1 . Rheumatic fever and rheumatic heart disease.
Report of a WHO Study Group. Geneva, World Health Organization, 1988 (WHO Technical Report Series, No. 764).
2. A joint WHOj/SFC global strategy to prevent rheumatic fever/rheumatic heart disease. Report of a Consultation, Geneva, 26-27 February 1990.
Geneva, World Health Organization, 1990 (unpublished document WHO/CVD/90.3).
3. Community control of rheumatic heart disease in developing countries: 1 . A major public health problem. WHO Chronicle, 34: 336-345 (1980).
4. Strasser, T. et al. The community control of rheumatic fever and rheumatic heart disease:
report of a WHO international cooperative project.
Bulletin of the World Health Organization, 59(2): 285-294 (1981).
5. WHO Global Programme for the prevention of rheumatic fever/rheumatic heart disease in sixteen developing countries (AGFUND supported).
Meeting of National Programme Managers, Geneva, 4-6 November 1986.
Geneva, World Health Organization, 1987 (unpublished document WHO/CVD/87.1).
6. WHO/Cardiovascular Diseases unit and principal investigators. WHO programme for the prevention of rheumatic fever/rheumatic heart disease in 16 developing countries: report from Phase I (1986-90). Bulletin of the World Health Organization, 70: 213-218 (1992).
Tropical rheumatology- time for action
SIR-Over the last few years we have been involved in studies on various aspects of the rheumatic diseases in West Africa. These rheumatic diseases include osteoarthritis, rheumatoid arthritis, septic arthritis,
spondyloarthropathies, metabolic joint disease, connective tissue diseases and soft tissue lesions.
Several of our medical colleagues and members of the public, both in Europe and Africa, have expressed surprise that rheumatic diseases are prevalent in the tropics, believing them to affect only people in temperate zones.
There is a significant morbidity and socio- economic burden arising from rheumatic diseases in Africa (1, 2), but recognition of this fact will depend upon a deliberate search for data. While
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some rheumatic diseases (such as Mseleni's disease) are peculiar to Africa, degenerative and inflammatory arthritides seen in temperate countries also occur; 10% of patients seen at a rural outpatient clinic had musculoskeletal problem5.
We feel that the time has come for a wider appreciation of rheumatic diseases in tropical countries by both health care planners and those in charge of medical education. Currently, rheumatology is neither taught nor recognized as a subspecialty of medicine in most African medical schools. Apart from helping people who suffer from rheumatic diseases in African countries, there is much that their study would bring to the specialty of rheumatology as a whole (2).
A. 0. Adebajo & B. L. Hazleman Rheumatology Research Unit, Unit E6, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QQ, England
1. Adebajo, A. 0. et al. The pattern of rheumatic disorders seen amongst patients attending urban and rural clinics in West Africa. Clinical
rheumatology, 11 : 512-515 ( 1992).
2. Muirden, K. D. What can be learned from Third World rheumatism. British journal of rheumatology, 26: 1-2 (1987).
Leprosy workers
SIR-India was one of the first countries to adopt WHO's recommendations about ten years ago on multidrug therapy against leprosy (1).
Following this, changes in the administrative structure of the vertical programme resulted in a significant rise in staff satisfaction with the work and the working environment.
In the 1960s, for example, the low self-image of leprosy workers was reflected in the difficulties experienced by leprosy agencies in recruiting staff for their programmes. Field workers were
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