PDF(Pubmed)
Abstract：
Environmental factors including household crowding and inadequate washing facilities underpin recurrent streptococcal infections in childhood that cause acute rheumatic fever (ARF) and subsequent rheumatic heart disease (RHD). No community-based \'primordial\'-level interventions to reduce streptococcal infection and ARF rates have been reported from Australia previously. We conducted a study at three Australian Aboriginal communities aiming to reduce infections including skin sores and sore throats, usually caused by Group A Streptococci, and ARF. Data were collected for primary care diagnoses consistent with likely or potential streptococcal infection, relating to ARF or RHD or related to environmental living conditions. Rates of these diagnoses during a one-year Baseline Phase were compared with a three-year Activity Phase. Participants were children or adults receiving penicillin prophylaxis for ARF. Aboriginal community members were trained and employed to share knowledge about ARF prevention, support reporting and repairs of faulty health-hardware including showers and provide healthcare navigation for families focusing on skin sores, sore throat and ARF. We hypothesized that infection-related diagnoses would increase through greater recognition, then decrease. We enrolled 29 participants and their families. Overall infection-related diagnosis rates increased from Baseline (mean rate per-person-year 1.69 [95% CI 1.10-2.28]) to Year One (2.12 [95% CI 1.17-3.07]) then decreased (Year Three: 0.72 [95% CI 0.29-1.15]) but this was not statistically significant (p = 0.064). Annual numbers of first-known ARF decreased, but numbers were small: there were six cases of first-known ARF during Baseline, then five, 1, 0 over the next three years respectively. There was a relationship between household occupancy and numbers (p = 0.018), but not rates (p = 0.447) of infections. This first Australian ARF primordial prevention study provides a feasible model with encouraging findings.
摘要：
包括家庭拥挤和洗涤设施不足在内的环境因素是儿童复发性链球菌感染的基础，这些感染会导致急性风湿热（ARF）和随后的风湿性心脏病（RHD）。以前，澳大利亚没有报道过减少链球菌感染和ARF发生率的基于社区的“原始”水平干预措施。我们在三个澳大利亚原住民社区进行了一项研究，旨在减少感染，包括皮肤疮和喉咙痛，通常由A组链球菌引起,ARF。收集与可能或潜在链球菌感染一致的初级保健诊断数据，与ARF或RHD有关或与环境生活条件有关。将一年基线阶段的这些诊断率与三年活动阶段进行比较。参与者是接受青霉素预防ARF的儿童或成人。土著社区成员接受了培训和雇用，以分享有关ARF预防的知识，支持故障健康硬件的报告和维修，包括淋浴，并为关注皮肤疮的家庭提供医疗保健导航，喉咙痛和ARF。我们假设感染相关的诊断会通过更多的识别而增加，然后减少。我们招募了29名参与者及其家人。总体感染相关诊断率从基线（平均每人每年1.69[95％CI1.10-2.28]）增加到第一年（2.12[95％CI1.17-3.07]），然后下降（第三年：0.72[95％CI0.29-1.15]），但没有统计学意义（p=0.064）。首次已知的ARF的年度数量减少，但数量很少：基线期间有6例首次已知的ARF，然后五个，1，未来三年分别为0。家庭入住率和人数之间存在关系(p=0.018)，但不是感染率（p=0.447）。这项首次澳大利亚ARF原始预防研究提供了一个可行的模型，其结果令人鼓舞。
