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HEARTY facts
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The prevalence of Rheumatic Heart Disease in selected regions of Ernakulam district is encouragingly low, according to a survey conducted by the AIMS, finds K. PRADEEP.
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KEEP SMILING: Students of St. Joseph's LPS, Munambam, one of the schools that was part of the survey.
IT ALL starts with an untreated sore throat. Every year many children and young adults are crippled or die as a result of rheumatic heart disease (RHD). Approximately 400,000 deaths have been reported worldwide annually, mainly among children and young adults, a huge chunk of it from developing countries. Along with Egypt and Brazil, India has the dubious record of having more lives claimed by RHD than any other country in the world. Unlike many other heart diseases rheumatic fever and rheumatic heart disease affects mainly the poor.
In spite of the enormity of the problem, most researchers and educators have given little attention to the disease. Statistics from selected populations often cannot be generalised to a vast and diverse country like ours.
Good news
It is in this context that the Rheumatic Fever (RF)/Rheumatic Heart Disease Registry Project, undertaken by the Amrita Institute of Medical Sciences, Kochi, under the Indian Council of Medical Research, Jai Vigyan Mission Mode, attains significance.
And if the first phase survey report that determined the prevalence in school children is any sort of firm indicator, there is good news for Ernakulam District.
It appears that the prevalence of RHD and incidence of RF, in the selected regions of the district, is encouragingly low.
Project
This project, launched under the guidance of the Paediatric Cardiology department of AIMS, is a three-year one, targeted with clear milestones and time schedules.
Launched in 2003, the first phase focussed on 46 selected schools in the Cochin Corporation, 20 panchayats and three municipalities in and around the corporation. The school health programme, conducted in three stages, managed to screen 25,295 children for any heart disease including RHD.
"We adopted a two-fold study design, Passive Surveillance for registry and Active Surveillance for the school survey. The first is basically a community-based survey. In the school survey, we stratified schools according to strength on a basis of random sampling. Then we had evaluations by medical officers who checked children between the age of five and 15 for any heart abnormality. This was followed by drawing out a list of children with abnormality, which was checked by a paediatric cardiologist and echocardiography was subsequently performed at the AIMS," informs Dr. Manu Raj, Research Officer.
Findings
The survey revealed that out of the 25, 295 children only two children were found to have RHD, five had previous history of rheumatic fever and two were diagnosed to have rheumatic fever. Since the survey encompassed heart diseases in general, it was found that 61 children had other heart problems, mainly congenital heart diseases.
"We are looking at a district that has the best indices in the country and the best health infrastructure. But I personally feel there is more scope for improvement. What we need is even better cooperation from the medical sector, both public and private. This project is looked on, by the Central Government, as a sort of model project. Now, at least we have identified a method. This can be adapted in States like Gujarat and Chattisgarh where there are districts that have a shockingly high prevalence of rheumatic heart disease," says Dr. R. Krishna Kumar, Chief Paediatric Cardiologist, AIMS, who functions as the principal investigator of the project.
Health education
The success of the other phases of the project will depend on the efforts of the Kudumbashree health volunteers identified and trained as part of this project. A total number of 2,835 volunteers have already been trained. They now act as a liaison between the patients in their respective areas and the project office. They have so far reported at least 15 cases. The goal is to sensitise the community by providing relevant health education. And this is being done through these Kudumbashree units, teachers and children. A 12-minute documentary titled `Spandanam' has been produced to intensify public health education. Efforts are on to telecast this film through television channels.
"This is one of the projects that AIMS has undertaken. As a follow up to this we have another one coming up on the creation and evaluation of a clinical strategy to screen for congenital heart disease in newborn babies. Before every project we have a pilot scheme and on the results of this we go ahead with the project proper and approaching funding agencies. A lot of work in going on the research front," states Dr. A. K. K. Unni, Research Coordinator.
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