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Community control of acute post-streptococcal glomerulonephritis

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Community control of acute post-streptococcal glomerulonephritis

by Ashbridge D

Thesis
Year 1992
City Sydney, New South Wales
University University of New South Wales
Thesis type Master of Public Health

Australian Indigenous HealthInfoNet abstract

In the developed world acute post streptococcal glomerulonephritis (APSGN) is a condition which occurs sporadically and which has a benign outcome.

APSGN is both an endemic and epidemic condition in many tropical regions today, and there is dispute as to whether APSGN is a benign condition. The tropical areas were APSGN is a major public health problem are characterised by poor living conditions.

The microbiology, immunology and epidemiology of APSGN in the tropics have been well described, but there is little known about the prevention of APSGN.

This dissertation will describe and evaluate an intervention (Bicillin injection) given to the children in an Aboriginal community in the Northern Territory to avert an epidemic of APSGN.

Epidemics of APGSN are well documented in Aboriginal communities in the Northern Territory. In June 1991 there were two cases of APSGN within three days admitted to Royal Darwin Hospital from this community and this was the trigger to implement a disease control procedure. However no protocol was available locally and the world literature provided only empirical suggestions for epidemic control.

The results support previous studies in highlighting the importance of streptococcal skin lesions as precursors to APSGN in the tropics. Approximately seventy percent of the children grew a group A beta-haemolytic streptococcus (GABHS) from skin lesions. Following a single does of Bicillin there was marked clinical improvement of the skin, repeat swabs had low growth rates, and there were no further cases of APSGN in the community. The implication was that a nephritogenic streptococcus had been eradicated from the community and that by early intervention it may be possible to control APSGN.

The medium term evaluation of the intervention revealed a reversion to the level of skin infection present at the time of the epidemic. Public health measures appear to offer the best hope to control APSGN.

The objective of such measures is to reduce the acute morbidity of APSGN and, in the long term, end stage renal failure in these communities.

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