Addressing rheumatic fever inequities in Aotearoa New Zealand: a scoping review of prevention interventions
Siobhan Tu’akoi
1 * , Malakai Ofanoa 1 , Samuela Ofanoa 1 , Hinamaha Lutui 2 , Maryann Heather 1 , Rawiri McKree Jansen 3 , Felicity Goodyear-Smith 4
+ Author Affiliations
- Author Affiliations
1 Pacific Health Section, Faculty of Medical & Health Sciences, University of Auckland, PB 92019, Grafton Campus, Auckland 1142, New Zealand.
2 Alliance Health Plus, Mount Wellington, Auckland, New Zealand.
3 Te Aka Whai Ora Māori Health Authority, Auckland, New Zealand.
4 Department of General Practice & Primary Health Care, University of Auckland, Grafton Campus, Auckland, New Zealand.
Journal of Primary Health Care 15(1) 59-66 https://doi.org/10.1071/HC22093
Published: 14 November 2022
© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of The Royal New Zealand College of General Practitioners. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)
Abstract
Introduction: Rheumatic fever is a preventable illness caused by untreated Group A Streptococcus (GAS) infection. Despite reductions in most high-income countries, rheumatic fever rates remain a concern in Aotearoa New Zealand. Pacific and Māori people are inequitably affected, with risk of initial hospitalisation due to rheumatic fever 12- and 24-fold more likely, respectively, compared to non-Māori and non-Pacific people.
Aim: This scoping review aims to explore the range of interventions and initiatives in New Zealand seeking to prevent GAS and rheumatic fever, with a particular focus on Pacific and Māori.
Methods: Databases Scopus, Medline, EMBASE and CINAHL, along with grey literature sources, were searched to broadly identify interventions in New Zealand. Data were screened for eligibility and the final articles were charted into a stocktake table.
Results: Fifty-eight studies were included, reporting 57 interventions. These targeted school-based throat swabbing, awareness and education, housing, secondary prophylaxis, improving primary care guidelines and diagnosis of sore throats and skin infections. Some interventions reported short-term outcomes of improvements in awareness, a reduction in rheumatic fever risk and fewer hospitalisations. Evaluation outcomes were, however, lacking for many initiatives. Pacific and Māori people primarily served only in an advisory or delivery capacity, rather than as partners in co-design or leadership from the beginning.
Discussion: Although positive outcomes were reported for some interventions identified in this review, rheumatic fever rates have not shown any long-term reduction over time. Co-designing interventions with affected communities could ensure that strategies are better targeted and do not contribute to further stigma.
Keywords: inequity, intervention, New Zealand, Pacific, Pasifika, Māori, rheumatic fever, rheumatic heart disease.
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