Academic journal article Bulletin of the World Health Organization

WHO Programme for the Prevention of Rheumatic Fever/rheumatic Heart Disease in 16 Developing Countries: Report from Phase I (1986-90)

Academic journal article Bulletin of the World Health Organization

WHO Programme for the Prevention of Rheumatic Fever/rheumatic Heart Disease in 16 Developing Countries: Report from Phase I (1986-90)

Article excerpt


Rheumatic fever/rheumatic heart disease (RF/RHD) is the most common cardiovascular disease in children and young adults and remains a major public health problem in developing countries [1]. The cost is very high because of repeated hospitalizations (often resulting in premature death), the enormous resources needed for medical and surgical treatment of large numbers of patients, and the suffering caused to patients and relatives [2].(a) The resurgence of acute RF in the USA in the mid-1980s, with its specific epidemiological characteristics, plus other isolated epidemics of RF [1, 2],(a) and the absence of an effective antirheumatic streptococcal vaccine or genetic marker to identify people at high risk of developing RF, point to the fact that intensified research is needed in these areas. Meanwhile, the available and feasible preventive methods must be applied [1, 2].(a)

WHO has been concerned with RF/RHD prevention and control since 1954, when the WHO Expert Committee on Rheumatic Diseases suggested the possibility of using antibiotics and sulfonamides to prevent RF/RHD on a worldwide scale [3]. Subsequently, other WHO Expert Committees have directed their efforts towards public health practices with regard to the study, prevention and control of group A streptococcal infections and RF/RHD [1, 3-8].(b, c)

In the 1970s, WHO initiated an international cooperative study on RF/RHD prevention in seven developing countries in Africa, the Americas and Asia, and the Pan American Health Organization (PAHO) developed another study in seven Latin American countries. Both of these demonstrated that community programmes for the secondary prevention of RF/RHD were not only feasible but also cost-effective in developing countries [9], and this has been stressed in several WHO reports on RF/RHD [1, 6-10].(b, c, d)

In 1984, in response to a World Health Assembly resolution (WHA36.32), WHO, in close collaboration with the International Society and Federation of Cardiology (ISFC), initiated the global programme for the prevention of RF/RHD in 16 developing countries.(d) This programme, which was designed to encourage the application of proven control measures to decrease morbidity and mortality due to RF/RHD and to support national strategies for Health for All by the Year 2000, is partly funded by the Arab Gulf Programme for United Nations Development Organizations (AGFUND).


Based on the experiences from the earlier WHO cooperative research study [9], the present programme was conceived and planned as a service-oriented activity to be implemented through primary health care (PHC) and the national health care delivery system.(d) The Ministry of Health therefore has executive responsibility for the national programme, appointing the national programme

manager and a multi-disciplinary advisory committee, and providing local inputs to maintain the programme at a viable level.

Each collaborating country has prepared a national plan of operation following guidelines provided by WHO, with objectives and targets and a commitment to extend programme activities in realistic steps towards nationwide coverage. Each approved plan to operation was signed by the Minister of Health and the respective WHO Regional Director to indicate their endorsement of the plan as a basis for collaboration with WHO.

The programme's implementation was in three phases:

* short-term (Phase I): planning and development, pre-programme pilot study, and programme of control in the selected area:

* medium-term (Phase II): community control (consolidation and extension to the whole selected community);

* long-term (Phase III): nationwide extension (consolidation and extension to the whole country.

Collaborating countries. Sixteen countries from five WHO Regions were identified in 1984 and have been participating in the global programme. …

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