Yemen Observer: http://www.yobserver.com
Posted in:
Sports, Health & Lifestyle
Written By: Thuria Ghaleb
Article Date: Mar 18, 2008 - 6:27:00 AM
Researchers from the Faculty of Medicine and Health Sciences at Sana’a University have found that rheumatic heart disease (RHD) is still a serious cardiac problem among Yemenis, affecting most commonly those people in the most productive age groups.
A study supervised by Professor Mohammed al-Naib and Professor Ahmed al-Motarreb of Sana’a University was carried out to study the different type of cardiac diseases coming to the referral cardiac center at the al-Thawrah Hospital in Sana’a and their pattern of distribution over the period from June 1st to the 30th of November 2006.
Researcher Amal al-Suqaf says that rheumatic heart disease affects the majority of patients who are suffering from cardiac diseases (cardiovascular diseases) which involve the heart or blood vessels. About 54 percent of 552 patients admitted to the al-Thawrah cardiac center were diagnosed with rheumatic heart disease, the study found.
Rheumatic heart disease is a condition in which the heart valves are damaged by rheumatic fever. Rheumatic fever mostly affects children in developing countries where poverty is widespread. It results in around 300,000 deaths each year, with two million people requiring repeated hospitalization and one million likely to require surgery 5 to 20 years after the fever’s occurance.
The study found that males are more affected with cardiac disease than females: more than half of suffering patients were male. However, female patients are found to be more affected with RHD, at 58 percent, than males, at 42 percent.
Worldwide, out of 12 million people currently affected by rheumatic fever and RHD, two-thirds are children between 5 and 15 years of age.
Poverty, illiteracy, poor health education and lack of medical services are responsible for the increased incidence of RHD and its complications among Yemenis, the study said.
The mitral valve lies between the left atrium (the heart’s upper chamber) and the left ventricle (the heart’s lower main pumping chamber) and controls the flow of blood. In the study, the mitral valve was found to be the most commonly affected among RHD patients (92 percent), while the majority of patients (43 percent) had triple valve affection.
The study found that 66 percent of the patients with cardiac disease were younger than 40 years old. This means that the majority of patients are children and young adults. Only 34 percent of patients were older than 40 years of age.
Most of the patients studied, 40 percent, came from Sana’a because the cardiac center at the al-Thawrah Hospital is the only qualified center in Yemen for heart disease management. This makes it easier for patients who live in Sana’a to seek help while patients from other governorates, such as Ibb, Dhamar, Taiz and al-Hodeidah, come only when the disease is advanced or complications present themselves.
The study found that about 53 percent of patients came in later stages of the disease or when complications had arisen. Due to this, the patients were often admitted to the surgical department of the center and underwent surgical procedures. “It is also the only center specialized in cardiac surgery, while medical cases may be hospitalized in a medical department for a long time or admitted to other hospitals which receive cardiac disease patient in their units,” said Ahlam Kolipe, another researcher.
The al-Thawrah Teaching Hospital consists of 873 beds for different specialties; it is a referral hospital receiving cases from all over Yemen. The occupancy rate is almost always more than 100 percent and most of the time there are no vacant beds. In 2006 the hospital received a total of 38,289 patients, 4,330 of these in the cardiac center. Before opening the cardiac center, about 12,000 Yemeni patients a year used to go abroad for treatment.
Cardiovascular diseases are generally considered the leading cause of death in both developed and developing countries. They caused the death of an estimated 17.5 million people in 2005, representing 30 percent of all global deaths. By the year 2015, almost 20 million people will die from these types of diseases.
Ischemic heart disease (IHD) is a disease characterized by reduced blood supply to the heart muscle. It follows rheumatic heart disease among cardiovascular diseases in frequency of occurance; this may be explained by increased exposure to its risk factors such as diabetes mellitus or stressful lifestyle during life.
According to the study, about 21 percent of patients with cardiac diseases are afflicted with IHD and another 19 percent with congenital heart disease (CHD), which refers to a problem with the heart’s structure and function due to abnormal heart development before birth.
Social habits in Yemen such as cigarette smoking, habble babble smoking, shamma using and qat chewing may strongly contribute to aggravating existent ischemic heart disease, hypertension and subsequent heart failure.
Smoking is still the main risk factor for IHD, as 56 percent of IHD patients are smokers. Qat chewing is also considered as a risk factor for IHD, but the study found that the rate of qat chewers among IHD patients was less than it was expected, at just 29 percent.
Heart failure is the end stage of all heart diseases and is a major cause of mortality. It affects 15 million patients worldwide and is one of the most common causes of hospitalization.
Heart failure in Yemen is a very common medical problem facing cardiologists, as most Yemeni people usually do not seek medical advice until advanced stages of heart disease. The study found that 15 percent of cases were complicated by heart failure in which rheumatic heart disease formed the major cause. Many patients presented in late stages of the disease, while these diseases could have been easily prevented, the study said.
Yemen is now in a state of epidemiological transition, having the double burden placed upon its health care system of both infectious diseases and emerging non-communicable cardiovascular diseases.
The study recommended increasing awareness among families, schoolchildren and medical staff; encouraging the government to activate and integrate preventive measures in primary health care; encouraging further research; performing early detection of heart failure and its causes; establishing cardiac centers in all governorates to facilitate the medical services; and implementing prevention and screening programs in all general hospitals.
The study was conducted by Anas Abdul-Kayoum, Ahlam Kolipe, Amal al-Suqaf, Haider al-Temimi and Khalid al-Qalmish.