الفهرس 
AcknowledgementOnly 14 pages are availabe for public view
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Abstract
Acute rheumatic fever (ARF) is a non suppurative sequela of GABS infection which may lead to a permanently disabled heart (Rheumatic heart disease: RHD) of children and young adults. Although it may occur at any age, the peak incidence usually ranges between 5- 15 years old. RHD is a serious public health problem specially in developing countries, where WHO has estimated in 1987 that about 30 million children and young adults ,..’ were affected by RHD. In these countries the premature deaths md the economic burden on the health services caused by RHD is m important cause of economic losses. The disease is known to be more prevalent among socially and economically disadvantaged populations and overcrowding is one of the most important risk factors of ARF, as it facilitates the spread of streptocci among the population, and hence ARF /RHD may easily develop. The aim of this study is to estimate the magnitude of the ARF anp. RHD problem among primary and preparatory school children in Alexandria, in terms of estimation of the prevalence of RHD and incidence of ARF. The socioeconomic and demographic ~~acteristics of the affected children were studied as well. To achieve these aims, a stratified random sampling technique was used to allocate a representative sample of primary and preparatory school children in the six educational zones of Alexandria. A representative sample of 5465 students was screened to identify clinical RHD cases. These cases were confirmed by using X-ray chest, ECG and echocardiography. To identify factors rela ted to occurrence of RHD, a case control approach was , i~lemented, two controls matched for age and sex were randomly selected for each RHD case. To assess the magnitude of ARF incidence, the study population (5465 students) was followed up for a complete scholastic year to identify incident cases of ARF that fulfill the revised Jones criteria. A nested case control approach was then followed, as for each ARF case two controls, matched for age and sex where chosen. Besides laboratory investigations e. g. ASO ti tre, ESR, CRP and total leucocytic count; X-ray chest, ECG, and echocardiography were applied to ARF cases. Standardized questionnaires were used to collect data from ARF/RHD cases and their controls and the appropriate test of significance was applied at 95 confidence level. During this study, 34 RHD cases were diagnosed (with an estimated prevalence of 6.2/1000 students), out of whom four cases (12) were detected for the first time during this study. The study revealed that the mean age of RHD cases was 11.2 t 2.7 years, with female to male ratio of 3:1. Ten cases (about 30) occurred in Amria Zone. Children of low socioeconomic families showed a higher estimated risk to develop RHD. Some socioeconomic determinants e. g. high crowding index and low monthly income were proven to be predictive variables of RHD. Other factors that showed a statistically significant difference were chronic tonsillitis, positive family history of ARF/RHD and consanguineous marriage of parents.