بررسی میزان شیوع بیماری روماتیسم قلبی در دانش‌آموزان چهار منطقه استان گیلان

ABSTRACT: Acute rheumatic fever and rheumatic heart disease are the common health problems of developing countries.Prevention and Control of Rheumatic heart disease is an important task of cardiovascular health program under World Health organisation. During 3 years 422,000 School children in four areas of Guilan province were screened (371400 urban and 50600 rural area children ). 166 cases (39.3 per hundred thousand school age population )of acute rheumatic fever were detected . 88 cases had rheumatic heart disease giving the data of 0.2 per thousand of school- going Population. Prevalence of rheumatic fever and rheumatic heart disease was more among male children than that in the females. Prevalence rate in urban school children was 0.16 per thousand while that in rural areas was 0.58 per thousand. As compared, the prevalence rate in different age groups ,middle school children (early second decade )suffered more than primary and secondary School children . Single valvular diseases were Mitral regurgitation, Mitral stenosis and Aortic incompetence in order of prevalence. Prevalence of multiValvular rheumatic heart disease,was Mitral Stenosis with regurgctation; Mitral stenosis with Aortic incompetence; Aortic Stenosis and incompetence, then the Aortic incompentence with Mitral regurgitation were in decreasing order. Rarest form was Aortic Stenosis with mitral Stenosis. Regarding Sex incidence of Valve disorders, Mitral Regurgitation was common among girls and mitral stenosis was common among boys (Reverse to the incidence,as stated in the textbooks).Prevalence of Aortic Regurgitation was more in boys than the girls . Prevalence of Multivalvular disorders in different grades comprises as 0.0112 per thousend in primary school 0.0362 per thousand in middle guidance school and 0.0116 per thousandin higher Secondary School. prevalence of single Valve disorder among primary school children was 0.0358 per thousand, in middle school it was 0.075 perthousand and in high school 0.031 per thousand, As a whole Prevalence of Rheumatic heart disease is more common ammong middle school childern than other two age groups ,but chisquare test with 99% accuracy did not confirm the significance. Result of this survey in Guilan shows that prevalence of rheumetic fever and rheumatic heart disease is lesser then other developing and industrial countries for example ,in a study at New Zealand incidence of RHD was 11,6 per thousand in USA,0.6 per thousand, and in japan 0.7 per thousand . Again, followibg WHO Proposal in 1988 Sixteen developing countries of the world, surveyed for RHD in school children in 1990 (During the time period of Guilan study) and declared the prevalence as 2.2 per thousend which is eleven times greater than Guilan incidence. Of course the incidence of RHD is one and half times more in rural and Mountainous areas. It seems that poverty ,lack of knowledge and remoteness, large family size ,living toghether in small and dark room are the factors involved. If Special care is given to the health anal medical treatment and betterment of economic condition of people Streptococal throat infection is managed well in time and people be educated through mass media, then prevalence of rheumatic fever and rheumate heart disease may be decreased much lesser like other developed and industralized countries.