Rheumatic fever and rheumatic heart disease in Barbados: detection and prophylaxis.

The objectives of this study were to improve our methods of secondary prophylaxis of rheumatic fever and rheumatic heart disease in Barbados, to estimate the overall prevalence of these diseases and the relative load imposed by them on available health services, and to measure the yield, feasibility, and effectiveness of mass programmes for the detection and prophylactic management of rheumatic heart disease in schoolchildren.Improved methods of surveillance and follow-up resulted in 97% adherence to therapy by patients on prophylactic penicillin. Thirty-four children, 27 with a first attack, were admitted with acute rheumatic fever, representing a 7% occupancy of children's medical beds during the 12-month period of the study. Out of a possible 3,942 schoolchildren aged 5-11 years, 3,882 (98%) were screened for rheumatic heart disease. Four cases (about 1 per 1,000) were discovered.