Acute pharyngitis as challenge for primary prevention of rheumatic fever at a rural community in Gharbia Governorate

ABSTRACT

It is known that streptococcal infections of the pharynx are the precipitating cause of rheumatic fever. The aim of the present study was to determine some preventable challenges in dealing with acute pharyngitis at a rural community in Gharbia Governorate. This study was conducted at Kafr Hegazy Village, during a period of four months from October 2004 up to the end of January 2005. All primary and preparatory schools of Kafr Hegazy Village were surveyed for children taking long acting penicillin as a preventive measure for rheumatic fever. Sociodemographic characteristics, history of attacks of acute pharyngitis, investigations performed for diagnosis, source of medical care, and type and duration of medications used for treatment were obtained from parents by direct interview using structured questionnaire sheet. All related investigations were reviewed. The results revealed that In all primary and preparatory schools of Kafr Hegazy Village, 173 children were taking long acting penicillin as a prophylactic measure for rheumatic fever. Of them, 95.4% had past history of acute pharyngitis and 61.9% of them had their first attacks below 6 years and suffered from more than 6 attacks per year. There was no statistically significant difference between mother's education [chi[2] =7.194] and source of medical care [chi[2] =5.838] on one hand and frequency of attacks of acute pharyngitis on the other. Governmental health services [53.3%], mainly school health insurance and primary health care unit were the main sources of medical care. The study showed that 58.2% of studied children were not asked for any investigations and only 1.2% of them were asked for throat culture. Also, the study revealed that the majority [84.2%] of rural mothers were seeking medical care for treating acute pharyngitis which was not significantly affected by their education [chi[2] =1.309]. According to the findings of the study, oral antibiotic therapy was the commonly prescribed, [42.4%], but it was used for 3.9+/-1.6 days. On the other hand, injection therapy [30.3%] was used commonly for 2.4+/-0.7 days. There was no statistically significant effect of mother's education or source of medical care on duration of treatment. The following was recommended Special health education program for mothers to minimize throat infections and rheumatic fever and stress on the necessity of 10-day course of oral treatment, orientation and on job training courses for physicians especially those of the school health insurance, primary health care units, and private ones. Strategies for diagnosis and treatment of acute pharyngitis should be directed at identifying those patients who have group A Beta hemolytic streptococcal infections by using throat culture [especially for children under 6 years] and implementation of a single injection of benzathine penicillin G as recommended regimen for both treatment of acute pharyngitis and primary prevention of rheumatic fever