Background: This study was conducted in a rural community of north India to evaluate a rheumatic fever and rheumatic heart disease control programme which used the existing health and educational infrastructure.
Methods: A health education campaign was launched in a rural community block (population 140 000) with a similar non-contiguous block (population 180 000) serving as a control. In the intervention block, 74 primary health workers, 773 teachers and 12 500 students were trained to suspect the disease. Twelve medical officers in four health centres registered patients, who were put on secondary prophylaxis with penicillin or sulphonamide, and monitored their compliance. All the cases were examined by a cardiologist to confirm the diagnosis; if the diagnosis was not confirmed secondary prophylaxis was stopped.
Results: In the two years preceding intervention, 13 cases (case detection rate 3.6/100 000 population/year) were detected from the health centre records in the control and 22 (7.8/100 000/year) from the intervention block. During the two years of study 16 new cases (4.4/100 000/year) were registered in the control block whereas 254 suspected cases of rheumatic fever and rheumatic heart disease were referred to medical officers in the intervention block. Of these, 77 new cases (27.5/100 000/year) were registered, of which 61 (79%) were subsequently confirmed to have the disease- 48 had chronic rheumatic disease and 13 their first attack of acute rheumatic fever. Secondary prophylaxis in the form of penicillin or sulphonamide was instituted in these patients with a compliance of 85% to 95%.
Conclusions: In developing countries, it is possible to successfully apply a secondary prevention programme for the early detection of rheumatic fever and rheumatic heart disease using existing primary health care auxiliaries, school teachers and pupils at an affordable additional cost.