Women with heart disease in sub-Saharan Africa face challenges, but stigma may be worst of all

Heart disease is the number one killer of women, claiming a 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 often 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.

This shift has, in part, been due to ongoing successes in fighting contagious epidemics, particularly HIV/AIDS and childhood infections. Industrialization and economic development of low-income nations has brought more food security and decreased reliance on manual labor. Yet, these changes have fueled an increase in noncommunicable disease such as diabetes, high blood pressure and high cholesterol, leading to a surge in cardiovascular disease.

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 is rarely seen now 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 can permanently damage the heart valves.

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 are 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.

Impact on women

Women at an educational health event in Kampala, Uganda on Oct. 31, 2017. Tao Farren-Hefer, CC BY-NC-SA
Women of childbearing age with rheumatic heart diseases are especially vulnerable, as the disorder places them at increased risk of complications during 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 percent 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.

Several themes emerged: First, we discovered that female rheumatic heart disease patients understood that their disease increased their risk of complications and death during pregnancy. Nevertheless, they still felt pressure to take the risk, citing the societal pressures to have many children. In fact, 100 percent of our participants answered that society would look poorly upon a woman who cannot bear children.