Interventions for Rheumatic Heart Disease

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Age Cohort: Pregnancy and newborn

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Awareness creation among the communities/families on Rheumatic Heart disease including prevention measures Awareness creation on risk factors of Rheumatic heart disease such as overcrowding, poor sanitary conditions Distribution of IEC materials on RHD Advocacy for ANC attendance for the mother Promote multi-sectoral approach in promoting improvement in environmental conditions such as housing conditions, improving the standards of living Advocacy for Improved access health services including to oral health care, access to life saving heart surgery Community Health Workers training on RHD	ANC attendance for women with RHD Guidance on Proper nutrition for women with AHD Guidance on healthy hygiene practice for the pregnant women Teaching/guidance on Good oral hygiene practices for the mothers Advice on Adherence to antibiotics medication including completion of doses as prescribed Advice on early health seeking behavior		Recognition of symptoms indicative of RHD including fever, painful joints especially knees ankles, elbows and wrists, pain that moves between different joints, fatigue, jerky uncontrollable body movements, nodules under the skin near joints and/or a non-itchy rash Relive of pain with pain killers Relieve of fever with paracetamol Proper nutrition for mothers with RHD Ensure adherence to any prescribed medicines such as antibiotics Early Referral to a health facility		Psychosocial support and counselling to reduce stress associated with the prolonged treatment or admission Linkage with social and support services
Primary Care
Awareness creation among the communities/families on Rheumatic Heart disease including prevention measures Awareness creation on risk factors of Rheumatic heart disease such as overcrowding; poor sanitary conditions Distribution of IEC materials on RHD Promote multi-sectoral approach in promoting improvement in environmental conditions such as housing conditions, improving the standards of living Advocacy for Improved access health services including to oral health care, access to life saving heart surgery Community health workers training on RHD	Provide ANC services for women with RHD Guidance on Proper nutrition for women with AHD Guidance on healthy hygiene practice for the pregnant women Teaching/guidance on Good oral hygiene practices for the under 5s Advice on Adherence to antibiotics medication including completion of doses as prescribed		Complete physical and clinical examination Management of pain with analgesics Management of fever with antipyretics Use of anti-coagulants with close monitoring including Foetal monitoring Antibiotics prophylaxis to avoid recurrence of rheumatic fever and worsening of the rheumatic heart disease Foetal monitoring Recognition of any signs and symptoms indicating severe or complications of RHD Referral to a hospital		Psychosocial support and counselling to reduce stress associated with the prolonged treatment or admission Linkage with social and support services
Referral Facility: General
Awareness creation among women/families families on Rheumatic Heart disease including prevention measures Awareness creation on risk factors of Rheumatic heart disease such as overcrowding, poor sanitary conditions Distribution of IEC materials on RHD Advocacy for a multi-sectoral approach in promoting improvement in environmental conditions such as housing conditions, improving the standards of living Advocacy for Improved access health services including to oral health care; access to life saving heart surgery Community health workers training on RHD	Promote ANC attendance for women with RHD Proper nutrition for women with AHD Guidance on healthy hygiene practice for the pregnant women Teaching/guidance on Good oral hygiene practices for the under 5s Advice on Adherence to antibiotics medication including completion of doses as prescribed Careful preconception assessment and planning for women with RHD Guided fertility planning for all women with RHD		Complete physical and clinical examination Management of pain with analgesics Management of fever with antipyretics Use of anti-coagulants with close monitoring including Foetal monitoring Antibiotics prophylaxis to avoid recurrence of rheumatic fever and worsening of the rheumatic heart disease. Foetal monitoring Admissions for close monitoring of women with moderate or severe rheumatic heart disease Prevention and management of any maternal cardiac complications in pregnancy due to RHD including heart arrythmias and heart failure, pulmonary oedema Prevention and management of delivery complications due to heart damage ICU services for women with severe rheumatic heart disease Close follow up N/B Assessment pre conception or early in pregnancy for women acute rheumatic fever or mild rheumatic disease to establish safest birth pathway Diagnostics -tests including. Throat swab culture for evidence of streptococcus infection Blood tests Echocardiogram (echo)- check the heart's chambers and valves		Psychosocial support and counselling to reduce stress associated with the prolonged treatment or admission Linkage with social and support services
Referral Facility: Specialist
Awareness creation among women/families families on Rheumatic Heart disease including prevention measures Awareness creation on risk factors of Rheumatic heart disease such as overcrowding, poor sanitary conditions Distribution of IEC materials on RHD Advocacy for a multi-sectoral approach in promoting improvement in environmental conditions such as housing conditions, improving the standards of living Advocacy for Improved access health services including to oral health care; access to life saving heart surgery Community health workers training on RHD	Promote ANC attendance for women with RHD Proper nutrition for women with AHD Guidance on healthy hygiene practice for the pregnant women Teaching/guidance on Good oral hygiene practices for the under 5s Advice on Adherence to antibiotics medication including completion of doses as prescribed Careful preconception assessment and planning for women with RHD Guided fertility planning for all women with RHD		Complete physical and clinical examination Management of pain with analgesics Management of fever with antipyretics Use of anti-coagulants with close monitoring including Foetal monitoring Antibiotics prophylaxis to avoid recurrence of rheumatic fever and worsening of the rheumatic heart disease. Foetal monitoring Admissions for close monitoring of women with moderate or severe rheumatic heart disease Prevention and management of any maternal cardiac complications in pregnancy due to RHD including heart arrythmias and heart failure, pulmonary oedema Prevention and management of delivery complications due to heart damage ICU services for women with severe rheumatic heart disease Close follow up N/B Assessment pre conception or early in pregnancy for women acute rheumatic fever or mild rheumatic disease to establish safest birth pathway Diagnostics -tests including; Throat swab culture for evidence of streptococcus infection Blood tests Echocardiogram (echo) check the heart's chambers and valves		Psychosocial support and counselling to reduce stress associated with the prolonged treatment or admission Linkage with social and support services

Age Cohort: < 5 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Awareness creation among the communities/families on Rheumatic Heart disease including prevention measures Awareness creation on risk factors of Rheumatic heart disease such as overcrowding, poor sanitary conditions Distribution of IEC materials on RHD Promote multi-sectoral approach in promoting improvement in environmental conditions such as housing conditions, improving the standards of living Advocacy for Improved access health services including to oral health care, access to life saving heart surgery Community health workers training on RHD	Awareness creation among the communities/families on Rheumatic Heart disease including prevention measures Awareness creation on risk factors of Rheumatic heart disease such as overcrowding, poor sanitary conditions Distribution of IEC materials on RHD Promote multi-sectoral approach in promoting improvement in environmental conditions such as housing conditions, improving the standards of living Advocacy for Improved access health services including to oral health care, access to life saving heart surgery Community health workers education on RHD		Recognition of symptoms indicative of RHD including fever, painful joints especially knees ankles, elbows and wrists pain that moves between different joints, fatigue, jerky uncontrollable body movements, nodules under the skin near joints and/or a non-itchy rash Relive of pain with pain killers Relieve of fever with ibuprofen or through tepid sponging Proper nutrition for child suspected to have RHD Ensure adherence to any prescribed medicines such as antibiotics Recognition of symptoms indicative of worsening of the condition such as complaints of chest pain, shortness of breath, swelling of the stomach, hands or feet Early Referral to a health facility		Psychosocial support and counselling to reduce stress associated with the prolonged treatment or admission Linkage with social and support services
Primary Care
Awareness creation among the communities/families on Rheumatic Heart disease including prevention measures Awareness creation on risk factors of Rheumatic heart disease such as overcrowding, poor sanitary conditions Distribution of IEC materials on RHD Promote multi-sectoral approach in promoting improvement in environmental conditions such as housing conditions, improving the standards of living Advocacy for Improved access health services including to oral health care, access to life saving heart surgery Community health workers training on RHD	Guidance to parents/families/children on healthy hygiene practice for the under 5s Advice to parents/families on the need for seeking treatment early for any child with sore throat or any signs of infection such as fever Promoting good nutrition for children Teaching/guidance on Good oral hygiene practices for the under 5s Advice to parents on the need to ensure Adherence to antibiotics medication for the under 5 Early identification and treatment of streptococcal infections with antibiotics such as penicillin to reduce the risk of Rheumatic fever and possible eventual progression to Rheumatic Heart disease		Complete Medical History and clinical examination Relive pain Relive fever Management of inflammation with anti-inflammatory medications such as aspirin Antibiotic prophylaxis to prevent recurrent infection with Group A streptococcus. -use/Benzathine penicillin G Recognition of any signs and symptoms indicating severe or complications of RHD eg severe chest pain, feet oedema Referral to a hospital		Psychosocial support and counselling for families/parents with an under 5 with RHD for any psychological trauma due to the long nature of treatment
Referral Facility: General
Awareness creation among the communities/families on Rheumatic Heart disease including prevention measures Awareness creation on risk factors of Rheumatic heart disease such as overcrowding, poor sanitary conditions Distribution of IEC materials on RHD Promote multi-sectoral approach in promoting improvement in environmental conditions such as housing conditions, improving the standards of living Advocacy for Improved access health services including to oral health care, access to life saving heart surgery Community health workers training on RHD	Guidance to parents/families/children on healthy hygiene practice for the under 5s Advice to parents/families on the need for seeking treatment early for any child with sore throat or any signs of infection such as fever Promoting good nutrition for children Teaching /guidance on Good oral hygiene practices for the under 5s Advice to parents on the need to ensure Adherence to antibiotics medication for the under 5 Early identification and treatment of streptococcal infections with antibiotics such as penicillin to reduce the risk of Rheumatic fever and possible eventual progression to Rheumatic Heart disease Early identification and treatment of Rheumatic fever to reduce the likelihood of Rheumatic Heart disease		Complete Physical and clinical examination Diagnostics -tests including; Throat swab culture for evidence of streptococcus infection Blood tests Echocardiogram (echo)-. check the heart's chambers and valves. Electrocardiogram (ECG)-.To test the strength and timing of the electrical activity of the heart. Chest x-rays Cardiac MRI Relive pain Relive fever Management of inflammation with anti-inflammatory medications such as aspirin or corticosteroids Antibiotic prophylaxis to prevent recurrent infection with Group A streptococcus. -use/Benzathine penicillin G Early identification and treatment of ARF, as well as interventions to prevent recurrences of ARF and therefore reduce the likelihood of RHD.-use of antibiotics, Management of heart failure or heart rhythm abnormalities heart failure e.g. with diuretics, beta blockers Prevention and management of clotting with blood thinners Anti-coagulants Surgical interventions including Cardiac catheterization to repair damaged valves or ICU services for severely ill patients e.g. post-surgery Follow up		Psychosocial support and counselling for families/parents with an under 5 with RHD for any psychological trauma due to the long nature of treatment
Referral Facility: Specialist
Awareness creation among the communities/families on Rheumatic Heart disease including prevention measures Awareness creation on risk factors of Rheumatic heart disease such as overcrowding, poor sanitary conditions Distribution of IEC materials on RHD Promote multi-sectoral approach in promoting improvement in environmental conditions such as housing conditions, improving the standards of living Advocacy for Improved access health services including to oral health care, access to life saving heart surgery Community health workers training on RHD	Guidance to parents/families/children on healthy hygiene practice for the under 5s Advice to parents/families on the need for seeking treatment early for any child with sore throat or any signs of infection such as fever Promoting good nutrition for children Teaching /guidance on Good oral hygiene practices for the under 5s Advice to parents on the need to ensure Adherence to antibiotics medication for the under 5 Early identification and treatment of streptococcal infections with antibiotics such as penicillin to reduce the risk of Rheumatic fever and possible eventual progression to Rheumatic Heart disease Early identification and treatment of Rheumatic fever to reduce the likelihood of Rheumatic Heart disease		Complete Physical and clinical examination Diagnostics -tests including; Throat swab culture for evidence of streptococcus infection Blood tests Echocardiogram (echo)-. check the heart's chambers and valves. Electrocardiogram (ECG)-.To test the strength and timing of the electrical activity of the heart. Chest x-rays Cardiac MRI Relive pain Relive fever Management of inflammation with anti-inflammatory medications such as aspirin or corticosteroids Antibiotic prophylaxis to prevent recurrent infection with Group A streptococcus. -use/Benzathine penicillin G Early identification and treatment of ARF, as well as interventions to prevent recurrences of ARF and therefore reduce the likelihood of RHD.-use of antibiotics, Management of heart failure or heart rhythm abnormalities heart failure e.g. with diuretics, beta blockers Prevention and management of clotting with blood thinners Anti-coagulants Surgical interventions including Cardiac catheterization to repair damaged valves or ICU services for severely ill patients e.g. post-surgery Follow up		Psychosocial support and counselling for families/parents with an under 5 with RHD for any psychological trauma due to the long nature of treatment

Age Cohort: 5 - 11 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Awareness creation among the communities/families on Rheumatic Heart disease including prevention measures Awareness creation on risk factors of Rheumatic heart disease such as overcrowding, poor sanitary conditions Distribution of IEC materials on RHD Promote multi-sectoral approach in promoting improvement in environmental conditions such as housing conditions, improving the standards of living Advocacy for Improved access health services including to oral health care, access to life saving heart surgery Community health workers training on RHD	Guidance on healthy hygiene practice for school age child Seek treatment early for any child with sore throat or any infections Teaching/guidance on Good oral hygiene practices for the school age child Guidance to the school age child their families/parents to ensure that the child takes antibiotics as prescribed and to complete the dose as instructed.		Recognition of symptoms indicative of RHD including fever, painful joints especially knees ankles, elbows and wrists, pain that moves between different joints, fatigue, jerky uncontrollable body movements, nodules under the skin near joints and/or a non-itchy rash Relive of pain with pain killers Relieve of fever with ibuprofen or through tepid sponging Proper nutrition for child suspected to have RHD Ensure adherence to any prescribed medicines such as antibiotics Recognition of symptoms indicative of worsening of the condition such as complaints of chest pain, shortness of breath, swelling of the stomach, hands or feet Early Referral to a health facility		Psychosocial support and counselling to reduce stress associated with the prolonged treatment or admission Linkage with social and support services
Primary Care
Awareness creation among the communities/families on Rheumatic Heart disease including prevention measures Awareness creation on risk factors of Rheumatic heart disease such as overcrowding, poor sanitary conditions Distribution of IEC materials on RHD Promote multi-sectoral approach in promoting improvement in environmental conditions such as housing conditions, improving the standards of living Advocacy for Improved access health services including to oral health care, access to life saving heart surgery Community health workers training on RHD	Guidance to parents/families/children on healthy hygiene practice Advice to parents/families/school age child on the need for seeking treatment early for any child with sore throat or any signs of infection such as fever Promoting good nutrition for children Teaching/guidance on Good oral hygiene practices for the school age children Advice to school age children on the need to ensure Adherence to antibiotics medication Early identification and treatment of streptococcal infections with antibiotics such as penicillin to reduce the risk of Rheumatic fever and possible eventual progression to Rheumatic Heart disease				Psychosocial support and counselling for the child and their families/parents for any psychological trauma due to the long nature of treatment
Referral Facility: General
Awareness creation among the communities/families on Rheumatic Heart disease including prevention measures Awareness creation on risk factors of Rheumatic heart disease such as overcrowding, poor sanitary conditions Distribution of IEC materials on RHD Promote multi-sectoral approach in promoting improvement in environmental conditions such as housing conditions, improving the standards of living Advocacy for Improved access health services including to oral health care, access to life saving heart surgery Community health workers training on RHD	Guidance to parents/families/children on healthy hygiene practice Advice to parents/families/school age child on the need for seeking treatment early for any child with sore throat or any signs of infection such as fever, Promoting good nutrition for children Teaching/guidance on Good oral hygiene practices for the school age children Advice to school age children on the need to ensure Adherence to antibiotics medication* Early identification and treatment of streptococcal infections with antibiotics such as penicillin to reduce the risk of Rheumatic fever and possible eventual progression to Rheumatic Heart disease Early identification and treatment of Rheumatic fever to reduce the likelihood of Rheumatic Heart disease		Complete Physical and clinical examination Diagnostics -tests including; Throat swab culture for evidence of streptococcus infection Blood tests Echocardiogram (echo)-. check the heart's chambers and valves. Electrocardiogram (ECG)-.To test the strength and timing of the electrical activity of the heart. Chest x-rays Cardiac MRI Relive pain Relive fever Management of inflammation with anti-inflammatory medications such as aspirin or corticosteroids Antibiotic prophylaxis to prevent recurrent infection with Group A streptococcus. -use/Benzathine penicillin G Early identification and treatment of ARF, as well as interventions to prevent recurrences of ARF and therefore reduce the likelihood of RHD.-use of antibiotics, Admissions for management of severe disease/complications Management of heart failure or heart rhythm abnormalities heart failure e.g.with diuretics, beta blockers Prevention and management of clotting with blood thinners Anti-coagulants Surgical interventions including Cardiac catheterization to repair damaged valves or ICU services for severely ill patients e.g. post-surgery Follow up		Psychosocial support and counselling for child and families for any psychological trauma due to the long nature of treatment
Referral Facility: Specialist
Awareness creation among the communities/families on Rheumatic Heart disease including prevention measures Awareness creation on risk factors of Rheumatic heart disease such as overcrowding, poor sanitary conditions Distribution of IEC materials on RHD Promote multi-sectoral approach in promoting improvement in environmental conditions such as housing conditions, improving the standards of living Advocacy for Improved access health services including to oral health care, access to life saving heart surgery Community health workers training on RHD	Guidance to parents/families/children on healthy hygiene practice Advice to parents/families/school age child on the need for seeking treatment early for any child with sore throat or any signs of infection such as fever, Promoting good nutrition for children Teaching/guidance on Good oral hygiene practices for the school age children Advice to school age children on the need to ensure Adherence to antibiotics medication Early identification and treatment of streptococcal infections with antibiotics such as penicillin to reduce the risk of Rheumatic fever and possible eventual progression to Rheumatic Heart disease Early identification and treatment of Rheumatic fever to reduce the likelihood of Rheumatic Heart disease		Complete Physical and clinical examination Diagnostics -tests including; Throat swab culture for evidence of streptococcus infection Blood tests Echocardiogram (echo)-. check the heart's chambers and valves. Electrocardiogram (ECG)-.To test the strength and timing of the electrical activity of the heart. Chest x-rays Cardiac MRI Relive pain Relive fever Management of inflammation with anti-inflammatory medications such as aspirin or corticosteroids Antibiotic prophylaxis to prevent recurrent infection with Group A streptococcus. -use/Benzathine penicillin G Early identification and treatment of ARF, as well as interventions to prevent recurrences of ARF and therefore reduce the likelihood of RHD.-use of antibiotics, Admissions for management of severe disease/complications Management of heart failure or heart rhythm abnormalities heart failure e.g.with diuretics, beta blockers Prevention and management of clotting with blood thinners Anti-coagulants Surgical interventions including Cardiac catheterization to repair damaged valves or ICU services for severely ill patients e.g. post-surgery Follow up		Psychosocial support and counselling for child and families for any psychological trauma due to the long nature of treatment

Age Cohort: 12 - 24 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Awareness creation among the communities/families on risk factors for rheumatic heart disease, complications and prevention measures Promote multi-sectoral approach in promoting improvement in environmental conditions such as housing conditions, improving the standards of living	Seek treatment early for sore throat or any infections	Recognition of rheumatic fever and rheumatic heart disease signs and symptoms	Analgesics Antipyretics Referral to the next level for appropriate care	Physical rehabilitation Family or caregiver educational training	Physical, emotional, social and spiritual support based on cultural needs, values and preferences of patients and families
Primary Care
Patient education on early identification of signs and symptoms and adherence to primary and secondary prevention treatments	Early recognition and treatment of group A streptococcal pharyngitis Secondary prophylaxis to prevent recurrence	History Physical examination X-ray	Antibiotic therapy Analgesics Antipyretics Referral to the next level for appropriate care	Physical rehabilitation Occupational therapy Family or caregiver educational training	Physical, emotional, social and spiritual support based on cultural needs, values and preferences of patients and families
Referral Facility: General
Patient education on early identification of signs and symptoms and adherence to primary and secondary prevention treatments	Early recognition and treatment of group A streptococcal pharyngitis Secondary prophylaxis to prevent recurrence	History Physical examination Chest radiography Complete blood count C reactive protein Electrocardiography Echocardiograph	Antibiotic therapy Analgesics Antipyretics Heart failure management Referral to next level	Physical rehabilitation Occupational therapy Family or caregiver educational training	Physical, emotional, social and spiritual support based on cultural needs, values and preferences of patients and families
Referral Facility: Specialist
Patient education on early identification of signs and symptoms and adherence to primary and secondary prevention treatments	Early recognition and treatment of group A streptococcal pharyngitis Secondary prophylaxis to prevent recurrence	History Physical examination Chest radiography Complete blood count C reactive protein Electrocardiography Echocardiograph Throat swab culture Contrast CT scan Magnetic resonance imaging (MRI)	Antibiotic therapy Anti-arrhythmias Anticoagulation Heart failure management Balloon mitral valvuloplasty Surgical valve repair Surgical valve replacement	Physical rehabilitation Occupational therapy Family or caregiver educational training	Physical, emotional, social and spiritual support based on cultural needs, values and preferences of patients and families

Age Cohort: 25 - 59 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Awareness creation among the communities/families on Rheumatic Heart disease including prevention measures Awareness creation on risk factors of Rheumatic heart disease such as overcrowding, poor sanitary conditions Distribution of IEC materials on RHD Promote multi-sectoral approach in promoting improvement in environmental conditions such as housing conditions, improving the standards of living Advocacy for Improved access health services including to oral health care, access to life saving heart surgery Community health workers training on RHD Population wide reduction in daily salt consumption Financial incentives to consume a healthy diet Reduction of sugar consumption Mass media campaign on salt reduction Tax reduction on fruit & vegetables and tax increase on fats & sugar Taxation of junk food Front of pack - Traffic Light Labeling of nutrition on processed foods Legislation to limit trans fats in processed food Food product reformulation with less sodium Higher consumption of grain-based foods, seafood, fruits and vegetables and lower consumption of meat, dairy, fats Tobacco price increase	Guidance on healthy hygiene practice for adults Seek treatment early for adults with sore throat or any infections Teaching/guidance on Good oral hygiene practices for the adults Adherence to antibiotics medication including completion of doses as Good nutrition/healthy diet Community based management of hypertension Screening and treatment of CVD risk factors Mobile technology enabled community based CVD risk assessment and mitigation Integration of hypertension screening and treatment program into community services Use of polypill for secondary CVD prevention in high risk candidates		Recognition of symptoms indicative of RHD including fever, painful joints especially knees ankles, elbows and wrists, pain that moves between different joints, fatigue, jerky uncontrollable body movements, nodules under the skin near joints and/or a non-itchy rash Relive of pain with pain killers Relieve of fever Proper nutrition for the adult with RHD Ensure adherence to any prescribed medicines such as antibiotics Recognition of symptoms indicative of worsening of the condition such as complaints of chest pain, shortness of breath, swelling of the stomach, hands or feet Early Referral to a health facility	Home based self management rehabilitation Addition of person-centered care services to usual care in chronic heart failure or COPD for individualised health plan	Psychosocial support and counselling to reduce stress associated with the prolonged treatment or admission Linkage with social and support services
Primary Care
Information to the adults on Rheumatic Heart disease including prevention measures Awareness creation on risk factors of Rheumatic heart disease such as overcrowding, poor sanitary conditions Distribution of IEC materials on RHD Advocacy for a multi-sectoral approach in promoting improvement in environmental conditions such as housing conditions, improving the standards of living Advocacy for Improved access health services including to oral health care, access to life saving heart surgery Health workers training on RHD Population wide reduction in daily salt consumption Financial incentives to consume a healthy diet	Information to adults on healthy hygiene practices Promoting good nutrition for the adults Good oral hygiene practices Advice to adults on the need to ensure Adherence to antibiotics medication Early identification and treatment of streptococcal infections with antibiotics such as penicillin to Early identification and treatment of Rheumatic fever to reduce the likelihood of Rheumatic Heart disease Screening and treatment of CVD risk factors Integration of hypertension and diabetes screening & treatment in HIV programs Use of polypill for secondary CVD prevention in high risk candidates		Complete Physical and clinical examination Relive pain Relive fever Management of inflammation with anti-inflammatory medications such as aspirin Antibiotic prophylaxis to prevent recurrent infection with Group A streptococcus. -use/Benzathine penicillin G Recognition of any signs and symptoms indicating severe or complications of RHD eg severe chest pain, feet oedema Referral to a hospital Nicotine replacement Availability of metformin for diabetes treatment	Addition of person-centered care services to usual care in chronic heart failure or COPD for individualised health plan	Psychosocial support and counselling for the adults with RHD for any psychological trauma due to the long nature of treatment
Referral Facility: General
Information to the adults on Rheumatic Heart disease including prevention measures Awareness creation on risk factors of Rheumatic heart disease such as overcrowding, poor sanitary conditions Distribution of IEC materials on RHD Advocacy for a multi-sectoral approach in promoting improvement in environmental conditions such as housing conditions, improving the standards of living Advocacy for Improved access health services including to oral health care, access to life saving heart surgery Health workers training on RHD Population wide reduction in daily salt consumption Financial incentives to consume a healthy diet	Information adults on healthy hygiene practices Promoting good nutrition for the adults Good oral hygiene practices Advice to adults on the need to ensure Adherence to antibiotics medication Early identification and treatment of streptococcal infections with antibiotics such as penicillin to Early identification and treatment of Rheumatic fever to reduce the likelihood of Rheumatic Heart disease Screening and treatment of CVD risk factors Integration of hypertension and diabetes screening & treatment in HIV programs Use of polypill for secondary CVD prevention in high risk candidates		Complete Physical and clinical examination Diagnostics -tests including; Throat swab culture for evidence of streptococcus infection Blood tests Echocardiogram (echo)-. check the heart's chambers and valves. Electrocardiogram (ECG)-.To test the strength and timing of the electrical activity of the heart. Chest x-rays Cardiac MRI Management of pain Management of fever Management of inflammation with anti-inflammatory medications such as aspirin or corticosteroids Antibiotic prophylaxis to prevent recurrent infection with Group A streptococcus. -use/Benzathine penicillin G Early identification and treatment of ARF, as well as interventions to prevent recurrences of ARF and therefore reduce the likelihood of RHD.-use of antibiotics, Admission to manage severe cases /complications Management of heart failure or heart rhythm abnormalities heart failure e.g. with diuretics, beta blockers Prevention and management of clotting with blood thinners Anti-coagulants Surgical interventions including Cardiac catheterization to repair damaged valves ICU services for severely ill patients e.g. post-surgery Follow up Availability of metformin for diabetes treatment	Addition of person-centered care services to usual care in chronic heart failure or COPD for individualised health plan	Psychosocial support and counselling for adults with RHD for any psychological trauma due to the long nature of treatment
Referral Facility: Specialist
Information to the adults on Rheumatic Heart disease including prevention measures Awareness creation on risk factors of Rheumatic heart disease such as overcrowding, poor sanitary conditions Distribution of IEC materials on RHD Advocacy for a multi-sectoral approach in promoting improvement in environmental conditions such as housing conditions, improving the standards of living Advocacy for Improved access health services including to oral health care, access to life saving heart surgery Health workers training on RHD Population wide reduction in daily salt consumption Financial incentives to consume a healthy diet	Information adults on healthy hygiene practices Promoting good nutrition for the adults Good oral hygiene practices Advice to adults on the need to ensure Adherence to antibiotics medication Early identification and treatment of streptococcal infections with antibiotics such as penicillin to Early identification and treatment of Rheumatic fever to reduce the likelihood of Rheumatic Heart disease		Complete Physical and clinical examination Diagnostics -tests including; Throat swab culture for evidence of streptococcus infection Blood tests Echocardiogram (echo)-. check the heart's chambers and valves. Electrocardiogram (ECG)-.To test the strength and timing of the electrical activity of the heart. Chest x-rays Cardiac MRI Management of pain Management of fever Management of inflammation with anti-inflammatory medications such as aspirin or corticosteroids Antibiotic prophylaxis to prevent recurrent infection with Group A streptococcus. -use/Benzathine penicillin G early identification and treatment of ARF, as well as interventions to prevent recurrences of ARF and therefore reduce the likelihood of RHD.-use of antibiotics, Admission to manage severe cases /complications Management of heart failure or heart rhythm abnormalities heart failure e.g. with diuretics, beta blockers Prevention and management of clotting with blood thinners Anti-coagulants Surgical interventions including Cardiac catheterization to repair damaged valves ICU services for severely ill patients e.g. post-surgery Follow up Availability of metformin for diabetes treatment		Psychosocial support and counselling for adults with RHD for any psychological trauma due to the long nature of treatment

Age Cohort: 60+ years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Awareness creation among the communities/families on Rheumatic Heart disease including prevention measures Awareness creation on risk factors of Rheumatic heart disease such as overcrowding, poor sanitary conditions Distribution of IEC materials on RHD Promote multi-sectoral approach in promoting improvement in environmental conditions such as housing conditions, improving the standards of living Advocacy for Improved access health services including to oral health care, access to life saving heart surgery Community health workers training on RHD	Guidance on healthy hygiene practice for the elderly Seek treatment early for elderly with sore throat or any infections Teaching/guidance on Good oral hygiene practices for the elderly Adherence to antibiotics medication including completion of doses as prescribed		Recognition of symptoms indicative of RHD including fever, painful joints especially knees ankles, elbows and wrists, pain that moves between different joints, fatigue, jerky uncontrollable body movements, nodules under the skin near joints and/or a non-itchy rash Relive of pain with pain killers Relieve of fever with antipyretics Proper nutrition for the elderly person with RHD Ensure adherence to any prescribed medicines such as antibiotics Recognition of symptoms indicative of worsening of the condition such as complaints of chest pain, shortness of breath; swelling of the stomach, hands or feet Early Referral to a health facility		Psychosocial support and counselling to reduce stress associated with the prolonged treatment or admission Linkage with social and support services
Primary Care
Information to the elderly on Rheumatic Heart disease including prevention measures Awareness creation on risk factors of Rheumatic heart disease such as overcrowding, poor sanitary conditions Distribution of IEC materials on RHD Advocacy for a multi-sectoral approach in promoting improvement in environmental conditions such as housing conditions, improving the standards of living Advocacy for Improved access health services including to oral health care, access to life saving heart surgery Health workers training on RHD	Information to elderly on healthy hygiene practices Promoting good nutrition for the elderly Good oral hygiene practices Advice to elderly on the need to ensure Guidance on Adherence to antibiotics medication Early identification and treatment of streptococcal infections with antibiotics such as penicillin to Early identification and treatment of Rheumatic fever to reduce the likelihood of Rheumatic Heart disease		Complete Physical and clinical examination Referral to a hospital Relive pain Relive fever Management of inflammation with anti-inflammatory medications such as aspirin Antibiotic prophylaxis to prevent recurrent infection with Group A streptococcus. -use/Benzathine penicillin G Recognition of any signs and symptoms indicating severe or complications of RHD eg severe chest pain, feet oedema Referral to a hospital	Physical rehabilitation/physical exercises	Psychosocial support and counselling the elderly with RHD for any psychological trauma due to the long nature of treatment
Referral Facility: General
Information to the elderly on Rheumatic Heart disease including prevention measures Awareness creation on risk factors of Rheumatic heart disease such as overcrowding, poor sanitary conditions Distribution of IEC materials on RHD Advocacy for a multi-sectoral approach in promoting improvement in environmental conditions such as housing conditions, improving the standards of living Advocacy for Improved access health services including to oral health care, access to life saving heart surgery Health workers training on RHD	Information to elderly on healthy hygiene practices Promoting good nutrition for the elderly Good oral hygiene practices Advice to elderly on the need to ensure Guidance on Adherence to antibiotics medication Early identification and treatment of streptococcal infections with antibiotics such as penicillin to Early identification and treatment of Rheumatic fever to reduce the likelihood of Rheumatic Heart disease		Complete Physical and clinical examination Diagnostics -tests including; Throat swab culture for evidence of streptococcus infection Blood tests Echocardiogram (echo)-. check the heart's chambers and valves. Electrocardiogram (ECG)-.To test the strength and timing of the electrical activity of the heart. Chest x-rays Cardiac MRI Management of pain Management of fever Management of inflammation with anti-inflammatory medications such as aspirin or corticosteroids Antibiotic prophylaxis to prevent recurrent infection with Group A streptococcus. -use/Benzathine penicillin G Early identification and treatment of ARF, as well as interventions to prevent recurrences of ARF and therefore reduce the likelihood of RHD.-use of antibiotics, Admission to manage severe cases/complications Management of heart failure or heart rhythm abnormalities heart failure e.g. with diuretics, beta blockers Prevention and management of clotting with blood thinners/anti-coagulants Surgical interventions including Cardiac catheterization to repair damaged valves or ICU services for severely ill patients e.g. post-surgery Follow up	Physical rehabilitation/physical exercises	Psychosocial support and counselling the elderly with RHD for any psychological trauma due to the long nature of treatment
Referral Facility: Specialist
Information to the elderly on Rheumatic Heart disease including prevention measures Awareness creation on risk factors of Rheumatic heart disease such as overcrowding, poor sanitary conditions Distribution of IEC materials on RHD Advocacy for a multi-sectoral approach in promoting improvement in environmental conditions such as housing conditions, improving the standards of living Advocacy for Improved access health services including to oral health care, access to life saving heart surgery Health workers training on RHD	Information to elderly on healthy hygiene practices Promoting good nutrition for the elderly Good oral hygiene practices Advice to elderly on the need to ensure Guidance on Adherence to antibiotics medication Early identification and treatment of streptococcal infections with antibiotics such as penicillin to Early identification and treatment of Rheumatic fever to reduce the likelihood of Rheumatic Heart disease		Complete Physical and clinical examination Diagnostics -tests including; Throat swab culture for evidence of streptococcus infection Blood tests Echocardiogram (echo)-. check the heart's chambers and valves. Electrocardiogram (ECG)-.To test the strength and timing of the electrical activity of the heart. Chest x-rays Cardiac MRI Management of pain Management of fever Management of inflammation with anti-inflammatory medications such as aspirin or corticosteroids Antibiotic prophylaxis to prevent recurrent infection with Group A streptococcus. -use/Benzathine penicillin G Early identification and treatment of ARF, as well as interventions to prevent recurrences of ARF and therefore reduce the likelihood of RHD.-use of antibiotics, Admission to manage severe cases/complications Management of heart failure or heart rhythm abnormalities heart failure e.g. with diuretics, beta blockers Prevention and management of clotting with blood thinners/anti-coagulants Surgical interventions including Cardiac catheterization to repair damaged valves or ICU services for severely ill patients e.g. post-surgery Follow up	Physical rehabilitation/physical exercises	Psychosocial support and counselling the elderly with RHD for any psychological trauma due to the long nature of treatment