Rheumatic fever.

The incidence of RF and RHD in the tropics remains high, with a high proportion of children suffering from carditis with the first attack. Severe, incapacitating haemodynamic disturbances occur early. Many patients are seen with established RHD at their first visit, and the default rate is high. Poverty, overcrowding, poor transport facilities, understaffed and overburdened clinics, and poor follow-up add to the problem. A genetic predisposition to develop RHD appears to be important in certain countries like India, Egypt and Turkey, but no work to show this has been done in black Africa. Secondary prophylaxis remains the most practical means of controlling the disease in the tropics. Compliance with long-term prophylaxis depends on organized and concerted efforts of physicians, other health personnel, parents, teachers, and the community.