title: Acute rheumatic fever and exposure to poor housing conditions in New Zealand: A descriptive study.
abstract: OBJECTIVE
  Acute rheumatic fever (ARF) is an important public health problem in low- and middle-income countries and in certain populations in high-income countries. Indigenous Australians, and New Zealand Māori and Pacific people, have incidence rates among the highest in the world. We aimed to investigate ARF cases' housing conditions and sore throat treatment to identify opportunities for improving ARF prevention in New Zealand.
  
  
  METHODS
  Recently diagnosed cases and their care givers were interviewed. Information was obtained about the cases' demographics, housing circumstances and conditions, and sore throat treatment preceding ARF.
  
  
  RESULTS
  We interviewed 55 cases. Most (75%) lived in rental housing and reported multiple measures of deprivation. Common exposures were household crowding (58%), bed-sharing (49%), dampness and mould (76%), cold (82%) and co-habiting with smokers (71%). Experiencing sore throat in the weeks before ARF was recalled by 62%, with 29% seeing a doctor or nurse and 13% of the total sample receiving antibiotics.
  
  
  CONCLUSIONS
  The environmental conditions reported could contribute to high group A Streptococcus transmission and susceptibility to infection, thus increasing ARF risk. Sore throat treatment has important limitations as an intervention, particularly as 38% of participants did not recall sore throat preceding the diagnosis. The results support the need to improve rental housing. Interventions promoting minimum enforceable standards in social housing and private rental sectors (such as a housing warrant of fitness) could support these changes. A rigorous investigation, such as a case control study, is needed to explore risk factors further.
authors.affiliation: University of Otago, and, New Zealand.
authors.forename: Jane R
authors.initials: JR
authors.lastname: Oliver
authors.affiliation: University of Otago, and, New Zealand.
authors.forename: Nevil
authors.initials: N
authors.lastname: Pierse
authors.affiliation: New Zealand Ministry of Health, Wellington, New Zealand.
authors.forename: Niki
authors.initials: N
authors.lastname: Stefanogiannis
authors.affiliation: Auckland Regional Public Health Service, Auckland, New Zealand.
authors.forename: Catherine
authors.initials: C
authors.lastname: Jackson
authors.affiliation: University of Otago, and, New Zealand.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Baker
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003710:Demography; D005260:Female; D006798:Housing; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009520:New Zealand / Q000453:epidemiology; D036301:Qualitative Research; D012213:Rheumatic Fever / Q000453:epidemiology*; D055815:Young Adult
keywords: cardiology; general paediatrics; infectious disease