{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T13:21:03Z","timestamp":1773926463071,"version":"3.50.1"},"reference-count":14,"publisher":"BMJ","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Epidemiol Community Health"],"published-print":{"date-parts":[[1996,2]]},"abstract":"<jats:p>STUDY OBJECTIVE: To determine the prevalence of rheumatic heart disease (RHD) and study the relationship of this disease to factors such as age, sex, housing, and socioeconomic status in Shimla town and the adjoining rural area. DESIGN: A cross sectional survey, carried out by a specially trained examiner in cardiology. SETTING: The study involved high risk school children (5-16 years of age) from Shimla town and the adjoining rural area of Kasumpti-Suni Block in the period 1992-93. SUBJECTS: A total of 15,080 children on the school register (8120 boys and 6960 girls) were examined generally and specifically for evidence of RHD. MAIN RESULTS: Of the 15,080 children screened, the prevalence of rheumatic fever (RF)\/RHD was 2.98 per thousand with no significant difference between the age groups of 5-10 and 11-16 years or in either sex (p &gt; 0.05). The prevalence was significantly greater in rural schools (4.8\/1000) than in urban schools (1.98\/1000) (p &lt; 0.05). There was overcrowding and poor housing in most cases. There were fewer cases of RHD with severe valvular lesions in the younger age group than in the older children. The mitral valve was the valve most commonly affected by RF\/RHD. CONCLUSIONS: RHD continues to be a serious health problem. Regular surveys are needed to identify cases early and to ensure secondary prophylaxis with penicillin is given thereby preventing recurrence of RF and progression of the severity of the valvular lesion. Echocardiography is necessary to identify cases of RF\/RHD. Strategies for preventing RHD should involve primary prevention to avert the first attack of carditis and strengthening of secondary prophylaxis through improved education and motivation of patients, parents, and physicians.<\/jats:p>","DOI":"10.1136\/jech.50.1.62","type":"journal-article","created":{"date-parts":[[2008,11,12]],"date-time":"2008-11-12T15:10:54Z","timestamp":1226502654000},"page":"62-67","source":"Crossref","is-referenced-by-count":50,"title":["Epidemiological survey of rheumatic heart disease among school children in the Shimla Hills of northern India: prevalence and risk factors."],"prefix":"10.1136","volume":"50","author":[{"given":"J S","family":"Thakur","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P C","family":"Negi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S K","family":"Ahluwalia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N K","family":"Vaidya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1996,2,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"60","DOI":"10.4103\/0970-0218.53642","article-title":"Social classification - need for constant updating","volume":"2","author":"Kumar, P.","year":"1993","unstructured":"Kumar P. Social classification - need for constant updating. Indian Journal of Community Medicine 1993;XVIII(2): 60-1.","journal-title":"Indian Journal of Community Medicine"},{"key":"ref_2","article-title":"Rheumatic heart disease: report of a WHO study group. Geneva: WHO, WHHO Tech Rep Ser No 764","author":"Organisation, World Heath","year":"1988","unstructured":"World Heath Organisation. Rheumatic heart disease: report of a WHO study group. Geneva: WHO, WHHO Tech Rep Ser No 764, 1988."},{"issue":"8","key":"ref_3","first-page":"421","article-title":"Resurgence of acute rheumatic fever in the intermountain area of the United States","volume":"316","author":"Veasy, L.G.; Weidmeier, S.E.; Ormond, G.S.","year":"1990","unstructured":"Veasy LG, Weidmeier SE, Ormond GS et al. Resurgence of acute rheumatic fever in the intermountain area of the United States. 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Epidemiology of rheumatic heart disease among primary school children in Western Kenya. fqt J Cardiol 1989;23(2):249-52.","journal-title":"fqt J Cardiol"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1093\/tropej\/35.1.10","article-title":"Clinical profile of acute rheumatic fever in children","volume":"35","author":"Jamal, M.; Abbas, K.A.","year":"1989","unstructured":"Jamal M, Abbas KA. Clinical profile of acute rheumatic fever in children. J Trop Pediatr 1989;35:10-3.","journal-title":"J Trop Pediatr"},{"issue":"1","key":"ref_7","first-page":"26","article-title":"Prevalence survey of rheumatic fever and rheumatic heart disease in urban and rural school children","volume":"39","author":"Avasthi, G.; Singh, D.; Singh, C.; Aggarwal, S.P.; Bidwai, P.S.; Avasthi, R.","year":"1987","unstructured":"Avasthi G, Singh D, Singh C, Aggarwal SP, Bidwai PS, Avasthi R. Prevalence survey of rheumatic fever and rheumatic heart disease in urban and rural school children. Indian HeartJ 1987;39(1):26-8.","journal-title":"Indian HeartJ"},{"issue":"3","key":"ref_8","first-page":"57","article-title":"Epidemiology of rheumatic and congenital heart disease in school children","volume":"90","author":"Gupta, I.; Gupta, M.L.; Parihar, A.; Gupta, C.B.","year":"1992","unstructured":"Gupta I, Gupta ML, Parihar A, Gupta CB. Epidemiology of rheumatic and congenital heart disease in school children. Indian Med Assoc 1992;90(3):57-9.","journal-title":"Indian Med Assoc"},{"issue":"4","key":"ref_9","first-page":"245","article-title":"Rheumatic heart disease: a school survey in a rural area of Rajasthan","volume":"44","author":"Kumar, P.; Garhwal, S.; Chaudhary, V.","year":"1992","unstructured":"Kumar P, Garhwal S, Chaudhary V. Rheumatic heart disease: a school survey in a rural area of Rajasthan. Indian Heart 1992;44(4):245-6.","journal-title":"Indian Heart"},{"issue":"1","key":"ref_10","first-page":"59","article-title":"Epidemiology of rheumatic fever and rheumatic heart disease in a rural community in northern India","volume":"71","author":"Grover, A.; Dhawan, A.; Iyengar, S.D.; Anand, I.S.; Wahl, P.L.; Ganguly, N.K.","year":"1993","unstructured":"Grover A, Dhawan A, Iyengar SD, Anand IS, Wahl PL, Ganguly NK. Epidemiology of rheumatic fever and rheumatic heart disease in a rural community in northern India. Bull WHO 1993;71(1):59-66.","journal-title":"Bull WHO"},{"key":"ref_11","first-page":"821","article-title":"Prevalence of rheumatic heart disease in Delhi school children","volume":"69","author":"Shrestha, N.K.; Padmavati, S.","year":"1979","unstructured":"Shrestha NK, Padmavati S. Prevalence of rheumatic heart disease in Delhi school children. Indian Med Res 1979; 69:821-33.","journal-title":"Indian Med Res"},{"issue":"2","key":"ref_12","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1159\/000174993","article-title":"Rheumatic heart disease prevalence among school children of an Ethiopian rural town","volume":"80","author":"Oli, K.; Tekle Haimanot, R.; Forsgren, L.; Ekstedt, J.","year":"1992","unstructured":"Oli K, Tekle Haimanot R, Forsgren L, Ekstedt J. Rheumatic heart disease prevalence among school children of an Ethiopian rural town. Cardiology 1992;80(2): 152-5.","journal-title":"Cardiology"},{"key":"ref_13","first-page":"367","article-title":"Epidemiology of rheumatic heart disease - a study of 29922 school children","volume":"7","author":"Mathur, K.S.; Wahal, P.K.","year":"1982","unstructured":"Mathur KS, Wahal PK. Epidemiology of rheumatic heart disease - a study of 29922 school children. Indian Heart 7 1982;34(6):367-71.","journal-title":"Indian Heart"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1136\/hrt.34.2.143","article-title":"Prevalence survey of chronic rheumatic heart disease and rheumatic fever in Northern India","volume":"34","author":"Berry, J.N.","year":"1972","unstructured":"Berry JN. Prevalence survey of chronic rheumatic heart disease and rheumatic fever in Northern India. 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