Community-led approach reducing rheumatic fever

A community-based research project in the Northern Territory is providing hope to remote communities in reducing rheumatic fever cases and the bacterial infections that trigger the condition.

Rheumatic fever, caused by household crowding and high rates of untreated streptococcal infections in children, can have devastating consequences, such as causing heart disease at a young age.

Community-driven activities key to success

The study – part of a 4-year collaboration with Menzies School of Health Research, Telethon Kids Institute, Sunrise Health Service and NT Health – focused on reducing household health risks through community-based activities led by Aboriginal Community Workers, in a bid to curb infection rates.

Housing and environmental health support – such as fixing showerheads, broken pipes and other health hardware – as well as information-sharing about rheumatic fever and assisting families to navigate healthcare, made up the focus of the activities.

This helped people gain the knowledge needed to seek medical treatment, which initially increased the number of reported infections. Because those infections were then able to be properly treated, rates of infection decreased to below baseline levels, especially in children.

Study co-author and Chairperson of the Board for Sunrise Health Service, Anne-Marie Lee, said the findings suggested the community-led activities translated into a reduction of the types of infection that drive rheumatic fever. The number of new cases of rheumatic fever also decreased during the study.

“Indigenous people working on the ground from that community, it works well. It doesn’t work if an outsider thinks that they can come in. You have to get local people on the ground to do the job,” Ms Lee said.

Director of RHDAustralia and Aboriginal advisor for the study, Ms Vicki Wade, agreed.

“It is so important for rheumatic fever control to be community-led. Rheumatic fever is fuelled by the socio-economic determinants of health, so that’s what we need to tackle, using scientifically based approaches that are co-designed in partnership with communities,” Ms Wade said.

Members of the research team together in Northern Territory, Australia
Members of the research team together in Northern Territory, Australia (L-R): Dr Vicki Kerrigan, Angela Kelly, Anne-Marie Lee, Segora Babui, Professor Anna Ralph, Valerina Mungatopi, Catherine Halkon

First of its kind study in Australia

Study lead and Senior Clinical Research Fellow at Menzies School of Health Research, Professor Anna Ralph, said rheumatic fever had declined in southern parts of Australia and globally in high income countries in the mid-1900s as standards of living improved – otherwise known as primordial prevention.

“Translating the key components of primordial prevention into tropical and central Australia requires innovation and strong partnerships,” Professor Ralph said.

“This is the first time Australian data has been published on the health impacts of community-led rheumatic fever primordial prevention. These findings are promising but need to be scaled up to whole communities.”

The research has been published in the International Journal of Environmental Research and Public Health and funded by the National Health and Medical Research Council, the National Heart Foundation and Bupa Foundation.