10-year educational programme aimed at rheumatic fever in two French Caribbean islands

Area of Science:

• Public Health
• Epidemiology
• Infectious Disease Control

Background:

• Rheumatic fever remains a significant public health concern in less developed countries.
• A 10-year educational program was implemented in Martinique and Guadeloupe to address rheumatic fever incidence.

Purpose of the Study:

• To evaluate the effectiveness of a community and healthcare worker-focused educational program in reducing rheumatic fever incidence.
• To assess the impact of the program on carditis and acute glomerulonephritis rates.
• To determine the cost-effectiveness of the intervention.

Main Methods:

• Established a 10-year registry (1981-1991) for rheumatic fever cases using modified Jones' criteria.
• Systematic hospital admission of children and grading of carditis severity.
• Public and healthcare worker education via various media, emphasizing streptococcal infection consequences.

Main Results:

• Initial increase in reported cases due to heightened awareness, with 1982 as baseline.
• Significant reduction in rheumatic fever incidence by 78% in Martinique and 74% in Guadeloupe.
• Decreased frequency of carditis and acute glomerulonephritis; disease prevalence highest in impoverished areas.

Conclusions:

• A community-based educational program achieved a rapid and substantial decline in rheumatic fever incidence at a modest cost.
• The program demonstrated significant cost savings compared to the initial burden of childhood rheumatic fever.
• Sustained intervention is necessary to maintain reduced incidence and prevent potential disease resurgence.