Prevalence of rheumatic fever and rheumatic heart disease in school children of Kathmandu city.

To find out the prevalence of rheumatic fever/rheumatic heart disease in an urban area, a survey of school children aged between 5 to 16 years studying in randomly selected government schools in Kathmandu city was done. Out of 4984 students enrolled in the study 4736 were examined, the percentage of absentees being five. Revised Jones Criteria (1992) was used for the diagnosis of rheumatic fever. Diagnosis of rheumatic heart disease was confirmed only after Doppler echocardiography in suspected cases. A total of six cases of definite rheumatic heart disease (out of 13 suspected cases) were identified giving overall prevalence rate of 1.2 per 1000. Fifty percent rheumatic heart disease cases gave a history suggestive of rheumatic fever. No case of active rheumatic fever could be identified. The study gave lower result than that reported in most earlier studies from developing countries but it is similar to that reported from rural Kathmandu in 1991. It is concluded that there is some downward trend in rheumatic fever/rheumatic heart disease prevalence but the low prevalence is also due to the use of Doppler echocardiography which has prevented overdiagnosis in the present study. We feel that there is an urgent need to launch a National Programme for the control of rheumatic fever/rheumatic heart disease in Nepal with emphasis on primary and secondary prophylaxis of the disease.