Nurses make mark on rheumatic fever rates

9 March 2017

World first research showing sore throat clinics in South Auckland schools helped dramatically drop rheumatic fever rates justifies the hard work put in by nurses and whānau workers, says nurse leader and co-researcher Lizzie Farrell.

Findings of the research, lead by Professor Diana Lennon of the University of Auckland, have just been published in the latest Pediatric Infectious Disease Journal.  Lennon said the 2010-2016 study was a global first as for the first time there was robust evidence that a primary prevention approach in the community, that is nurse-led sore throat clinics, could work in preventing first presentation acute rheumatic fever (ARF).

The study measured the effect of introducing registered nurse-led sore throat clinics in 61 primary and intermediate schools in Counties-Manukau and found the ARF rate dropped from 88 per 100,000 children pre-clinic down to 37 per 100,000 children two years after the clinics were introduced – a reduction of 58 per cent.

The prevention model uses a team of school-based nurses with a whānau support worker, based at school clinics five days per week. The teams offer swabs for children with sore throats and follow-up treatment with a ten day course of oral amoxicillin for children found positive for group A streptococcal (GAS) – the 'strep throat' bacteria that can lead to acute rheumatic fever and the risk of rheumatic heart disease. Lennon said rheumatic fever has continued at an unacceptably high rate with hospitalization for ARF affecting about one in 150 Māori or Pacific Island children, aged under 13 years. “Life span in Māori adults with heart damage from rheumatic fever is reduced by more than 10 years.”

Farrell, clinical nurse manager of Counties-Manukau Health's Kidz First Public Health Nursing team, said the research findings justified the "extremely hard work" by the registered nurses and whānau workers involved in the project 

She was a co-author of the latest research article and has been involved in Lennon's rheumatic fever research since the initial groundbreaking throat swabbing research in South Auckland in the late 1990s.

The South Auckland sore throat programme is delivered as part of the Mana Kidz school clinic programme which draws on Kidz First public health nurses as well as practice and community nurses from local primary health providers to provide a school public health programme to 25,000 children including treating skin infections and health referrals. Mana Kidz is led by the National Hauora Coalition, which won the Ministry of Health contract in 2012 to deliver sore throat clinics in South Auckland– the region with the country's highest number of rheumatic fever sufferers.

Farrell said the Kidz First public health nurse and whānau worker team also partnered with Lennon's research team to carry out intensive throat swabbing at a subset of schools.  These findings helped assess changes in the prevalence of GAS amongst children in the community and indicated that GAS prevalence had fallen from 22.4% of children before the clinics down to 11.4% two years after the clinics were introduced.

Farrell said being involved with the research project had been an amazing opportunity for her staff. "Being part of a research project that is actually what you do everyday – everyday nursing practice but in an intense way – that is then evaluated and comes out with really good outcomes." She said Lennon's research was always very community-minded and was carried out where and with the people who needed it.  Farrell said the research also added value to all the health promotion messages about the prevention of rheumatic fever.  "There's a lot of parental/caregiver contact with the registered nurse to talk about treatment of children with positive strep throats – so the information spreads in the community that you need to report a sore throat, treat a strep throat and take the medication for the ten days."

Lennon said the study demonstrated this ‘proof of principle’ - the first both nationally and internationally – for supporting prevention of first presentation rheumatic fever through sore throat management delivered in school clinics.

She said the findings also supported the continuation of school clinics already underway in Northland, Auckland, the Bay of Plenty, Hawkes Bay and other regions around New Zealand."

“This has been a 30 year journey, based on community advocacy and partnership, empowerment, and knowledge sharing that began with participation from the Māori Women’s Welfare League,” said Lennon.

An earlier 2014 evaluation of the Mana Kidz programme found that 11 per cent of the 119,423 throat swabs taken between February 2013 and September 2014 were positive and more than 20,000 sore throats were treated over that time. In the same time period the Mana Kidz teams treated 17,593 skin infections and actioned 4178 school health referrals.  The evaluation also found improved health literacy in the schools' children and families – especially knowledge of sore throats, ARF, medication adherence and skin infection.


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