Te Mana Hauora O Te Tairawhiti
24 March 2016
The number of children with rheumatic fever, New Zealand’s third world illness affecting mainly Māori and Pacific children, fell in 2015, suggesting the local Rheumatic Fever Prevention Programme is having an impact.
In 2015 there were three confirmed cases of rheumatic fever inTairāwhiti compared with 10 in 2014, and 7 in 2013. “The figures, while not statistically significant, are very encouraging,” says Chair of the Rheumatic Fever Steering Group, and Hauora Tairāwhiti’s Medical Officer of Health, Margot McLean.
“The figures suggest that the prevention programme alongside increased public awareness, and the hard work of our local nurses, general practitioners and community health workers, has started to take effect,” says Dr McLean.
The Rheumatic Fever Prevention Programme is a partnership between Turanga Health, Ngati Porou Hauora, Hauora Tairāwhiti, and primary care (medical centres). Rheumatic fever and sore throat education, as well as free sore throat swabbing services are available for the public in an effort to reduce the rate of acute rheumatic fever in Tairāwhiti.
As part of the campaign Turanga Health supported the implementation of rapid response sore throat clinics in Gisborne’s general practices, and in its own medical centre at Te Karaka. On the east coast, children with sore throats are managed by Ngati Porou Hauora general practitioners and nurses based at the local health clinics. Anyone with a child or young person aged 4-19 who has a sore throat can visit a practice for free and with no appointment needed. A nurse will take a throat swab and offer free antibiotics.
In Gisborne if a throat swab comes back positive for Group A Streptococcus (GAS) bacteria, which can lead to rheumatic fever, and where there is consent, the child is referred to Turanga Health’s Rheumatic Fever Prevention Programme. The child and family receive education and support from the programme’s kaiāwhina. This support service will be extended to the east coast later in the year and be provided by Ngati Porou Hauora.
Between May 2015 and February 2016, of the 5899 throat swabs taken across the district, exactly 1000 were found positive for GAS bacteria. In the same time period Turanga Health received 211 referrals to its Rheumatic Fever Prevention Programme for antibiotic education and support, and or a Healthy Home assessment.
Rheumatic fever is associated with cold and overcrowded housing. Because of this, children who have been hospitalised with rheumatic fever (as well as certain other infectious illnesses related to poor housing) are referred to the Healthy Homes programme. Housing-related interventions include referral to health and social agencies, installing insulation and ventilation, and design improvements to the house. The support given may be anything from curtains, draft stoppers (made by Vanessa Lowndes Centre clients), or in some cases help with transferring the family to more appropriate housing. Turanga Health’s Healthy Home kaiāwhina is currently working with 25 families.
One Gisborne mum to benefit from the Healthy Homes initiative, Faith Rihia, says she and her daughter are much happier, warmer, and healthier in their new home which they moved into late last year with help from Turanga Health.
“It was stressful and I had no sleep,” remembers Faith from earlier demanding days when her 11-month-old baby girl had numerous chest, breathing, and throat conditions, leading to multiple hospital admissions. “It’s had a real benefit for [baby] Kerry-Anne and me, things are getting easier, it was a bit of extra help.”
Dr McLean said rheumatic fever is sometimes described as the disease that casts a long shadow. ”The ongoing consequences are serious. Although initial symptoms of rheumatic fever like swollen joints and fever get better, the heart valves may be damaged and this damage is permanent.”
“Young people who’ve had rheumatic fever need a decade, maybe more, of monthly painful antibiotic injections, to prevent the development of rheumatic heart disease, or to stop it getting worse. Rheumatic heart disease can lead to heart failure, the need for surgery, and for some people, a shorter life.”
Dr McLean said work initially done across this region including the school-based throat swabbing programme, and now the rapid response clinics and Healthy Homes initiative, mean in time it might be possible to rid the region of the disease. However there has already been one case of rheumatic fever recorded for 2016 – a reminder that families and health staff cannot afford to be complacent. “Sore throats matter!” says Dr McLean.
Parents and caregivers are reminded that if your child has a sore throat and especially if your family is Māori or Pacific, you need to take them to a doctor, nurse or community worker and get a throat swab.