Table 1 Characteristics of included studies
Study (ref)LocationStudy durationSource population sizeTarget age years)Nature of pre-existing/additional intervention usedSources of identifiable casesMethod of case ascertainment
Studies using active methods of surveillance
Quinn, 196712Metropolitan Nashville, Tennessee, USA3-Year study from 1963 to 1965431 000. Active search for cases in community and hospitalsAllDetailed 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 ARFAll potential sources of healthcare, including educational centres; as in previous cellExamination 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, 198421HHD in North Island areas of New Zealand5 Years; 1978–82 Retrospective component from 1972 to1982129 765<30Establishment 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 casesHospital 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 directlyCases 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, 199614French Caribbean Islands of Martinique and Gouadaloupe11 Years; 1981–92326 000* Active search for new cases of ARF<20Educational 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 childrenCirculation of questionnaires to doctors and clinics at all levels of healthcareEach case was documented with a questionnaire Application of definitions of carditis designed a priori, and of modified Jones criteria throughout all investigations
Majeed, 199318Kuwait5 Years; 1984–8382 885. Third largest study population of all included studies5–14Launch of a National Committee for the Prevention of ARF, declaring ARF a registrable diseaseDoctors in primary care centresSuspected 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, 199320Rural community of Ambala District of Haryana State in northern India3-Year study from 1988 to 199131 200. Smallest population at risk of included studies5–18Training 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 centresThree 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, 196716Malmo (urban). Upsalla, Boden and Sundsvall, (all with urban and rural areas). Sweden10 Years; 1952–61. Oldest included study190 0000–15Relying on similarity in local admission policies in hospitals across the countryReviewing 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 ARFApplication of modified Jones criteria to each case, and further discussion and judgment on cases before accepting/omitting cases
Sramek, 19811514 Agricultural and industrial districts in Prague, former Czechoslovakia12 Years; 1961–72370 000AllPre-existing system in context of a state-wide obligatory dispensary-care programme for rheumatic childrenAdult 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, 197619A district in South-East Teheran, Iran 40% of population are registered for medical care under social insurance organisation3 Years; 1971–9.56 800. Second smallest included study population, but representative of population at riskAllSpecific day clinic that covers the medical ailments of inhabitants of this district areaSuspected cases were referred to the project group at Khazaneh general hospital for diagnosis confirmation Modified Jones criteria were used
Berrios, 198413Santiago, Chile6 Years; 1976–81590 000AllAll patients admitted to medical and paediatric departments of the Soto del Rio hospital (serving over five municipalities in Santiago) during the study periodStandardised examination procedure performed on all cases admitted (suspected) of ARF Modified Jones criteria applied
Majeed, 198717Kuwait. 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 studies225 000<14Two regional hospitals that serve half of Kuwait’s population. Primarily sought to compare epidemiological aspects of ARF with those of acute glomerulonephritisReferred 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.