A cute rheumatic fever (ARF) and its sequelae are now rare in wealthy industrialised nations.1 Yet, ARF and rheumatic heart disease (RHD) remain important causes of mortality and chronic ill health in poor countries and minority Indigenous populations, such as Aboriginal Australians. 2,3 In the Top End of the Northern Territory, 2.7% of Aboriginal people have an episode of ARF in their lifetime, compared with 0.014% of the non-Aboriginal population. 4 Primary prophylaxis of ARF, the provision of antibiotics to treat streptococcal pharyngitis, is largely unworkable and unsustainable in high-incidence populations, especially where health services are underresourced. 5 Besides, many cases of ARF do not follow clinically identified pharyngitis. Register-based secondary prevention programs can be effective at limiting recurrent ARF and progression to RHD, 7,8 but require early and correct diagnosis of ARF/RHD, followed by long-term administration of an antibiotic (usually benzathine penicillin) on a regular basis. The establishment of a register of patients with known past ARF and/or RHD is the central requirement of a secondary prevention program.9,10 Evaluation of service delivery is regarded as an important part of program design.
11,12A register-based RHD secondary prevention program was established in the Top End of the Northern Territory (NT) in 1997.13 New and recurrent cases of ARF are notif iable in the NT. Clinicians are encouraged to inform the register of all new cases of ARF and newly diagnosed RHD, including 'probable' cases where the diagnosis has not been proven but there is a high index of suspicion. Sources of data for the register include notifications, hospital discharge records, community clinic records, echocardiogram reports and professional correspondence. The register keeps details
Objective: To investigate the effectiveness of the Northern Territory Women's Cancer Prevention Program in improving cervical screening participation for Indigenous women.
Design: Descriptive longitudinal period prevalence study.
Participants: All NT resident women aged 20–69 years who had at least one Pap smear recorded on the NT Pap Smear Register between 1997 and 2004.
Main outcome measures: Indirectly estimated percentage of NT Indigenous women in rural and remote areas with a predominantly Indigenous population (accounting for 55% of the NT Indigenous population) who participated in screening, in biennial periods between 1997 and 2004. Participation by all eligible NT women (both Indigenous and non‐Indigenous) is also reported by region for the same period.
Results: In 1997–1998, estimated participation for Indigenous women was about half the national rate (33.9% [95% CI, 32.6%–35.2%] v 63.9% [95% CI, 63.8%–63.9%]). Participation increased to 44.0% (95% CI, 42.7%–45.4%) in 1999–2000, and changed little thereafter; participation was higher in the Top End compared with Central Australia, and varied from 16.6% to 75.0% between remote areas. Participation rates for all women living in rural/remote regions were lower than those in urban regions.
Conclusions: Recruitment of Indigenous women for cervical screening has improved since 1999. This may have partly contributed to the fall in their cervical cancer incidence and mortality in recent years. Although in most areas Indigenous participation is lower than national levels, in one area it was considerably higher. Improvements can be achieved by learning from these communities, to further close the gap in morbidity and mortality between Indigenous and non‐Indigenous women.
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