Acute 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.