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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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

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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 - heart auscultation

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KW - incidence

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KW - male

KW - preschool child

KW - primary medical care

KW - rheumatic fever

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KW - Adult

KW - Child

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KW - Developing Countries

KW - Female

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KW - Incidence

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