| Study (ref) | Location | Study duration | Source population size | Target age years) | Nature of pre-existing/additional intervention used | Sources of identifiable cases | Method of case ascertainment |
| Studies using active methods of surveillance | |||||||
| Quinn, 196712 | Metropolitan Nashville, Tennessee, USA | 3-Year study from 1963 to 1965 | 431 000. Active search for cases in community and hospitals | All | Detailed briefing of principals and health staff in schools, public and private health facilities (including other educational, domiciliary, rehabilitative and disciplinary institutions) of study proposal and processes required of them Maintaining regular contact with private doctors Initial interview with doctors Routine periodic telephone contact of study secretary with private doctors serving as a case-finding measure and a repeated reminder of the continued interest in his new cases of ARF | All potential sources of healthcare, including educational centres; as in previous cell | Examination of patient by one of the two study doctors when reported Otherwise, if already discharged, case ascertainment occurred by studying their hospital medical record For non-hospitalised patients, relevant information was obtained from their doctor by one of the study doctors Revised Jones criteria used |
| Talbot, 198421 | HHD in North Island areas of New Zealand | 5 Years; 1978–82 Retrospective component from 1972 to1982 | 129 765 | <30 | Establishment of an RF/RHD register in 1977 to facilitate second degree prophylaxis Two questionnaires sent to all GPs in HHD requesting information on patients meeting register criteria In 1983, a computer printout sent to all district GPs requesting corrections be made on the printout to details of patients known to be under their care, also updating and adding new cases | Hospital registries, based on a history of RF before the age of 30 years while resident in HHD OPD records of all patients attending adult and paediatric cardiology OPD clinic at Waikato Hospital Records from more specialised hospitals Eventually private practitioners (including dental surgeons) and other hospital departments referred cases directly | Cases satisfying revised Jones criteria were categorised as definite cases Cases satisfying modified criteria were categorised as possible cases All hospital case notes were scrutinised by author Doubtful GP information was clarified by telephone call, letter, or review at an outpatient clinic |
| Bach, 199614 | French Caribbean Islands of Martinique and Gouadaloupe | 11 Years; 1981–92 | 326 000* Active search for new cases of ARF | <20 | Educational programme aimed at healthcare workers, social and educational professionals and the public Establishment of a registry for documenting first and recurrent cases of ARF in the islands with systematic hospital admission of children | Circulation of questionnaires to doctors and clinics at all levels of healthcare | Each case was documented with a questionnaire Application of definitions of carditis designed a priori, and of modified Jones criteria throughout all investigations |
| Majeed, 199318 | Kuwait | 5 Years; 1984–8 | 382 885. Third largest study population of all included studies | 5–14 | Launch of a National Committee for the Prevention of ARF, declaring ARF a registrable disease | Doctors in primary care centres | Suspected cases were referred to paediatric department of the regional hospital, where case ascertainment would take place. Revised criteria were used to confirm cases, which were entered in the registry |
| Grover, 199320 | Rural community of Ambala District of Haryana State in northern India | 3-Year study from 1988 to 1991 | 31 200. Smallest population at risk of included studies | 5–18 | Training programme for health workers, teachers, students and three pharmacists took place in the 1-year period preceding study onset. Training was regular with monthly meetings as well, with continuing training for pupils Set up of ARF/RHD registry at each of the three primary health centres | Three primary healthcare registries in this rural community that covered 121 villages. Healthcare workers and pharmacists from schools and villages identified cases Programme medical officers also screened children during school medical check-ups to identify cases. | As trained, suspected cases to be referred to medical officers in the health centres for case ascertainment Every case entered on registry by medical officers, or suspected of having ARF/RHD, was examined by one of the authors to confirm diagnosis, using predefined criteria Revised Jones criteria used |
| Studies using passive methods of case detection | |||||||
| Ekelund, 196716 | Malmo (urban). Upsalla, Boden and Sundsvall, (all with urban and rural areas). Sweden | 10 Years; 1952–61. Oldest included study | 190 000 | 0–15 | Relying on similarity in local admission policies in hospitals across the country | Reviewing records over a 10-year period of all under 16-year olds in the four (regional) hospitals with a specified range of diagnoses differential to ARF | Application of modified Jones criteria to each case, and further discussion and judgment on cases before accepting/omitting cases |
| Sramek, 198115 | 14 Agricultural and industrial districts in Prague, former Czechoslovakia | 12 Years; 1961–72 | 370 000 | All | Pre-existing system in context of a state-wide obligatory dispensary-care programme for rheumatic children | Adult case detection separate from child case detection Children via the state-wide dispensary programme Adults via similar but locally limited programme carried out by Research Institute of Rheumatic Diseases (RIRD) | All definite or suspected cases were referred to hospital: - children to one of 16 departments of paediatrics or to RIRD (according to domicile) - adults to the department of internal medicine of the local hospital or, more often, to RIRD Patients discharged from hospital diagnosed as ARF were entered in a district register for rheumatic patients Modified Jones criteria applied |
| Gharagozloo, 197619 | A district in South-East Teheran, Iran 40% of population are registered for medical care under social insurance organisation | 3 Years; 1971–9. | 56 800. Second smallest included study population, but representative of population at risk | All | Specific day clinic that covers the medical ailments of inhabitants of this district area | Suspected cases were referred to the project group at Khazaneh general hospital for diagnosis confirmation Modified Jones criteria were used | |
| Berrios, 198413 | Santiago, Chile | 6 Years; 1976–81 | 590 000 | All | All patients admitted to medical and paediatric departments of the Soto del Rio hospital (serving over five municipalities in Santiago) during the study period | Standardised examination procedure performed on all cases admitted (suspected) of ARF Modified Jones criteria applied | |
| Majeed, 198717 | Kuwait. Densely populated areas; mostly flats of expatriates, two rooms average Family size 3–9 (mean 5.3) | 3 Years; 1980–3. Earliest of two included Kuwait studies | 225 000 | <14 | Two regional hospitals that serve half of Kuwait’s population. Primarily sought to compare epidemiological aspects of ARF with those of acute glomerulonephritis | Referred cases admitted to hospital. Revised Jones criteria applied | |
Figures at and below the asterisk in these cells had to undergo some calculations by the author using the data provided.
ARF, acute rheumatic fever; HHD, Hamilton Health District; OPD, outpatients department; RF, rheumatic fever; RHD, rheumatic heart disease; RIRD, Research Institute of Rheumatic Diseases.