AbstractAcute rheumatic fever (ARF) is an autoimmune response following an untreated streptococcal infection. The devastating effect of ARF is residual damage to the heart valves; a condition called rheumatic heart disease (RHD).
Diagnosis and management of these conditions is complex. The most important yet most difficult element of treatment is delivery of regular intramuscular injections to prevent recurrence of ARF and worsening of RHD.
Two contemporary models were employed to investigate current approaches to diagnosis and management and whether they could be improved.
Diagnosis of ARF in Australian children was monitored through an existing national surveillance system over a 3 year period (2007 to 2010). One hundred and fifty-one cases were identified, with joint symptoms, fever and carditis being the most common features. There were delays in presentation of children to primary care services, and referral by medical officers to higher-level care across both urban and remote areas. Results of ARF in low risk children suggest that subtle presentations of ARF in this group are being missed.
Management of ARF and RHD was analysed at three sites in Fiji over a two and a half year period (2009 to 2011). A process of continuous quality improvement (CQI) was applied to determine what impact such an intervention might have on key aspects of service delivery and client health outcomes.
The study produced mixed results. Overall, the quality of clinical documentation improved; however there was not a consistently positive impact on the delivery of intramuscular injections despite reported improvements in clinical delivery systems.
Based on the experience of using CQI in Fiji it is not a valid tool in its current form. Modification of the CQI tool and a higher level of technical and financial support for CQI activities should be considered prior to any future research.
|Date of Award
|Jonathan Carapetis (Supervisor), Ross Stewart Bailie (Supervisor) & Samantha Margaret Colquhoun (Supervisor)