Heart disease is the No. 1 killer of women, claiming to female life every minute. Yet it is often seen as a "man's disease." This disparity is magnified in sub-Saharan Africa, where we have recently conducted an investigation into the experiences of women living with rheumatic heart disease.

Rethinking heart disease in the developing world

Another prevailing myth that we encounter is that cardiovascular disorders are not a major issue in the developing world. To the contrary, heart disease is already the number one cause of death worldwide as well as in low- and middle-income countries.

In contrast to their high-income counterparts, patients in poor countries are struck by, and die from, cardiovascular conditions at younger ages. Their health systems are often unprepared to combat the dual tides of infectious and noncommunicable illnesses .

Furthermore, the causes of heart disease are somewhat different in poor countries, where the proliferation of "Western" maladies like heart attacks and hypertension are accompanied by "endemic" cardiovascular diseases of poverty such as rheumatic heart disease.

An old foe revisited

Rheumatic heart disease is a preventable disorder that is a late effect of rheumatic fever, which ravaged Western Europe and the United States only a generation ago, but it is rarely seen in these settings. It is triggered by Group A  streptococci , which causes strep throat. Some individuals will develop a systemic reaction known as acute rheumatic fever, which permanently damages the heart valves ago, acute rheumatic fever, which can 

In the developed world, acute rheumatic fever is rarely seen, because strep throat is regularly treated with antibiotics. In developing nations, however, appropriate medications are often missed or financially unfeasible. Rheumatic heart disease afflicts up to 43 million people worldwide and leads to up to 1.4 million deaths each year. It can have terrible consequences, including heart failure, irregular heart rhythms, and debilitating stroke .and debilitating 

Impact on women

Women of childbearing age with rheumatic heart diseases are especially vulnerable, as the disorder places them at increased risk of pregnancy. Furthermore, the blood-thinning medications used to treat RHD can also raise the risk of miscarriage and maternal hemorrhage. Although pregnancy in this population is high-risk, only 3.6% of women with RHD of childbearing age are on contraceptives.

Our research group recently concluded a mixed methods study in Uganda of women of reproductive age living with rheumatic heart disease to better understand the lived experience of this population.

Compounding their challenges, participants suggested that contraception may be criticized, leading to poor adoption – a social norm previously reported in Uganda and its neighbors.

Building systems, targeting future efforts

In light of these sobering findings, our team also asked participants how they thought the current medical system could better serve their needs. First, patients suggested that health care providers discuss the reproductive consequences of the illness and its therapies.

Our study suggests that there is still work to be done in identifying the comorbidities and downstream outcomes of this population. These are areas of ongoing investigation for our team. Nevertheless, we are optimistic that there are opportunities for improved family and societal education programs and community engagement, leading to better outcomes and patient empowerment.