were extracted from thirty articles. RHD prevalence among Malawian children ranges between 3.4% and 5.3%, with high rates of late presentation (62%-82.5% presenting with severe disease). Inadequate health system infrastructure, limited RHD-specific education for healthcare providers, and inconsistent availability of benzathine penicillin G for secondary prophylaxis were identified as key challenges. Rural areas, comprising 84% of Malawi\u2019s population, are particularly underserved. Task-shifting to non-physician healthcare workers in primary care has shown promise. Much less research was available on ARF and GAS infections.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The significant morbidity and mortality associated with RHD is a major concern in the communities and healthcare systems of Malawi. Primary care resourcing and improved education are areas requiring attention. To address the high burden of disease in the country, ongoing research is largely focused on establishing a sufficiently large and appropriately trained workforce to diagnose and monitor RHD using the resources available within the constraints of the country\u2019s socioeconomic context.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pntd.0013400","type":"journal-article","created":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T17:38:02Z","timestamp":1755625082000},"page":"e0013400","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["The burden of rheumatic heart disease and issues affecting the provision of care in Malawi: A scoping review"],"prefix":"10.1371","volume":"19","author":[{"given":"Eva","family":"Blennerhassett","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oisin","family":"Brady Bates","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maire","family":"O\u2019Connor","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hastings","family":"Gondwe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lillian","family":"Msimuko","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Ledwidge","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Balwani","family":"Mbakaya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph","family":"Gallagher","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,8,19]]},"reference":[{"key":"pntd.0013400.ref001","article-title":"Rheumatic Heart Disease","volume-title":"StatPearls [Internet]","author":"C Dass","year":"2023"},{"issue":"9859","key":"pntd.0013400.ref002","doi-asserted-by":"crossref","first-page":"2197","DOI":"10.1016\/S0140-6736(12)61689-4","article-title":"Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010","volume":"380","author":"CJL Murray","year":"2012","journal-title":"Lancet"},{"key":"pntd.0013400.ref003","unstructured":"Global Burden of Disease (GBD) Study 2021 [cited Dec 2024]. 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