title: Prophylactic penicillin by the full moon: a novel approach in Central Australia that may help to reduce the risk of rheumatic heart disease.
abstract: BACKGROUND
  Uptake of penicillin prophylaxis to prevent recurrent rheumatic fever and its sequela rheumatic heart disease (RHD) is not optimal in the Northern Territory of Australia. The Full Moon Strategy (the Strategy) was introduced in the Central Australian region in June 2006 to improve the uptake of prophylactic penicillin: clients and healthcare workers were encouraged to use the full moon as a cue for the timing of the 4 weekly prophylactic penicillin injection.
  
  
  OBJECTIVE
  To determine the impact and effectiveness of the Strategy on knowledge and uptake of benzathine penicillin prophylaxis for clients at risk of RHD, and for primary healthcare workers in Central Australia.
  
  
  METHODS
  Clients at risk of RHD in four remote Aboriginal communities and the town camps of Alice Springs were identified from the RHD database. Consenting clients or their carers were interviewed about their knowledge of the Strategy and the health promotional tools used. Their healthcare records were then reviewed for prophylaxis uptake 2 years prior to and 2 years following the introduction of the Strategy. Primary healthcare workers in the four remote communities who were available at the time of the study visit were interviewed about their knowledge and use of the Strategy and the health promotional tools.
  
  
  RESULTS
  Fifty RHD clients and 19 healthcare workers were interviewed. Most were aware of the flipchart but less than half knew of the calendar poster, hand-held card or radio advertisement. Prophylaxis uptake increased significantly from 47% in the 2 years prior to the introduction of the Strategy, to 57% 2 years after the Strategy was introduced.
  
  
  CONCLUSIONS
  Introduction of the Strategy coincided with an improvement in uptake of prophylaxis but not around the time of the full moon. Uptake of benzathine penicillin remains inadequate and further innovative measures are needed to control rheumatic fever and its sequela in Aboriginal and Torres Strait Islander people.
authors.affiliation: Menzies School of Health Research, Darwin, Northern Territory, Australia. therese.kearns@menzies.edu.au
authors.forename: T M
authors.initials: TM
authors.lastname: Kearns
authors.forename: R
authors.initials: R
authors.lastname: Schultz
authors.forename: V
authors.initials: V
authors.lastname: McDonald
authors.forename: R M
authors.initials: RM
authors.lastname: Andrews
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D017723:Drug Utilization Review; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence / Q000706:statistics & numerical data; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000458:organization & administration; D006801:Humans; D008297:Male; D008875:Middle Aged; D015876:Northern Territory; D010401:Penicillin G Benzathine / Q000627:therapeutic use*; D012213:Rheumatic Fever / Q000453:epidemiology / Q000517:prevention & control*; D012307:Risk Factors; D019035:Rural Health Services / Q000458:organization & administration*; D055815:Young Adult; D000095283:Australian Aboriginal and Torres Strait Islander Peoples
chemical_list: D000900:Anti-Bacterial Agents; D010401:Penicillin G Benzathine