Posted by Dr Pip Anderson on 17 December 2014 |
Rheumatic fever is an important illness because it can lead to long-term heart damage, affecting both the quality and quantity of a person’s life. We also think of Rheumatic fever as a useful indicator of child wellbeing, as it reflects health knowledge, access to health care, integration across the health system and social issues such as poor housing.
In Counties Manukau we have the highest rates and absolute numbers of Rheumatic fever in New Zealand. The Ministry of Health estimated there were 77 new cases of Rheumatic fever in people living in Counties Manukau in 2013. Rheumatic fever mainly affects Maaori and Pacific children and young people.
It is not well understood why some people get rheumatic fever and others don’t. However, what we do know is that by recognising and treating sore throats caused by a bug called Group A strep we can help prevent the disease. This means understanding the importance of getting sore throats checked and being able to access healthcare. We also know that in New Zealand Rheumatic fever is more common in people living in crowded households, which makes addressing housing another key action area.
Reducing rates of Rheumatic fever has been identified as a national priority through a Better Public Service target. Both the Ministry of Health and CM Health are investing heavily to try to achieve this. There are a number of initiatives underway to “fight the fever” – activities to both prevent people developing rheumatic fever in the first place, and if they do get the disease, making sure they get the best possible care to ensure they don’t get future episodes, which can further damage their heart.
These activities include sore throat swabbing in high risk schools, free throat swabbing in some General Practices, a Housing initiative (Auckland Wide Healthy Homes initiative), regional work focused on increasing Pacific people’s understanding of Rheumatic fever as well as a national awareness raising campaign.
One of the initiatives under way in Counties Manukau is a school based programme, known as Mana Kidz, which provides targeted primary care interventions in 61 primary and intermediate schools (Year 1-8) in the district. As at September 2014, 97% of all eligible children are consented into the programme (~24,000 children). The programme involves having a nurse and a whaanau support worker (WSW) based in each school. Throat swabbing is offered five days a week for children complaining of a sore throat. Mana Kidz visits 991 classrooms a day in Counties Manukau. Nurses can provide free medication to a child’s family if the child has a throat swab that grows the Group A Strep bug. In addition, having a nurse and WSW in schools enables them to address other health issues such as immunisation, skin infections, child protection issues, and make referrals for housing support.
The evaluation of Mana Kidz is just being completed. The results look promising. Overall the programme was found to provide increased access to health care for Maaori and Pacific children, resulting in a decrease in Group A Strep throat infections. It is too early to know whether this is resulting in a reduction in Rheumatic Fever hospital admissions, however, the rates observed in 5-12 years olds in CM Health for the year ending 30th June 2014 were the lowest for the last 4 years. Information also suggests a continued downward trend in the last 6 months since June. The rate of admissions for skin infections in 5-12 years olds for the year to 30th June 2014 was also the lowest in 8 years, but again further information will be needed to assess the contribution of the programme to these rates. Importantly the programme is highly valued by school staff and whaanau.
Investment in preventing Rheumatic Fever provides an opportunity to get things right for children and whaanau in our community. This means creating a health system that provides knowledge in a relevant, understandable way, provides services that are accessible for children and to work to address social factors that impact on their health such as housing.
If we can “fix” Rheumatic fever, chances are we will “fix” a whole lot of things which will benefit the health and wellbeing of our children.
Dr Pip Anderson
Public Health Physician