Underdiagnosis of acute rheumatic fever in primary care settings in a developing country

T PARKS, Joseph Kado, S COLQUHOUN, Jonathan Carapetis, Andrew Steer

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Objectives To determine the incidence rate, characterize the clinical features and assess the diagnostic evaluation of children presenting with features of acute rheumatic fever (ARF) at two clinics in a region of Fiji where rheumatic heart disease is known to be endemic. Methods We reviewed 5 years (2003-2008) of primary care records from 15 841 patients aged 4-20 years using a pre-determined case definition for ARF; and we reviewed detailed clinical data from 944 cases with features of possible ARF. Results The crude incidence of first episodes of definite ARF in this setting among patients aged 4-20 years was 24.9 per 100 000 person-years. Joint involvement suggestive of a potential first presentation of ARF but not sufficient for a definite retrospective diagnosis was documented in a further 94 records. There were another 514 cases of joint involvement less suggestive of ARF and 316 cases of unexplained fever with no evidence of localized infection. Patients presenting with potential features of ARF seldom had a diagnostic evaluation sufficient to exclude its diagnosis. Conclusions The incidence of ARF at these clinics is nearly twice that reported in a local hospital-based study, but it is likely to under-represent the actual number of cases presenting to primary care. There is a need for better surveillance for ARF and to develop simple and practical approaches to diagnosing ARF in primary care in low-resource settings. � 2009 Blackwell Publishing Ltd.
    Original languageEnglish
    Pages (from-to)1407-1413
    Number of pages7
    JournalTropical Medicine and International Health
    Volume14
    Issue number11
    Publication statusPublished - 2009

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    Rheumatic Fever
    Developing Countries
    Primary Health Care
    Incidence
    Joints
    Fiji
    Rheumatic Heart Disease
    Fever

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    PARKS, T., Kado, J., COLQUHOUN, S., Carapetis, J., & Steer, A. (2009). Underdiagnosis of acute rheumatic fever in primary care settings in a developing country. Tropical Medicine and International Health, 14(11), 1407-1413.
    PARKS, T ; Kado, Joseph ; COLQUHOUN, S ; Carapetis, Jonathan ; Steer, Andrew. / Underdiagnosis of acute rheumatic fever in primary care settings in a developing country. In: Tropical Medicine and International Health. 2009 ; Vol. 14, No. 11. pp. 1407-1413.
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    abstract = "Objectives To determine the incidence rate, characterize the clinical features and assess the diagnostic evaluation of children presenting with features of acute rheumatic fever (ARF) at two clinics in a region of Fiji where rheumatic heart disease is known to be endemic. Methods We reviewed 5 years (2003-2008) of primary care records from 15 841 patients aged 4-20 years using a pre-determined case definition for ARF; and we reviewed detailed clinical data from 944 cases with features of possible ARF. Results The crude incidence of first episodes of definite ARF in this setting among patients aged 4-20 years was 24.9 per 100 000 person-years. Joint involvement suggestive of a potential first presentation of ARF but not sufficient for a definite retrospective diagnosis was documented in a further 94 records. There were another 514 cases of joint involvement less suggestive of ARF and 316 cases of unexplained fever with no evidence of localized infection. Patients presenting with potential features of ARF seldom had a diagnostic evaluation sufficient to exclude its diagnosis. Conclusions The incidence of ARF at these clinics is nearly twice that reported in a local hospital-based study, but it is likely to under-represent the actual number of cases presenting to primary care. There is a need for better surveillance for ARF and to develop simple and practical approaches to diagnosing ARF in primary care in low-resource settings. � 2009 Blackwell Publishing Ltd.",
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    PARKS, T, Kado, J, COLQUHOUN, S, Carapetis, J & Steer, A 2009, 'Underdiagnosis of acute rheumatic fever in primary care settings in a developing country', Tropical Medicine and International Health, vol. 14, no. 11, pp. 1407-1413.

    Underdiagnosis of acute rheumatic fever in primary care settings in a developing country. / PARKS, T; Kado, Joseph; COLQUHOUN, S; Carapetis, Jonathan; Steer, Andrew.

    In: Tropical Medicine and International Health, Vol. 14, No. 11, 2009, p. 1407-1413.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Underdiagnosis of acute rheumatic fever in primary care settings in a developing country

    AU - PARKS, T

    AU - Kado, Joseph

    AU - COLQUHOUN, S

    AU - Carapetis, Jonathan

    AU - Steer, Andrew

    PY - 2009

    Y1 - 2009

    N2 - Objectives To determine the incidence rate, characterize the clinical features and assess the diagnostic evaluation of children presenting with features of acute rheumatic fever (ARF) at two clinics in a region of Fiji where rheumatic heart disease is known to be endemic. Methods We reviewed 5 years (2003-2008) of primary care records from 15 841 patients aged 4-20 years using a pre-determined case definition for ARF; and we reviewed detailed clinical data from 944 cases with features of possible ARF. Results The crude incidence of first episodes of definite ARF in this setting among patients aged 4-20 years was 24.9 per 100 000 person-years. Joint involvement suggestive of a potential first presentation of ARF but not sufficient for a definite retrospective diagnosis was documented in a further 94 records. There were another 514 cases of joint involvement less suggestive of ARF and 316 cases of unexplained fever with no evidence of localized infection. Patients presenting with potential features of ARF seldom had a diagnostic evaluation sufficient to exclude its diagnosis. Conclusions The incidence of ARF at these clinics is nearly twice that reported in a local hospital-based study, but it is likely to under-represent the actual number of cases presenting to primary care. There is a need for better surveillance for ARF and to develop simple and practical approaches to diagnosing ARF in primary care in low-resource settings. � 2009 Blackwell Publishing Ltd.

    AB - Objectives To determine the incidence rate, characterize the clinical features and assess the diagnostic evaluation of children presenting with features of acute rheumatic fever (ARF) at two clinics in a region of Fiji where rheumatic heart disease is known to be endemic. Methods We reviewed 5 years (2003-2008) of primary care records from 15 841 patients aged 4-20 years using a pre-determined case definition for ARF; and we reviewed detailed clinical data from 944 cases with features of possible ARF. Results The crude incidence of first episodes of definite ARF in this setting among patients aged 4-20 years was 24.9 per 100 000 person-years. Joint involvement suggestive of a potential first presentation of ARF but not sufficient for a definite retrospective diagnosis was documented in a further 94 records. There were another 514 cases of joint involvement less suggestive of ARF and 316 cases of unexplained fever with no evidence of localized infection. Patients presenting with potential features of ARF seldom had a diagnostic evaluation sufficient to exclude its diagnosis. Conclusions The incidence of ARF at these clinics is nearly twice that reported in a local hospital-based study, but it is likely to under-represent the actual number of cases presenting to primary care. There is a need for better surveillance for ARF and to develop simple and practical approaches to diagnosing ARF in primary care in low-resource settings. � 2009 Blackwell Publishing Ltd.

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    KW - primary health care

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    KW - clinical feature

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    KW - Incidence

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