Table 11.4Components of an Integrated Program on ARF and RHD Prevention and Control

Component activityElementsComments
Planning phaseEstablishment of a national advisory committee; assessment of disease burden; stepwise implementation, monitoring, and evaluationProgram should be multisectoral, engaging stakeholders in ministries of health and education, and streamlined into existing infrastructure.
Primary preventionTraining of health care providers to accurately detect and treat streptococcal pharyngitis; ensuring adequate supply of and affordability of penicillinMost effective when the importance of primary prevention is integrated into a public education program.
Secondary preventionEstablishment of national, regional, and local disease registers; active case finding, surveillance, and follow-up of existing casesParticular focus should be given to cases at risk of poor adherence to regular prophylaxis.
Provider trainingTraining health care workers on primary and secondary prevention as appropriate, as well as management of anaphylactic reactions to penicillinEngagement of public health nurses is essential in areas with physician shortages.
Health educationRegular educational activities to be carried out in schools and using local and nationwide print and electronic media programsMessaging should summarize importance of primary and secondary prevention, promote health-seeking behavior for sore throat, and encourage efforts to limit spread of infection.
Epidemiologic surveillanceRegular audits of disease registers and conduct of prevalence studies (resources permitting), including microbiological surveillanceReports should note seasonal frequency, distribution of cases, and streptococcal serotypes implicated.
Community engagementMajor stakeholders include health and educational administrators, school teachers and school health services, and families of patients.Active screening of school children for RHD may be indicated in high-prevalence settings.

Adapted from WHO 2004.

Note: ARF = acute rheumatic fever; RHD = rheumatic heart disease.

From: Chapter 11, Structural Heart Diseases

Cover of Cardiovascular, Respiratory, and Related Disorders
Cardiovascular, Respiratory, and Related Disorders. 3rd edition.
Prabhakaran D, Anand S, Gaziano TA, et al., editors.
© 2017 International Bank for Reconstruction and Development / The World Bank.

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