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Result 3 Case Study 4

The $46 million government-funded Rheumatic Fever Prevention Programme is being strengthened by strong collaboration between a wide variety of agencies and local communities.

In Porirua East, where there is a high rate of rheumatic fever, implementation of the programme is supported by the Ministry of Health, Regional Public Health's public health nurses, Compass Health, schools and local families/whanau.

Working alongside other health professionals, seven public health nurses visit the 12 schools in Porirua East a couple of times a week to swab the throats of children who report having sore throats.

Public Health Nurse Chris Campbell says, "Since the school-based throat swabbing programme started in Porirua in May 2012, the Porirua public health nurses have performed more than 4000 swabs, with over 370 of the swabs testing positive for Group A Streptococcus infection which can cause rheumatic fever."

If a throat swab result is positive for Group A Strep, a public health nurse can take antibiotics to the child's home, or the family may choose to go to the GP. Antibiotics are important in halting the infection and preventing it from developing into rheumatic fever and potentially rheumatic heart disease.

The nurse will talk with the family about rheumatic fever, what causes it and how to prevent it, and the importance of their child completing the course of antibiotics. A kaiawhina the health worker), employed by the Compass Primary Healthcare Network, also follows up to check that the medicine is being taken properly and the course of antibiotics is completed.

"The increased connection that public health nurses are having with children and their parents through the throat swabbing programme means that we are also able to offer more support with other health concerns. It's providing some great opportunities to improve the health of these children", Chris says.

Judith Wootton, principal at Porirua East's Windley School, has seen the impact of the disease on several of her students; "It is often quite considerable and it's distressing to know that it can be prevented if people know that sore throats need medical attention."

"The teachers really push the message about the need for throat swabs and are quite explicit with older students about how seriously rheumatic fever can damage your health," Judith says.

"Asking children if they have a sore throat and need to see the nurse is part of the day-to-day routine. Younger children are asked every day with the roll call and older ones are given regular reminders. Rheumatic fever is embedded in our health and hygiene programme, along with blowing your nose properly, washing your hands and eating healthy food," Judith says.

Windley School, which is the largest year 1-8 school in Porirua, has taken a multi-pronged approach to educating parents about sore throats and rheumatic fever. Whenever someone calls to say their child is going to be away sick, they are asked if the child has a sore throat, and if so advised to take them to their local medical centre to get it checked.

Tepa Dol, the school's public health nurse, and kaiawhina Rose Russell visit parents at home if a child is identified as having a strep throat. Rheumatic fever and the throat-swabbing programme are also highlighted regularly in school newsletters.

The throat-swabbing programme in Porirua is part of the Porirua Kids Project - a joint initiative between primary care providers, Primary Health Organisations, Regional Public Health and Capital and Coast District Health Board. The main aims of the Project are to reduce the high rates of rheumatic fever and serious skin infections in children in Porirua East.

Initiatives developed include primary care providers delivering more training for practice nurses in identifying and treating sore throats and a community awareness campaign - Strong Hearts in Porirua - which has been highlighting the link between sore throats and rheumatic fever.

Ministry of Health Rheumatic Fever Programme Lead Dr Chrissie Pickin says that more than 47,500 children have joined the government's school-based throat swabbing programme to reduce rheumatic fever.

"We now have 211 low decile primary and intermediate school and nine community based clinics taking part - with 146 new schools have joining in the last 12 months. These are all schools in communities with the highest rates of rheumatic fever. "

With additional money from the recent Budget, the programme will expand to provide rapid access nurse-led community services to children, who do not attend schools that are part of the throat swabbing programme. Existing school-based sore throat swabbing services will continue to be implemented in all areas where there are at risk children.

The new services step up the focus on Pacific children, as they have the highest rates of rheumatic fever. Nearly 90 percent of rheumatic fever cases in Pacific children occur in Auckland and Porirua so the focus will be in these areas.

Any family in Auckland whose children have housing-related health issues, that are eligible for help, will also be referred to services under the Auckland wide Healthy Homes Initiative.

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