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PubMed1998

Developing a model to reduce blindness in India: The International Centre for Advancement of Rural Eye Care.

With the continuing high magnitude of blindness in India, fresh approaches are needed to effectively deal with this burden on society. The International Centre for Advancement of Rural Eye Care (ICARE) has been established at the L.V. Prasad Eye Institute in Hyderabad to develop such an approach. This paper describes how ICARE functions to meet its objective. The three major functions of ICARE are design and implementation of rural eye-care centres, human resource development for eye care, and community eye-health planning. ICARE works with existing eye-care centres, as well as those being planned, in underserved areas of India and other parts of the developing world. The approach being developed by ICARE, along with its partners, to reduce blindness is that of comprehensive eye care with due emphasis on preventive, curative and rehabilitative aspects. This approach involves the community in which blindness is sought to be reduced by understanding how the people perceive eye health and the barriers to eye care, thereby enabling development of strategies to prevent blindness. Emphasis is placed on providing good-quality eye care with attention to reasonable infrastructure and equipment, developing a resource of adequately trained eye-care professionals of all cadres, developing a professional environment satisfactory for patients as well as eye-care providers, and the concept of good management and financial self-sustainability. Community-based rehabilitation of those with incurable blindness is also part of this approach. ICARE plans to work intensively with its partners and develop these concepts further, thereby effectively bringing into practice the concept of comprehensive eye care for the community in underserved parts of India, and later in other parts of the developing world. In addition, ICARE is involved in assessing the current situation regarding the various aspects of blindness through well-designed epidemiologic studies, and projecting the eye-care needs for the future with the help of reliable information. With balanced attention to infrastructure, manpower, financial self-sustenance, and future planning, ICARE intends to develop a practical model to effectively reduce blindness in India on a long-term basis.

Blindness↗

PubMedDate not supplied

Epidemiology of visceral leishmaniasis in India.

Kala-azar has re-emerged from near eradication. The annual estimate for the incidence and prevalence of kala-azar cases worldwide is 0.5 million and 2.5 million, respectively. Of these, 90% of the confirmed cases occur in India, Nepal, Bangladesh and Sudan. In India, it is a serious problem in Bihar, West Bengal and eastern Uttar Pradesh where there is under-reporting of kala-azar and post kala-azar dermal leishmaniasis in women and children 0-9 years of age. Untreated cases of kala-azar are associated with up to 90% mortality, which with treatment reduces to 15% and is 3.4% even in specialized hospitals. It is also associated with up to 20% subclinical infection. Spraying of DDT helped control kala-azar; however, there are reports of the vector Phlebotomus argentipes developing resistance. Also lymphadenopathy, a major presenting feature in India raises the possibility of a new vector or a variant of the disease. The widespread co-existence of malaria and kala-azar in Bihar may lead to a difficulty in diagnosis and inappropriate treatment. In addition, reports of the organism developing resistance to sodium antimony gluconate--the main drug for treatment--would make its eradication difficult. Clinical trials in India have reported encouraging results with amphotericin B (recommended as a third-line drug by the National Malaria Eradication Programme). Phase III Trials with a first-generation vaccine (killed Leishmania organism mixed with a low concentration of BCG as an adjuvant) have also yielded promising results. Preliminary studies using autoclaved Leishmania major mixed with BCG have been successful in preventing infection with Leishmania donovani. Until a safe and effective vaccine is developed, a combination of sandfly control, detection and treatment of patients and prevention of drug resistance is the best approach for controlling kala-azar.

Adolescent↗

PubMed2000

Distribution of various subtypes of non-Hodgkin's lymphoma in India: a study of 2773 lymphomas using R.E.A.L. and WHO Classifications.

INTRODUCTION: The distribution of the major subtypes of non-Hodgkin's lymphoma (NHL) differs across geographic regions. This is the first study from India that has incorporated immunophenotypic findings while investigating the distribution of NHL subtypes. PATIENTS AND METHODS: All cases diagnosed as NHL between January 1995 and June 1998 in the Department of Pathology and in the Lymphoma Registry, Tata Memorial Hospital, Bombay, were selected for the study. The cases were reviewed by three pathologists and diagnostic problems were discussed by a panel of pathologists with a special interest in lymph node pathology. Of a total of 2831 cases, the diagnosis of NHL was accepted in 2773 cases. RESULTS: B-cell lymphomas formed 79.1% of the NHLs, whereas T-cell lymphomas formed 16.2% of the total. Diffuse large B-cell lymphoma was the most common subtype (34% of all NHLs). Follicular centre-cell lymphomas, B-cell small lymphocytic lymphoma, mantle-cell lymphoma, and marginal zone B-cell lymphomas (including MALT lymphomas) amounted to 12.6%, 5.7%, 3.4%, and 8.2%, respectively. Among the T-cell lymphomas, T-cell lymphoblastic lymphoma, anaplastic large-cell lymphomas of T/null-cell type, and other nodal peripheral T-cell lymphomas accounted for 6%, 4.3%, and 2.9% of all cases, respectively. CONCLUSIONS: The distribution of NHL subtypes in India shows important differences with those from the rest of the world. Follicular lymphoma and mantle-cell lymphoma are less common in India compared to Europe and the USA. Peripheral T-cell lymphomas and T/NK-cell lymphomas of nasal and nasal types, which are common in many other Asian countries, are also less prevalent. T-cell lymphoblastic lymphoma and anaplastic large T/null cell lymphoma are more prevalent in India.

Europe↗

PubMedDate not supplied

Screening for chronic impairments using medical interns in rural Haryana, India.

BACKGROUND: With the increase in life expectancy, prevalence of impairments and disabilities are expected to increase in India. However, there have been very few studies to estimate the magnitude of the problem in rural India. This is essential, if appropriate rehabilitation services are to be planned in the country. METHODS: The study was done in the rural field practice area of the All India Institute of Medical Sciences at Ballabgarh, Haryana. The survey was conducted by successive batches of interns posted at Ballabgarh as a part of their compulsory rotating internship programme. The diagnostic criteria were based on history and simple clinical examination done at the domiciliary level. RESULTS: A total population of 25,509 in twelve villages were screened. The total impairment rate was 5.4% with no significant men/women difference. The prevalence of physical impairment was 4.7 per 1000 population. The prevalence of corneal opacity in children below 15 years of age was 4.7 per 1000. Prevalence of cataract was almost 35% in the population over 60 years of age and 15% in the population between 45 to 60 years. Auditory impairment was 19.6 per 1000 as ascertained by history. Three-fourths of this was conductive deafness and was found mainly in people above 60 years of age. CONCLUSION: Utilizing the rural field practice areas of medical colleges for collection of data on issues of national health importance would not only strengthen the health system in the country but also improve medical education. There is a need for a comprehensive preventive, promotive, curative and rehabilitative approach to disabilities in India.

Adolescent↗

PubMed2001

Geriatric oral health issues in India.

An overview of the demographics and oral health status of the elderly population of India is presented. India is a vast country with a population of one billion people. Of this, people older than 60 years constitute 7.6%, which in actual number is 76 million. There are several factors that affect the oral health of elderly. The dentist:population ratio is 1:27,000 in urban areas and 1:300,000 in rural areas, whereas 80% of the elderly population reside in rural India. Forty per cent of the elderly live below the poverty line and 73% are illiterate. Ninety per cent of the elderly have no social security and the dependency ratio is 12.26. Incidence of oral cancer, which is considered an old-age disease, is highest in India, 13.5% of all body cancers are oral cancers. Preventive dental care is almost nonexistent to the rural masses and very limited in urban areas. Above all, there is no orientation of dental graduates towards the special needs of the geriatric population. Recommendations include: the establishment of Continuing Dental Education programmes on geriatric oral care; inclusion of a geriatric component in undergraduate and postgraduate curricula; initiation of a diploma, certificate and degree courses in geriatric dentistry; research on various aspects of ageing and age-related oral health problems; provision of preventive and curative treatment for various oral diseases to the elderly.

Aged↗

PubMed2001

In vitro susceptibility pattern of Sporothrix schenckii strains isolated from three centers in India.

BACKGROUND & OBJECTIVES: With the availability of more number of antifungal agents in recent years, drugs other than saturated solution of potassium iodide (SSKI) are being increasingly used to treat sporotrichosis. It was therefore considered pertinent to evaluate in vitro antifungal susceptibility pattern of Sporothrix schenckii strains isolated at three centers in India against five commonly used antifungal agents. METHODS: Agar dilution method was used to evaluate 50 clinical isolates (25 from north, 17 from east and 8 from south India) both in its yeast and mycelial forms against amphotericin-B, 5-fluorocytosine, ketoconazole, fluconazole and itraconazole. RESULTS: No resistance was observed in the yeast form of S. schenckii against amphotericin B and azoles. However, 54 per cent strains in the yeast form were resistant to 5-fluorocytosine. None of the strains was susceptible to amphotericin B and ketoconazole, 56 and 10 per cent strains in the mycelial form were susceptible to itraconazole and fluconazole respectively. No significant difference was observed in the antifungal susceptibility pattern among the strains isolated from these three regions in India. INTERPRETATION & CONCLUSION: Clinical isolates of S. schenckii from three regions of India had a more or less uniform antifungal susceptibility pattern. Itraconazole had the best in vitro susceptibility results against the clinical isolates of S. schenckii and has the potential to replace SSKI.

Antifungal Agents↗

PubMedDate not supplied

Medico-social dimensions of menopause: a cross-sectional study from rural south India.

BACKGROUND: The quality of life of the increasing ageing population is becoming an important issue in India. There are very little data on the effect of menopause on women, especially from rural India. METHOD: A population-based cross-sectional study was conducted on perceptions regarding menopause, prevalence of menopausal symptoms and association of family environmental factors with menopausal symptoms among 100 postmenopausal and 100 premenopausal rural women in south India. RESULTS: Fifty-seven per cent of postmenopausal women perceived menopause as convenient. Sixty-nine per cent of them complained of diminishing abilities after menopause. Twenty-three per cent felt that sexual life ends with the onset of menopause. Sixteen per cent reported that their husbands had become disinterested in them after menopause and I1% were apprehensive about the loss of femininity. A higher proportion of postmenopausal women reported hot flushes, night sweats, urge incontinence and other somatic symptoms as compared to premenopausal women. Fifty-four per cent of postmenopausal and 32% of premenopausal women were currently not sexually active. Fifty-nine per cent of postmenopausal and 38% of premenopausal women expressed loss of sexual desire and this difference was statistically significant. There was no significant association between menopause and depression. A poor perceived relationship within the family was shown to have a significant association with depression. There was a significant association between multiple somatic symptoms and menopause. CONCLUSION: A significantly higher proportion of postmenopausal women suffer from vasomotor symptoms, urge incontinence, loss of sexual desire and multiple somatic symptoms. They do not link these symptoms with menopause. Poor family environmental factors have a stronger association with depression than menopause. In view of these findings, it is important to determine the feasibility and impact of hormone replacement therapy in preventive health care in rural India.

Adult↗

PubMed2002

Rapid DOTS expansion in India.

Since late 1998 the coverage of the DOTS strategy in India has been expanded rapidly. In both 2000 and 2001 the country probably accounted for more than half the global increase in the number of patients treated under DOTS and by early 2002 more than a million patients were being treated in this way in India. As a result, nearly 200 000 lives were saved. The lessons learnt relate to the importance of the following elements of the programme: (1) getting the science right and ensuring technical excellence; (2) building commitment and ensuring the provision of funds and flexibility in their utilization; (3) maintaining focus and priorities; (4) systematically appraising each area before starting service delivery; (5) ensuring an uninterrupted drug supply; (6) strengthening the established infrastructure and providing support for staff; (7) supporting the infrastructure required in urban areas; (8) ensuring full-time independent technical support and supervision, particularly during the initial phases of implementation; (9) monitoring intensively and giving timely feedback; and (10) continuous supervision. Tuberculosis (TB) control still faces major challenges in India. To reach its potential, the control programme needs to: continue to expand so as to cover the remaining half of the country, much of which has a weaker health infrastructure than the areas already covered; increase its reach in the areas already covered so that a greater proportion of patients is treated; ensure sustainability; improve the patient-friendliness of services; confront TB associated with human immunodeficiency virus (HIV) infection. It is expected that HIV will increase the number of TB cases by at least 10% and by a considerably higher percentage if HIV becomes much more widespread. India's experience shows that DOTS can achieve high case-detection and cure rates even with imperfect technology and often with an inadequate public health infrastructure. However, this can only happen if the delivery programme is appropriately designed and effectively managed.

Antitubercular Agents↗

PubMed2002

Initial experiences of implementation of functional integration (FI) in LEPRA India projects in Orissa.

In 2000, the Government of the State of Orissa (population 37 million) in India decided to introduce functional integration for the control of leprosy, in place of the long-established vertical programme, using the general health services and the primary health care system. This paper describes the initial (9 months) experience of implementing this strategy in two projects run by LEPRA India. One of these, in the district of Koraput, was established in 1991 and covers a population of 1.5 million people. The other, in Kalahandi district, started in 1997 and covers a population of 600,000. Both projects operate under difficult conditions with regard to terrain, the use of numerous tribal languages, illiteracy, water shortage, poor roads and communications. The preparatory phase included intensive health education of the public on leprosy, using a wide range of educational media and techniques. At the same time, LEPRA India supported the Government in the training and orientation of trainers, medical officers, primary health care staff and female health workers at village level. In all, over 2000 were trained. This paper describes all aspects of the implementation of functional integration in these two areas. In the 9-month period, 4207 suspect cases were referred to medical officers by health workers, but only 256 (6%) were confirmed as having leprosy. There were 169 confirmed self-reporting cases. Despite the clearly understood intention to involve primary health staff in case detection, 67% of all cases were in fact detected by LEPRA India, possibly due to overlapping attendance at clinics by vertical and general staff. There is obviously a need for further training of the general staff since only 6% of cases referred by them were confirmed as having leprosy. Steps must also be taken to ensure that the emphasis on case detection, confirmation and treatment shifts from the vertical to the general health staff. The supply of anti-leprosy drugs and steroids to primary health centers needs improvement. Appropriate teaching and learning material is urgently needed for both field staff and medical officers.

Delivery of Health Care, Integrated↗

PubMed1992

Regional variations in age pattern of mortality in India.

"Using the cluster analysis technique and Heligman-Pollard mortality model, the present paper analyses the regional variations in age pattern of mortality in India around 1986-88. The paper identifies three broad patterns of age-specific mortality rates in the country--the Central-India Pattern; the South-India Pattern; and the North-West India Pattern. In addition, Kerala has its own typical pattern of age-specific mortality. Similarly, Assam (Males) and Jammu and Kashmir (Males) have their own typical pattern of age-specific mortality rates while the same is also true for Rajasthan (Females). The implications of age patterns of mortality identified in this analysis have also been discussed."

Asia↗

PubMed2002

Occurrence of the lung fluke Paragonimus hueit'ungensis in Manipur, India.

BACKGROUND: Paragonimus has emerged as an important parasitic zoonosis in recent years in Manipur, India. However, no scientific data on the systematic and phylogenetic classification of lung fluke in India is available. Therefore, a study was conducted to determine the species of lung fluke prevalent in Manipur by infecting an experimental animal with Paragonimus metacercariae obtained from fresh water crabs. METHODS: Thirteen Paragonimus metacercariae isolated from the fresh water crabs, Potamiscus manipurensis, at Churachandpur, Manipur, India were used to infect a puppy orally using a Pasteur pipette. After the infection, fecal specimens were checked for Paragonimus eggs by microscopic examination. Autopsy was performed on day 121 post-infection. The worms recovered from the worm cysts were alcohol fixed, flattened and stained with carmine for morphological study. RESULTS: Four adult worms were recovered. The worms presented with singly spaced cuticular spines, and the ventral suckers were slightly larger than the oral suckers. The ovaries consisted of 4 to 5 lobed masses branched like a ginger stem, and the testes were irregularly lobed and elongated. One ofthe worms showed a different shape and size ofthe right testis. The morphological features of the worms are similar to the Chinese species, Paragonimus hueit'ungensis. CONCLUSION: The results of this study indicate the possibility of occurrence of P hueit'ungensis as 1 of the important Paragonimus species prevalent in Manipur, India after its initial discovery in China.

Animals↗

PubMed2000

Distribution of HIV-1 subtypes in female sex workers of Calcutta, India.

BACKGROUND & OBJECTIVES: Different routes for the transmission of HIV-1 in India have been reported and the majority of infections occurred through heterosexual route of transmission. In order to understand the dynamics of HIV-1 transmission, a systematic study was undertaken to determine the viral subtypes circulating among the female sex workers in Calcutta, India. METHODS: Peptide enzyme immunoassay (PEIA), heteroduplex mobility assay (HMA) and DNA sequence analysis were used to ascertain the HIV-1 subtypes. RESULTS: V3 serotyping of 52 HIV-1 seropositive samples identified 33 (60%) to be subtype C. A DNA fragment within C2-V3/C2-V5 regions of HIV-1 gp120 was amplified directly from the lymphocyte DNA to avoid any bias in selecting viral variants and used in HMA. Of the 40 samples analyzed, 38 (95%) belonged to subtype C and 2 were found to be non-typable. Further analysis of these 38 samples revealed that 26 (68%) had maximum homology to the C3-Indian reference strain (IND868), 11 (29%) were most homologous to C2-Zambian strain (ZM18) and 1 (3%) showed close resemblance to C1-Malawi strain (MA959). Nucleotide sequence of 11 subsamples encompassing about 325 base pairs was aligned for the Indian and other geographically distinct isolates. On distance and parsimony trees, most of the samples (8/11) clustered together as subtype C. INTERPRETATION & CONCLUSIONS: Subtype C was the major circulating HIV-1 strain in this geographical region, although variation within this subtype was also noticed. DNA sequence analysis was found to be the best method in determining the nature of the HIV-1 subtype followed by HMA and peptide enzyme immunoassay. These findings may have important implications for the design of effective vaccines in India and emphasizes the need for constant monitoring of the HIV-1 subtypes in different parts of India.

Amino Acid Sequence↗

PubMedDate not supplied

The bias against India in western literature on history of medicine: with special emphasis on public health.

The article describes a systematic bias against India in Western literature on history of medicine. While many authors have ignored the contributions of India in development of medicine altogether, the others have relegated India's role much behind other civilizations. Unnecessary and deliberate controversies on dating and origin of Ayurveda, primacy of Greek vs. Hindu Medicine and the origin of the practice of variolation have been elaborated by Western authors. Some medical historians, like Siegrist, have tried to give India its due place in the history of medicine. Suitable references of Indian authors have also been quoted to give a comparative and balanced picture. The need for settling this controversy has been emphasized.

Historiography↗

PubMed2003

A comparative study of maximal aerobic power of school boys of east and north-east regions of India.

OBJECTIVE: The evaluation of physiological responses during graded ergometry in children has been proven to be useful to determine the growth and development of cardio-respiratory and musculo-energetic systems and is also essential in sports and games. In India few attempts have been made to determine the peak oxygen consumption (VO2) of children from different regions. This study aims to investigate peak VO2 and its relation to other anthropometric parameters of school boys (8 to 14 years age) from east region (ER) and north east region (NER) of India. Also, this study attempts to find out the effect of regional variation, including their growth and development in comparison with the boys of other countries. DESIGN: Boys were selected from east and north-east states of India and then subdivided according to their age. SUBJECTS: The present study was carried out on 394 boys of 8 to 14 years of age, from three different states of ER and five states of the NER on the Indian subcontinent. METHODS: The habitual physical activity, socio-cultural characteristics were assessed by standard questionnaires. The sexual maturity status (age at puberty stage 2) was calculated by standard indices. Height, body weight and skinfold thickness were assessed by standard procedures. Peak oxygen uptake (peak VO2) of boys was measured by computerized motor driven treadmill by standard procedure. RESULTS: The results showed that the body size and peak VO2 of the boys from both regions increased significantly from 8 to 14 years of age. Peak VO2 of the subjects was less than untrained Japanese, European and American boys. The weight related and lean body weight (LBW) related peak VO2 was also changed from 8 years to 14 years boys in both the regions. It was also observed that peak VO2 was significantly and negatively correlated with the sum of skin fold thickness. Body size and peak VO2 were found to be significantly higher in the ER boys than their NER counterparts at 13 and 14 years of age only. Peak VO2 remained the same up to 12 years of age and then became significantly higher in the ER boys at 13 and 14 years of age as compared with their NER counterparts. CONCLUSIONS: There was a significant difference in peak VO2 of children from ER and NER. The high VO2 may be due to late sexual maturation and higher body size of the ER boys at that age. The difference in body size and sexual maturation may be due to genetic, racial, geographical, climatic and nutritional diversity in the east )ER) and north-east (NER) regions of India.

Adolescent↗

PubMed2002

Seroprevalence of cytomegalovirus among voluntary blood donors in Delhi, India.

Cytomegalovirus (CMV) is known to be a significant cause of morbidity and mortality following blood transfusion in children and immunocompromised adults. In India, it is not mandatory to screen donated blood for CMV in blood banks. Very few studies have been conducted in India to estimate the seroprevalence of this infection in voluntary blood donors. This study was conducted to estimate the seroprevalence of CMV among voluntary blood donors in Delhi, India. In this study, none of 200 donors tested positive for CMV IgM antibody, but 95% were positive for CMV IgG antibody. There was no statistically significant difference in seropositivity of CMV based on distribution of age. Of the 200 donors, 3% tested positive for HBsAg, 1% for HIV, 2% for hepatitis C virus, and 4.5% for syphilis. Since about 95% of blood donors in India are seropositive for CMV, it would seem superfluous to screen blood donors for CMV, as very few seronegative blood units would be available for transfusion. Other preventive strategies, such as leukoreduction, etc., could be more appropriate and cost-effective for the prevention of transmission of CMV through infected blood to immunosuppressed individuals.

Adolescent↗

PubMed2002

Epidemiological typing of Streptococcus pneumoniae from various sources in India & Korea using Box A PCR fingerprinting.

BACKGROUND & OBJECTIVES: Epidemiological typing of Streptococcus pneumoniae is necessary to study genetic relatedness among strains. The Box A PCR assay, a good epidemiological tool for high resolution typing of pneumococcal isolates, was used for comparison of strains of S. pneumoniae from Korea, an area of high penicillin resistance and India with low resistance to penicillin. METHODS: The pneumococcal strains from Indian and Korean sources included in the study belonged to serotypes 19F, 23F, 6A & 6B. The penicillin susceptibility of the strains was confirmed by determination of minimum inhibitory concentration values. The strains were then fingerprinted using the Box A PCR protocol and the results were further analysed by Molecular Analyst Software. RESULTS: The Box fingerprinting technique produced sharp, clear and reproducible banding patterns for strains of S. pneumoniae included in the study. There was no similarity between Indian and Korean strains at the genetic level. Among the Korean strains with similar serotypes, the level of similarity varied. Except for one pair (serotype 23F), that showed a level of homology of about 90 per cent, almost all the others showed less than 80 per cent homology. It was also seen that there was a high percentage of homology (> 90% in nasopharyngeal isolates from India belonging to serotype 19F) between isolates from similar source. Comparison of the Indian and Korean isolates of similar serotype showed low homology, except for one cluster of two strains with serotype 6B which showed 84 per cent homology (blood isolates from India and Korea). INTERPRETATION & CONCLUSION: Box A PCR is a highly discriminatory and useful method for typing S. pneumoniae. The results of the study have shown low levels of homology between strains from within India and also between two geographically distinct areas.

Bacterial Typing Techniques↗

PubMedDate not supplied

An epidemiological assessment of increasing incidence and trends in breast cancer in Mumbai and other sites in India, during the last two decades.

A great deal is known on the epidemiology of breast cancer. In this paper an attempt has been made to discuss the epidemiology and trends in incidence of breast cancer in various populations of India with special reference to the data available at Mumbai Cancer Registry. For discussing descriptive epidemiology of breast cancer the data collected for most recent year, 1999, by Mumbai Cancer Registry has been utilized. For studying time trends in breast cancer the data collected for the Mumbai Cancer Registry for the years 1982-99 and for Bangalore and Chennai 1982-96 and for Barshi, Bhopal and Delhi for the years 1988-96 has been employed. A linear regression model based on the logarithms of the various incidence rates, a method frequently used for studying time trends, was applied to the entire dataset. Age specific incidence rates for breast cancer for most of the urban population in India were found to show steep increase till menopause years, after which the curves plateau. Most of the registries data indicate that Christians in India have the greatest risk of breast risk and Muslims have the lowest rate. In all the populations breast cancer was found to be less prevalent at the lower education level and the incidence increased with the education level. The trends for increase in breast cancer incidence over time for most of the populations in India were found to be statistically significant.

Adult↗

PubMedDate not supplied

Declining prevalence of rheumatic heart disease in rural schoolchildren in India: 2001-2002.

BACKGROUND: Rheumatic heart disease is still a major health problem in developing countries such as India and, for the health planners to allocate funds, the actual prevalence of the disease should be known. This study aimed to assess the prevalence of rheumatic heart disease in rural school children in India. METHODS AND RESULTS: A total of 229,829 children between 6 and 18 years of age were screened as part of a school health program. All children with a valvar heart disease detected by the screening doctor were referred to a tertiary care center for evaluation by a cardiologist. The presence of cardiac lesions was confirmed by color Doppler examination. All children with known congenital heart disease were excluded from this study. A total of 374 children were found to have heart disease. Of these, 157 children were found to have rheumatic heart disease, confirmed by echocardiogram. Thus, the current prevalence of rheumatic heart disease is 0.68 per 1000 children. CONCLUSIONS: In the largest school survey conducted to date in India, we report the prevalence of rheumatic heart disease to be 0.68 per 1000 children. Our study suggests that there may have been a dramatic decline in the prevalence of rheumatic heart disease in India.

Adolescent↗