{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T22:07:15Z","timestamp":1790806035091,"version":"4.1.0"},"reference-count":15,"publisher":"AOSIS","issue":"1","license":[{"start":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T00:00:00Z","timestamp":1774915200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>The primary health care (PHC) approach to rheumatic heart disease emphasises preventing initial episodes of rheumatic fever through primary prevention, avoiding recurrences by secondary prevention and ensuring long-term follow-up and an effective referral system. Primary care providers act as gatekeepers of community healthcare needs. They are heavily involved in community engagement, primary prevention, continuity of care and are part of strong PHC referral networks. This positions them ideally to participate in the prevention and early detection of rheumatic heart disease. The main aim of this CPD article is to guide the early identification and management of rheumatic heart disease within PHC settings.<\/jats:p>","DOI":"10.4102\/safp.v68i1.6255","type":"journal-article","created":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T08:08:48Z","timestamp":1774858128000},"update-policy":"https:\/\/doi.org\/10.4102\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Primary health care approach to rheumatic heart disease management"],"prefix":"10.4102","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1405-4259","authenticated-orcid":false,"given":"Ruchika","family":"Meel","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03rp50x72","id-type":"ROR","asserted-by":"publisher"}],"name":"University of the Witwatersrand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9658-3826","authenticated-orcid":false,"given":"Ramprakash","family":"Kaswa","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02svzjn28","id-type":"ROR","asserted-by":"publisher"}],"name":"Walter Sisulu University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2580","published-online":{"date-parts":[[2026,3,31]]},"reference":[{"key":"ref0","doi-asserted-by":"crossref","unstructured":"Chinawa JM, Chinawa AT, Ogbuka FN, Elobuike PC, Nwankwo O. The prevalence rates of acute rheumatic fever in Africa: A systematic review and meta-analysis. Sage Open Pediatr. 2025;12:30502225251357145. https:\/\/doi.org\/10.1177\/30502225251357145","DOI":"10.1177\/30502225251357145"},{"key":"ref1","doi-asserted-by":"crossref","unstructured":"Dooley LM, Ahmad TB, Pandey M, Good MF, Kotiw M. Rheumatic heart disease: A review of the current status of global research activity. Autoimmun Rev. 2021;20(2):102740. https:\/\/doi.org\/10.1016\/j.autrev.2020.102740","DOI":"10.1016\/j.autrev.2020.102740"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"Rwebembera J, Marangou J, Mwita JC, et al. 2023. World Heart Federation guidelines for the echocardiographic diagnosis of rheumatic heart disease. Nat Rev Cardiol. 2024;21(4):250\u2013263. https:\/\/doi.org\/10.1038\/s41569-023-00940-9","DOI":"10.1038\/s41569-023-00940-9"},{"key":"ref3","unstructured":"Tibbutt DA. Valvular heart disease is changing \u2013 A challenge for Africa. South Sudan Med J. 2015;8(4):86\u201389."},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"Peters F, Karthikeyan G, Abrams J, Muhwava L, Zu\u0308hlke L. Rheumatic heart disease: Current status of diagnosis and therapy. Cardiovasc Diagn Ther. 2020;10(2):305\u2013315. https:\/\/doi.org\/10.21037\/cdt.2019.10.07","DOI":"10.21037\/cdt.2019.10.07"},{"key":"ref5","unstructured":"World Health Organization. Rheumatic heart disease key facts [homepage on the Internet]. 2020 [cited 2025 Sept 15]; p. 1\u20134. Available from: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/rheumatic-heart-disease"},{"key":"ref6","doi-asserted-by":"crossref","unstructured":"Meel R. Valvular heart disease and its growing impact in South Africa. SA Hear. 2024;21(3):204\u2013207. https:\/\/doi.org\/10.24170\/21-3-6890","DOI":"10.24170\/21-3-6890"},{"key":"ref7","doi-asserted-by":"crossref","unstructured":"Kumar RK, Antunes MJ, Beaton A, et al. Contemporary diagnosis and management of rheumatic heart disease: Implications for closing the gap: A scientific statement from the American Heart Association. Circulation. 2020;142(20):E337\u2013E357. https:\/\/doi.org\/10.1161\/CIR.0000000000000921","DOI":"10.1161\/CIR.0000000000000921"},{"key":"ref8","doi-asserted-by":"crossref","unstructured":"Z\u00fchlke L, Karthikeyan G, Engel ME, et al. Clinical outcomes in 3343 children and adults with rheumatic heart disease from 14 low- and middle-income countries. Circulation. 2016;134(19):1456\u20131466. https:\/\/doi.org\/10.1161\/CIRCULATIONAHA.116.024769","DOI":"10.1161\/CIRCULATIONAHA.116.024769"},{"key":"ref9","doi-asserted-by":"crossref","unstructured":"Messika-Zeitoun D, Baumgartner H, Burwash IG, et al. Unmet needs in valvular heart disease. Eur Heart J. 2023;44(21):1862\u20131873. https:\/\/doi.org\/10.1093\/eurheartj\/ehad121","DOI":"10.1093\/eurheartj\/ehad121"},{"key":"ref10","doi-asserted-by":"crossref","unstructured":"Moloi H, Z\u00fchlke L, Engel M, Daniels K. Health system factors influencing rheumatic heart disease prevention in nine African countries. J Public Health Africa. 2025;16(1):1\u201317. https:\/\/doi.org\/10.4102\/jphia.v16i1.1485","DOI":"10.4102\/JPHIA.v16i1.1485"},{"key":"ref11","unstructured":"WHO guideline on the prevention and diagnosis of rheumatic fever and rheumatic heart disease. Geneva: World Health Organization; 2024."},{"key":"ref12","doi-asserted-by":"crossref","unstructured":"Murugasen S, Abdullahi LH, Moloi H, et al. Burden of disease and barriers to comprehensive care for rheumatic heart disease in South Africa: An updated systematic review protocol. BMJ Open. 2023;13(6):e073300. https:\/\/doi.org\/10.1136\/bmjopen-2023-073300","DOI":"10.1136\/bmjopen-2023-073300"},{"key":"ref13","doi-asserted-by":"crossref","unstructured":"Aliyu IA, Bala JA, Yusuf I, et al. Rheumatic heart disease burden in Africa and the need to build robust infrastructure. JACC Adv. 2024;3(12):101347. https:\/\/doi.org\/10.1016\/j.jacadv.2024.101347","DOI":"10.1016\/j.jacadv.2024.101347"},{"key":"ref14","doi-asserted-by":"crossref","unstructured":"Cornick R, Picken S, Wattrus C, et al. The Practical Approach to Care Kit (PACK) guide: Developing a clinical decision support tool to simplify, standardise and strengthen primary healthcare delivery. 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