Objectives. The incidence of acute rheumatic fever (ARF), the antecedent of
rheumatic heart disease (RHD), in the developing world is largely unknown. We
aimed to determine the incidence rate, characterise the clinical features and assess the
diagnostic evaluation of children presenting with features of ARF at two clinics in a
region of Fiji where RHD is known to be endemic.
Methods. We reviewed 5 years (2003-2008) of primary care records from 15,841
patients aged 4-20 years using a predetermined case definition for ARF. Detailed
clinical data from 944 cases with features of possible ARF were reviewed.
Results. The crude incidence of first episodes of definite ARF in this setting amongst
patients aged 4-20 years was 24.9 per 100,000 person-years. Joint involvement
suggestive of a potential first presentation of ARF but not sufficient for a definite
retrospective diagnosis was documented in a further 94 records. There were a further
514 cases of joint involvement less suggestive of ARF and 316 cases of unexplained
fever with no evidence of localised infection. Patients presenting with potential
features of ARF seldom had a diagnostic evaluation sufficient to exclude the
diagnosis of ARF.
Conclusions. The incidence of ARF at these clinics is nearly twice that reported in a
local hospital-based study, but it is likely to under-represent the actual number of
cases presenting to primary care. There is a need for better surveillance for ARF and
to develop simple and practical approaches to diagnosing ARF in primary care in lowresource
settings.