Fiji Rheumatic Heart Disease (RHD) Control and Prevention

In June 2014, a five-year partnership project commenced with the aim of preventing and reducing the impact of rheumatic heart disease (RHD) in the Fiji Islands. Cure Kids is working collaboratively with the Fiji Ministry of Health and Medical Services, Auckland District Health Board, and the Centre for International Child Health at Murdoch Children’s Research Institute.

  • Affects one in 50 children, yet is a preventable condition
  • Fiji has one of the highest known rates in the world
  • A leading cause of death for young people
  • The second most common cause of death for pregnant women
  • In partnership with AccorHotels, the Fiji Ministry of Health and world-leading RHD experts from Australia and NZ, Cure Kids is leading a national-level, research-based project, improving and building capacity across all aspects of RHD control and prevention

The multi-million-dollar project was made possible as a result of joint funding provided through Cure Kids’ partnership with AccorHotels and MFAT’s New Zealand Partnerships for International Development Fund. FIJI Water Foundation generously provided funding for echocardiography machines which are critical to the delivery of the project. We are grateful for their support, and the support of our project delivery partners.

 

What is rheumatic heart disease and how big is the health problem in Fiji?

RHD is a serious heart condition that occurs following an attack of Acute Rheumatic Fever (ARF) which can occur after a strong immune response to a throat infection caused by a Group A Streptococcus (‘strep throat’ infection). If appropriate antibiotic treatment is not administered, inflammation of the heart can cause scarring of the heart valves resulting in significant morbidity and possible death. In Fiji it is common for children to present to clinical services late – already with symptomatic RHD – which means they are often too late for adequate treatment.

RHD is a significant health problem in Fiji, with the Pacific region having one of the highest reported RHD incidences in the world. Echocardiography-confirmed RHD prevalence in Fijian children, aged 5-14 years, is 35.4 per 1,000 which equates to approximately one child in every classroom living with RHD.

In Fiji, at least 60 deaths a year are attributed to RHD.

 

What is the project aiming to accomplish?

The goal is to expand and strengthen the existing Fiji Rheumatic Heart Disease Control Programme to include developing new models of ARF/RHD care and prevention with the aim of reducing RHD related morbidity and mortality. Fundamental to Project outputs is an effective national co-ordination structure for the Fiji RHD Control Programme (Fiji MOH). Increasing capacity at this level will provide a governance model that can continue beyond the life of the Project.

 

OUTPUT 1: REGISTER-BASED SECONDARY PREVENTION PROGRAMME OPERATIONAL INCLUDING QUALITY IMPROVEMENT PROCESSES

– Scoping and implementation of national web-based register system

– Develop a national co-ordination model and provide training

– Explore system level barriers to improve patient adherence and implement interventions/new models based on findings

– Develop and deliver a Data Management plan to include:

  • Data quality monitoring
  • Case ascertainment
  • Scoping integration into national clinical and public health information system

 

OUTPUT 2: BEST PRACTICE GUIDELINES FOR CLINICAL CARE FOR ARF/RHD IMPLEMENTED AND MONITORED AGAINST BENCHMARKS

– Patient and health care worker focus to identify current deficiencies and barriers to improved care

– Evaluation of health care system barriers to delivery of effective clinical

– Establishment of benchmarks and best practice monitoring

 

OUTPUT 3: MODEL FOR EARLY DETECTION OF ARF/RHD CASES DEVELOPED AND IMPLEMENTED NATIONALLY

– Determine system level implications of national echocardiographic screening programme, to inform the development of national case-detection programme

– Follow-up and evaluation of the people already screened via echo ultrasound in Fiji with a focus on clinical outcomes and experiences

– Determine efficacy of school-based, nurse-led echo screening

– Workforce development and training (competency development and maintenance) for sonographers, doctors, and nurses and other health professionals in the use of echo

– Implementation of a national case detection programme

 

OUTPUT 4: PRIMARY PREVENTION GUIDELINES DEVELOPED AND IMPLEMENTED INCLUDING HEALTH PROMOTION

– Development and implementation of primary prevention guidelines for health care professionals – Baseline evaluation of public awareness of ARF/RHD

– Development and implementation of a health promotion strategy.