Background: Hospital records and selected population based surveys suggest that parts of the developing world may have experienced a substantial decline in the prevalence of rheumatic fever (RF) and rheumatic heart disease (RHD) and this is generally attributed to improving health care and human development.
Objective: To study the prevalence of RHD and incidence of RF in the population of Wayanad District in Kerala, South India, that has the highest tribal population and least sophisticated health infrastructure and lowest human developmentindex among all districts in the state (one doctor/3148 people).
Methods: The entire district (population: 0.79 million) was selected. Information on RF/RHD patients was gathered over 28 months (2006-2008) through passive reporting using the health care infrastructure of the district after thorough orientation of all health care professionals through structured workshops, teaching sessions, distribution of educational material. Additionally active surveillance was performed in a population proportionate sample of 11172 school children between 5-15 years. Echocardiography was performed for diagnostic confirmation all suspected cases.
Results: Of 953 cases of suspected RF/RHD who were reported, 373 had RHD (overall prevalence of 0.47/1000; 36±18 years; 267 females) and 41 had previous history of RF and 27 instances of acute RF were recorded (incidence of 1.14-1.27/100,000/year). Of the 11172 schoolchildren surveyed, only one child had RHD (prevalence of 0.09/1000), and one child was on penicillin prophylaxis for a history of RF.
Conclusions: The incidence of RF and prevalence of RHD appear relatively low in this population in spite of limitations in health infrastructure.