The multimillion-dollar fight against rheumatic fever is being undermined by children not taking their medicine.
The Ministry of Health is now looking for bright ideas on encouraging families to stick to the antibiotics treatment.
Tens of millions of dollars are being spent on picking up sore throats - one of the first causes of rheumatic fever - in deprived communities. However, ministry documents show concerns about the prevention campaign being undermined, with one study showing fewer than one in three children who were prescribed antibiotics for rheumatic fever had taken them all.
"Antibiotics adherence is an issue," the documents say.
New Zealand has a high rate of rheumatic fever for a developed country. The disease is linked to poverty, overcrowding, and is disproportionately prevalent among young Maori and Pacific Islanders. It causes swelling, aching joints, and can lead to potentially fatal heart damage.
The Government wants to cut rheumatic fever rates by two-thirds by June 2017 but so far, despite tens of millions being spent on throat swabbing in schools and at GP clinics, the rates have not dropped.
Porirua GP Bryan Betty said children not finishing their antibiotics courses was one of the difficulties in treating the disease.
There was also some inconsistency in GPs' handling of sore throats, with some not prescribing treatment for long enough.
"Taking the antibiotics for the full 10 days is critical," Betty said. "If you stop one day short, then you are in trouble because the strep [sore throat] isn't eradicated."
The guidelines for treating a sore throat could also be confusing for families, because in less-deprived communities where rheumatic fever was not rampant, the advice was not to prescribe antibiotics at all. "But if you are a young Maori or Pacific Islander, the opposite is true."
Professor Diana Lennon, of Auckland University's paediatrics department, said it was difficult for anyone to stick to 10 days of daily treatment. "But when you've got 15 people in the house, the parents are working 16-hour days, and the 15-year-old sibling is left in charge, then it is even harder."
She said the prevention programme had lost focus, with money poured into community clinics run by GPs, at the expense of school-based swabbing.
Schools had regular contact with children, enabling them to follow up on treatment, whereas many at-risk families could not afford even to travel to see a GP. "I think the schools are heavily underfunded," Lennon said.
Dr Chrissie Pickin, who leads the ministry's rheumatic fever prevention programme, said getting anyone to take their medicine properly was often tricky.
"The general issue of antibiotic adherence is not unusual."
She said the ministry started a public education campaign this month to encourage families to make sure their children finished their courses for treating sore throats. Now the ministry was simply looking for fresh ideas to get the message across.
"Improving antibiotic adherence will improve the effectiveness of the rheumatic fever prevention," Pickin said.
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