Oral Presentation Lancefield International Symposium for Streptococci and Streptococcal Diseases 2025

A verbal autopsy study of paediatric rheumatic heart disease mortality in Malawi  (119127)

Treasure B Mkaliainga 1 , Agatha Bula 2 , Mina C Hosseinipour 2 , Norbert Kamchembere 1 , Msandeni Kayuni 1 , Kristy Murray 3 , Yamikani Chimalizeni 4 , Amy Sanyahumbi 5
  1. Department of Paediatrics and Child Health, Kamuzu Central Hospital, Lilongwe, Malawi, Africa
  2. University of North Carolina , Tidziwe Center, Lilongwe , Malawi, Africa
  3. Center for Human Immunomicrobiology, Baylor College of Medicine and Texas Children’sHospital, Houston, Texas, USA
  4. Department of Paediatric Cardiology , Queen Elizabeth Central Hospital , Blantyre, Malawi , Africa
  5. Department of Pediatric Cardiology, Baylor College of Medicine/Texas Children’sHospital, Houston , Texas, USA

Background

Rheumatic heart disease (RHD), a sequela of Streptococcus pyogenes infections, drives preventable mortality in low-resource settings like Malawi, despite benzathinpenicillin G (BPG) prophylaxis.

Methods

A longitudinal cohort study monitored 124 pediatric RHD patients (4-18 years) in Malawi. Caregivers of 30 deceased patients completed verbal autopsy (VA) interviews using a WHO questionnaire.

Results

Of 30 deceased, 19 were female (63%). Severe Rheumatic Heart Disease (SRHD) was noted in 9 cases, and other SRHD cases had other comobidities like CCF, endocarditis, dysentery, and dehydration, with 3(10%) cases suspected to be associated with BPG injections and arrhythmias. Up to13 cases (43%) died at home, and mixed adherence responses with most entries indicating non-adherence or partial adherence. Common reasons include new diagnosis, stockouts, or defaulting. In 62% of cases, the cause of death was not explained to the guardian.

Key Findings

1. High Mortality at Home: Over 40% of deaths occurred at home, raising concerns about access to healthcare or the timing of care.

2. Adherence Issues: Many patients were newly diagnosed or faced challenges in maintaining regular BPG injections.

3. Potential BPG Reactions: Although rare, BPG-related deaths highlight the need for monitoring and safer protocols.

Conclusion

This study highlights diagnostic delays, BPG distrust, and the importance of palliative care in RHD management. Findings advocate for context-specific strategies to strengthen streptococall infection control, optimize BPG delivery, and integrate caregiver perspectives into RHD care pathways.

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