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Evaluation of a Community-Led Program for Primordial and Primary Prevention of Rheumatic Fever in Remote Northern Australia

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  • Anna P. Ralph

    (Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia
    Division of Medicine, Royal Darwin Hospital, Darwin 0810, Australia
    Rheumatic Heart Disease Australia, Menzies School of Health Research, Darwin 0810, Australia)

  • Angela Kelly

    (Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia)

  • Anne-Marie Lee

    (Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia
    Sunrise Health Corporation, Katherine 0850, Australia)

  • Valerina L. Mungatopi

    (Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia)

  • Segora R. Babui

    (Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia)

  • Nanda Kaji Budhathoki

    (Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia)

  • Vicki Wade

    (Rheumatic Heart Disease Australia, Menzies School of Health Research, Darwin 0810, Australia)

  • Jessica L. de Dassel

    (Northern Territory Government Department of Health, Darwin 0810, Australia)

  • Rosemary Wyber

    (Telethon Kids Institute, Perth 6000, Australia
    George Institute for Global Health, Sydney 2000, Australia
    Australian National University, Canberra 2610, Australia)

Abstract

Environmental factors including household crowding and inadequate washing facilities underpin recurrent streptococcal infections in childhood that cause acute rheumatic fever (ARF) and subsequent rheumatic heart disease (RHD). No community-based ‘primordial’-level interventions to reduce streptococcal infection and ARF rates have been reported from Australia previously. We conducted a study at three Australian Aboriginal communities aiming to reduce infections including skin sores and sore throats, usually caused by Group A Streptococci, and ARF. Data were collected for primary care diagnoses consistent with likely or potential streptococcal infection, relating to ARF or RHD or related to environmental living conditions. Rates of these diagnoses during a one-year Baseline Phase were compared with a three-year Activity Phase. Participants were children or adults receiving penicillin prophylaxis for ARF. Aboriginal community members were trained and employed to share knowledge about ARF prevention, support reporting and repairs of faulty health-hardware including showers and provide healthcare navigation for families focusing on skin sores, sore throat and ARF. We hypothesized that infection-related diagnoses would increase through greater recognition, then decrease. We enrolled 29 participants and their families. Overall infection-related diagnosis rates increased from Baseline (mean rate per-person-year 1.69 [95% CI 1.10–2.28]) to Year One (2.12 [95% CI 1.17–3.07]) then decreased (Year Three: 0.72 [95% CI 0.29–1.15]) but this was not statistically significant ( p = 0.064). Annual numbers of first-known ARF decreased, but numbers were small: there were six cases of first-known ARF during Baseline, then five, 1, 0 over the next three years respectively. There was a relationship between household occupancy and numbers ( p = 0.018), but not rates ( p = 0.447) of infections. This first Australian ARF primordial prevention study provides a feasible model with encouraging findings.

Suggested Citation

  • Anna P. Ralph & Angela Kelly & Anne-Marie Lee & Valerina L. Mungatopi & Segora R. Babui & Nanda Kaji Budhathoki & Vicki Wade & Jessica L. de Dassel & Rosemary Wyber, 2022. "Evaluation of a Community-Led Program for Primordial and Primary Prevention of Rheumatic Fever in Remote Northern Australia," IJERPH, MDPI, vol. 19(16), pages 1-17, August.
    • Handle: RePEc:gam:jijerp:v:19:y:2022:i:16:p:10215-:d:890583
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    References listed on IDEAS

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    1. Pasqualina M Coffey & Anna P Ralph & Vicki L Krause, 2018. "The role of social determinants of health in the risk and prevention of group A streptococcal infection, acute rheumatic fever and rheumatic heart disease: A systematic review," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 12(6), pages 1-22, June.
    2. Haynes, Emma & Marawili, Minitja & Marika, Brendan Makungun & Mitchell, Alice G. & Phillips, Jodi & Bessarab, Dawn & Walker, Roz & Cook, Jeff & Ralph, Anna P., 2019. "Community-based participatory action research on rheumatic heart disease in an Australian Aboriginal homeland: Evaluation of the ‘On track watch’ project," Evaluation and Program Planning, Elsevier, vol. 74(C), pages 38-53.
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