Abstract
Background and Aims: Awareness raising is an important component of primary prevention of RHD. Data are lacking on primary prevention activities for rheumatic heart disease (RHD) prevention in Nepal. The aim of this study is to assess the effectiveness of various awareness raising activities on increasing knowledge about throat infection (TI), acute rheumatic fever (ARF) and RHD and their impact on RHD prevention.
 Methods: Fourteen randomly selected government health facilities in Lalitpur were enrolled in this study. A baseline study conducted in early 2015 analyzed the level of knowledge about RHD among care seekers attending health facilities in Lalitpur. An expansive public awareness raising activities on RHD were performed for 2.5 years starting from February 2015. Data were collected using structured interviews, and review of health facility records. Data were analyzed to compare the postintervention status with the baseline status.
 Results: The mean knowledge about ARF and RHD increased by over 71% (1.82 to 3.12) and 124% (0.37 to 0.83) respectively in post intervention group. There was significant difference in knowledge about TI, ARF and RHD among baseline and post intervention group (p-value<0.0001). The number of throat infection cases presented at health facilities increased by 30.39% from fiscal year (FY) 2071/72 to FY 2072/073 and by 4.69% in the next FY. 
 Conclusions: Awareness raising interventions are effective in increasing knowledge about TI, ARF and RHD which further can produce positive impact in the primary prevention of ARF and RHD.
Highlights
Acute Rheumatic Fever (ARF) and Rheumatic HeartDisease (RHD) are diffuse inflammatory disease, which is a delayed response to an infection by group A Beta-hemolytic Streptococcus.[1]
Awareness raising interventions were highly effective in increasing the knowledge about throat infection (TI), ARFand rheumatic heart disease (RHD)
The good knowledge on acute rheumatic fever (ARF) increased from 3.1% in baseline to 17.6% in post intervention
Summary
Acute Rheumatic Fever (ARF) and Rheumatic HeartDisease (RHD) are diffuse inflammatory disease, which is a delayed response to an infection by group A Beta-hemolytic Streptococcus.[1]. As per available data 0.8 to 1.35 per 1000 school children of age 5-16 years suffer from this disease.[3,4,5,6] In a school based cross sectional study in eastern Nepal, the prevalence of RHD (including subclinical) was found to be 10 per 1000 school children.[7] This study shows that subclinical RHD exist in large number in the community increasing the burden from. Awareness raising is an important component of primary prevention of RHD. Data are lacking on primary prevention activities for rheumatic heart disease (RHD) prevention in Nepal. The aim of this study is to assess the effectiveness of various awareness raising activities on increasing knowledge about throat infection (TI), acute rheumatic fever (ARF) and RHD and their impact on RHD prevention
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