Audit paints a grim picture

Maori children in Northland suffer a rheumatic fever rate similar to those seen in developing countries, and almost twice those revealed by studies elsewhere in New Zealand, according to an audit report co-authored by Northland DHB paediatrician Dr Roger Tuck and Medical Officer of Health Dr Clair Mills, with Audrey Robin and Diana Lennon.

The audit report (The epidemiology of acute rheumatic fever in Northland, 2002 - 2011) was published last week by the New Zealand Medical Journal.

"Rheumatic fever rates are very high for school-aged Maori in Northland, with an increasing [upward] trend in cases over 2002-2011," Dr Tuck said.

"It is clear that the upstream issues of poverty, poor housing and overcrowding for our children still urgently need to be addressed."

The audit of rheumatic fever surveillance in Northland was carried out for the period 2002-2011, to establish the accuracy and completeness of surveillance of the disease in the region and to provide a robust baseline for future comparison given current rheumatic fever prevention efforts.

Cases of acute rheumatic fever were identified and evaluated by auditing Northland hospital discharges, the Northland rheumatic fever secondary penicillin prophylaxis register and the national EpiSurv database. Cases were included in the audit if they met diagnostic criteria according to the 2008 Heart Foundation guidelines.

A total of 114 acute rheumatic fever cases met the audit criteria, an annualised incidence of 7.7 per 100,000 population. Ninety-five per cent of all cases were Maori, with a large disparity between Maori (24.8/100,000) and non-Maori (0.6/100,000). Acute rheumatic fever cases were strongly associated with living in high-deprivation areas.

The audit also noted both under- and over-notification of acute rheumatic fever.

Dr Tuck said acute rheumatic fever rates in Northland Maori children aged five to 14 years, at 78 per 100,000 population, were similar to those seen in developing countries, and almost double the rates seen in other New Zealand audits.

"The findings highlight the urgent need to address crowding, poverty and inequitable primary care access if rheumatic fever is to be eliminated," he added.