Rare Diseases Symptoms Automatic Extraction
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Epidemiological trends of RF/RHD in school children of Shimla in north India.
[acute rheumatic fever]
There
are
no
active
surveillance
studies
reported
from
South
East
Asian
Region
to
document
the
impact
of
change
in
socio-economic
state
on
the
prevalence
of
rheumatic
fever
/
rheumatic
heart
disease
(
RF
/
RHD
)
in
children
.
Therefore
,
we
conducted
a
study
to
determine
the
epidemiological
trends
of
RF
/
RHD
in
school
children
of
Shimla
city
and
adjoining
suburbs
in
north
India
and
its
association
with
change
in
socio-economic
status
.
Active
surveillance
studies
were
conducted
in
2007
-
2008
in
urban
and
rural
areas
of
Shimla
,
and
15145
school
children
,
aged
5
-
15
yr
were
included
and
identical
screening
methodology
as
used
in
earlier
similar
survey
conducted
in
1992
-
1993
was
used
.
The
study
samples
were
selected
from
schools
of
Shimla
city
and
adjoining
rural
areas
by
multistage
stratified
cluster
sampling
method
in
both
survey
studies
.
After
a
relevant
history
and
clinical
examination
by
trained
doctor
,
echocardiographic
evaluation
of
suspected
cases
was
done
.
An
updated
Jones
(
1992
)
criterion
was
used
to
diagnose
cases
of
acute
rheumatic
fever
(
ARF
)
and
identical
2
D-
morphological
and
Doppler
criteria
were
used
to
diagnose
RHD
in
both
the
survey
studies
.
The
socio-economic
and
healthcare
transitions
of
study
area
were
assessed
during
the
study
interval
period
.
Time
trends
of
prevalence
of
RF
/
RHD
revealed
about
five-fold
decline
from
2
.
98
/
1000
(
95
%
C
.
I
.
2
.
24
-
3
.
72
/
1000
)
in
1992
-
1993
to
0
.
59
/
1000
(
95
%
C
.
I
.
0
.
22
-
0
.
96
/
1000
)
in
2007
-
2008
.
(
P
<
0
.
0001
)
.
While
the
prevalence
of
ARF
and
RHD
with
recurrence
of
activity
was
0
.
176
/
1000
and
0
.
53
/
1000
,
respectively
in
1992
-
1993
,
no
case
of
RF
was
recorded
in
2007
-
2008
study
.
Prevalence
of
RF
/
RHD
was
about
two
-
fold
higher
in
rural
school
children
than
urban
school
children
in
both
the
survey
studies
(
4
.
42
/
1000
vs
.
2
.
12
/
1000
)
and
(
0
.
88
/
1000
vs
.
0
.
41
/
1000
)
,
respectively
.
The
indices
of
socio-economic
development
revealed
substantial
improvement
during
this
interim
period
.
The
prevalence
of
RF
/
RHD
has
declined
by
five-fold
over
last
15
yr
and
appears
to
be
largely
contributed
by
improvement
in
socio-economic
status
and
healthcare
delivery
systems
.
However
,
the
role
of
change
in
the
rheumatogenic
characteristics
of
the
streptococcal
stains
in
the
study
area
over
a
period
of
time
in
decline
of
RF
/
RHD
can
not
be
ruled
out
.
Policy
interventions
to
improve
living
standards
,
existing
healthcare
facilities
and
awareness
can
go
a
long
way
in
reducing
the
morbidity
and
mortality
burden
of
RF
/
RHD
in
developing
countries
.
