Rheumatic fever and rheumatic heart disease in Barbados - abstract

ABSTRACT

This paper is a preliminary report based on the first 12 months of a rheumatic fever programme which is being carried out in Barbados. Data are presented on the natural history of the disease, the load of the disease on the community, the effectiveness of a programme of secondary prophylaxis and the prevalence of rheumatic heart disease among school children aged 5-11 years. In February, 1970, a rheumatic fever clinic was started at the Queen Elizabeth Hospital, to which patient diagnosed as having had rheumatic fever were referred. At the same time twice weekly visits to the paediatric ward to identify cases of rheumatic fever and weekly visits to primary schools were made. Sixty-one (61) patients were registered as having had documented evidence of previous acute rheumatic fever. Thirty-seven (37) of these had a residual valvulitis of which 23 were aged 12 years or less. The major valve affected was the mitral which was incompetent in 19 of 37 patients. Seventy-four (74) patients received monthly injection of penicillin. Information which is available on 71 of these patients showed that after 1 year 533 patient/month injections were received out of a possible total of 547. Nineteen (19) patients were admitted to the paediatric ward with definite first attack of acute rheumatic fever and 6 patients were admitted with a second or more attack. Prevalence of rheumatic heart disease among 3,882 primary school children aged 5-11 years was found to be per 1000. Preliminary analysis demonstrates the high degree of effectiveness of a recently instituted programme of secondary prophylaxis, the presence of chronic rheuamatic heart disease among children and the significant morbidity produced by rheumatic fever and rheumatic heart disease (AU)