The child often fainted, skin turned bluish

Nancy and Japheth Mutai's ailing son started having complications at six months. He would frequently faint, was emaciated, had pale skin and delayed growth milestones.

Medics in Nandi and Uasin Gishu counties said Boaz Korir was malnourished and advised better nutrition on which the Mutais spent over Sh200,000 but their child's condition got worse and the skin turned bluish.

"After conducting tests, doctors at Tenwek Mission Hospital told us that he had a hole in the heart. He also had a condition called Tetralogy of Fallot," Nancy says and adds that their son is recuperating without any complications.

"The boy has already started putting on weight and his skin colour is normal," says his father.

Then there is another case of Brian Kiptoo whose tonsils were treated at a facility in Silibwet in Bomet, but the condition kept recurring. By August, complications included swollen face and limbs, fast breathing and pain on the left side of the body.

His aunt and caregiver Gloria Chepkoech, got him admitted at Tenwek where tests revealed he had two damaged valves in his heart. He underwent a 12-hour surgery.

Dr Arega Leta, a cardiothoracic surgeon says besides damaged valves, Brian also had developed acute rheumatic carditis, resulting in de-compensated heart failure.

After repairing the valves "Brian is now eating well, with minimal medication and no support of oxygen," says Dr Leta adding that Brian suffered from congenital heart disease, a more complex form of Tetralogy of Fallot, with pulmonary stenosis and was too sick to undergo complete surgery.

"As we waited for the perfect time to do the complete surgery, we modified Blalock-Taussig shunt-BT shunt to help in improving blood flow to the lungs. He recovered from the first surgery and was optimised well and then underwent the final surgery," explains Dr Leta adding that children born with such conditions die after birth and survivors have challenges in growth.

Dr Leta says rheumatic heart disease is an acute or chronic cardiovascular condition caused by rheumatic fever, an inflammatory disease triggered by a streptococcal infection that goes untreated or under-treated resulting in inflammation of connective tissues including the heart, joints and brain.

"Streptococcal infections, common in developing countries, could be as a result of crowded living conditions, poor hygiene and lack of proper information on how to deal with these infections," Dr Leta explains and says currently, the condition is becoming a health burden in Kenya and other African countries.

Over 37 million people globally suffer rheumatic heart disease with 97 per cent of the cases in developing countries including sub-Saharan Africa, according to the World Health Organisation.

Tenwek has about 400 rheumatic heart disease patients from Kenya and South Sudan, Uganda, Malawi, Tanzania, Ethiopia, Zimbabwe, Liberia and Sierra Leone "with most being referrals," says Dr Leta.

Rheumatic heart disease, he says, is such that the body produces a preventive mechanism, an antibody, against the infection that produces an antigen. While the antibody circulates in the human system, it treats the heart valves as a foreign objects thus damaging them.

However, the condition, if detected at an early stage can be treated using penicillin injections while avoiding the predisposing factors.

"Rheumatic heart diseases in children are alarming as the bulk of Western literature insinuated that the condition manifested after about 30 years and "this is not the case on the ground as children from five years are being diagnosed. We have a patient from South Sudan who is eight while Brian's condition was diagnosed when he was nine years old," says Dr Leta.

"This could be genetic exposure and the patient's sensitivity. It's an area that should be researched and addressed well."

The greatest challenge in treating heart diseases is the high cost of treatment as "a single valve costs over Sh100,000. If you are doing three valves, add all the expenses attached to cardiopulmonary bypass, ICU services, drugs and the attention needed, it's beyond what an ordinary citizen can afford."

Dr Leta says the other challenge with rheumatic heart conditions is being neglected without international recognition and thus no measures to eradicate them.

Shem Tangus, the Tenwek CEO says they're setting up a Cardio-Thoracic Centre "that will be dedicated to treating heart diseases.