CURRENT STATUS OF RHEUMATIC FEVER AND RHEUMATIC HEART DISEASE IN NEPAL

common problem, in most developing countries more than 50% of RF/RHD patients are unaware of this disease and more than 70% do not receive monthly benzathine penicillin for secondary prophylaxis.4 The mortality rate of RHD varies from 0.9 to 8 per 100000 every year.4 RF and RHD are especially common in underdeveloped, deprived and depressed areas of the world. Prevalence of RF and RHD has declined sharply in affluent developed countries.5 Nepal is a developing country Rheumatic fever (RF) and rheumatic heart disease (RHD) are common in underdeveloped, deprived and depressed areas of the world. The progression of RHD is rapid in deprived communuties. Prevalence of RF and RHD has sharply declined in affluent and developed countries, especially after the introduction of antibiotcs. RHD is a preventable disease. RHD is a leading cause of cardiovascular deaths in developing countries. The prevalence of RF and RHD varies from place to place. In developing countries, young productive age groups are suffering from this disease while in developed countries it is becoming geriatric disease due to the betterment of living standards and prompt awareness upon this disease. Studies and documentation of the current ststus of RF and RHD in Nepal is the present concern. 1. Shahid Gangalal National Heart Centre. Address for correspondence : Dr. Yuba Raj Limbu, Cardiology Shahid Gangalal National Heart Centre P.O.Box: 11360, Kathmandu, Nepal Email: yrlimbu@yahoo.com


INTRODUCTION
2][3] RF and RHD are common problems of developing countries.Despite being

CURRENT STATUS OF RHEUMATIC FEVER AND RHEUMATIC HEART DISEASE IN NEPAL
ABSTRACT common problem, in most developing countries more than 50% of RF/RHD patients are unaware of this disease and more than 70% do not receive monthly benzathine penicillin for secondary prophylaxis. 4The mortality rate of RHD varies from 0.9 to 8 per 100000 every year. 4RF and RHD are especially common in underdeveloped, deprived and depressed areas of the world.Prevalence of RF and RHD has declined sharply in affluent developed countries. 5Nepal is a developing country

GLOBAL SCENARIO
The dramatic decline from 100 to 200 cases per 100000 population to 0.5 per 100000 population in the incidence of acute RF in the past century has been documented in developed country like USA and the sharp decline has been observed especially after the introduction of antibiotics. 5owever reappearance of increased RHD cases due to large number of influxed immigrants, predominantly from developing countries, was recorded in USA in 1980s and 1990s.Although the occurrence of RF and RHD was sharply declined and RHD became a geriatric disease in developed country like USA, an outbreak of acute RF reappeared at some regions of the country at the close of last century. 8Moreover the outbreak was observed among middle-class Caucasian children with no risk factors other than household crowding. 9High rates of RHD in some deprived communities, such as Samoan children in Hawai (2.06 per 1000), Srilankans(1.42per 1000) and Maori children in Auckland, Newzealand (1.25 per 1000) has been reported at the end of last century. 10HD is reported as the commonest heart disease in most populous developing country like China. 11ecently declining trend of RHD is unveiled.In one retrospective study of heart diseases in 40 years 12 showed that RHD has declined from 50.3%, first in sequence order, to 24.23%, second in sequence order among all cardiovascular diseases.Similarly from other populous developing country like India the prevalence of RHD between 1940 and 1983 is reported in between 1.8 and 11 per thousand school children with national average 6 per thousand. 13The prevalence of RHD is reported declined from 1984 to 1995 with the prevalence of 1 to3.9 per thousand. 13Recently variation in prevalence in RHD, Urban 2.56 per thousand and rural 7.42 per thousand is reported in some region of India 14. Contemporarily the incidence of RF is reported 0.05 to 1.7 per thousand between 1940 and 1983 and 0.18 to 0.3 per thousand from 1984 to 199510.Similarly the variation in the prevalence of RF, 1.2 per thousand in rural area and 0.42 per thousand in urban area with average 0.75 per thousand is reported in some region of India. 14On one hand the overall incidence of RF and RHD in affluent developed countries has sharply declined, on the other hand in developing countries RHD is still a commonest heart disease and the prevalence of RF and RHD varies in between rural and urban areas.

CURRENT STATUS IN NEPAL
Few years back in one study it was reported that 0.34 percent of admitted cases were RF cases among all hospital admitted cases. 15

Rheumatic fever (RF) and rheumatic heart disease (RHD) are common in underdeveloped, deprived and depressed areas of the world. The progression of RHD is rapid in deprived communuties. Prevalence of RF and RHD has sharply declined in affluent and developed countries, especially after the introduction of antibiotcs. RHD is a preventable disease. RHD is a leading cause of cardiovascular deaths in developing countries. The prevalence of RF and RHD varies from place to place. In developing countries, young productive age groups are suffering from this disease while in developed countries it is becoming geriatric disease due to the betterment of living standards and prompt awareness upon this disease. Studies and documentation of the current ststus of RF and RHD in Nepal is the present concern.
There is still a possibility that large number of RF cases are undiagnosed and unvisited in large number of rural communities.The anticipation for the existence of hidden RF and progression of RHD is proved by the large number of hospital admitted RHD cases.RHD is the commonest among cardiovascular diseases in this country.Mitral stenosis is the predominant RHD and female preponderance, as other world literatures, is documented in Nepal.The onset of clinical symptoms due to RHD in younger, productive age group has certain impact on national economy, which evokes the realization of prompt awareness upon health care and preventive measures for the eradication of RF and RHD in this country.