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.

Djaalinj Waakinj leads to better hearing – and happier kids

More than 150 children are currently enrolled in an innovative program led by Telethon Kids Institute that is helping slash waiting times for Aboriginal children suffering from potentially debilitating ear infections.

The project – based in Perth’s south – is a unique clinical research program which focuses on early intervention to diagnose and fast-track treatment of children with middle ear infections (otitis media) to prevent hearing loss.

Ear health a priority

More than 150 children are currently enrolled in the project, which has dramatically reduced waiting times to allow children to have their ear problems checked within days.

Dr Chris Brennan-Jones, Head of Ear Health at the Wesfarmers Centre of Vaccines and Infectious Diseases, based at Telethon Kids Institute, said there was a clear need to prioritise early testing and treatment for Aboriginal children suffering otitis media (OM). 

“Some children spend over two years on waiting lists for treatment of ear infections. That’s too long for children who are in crucial stages of language, behavioural and educational development.”

Dr Brennan-Jones

“Working with the local Aboriginal community, the Djaalinj Waakinj (listening and talking) Ear Portal Program was established to address this gap. It ensures access to early diagnosis and intervention – within days instead of years – by reducing unnecessary travel and waiting times.”

Middle ear infections in Australia are common among children, but they disproportionately affect certain groups. A Telethon Kids study found that young Aboriginal children are at increased risk of developing middle ear infections compared to non-Aboriginal children.

The Djaalinj Waakinj (listening and talking) Ear Portal Program is a telehealth-driven clinical research program which uses technology to remotely diagnose and prioritise treatment of children with otitis media to prevent hearing loss.

Hearing loss caused by untreated OM is a lifelong burden, with the impact on lost wellbeing (due to unemployment, impacts on mental health and quality of life) estimated to cost $17.4 billion per annum in Australia.

Providing access for Aboriginal families

Val Swift, Aboriginal Cultural Governance Advisor at Wesfarmers Centre of Vaccines and Infectious Diseases said the program was aiming to make sure no child in the local community starts school with preventable or treatable hearing loss.

“There is an assumption that living in metropolitan Perth means you can access medical services without restrictions. But that isn’t the case for many Aboriginal families,” Ms Swift said.

“By working with the community to design and deliver the program, we’re ensuring the cultural security of the program so families feel safe and comfortable to participate. We’re making this a service they can access without restrictions.”