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Rheumatic fever and rheumatic heart disease in Gauteng on the decline: Experience at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.
[acute rheumatic fever]
Background
.
The
incidence
of
rheumatic
fever
(
RF
)
and
its
complications
has
waned
over
the
past
three
to
four
decades
throughout
the
Western
world
,
but
RF
remains
a
problem
in
developing
countries
and
in
the
indigenous
populations
of
some
well-resourced
countries
.
A
marked
decline
in
children
presenting
with
acute
rheumatic
fever
(
ARF
)
and
chronic
rheumatic
heart
disease
(
RHD
)
has
been
observed
over
the
past
two
decades
at
Chris
Hani
Baragwanath
Academic
Hospital
(
CHBAH
)
in
southern
Gauteng
Province
,
South
Africa
,
which
mainly
serves
the
periurban
population
of
Soweto
.
O
bjectives
.
To
analyse
the
observed
decline
in
ARF
and
RHD
,
and
consider
the
reasons
for
the
decrease
.
Methods
.
Review
of
children
with
ARF
and
RHD
captured
on
a
computerised
database
of
all
children
seen
in
the
Paediatric
Cardiology
Unit
at
CHBAH
during
1993
-
2010
.
Results
.
The
records
of
467
children
with
ARF
and
RHD
were
retrieved
from
the
database
.
The
majority
provided
addresses
in
Gauteng
,
Soweto
and
North
West
Province
.
The
number
of
children
documented
to
have
ARF
or
RHD
declined
from
64
in
1993
to
3
in
2010
.
One
-
third
of
the
patients
underwent
surgery
,
the
majority
mitral
valve
repair
.
Most
of
the
patients
requiring
surgery
had
addresses
in
parts
of
Gauteng
other
than
Soweto
and
other
provinces
,
with
relatively
few
originating
from
Soweto
.
Conclusion
.
The
decline
in
the
number
of
children
with
ARF
and
RHD
presenting
to
CHBAH
may
be
attributed
to
an
improvement
in
socioeconomic
conditions
and
better
access
to
medical
care
for
the
referral
population
over
the
past
two
decades
.
Diseases
Validation
Diseases presenting
"chronic rheumatic heart disease"
symptom
acute rheumatic fever
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