Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) have significant impact on the health of children and young adults. It remains common in low- and middle-income countries in sub-Saharan Africa and has lifelong health consequences. The underlying cause is an abnormal immune reaction to sore throat and/or skin infections caused by a specific bacteria (Group A streptococcus, GAS). RHD can be prevented with penicillin antibiotics, if diagnosed and treated early. Yet, in South Africa, a middle- income country, the burden of RHD is largely unchanged despite relatively good access to penicillin antibiotics in the community. This is research gap. Better identifying children in the community with predisposing GAS infections (i.e. sore throat and skin infection) will help ensure that prevention measures and other interventions have a higher chance of success.