Journal of Medicine Vol 2 - Amrita Institute of Medical Sciences and ...

Amrita Journal of Medicine
ORIGINAL ARTICLE
Control Strategies for Rheumatic Fever and
Rheumatic Heart Disease in Wayanad, Kerala
L. Krishnan, S. Vasudevan, S. Ajitha, R.K. Kumar*
ABSTRACT
Rheumatic Fever (RF) and Rheumatic Heart Disease (RHD) are still an important public health problem in the developing world. The disease
burden appears to be closely linked to human development. A recent survey in the Ernakulam District demonstrated that the estimated disease
burden of RF and RHD in this region was among the lowest in the developing world. There are parts of Kerala where access to health care and
human development indices are much lower than the state average. For this reason the Indian Council of Medical Research (ICMR has chosen
the district of Wayanad for determination of the magnitude of RF and RHD. The services of the entire health care infrastructure of the district
(both government and private) including many community volunteers are being used to identify patients with RF and RHD. The results of this
study will provide interesting epidemiological insights and help plan specific control strategies.
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INTRODUCTION
The incidence of Rheumatic fever
and prevalence of Rheumatic heart
diseases have declined in the developed
countries around the world,
although it still remains a major public
health problem in developing
countries. 1 In India, a study by
Padmavati 2 revealed that the estimated
average prevalence of
rheumatic heart disease in school surveys
during 1984-1995 was 0.18-3.0
per 1000. Another study by
Lachandani et al 3 revealed the prevalence
of RHD to be 4.54 per 1000 in
the year 2000. The RF/RHD registry
project of Amrita Institute of Medical
Sciences and Research Centre
(AIMS) at Kochi, Kerala during 2003
– 2004 showed the prevalence of RHD
to be 0.12 per 1000, which was the
lowest ever reported in India.
The control of Rheumatic fever /
Rheumatic Heart disease (RF/RHD)
includes a broad spectrum of activities
aimed at primary prevention,
secondary prevention, health education
activities, epidemiological
surveillance and creating registry.
Amrita Kripa Charitable Hospital & AIMS, Kochi.
* Dept. of Pediatric Cardiology, AIMS, Kochi.
The Indian Council of Medical
Research (ICMR), New Delhi, under
the government of India, which is the
apex body for the planning, formulation,
coordination, implementation
and promotion of biomedical research,
initiated The Jai Vigyan Mission mode
project on RF/RHD control. As part of
this project, the ICMR funded the department
of Paediatric Cardiology at
Amrita Institute of Medical Sciences
and Research Centre, Kochi to implement
the RF/RHD control programme
in the district of Wayanad in Kerala.
Its main objectives are to establish a
RF/RHD registry, sensitize the community
regarding the disease and its
prevention and to estimate the prevalence
of RHD among school children
aged 5-15 years in the district. This
paper gives an overview of the ongoing
activities of the project being
implemented by the Amrita Kripa
Charitable Hospital (AKCH), Kalpetta
at Wayanad.
PROJECT AREA
The State of Kerala with a population
of over 31 million and density of
819 persons per sq.km is located in
the southwest part of India. Its achievements
in terms of the basic indicators
of human development are in par with
some of the developed countries.
Kerala continues to rank at the top
among Indian States with respect to
the human development index, although
there are few variations within
districts across the state.
Wayanad district, the project area
is located in the northern part of
Kerala bordering Karnataka and Tamil
Nadu and has a population size of
nearly 7,87,000. Some of the characteristics
of Wayanad include relatively
low literacy rates, relative poverty and
a high proportion of tribal population
as compared to other districts in the
State. Given these conditions, the
Human Development Report of
Kerala 4 , recommends that special attention
is needed for implementing
policies and programmes to improve
the basic well-being indicators such
as quality of housing, access to water,
good sanitation. This project being
implemented at Wayanad could be a
stepping-stone in that direction.
CONTROL STRATEGIES
The Jai Vigyan Mission mode for
control of RF/RHD, adopts a time
bound, goal oriented approach and
emphasizes on standardized and uniform
methodologies. The metho
dology adopted for this project can
be summarized in two components: