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Say ahhhhh... for sore throats

Say ahhhhh... for sore throats

Reducing rheumatic fever


What is rheumatic fever?

Rheumatic fever is a serious but preventable illness that can cause lifelong heart damage. It can start with a sore throat that is caused by a bug called Group A Streptococcus, commonly known as ‘strep throat’. If ‘strep throat’ is not treated with a full course of antibiotics it can lead to rheumatic fever. Symptoms of rheumatic fever include sore or swollen joints, a skin rash, a fever, stomach pain or jerky movements.

Waitemata DHB Value: With CompassionRheumatic fever can have a large impact on the wider family / whānau and society as a person with rheumatic fever may have lifelong heart complications (rheumatic health disease where there is scarring of the heart valves) and need monthly penicillin injections to prevent further heart damage. Rheumatic heart disease can be life-threatening.

The risk of rheumatic fever is higher if you:

  • are aged between 4-15 years
  • live with a family member who has had rheumatic fever before
  • live in an overcrowded environment
  • live in substandard housing (for example with poor insulation)

Acute rheumatic fever rates by ethnicity for 0-24 year olds
Acute rheumatic fever admission rates by ethnicity for 0-24 year olds


What are we trying to achieve?

The rate of acute rheumatic fever (ARF) in New Zealand is increasing. Between 2005 and 2010, the rate of ARF doubled from 1.9 reported cases per 100,000 population to 3.8 per 100,000[1]. Our aim is to help reduce the rate by raising awareness amongst ‘at-risk’ groups in our community. A key target is Maori and Pacific populations as statistics show a much higher rate in these population groups.

We also implemented a school-based throat swabbing programme to identify children with strep throat infections so that they can receive appropriate treatment as soon as possible.

  1. Public Health Surveillance. Annual Surveillance Summary. Ministry of Health, 2011. www.surv.esr.cri.nz/surveillance/annual_surveillance.php

 

What have we done?

We identified schools that had higher incidences of rheumatic fever. In March 2013, we carried out a survey in those schools to determine the current level of knowledge about rheumatic fever among students, staff and the community. We then developed educational resources to address gaps in knowledge.

After obtaining consent from parents, public health nurses went to each school three days a week and took throat swabs from children who had sore throats. If a child tested positive for strep throat, the nurses:

  • contacted parents and encouraged them to take their child to the doctor
  • made follow-up phone calls to check if the child had been to the doctor and given the correct antibiotics
  • provided antibiotics directly if parents were unable to take their child to the doctor

Rheumatic fever health check consent forms
Rheumatic fever health check consent form for schools

Rheumatic fever chatterbox game
Rheumatic fever educational chatterbox game for students to play with family / whānau (download chatterbox game)

Display board and resources for schools and community events
Display board and resources for schools and community events

Healthy messages created by students
Healthy messages created by students

 

What can you do to help us?

  • Tell people that sore throats need to be checked.
  • If your child has a sore throat, please get them checked by a nurse or doctor.
  • If your child is given antibiotics, it is really important that they finish all of them.

 

Did we make a difference?

Repeat surveys showed an increased awareness of rheumatic fever and knowledge that sore throats can be serious.

Results from repeat surveys about whether participants thought sore throats can be dangerousResults from repeat surveys about whether participants had heard of rheumatic feverResults from repeat surveys about whether participants thought rheumatic fever causes heart damage

From March to September 2013, 1,633 children with sore throats were swabbed. Just over 300 tested positive for strep throat and received treatment. 

The success of this programme was largely due to the close partnership between local healthcare providers, the schools, our children, their parents and the wider community. We would like to thank everyone who helped us make this happen.

Feedback on rheumatic fever programme from school teacher


Where to from here?

The process has already been shared with Auckland DHB and other Waitemata DHB Child & Family services. The framework can also be applied to other health priorities in the future.

We plan to:

  • continue raising awareness of rheumatic fever and sore throats through ongoing education
  • carry out follow-up surveys each year to make sure the education is effective
  • continue the throat swabbing programme
  • continue reporting progress back to schools and the community
  • maintain the partnership between local healthcare providers, schools, our children, their parents and the wider community

For more information about Rheumatic Fever

Sore Throat Song

The Sore Throat song was taught to school children as part of the education programme