The protocol aims to diagnose and manage acute rheumatic fever, prevent recurrent attacks through secondary prophylaxis, and reduce rheumatic heart disease.It applies the Jones criteria, together with evidence of preceding streptococcal infection, to assess both new patients and people with established rheumatic heart disease.
Diagnose acute rheumatic fever using recognised clinical criteria and evidence of streptococcal infection.
Prevent recurrence through regular secondary antibiotic prophylaxis.
Continue prophylaxis until age 25 for people without carditis and lifelong for those with carditis or rheumatic heart disease.
Strengthen family understanding of sore-throat risks, oral hygiene and adherence to three-weekly benzathine penicillin injections.
Implementation
Implementation centres on clinical management, regular antibiotic prophylaxis, family engagement and notification to the Federal Ministry of Health's National Programme for Rheumatic Heart Disease Control.Care combines diagnostic assessment with treatment of inflammation, infection and cardiac complications, while specialist cardiology input is used where indicated.
Assess patients clinically and provide anti-inflammatory and antibiotic treatment, bed rest, and management of carditis or heart failure where required.
Provide benzathine penicillin every three weeks for secondary prophylaxis, using erythromycin as an alternative for patients with penicillin sensitivity.
Screen for penicillin allergy before injection, undertake skin-sensitivity testing and withhold penicillin following a positive test.
Notify the National Programme for Rheumatic Heart Disease Control and complete the relevant case-reporting form.
Identify family members with sore throat and arrange antibiotic treatment, and provide prophylaxis for eligible patients undergoing procedures associated with bacteraemia.
Monitor anti-inflammatory treatment through clinical review and acute-phase reactants, including erythrocyte sedimentation rate testing every two weeks, and adjust treatment according to response and tolerance.
Recognise that the protocol does not specify broader performance indicators, surveillance arrangements, formal accountability mechanisms, budgets, funding sources or resource requirements beyond clinical monitoring and case notification.
Monitoring & Evaluation
Clinical monitoring centres on treatment response and case notification for acute rheumatic fever and rheumatic heart disease. Response to anti-inflammatory treatment is assessed through clinical review and acute-phase reactants, including erythrocyte sedimentation rate measurement every two weeks; treatment is adjusted according to clinical response and tolerance.
Monitor inflammatory activity through regular clinical assessment and two-weekly erythrocyte sedimentation rate testing during anti-inflammatory treatment.
Adjust anti-inflammatory treatment according to the patient’s response and tolerance.
Notify the Ministry of Health National Programme of Rheumatic Heart Disease Control and complete the required case-reporting form.
The protocol does not specify a broader monitoring and evaluation framework, routine service-performance indicators, surveillance methods, reporting frequency beyond case notification, data-review processes, targets, or formal accountability arrangements.
Costing & Financing
No budgetary or economic framework is provided. The protocol does not specify programme budgets, unit costs, funding sources, financing arrangements, resource-mobilisation mechanisms, funding gaps, allocations, or economic assumptions for diagnosis, treatment, secondary prophylaxis, reporting, or programme administration.
Provide no explicit cost estimate for benzathine penicillin, erythromycin, diagnostic testing, anti-inflammatory medicines, cardiology consultation, reporting, or family education activities.
Specify no funding mechanism or responsible financing institution for the National Programme of Rheumatic Heart Disease Control.
Identify no quantified human-resource, commodity, laboratory, or service-delivery requirements.
