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A cost-effective strategy for primary prevention of acute rheumatic fever and rheumatic heart disease in children with pharyngitis.
[acute rheumatic fever]
Primary
prevention
of
acute
rheumatic
fever
(
ARF
)
and
rheumatic
heart
disease
(
RHD
)
in
children
depends
on
prompt
and
effective
diagnosis
and
treatment
of
pharyngitis
at
the
primary
level
of
care
.
Cost-effectiveness
modeling
shows
that
the
most
cost-effective
strategy
for
primary
prevention
in
South
Africa
(
SA
)
is
to
use
a
simple
symptomatic
clinical
decision
rule
(
CDR
)
to
diagnose
pharyngitis
in
children
presenting
at
the
primary
level
of
care
and
then
to
treat
them
with
a
single
dose
of
intramuscular
penicillin
.
Treat
All
and
CDR
2
+
strategies
are
affordable
and
simple
and
miss
few
cases
of
streptococcal
pharyngitis
at
the
primary
level
of
care
.
The
CDR
2
+
strategy
is
the
most
cost-effective
for
primary
prevention
of
ARF
and
RHD
in
urban
SA
and
should
complement
primordial
and
secondary
prevention
efforts
.
