Rheumatic fever and rheumatic heart disease: primary prevention is the cost effective option.

OBJECTIVE: To measure the economic output/input ratios for the various options of prevention of rheumatic fever/rheumatic heart disease (RF/RHD) and check the viability of primary prevention vis-à-vis secondary and tertiary preventions. METHODS: Cost accounting of the various prevention options was calculated for each variable as available in literature. Actual data as obtainable for the financial year ending March 2006 were computed for the Pondicherry population. Both direct and indirect costs (including community/social costs) were worked out using mostly primary data and wherever necessary, secondary data. Certain scientific assumptions were used where exact data was not available. RESULTS: Primary prevention is the definite viable economic option (1:1.56) compared to secondary (1: 1.07) and tertiary (1: 0.12) preventions. In fact, the current stress on only secondary and tertiary preventions is found to be economically unviable. CONCLUSION: It is postulated that primary prevention as a practical policy in tackling RF and RHD can be recommended.

Urban household food security, Madagascar.

PIP: This article discusses the success of the Madagascar Food Security and Nutrition project in decreasing malnutrition and monitoring child health. Success has occurred in the following realms: effective collaboration between government and nongovernmental organizations (NGOs), capacity building through investment in training of community workers, increased quality of services provided by community nutrition workers, community involvement, government commitment, and a flexible program design. NGOs were able to respond to community concerns by adding program inputs without losing the focus on core nutrition interventions. Community workers were selected from a group of mothers. Women were trained to monitor the growth of all children under age 5. Children who were severely malnourished were identified and referred to rehabilitation centers for treatment lasting up to 3 weeks. The program offered support and nutrition education for mothers of sick children. One drawback of the treatment program was the inability of mothers to stay for long periods of time during the duration of treatment. The program offers distribution of iodine capsules as part of a long-term salt iodization program that is supported by UNICEF and the World Bank. The program also offers microcredit. Since 1993, 28,000 children under age 5 have been weighed each month. These children came from two provinces and belonged to 300,000 families. The monitored children were 66% of the total number of children aged under 5 years. Malnutrition rates decreased from 46% to 37%.^ieng