ACUTE-RHEUMATIC-FEVER IN AN ARABIAN GULF COUNTRY - EFFECT OF CLIMATE,ADVANTAGEOUS SOCIOECONOMIC CONDITIONS, AND ACCESS TO MEDICAL-CARE

An eleven-year study of the incidence and consequences of acute rheuma tic fever was carried out in a country in which a uniform climate toge ther with national characteristics of insularity, wealth, and unrestri cted access to free medical care contribute prominently to the epidemi ologic milieu. Study subjects were 86 children, aged four to fourteen years, satisfying criteria for acute rheumatic fever. Study methods in cluded clinical evaluation, standard laboratory studies, and echocardi ography. A declining incidence of rheumatic episodes, ranging from 1.0 6 to 18.6/100,000 population (average 11.2/100,000), was identified. T he course of the episode was generally mild. Arthritic findings predom inated (92%), followed by carditis identified clinically in 43% and, w ith the addition of echocardiography, in 71%. Residual valvular regurg itation, as a longer term consequence, persisted in 46% of those with auscultatory confirmation of valvulitis. No recurrences were identifie d. Comparison with countries of similar socioeconomic status revealed relatively unimportant differences. Comparison with nearby disadvantag ed countries identified striking contrast. It may be concluded that am ong the contributing factors, for the improvement in the incidence and sequelae of a rheumatic episode, are an advantaged socioeconomic envi ronment and accessibility to unlimited medical care.