Rheumatic fever and rheumatic heart diseases in Fiji: a review from the surveillance system (1996 -2000).

The Surveillance System for many Notifiable Diseases in Fiji is described by many as inadequate. This system includes the reporting and recording of Acute Rheumatic Fever (ARF) and Rheumatic Heart Disease (RHD). Prominent amongst the inadequacies of this system is the under reporting and the diagnostic dilemma and classification of he cases. Under-reporting was estimated at about 40% in Viti Levu, 44% in Vanua Levu, and 66% in the outer islands. This paper reviews the Surveillance System pertaining to ARF and RHD and describes the trends and demographic distribution of ARF and RHD in Fiji during the period 1996-2000 while highlighting the problem of the system A retrospective review of admission records of the Pediatric Ward, Colonial War Memorial Hospital (PW/CWMH), Suva, Fiji, from 1996 to 2000 was undertaken. Admission books were cross-checked with patient folders, when required, to avoid inaccurate counting of cases. Data obtained were analyzed and compared with those obtained from the Ministry of Health (MoH) during the same period. Under-reporting of ARF was documented with fewer ARF cases reported less than the actual number of ARF cases admitted to PW/CWMH in 1998 to 2000. On average, 18 ARF cases were reported each year for a cumulative incidence of 2.3 per 100,000 population; 173 RHD cases were reported each year for a cumulative incidence of about 21 per 100,000 population during this 5-year period. The problems seemed to be more prevalent among the Fijians compared to Indians; children in the 5-9 age group were more affected by ARF and those in the 10-14 age group were more affected by RHD. There was no statistically significant difference in the mean age between Fijian and Indian cases for both ARF and RHD. Under-reporting was apparent in the surveillance of ARF and RHD in Fiji. The cumulative incidence of ARF in Fiji appeared much lower than that reported from other Pacific countries. There is a definite need to improve the Disease Surveillance System and to sustain an effective ARF/RHD prevention programme are needed in Fiji.