With 1,19,100 deaths, India is among the five nations — Indonesia, the DR Congo, China and Pakistan — that accounted for 73 per cent of rheumatic heart disease deaths globally in 2015, a study has showed.

The death toll in the other four nations stood at 1.18 million in Indonesia, 8,05,000 in the Democratic Republic of the Congo, 72,600 in China and 18,900 in Pakistan.

Rheumatic heart disease is a condition of damaged heart valves caused by bacterial infection that leads to rheumatic fever.

The highest estimated death rates — more than 10 per 1,00,000 — occurred in India, the Central African Republic, Federated States of Micronesia, Fiji, Kiribati, Lesotho, Marshall Islands, Pakistan, Papua New Guinea, the Solomon Islands, and Vanuatu.

“The persistence of rheumatic fever and rheumatic heart disease reflects the challenges many countries face in improving the social, environmental, and economic conditions that lead to the disease,” said Gregory A. Roth, Assistant Professor at the University of Washington

Further, the study showed that mortality has not appreciably declined in these regions, which include some of the world’s poorest countries, since 1990, although the risk of death from the disease has dropped around the world over the last 25 years.

The number of individuals who were living with rheumatic heart disease had not declined, either, the researchers said in the paper published in The New England Journal of Medicine.

In addition, about one per cent of school age children in these endemic countries have evidence of rheumatic heart disease.

“We have very cost-effective interventions that treat strep throat and prevent rheumatic fever and rheumatic heart disease from getting worse, but these children often don’t have access to the care they need,” said David Watkins, from the University of Washington School of Medicine..

“As a result, their heart conditions usually get worse with age and lead to premature death. Many of these individuals could be saved by open-heart surgery to repair or replace damaged valves, but unfortunately in these countries access to advanced cardiac surgery care is very low,” Watkins added.

Stronger national surveillance systems may help in prevention and early treatment in countries where rheumatic heart disease is endemic, the researchers said.