Aim: To describe the pattern of disease and other health problems in children living in remote Far North Queensland (FNQ). Design, setting and participants: Retrospective review of the FNQ Paediatric Outreach Service's Medical Director database for the period June 2001 to February 2006. Three subpopulations were compared: children from predominantly Aboriginal communities, predominantly Torres Strait Islander communities, and other communities. All children referred to the service during the study period were reviewed. Main outcome measures: Number of children seen and common diagnoses. Results: 3562 children were referred during the study period, and a total of 3932 diagnoses were made; 56% of the paediatric population of the Aboriginal communities and 23% of the paediatric population of Torres Strait Islander communities were seen. Of 40 separate diseases/health problems reviewed, the three most common reasons for presentation were chronic suppurative otitis media, suspected child abuse and neglect, and failure to thrive. In the paediatric population of Aboriginal communities, the prevalence of fetal alcohol spectrum disorder was at least 15/1000 (1.5%), and in Torres Strait Islander children, rheumatic heart disease prevalence was at least 6/1000 (0.6%). Rheumatic fever rates were among the highest in Australia. Conclusion: Rates of preventable complex and chronic health problems in Aboriginal and Torres Strait Islander children in remote FNQ are alarmingly high. Areas requiring urgent public health intervention include alcohol‐related conditions and rheumatic fever.

Objective: To describe the epidemiology and features of acute rheumatic fever (ARF) in Indigenous people in north Queensland from mid‐1999 to mid‐2004. Methods: Enhanced surveillance, including regular reminder letters to relevant clinicians and computer searches of hospital discharge diagnoses, was implemented to capture cases of ARR Results: Over the five years, 144 episodes of ARF occurred in 133 Indigenous people in seven of the Health Service Districts in north Queensland. The annual incidences of ARF were 61 cases/100,000 Indigenous people in these seven districts, and 54/100,000 throughout north Queensland. The median age of the cases was 12.0 years, and 76% of the cases occurred in children <15 years. More than one‐third of the definite cases were recurrences of ARF, and carditis was present in 42% of all cases. Conclusions: Within north Queensland, the incidences of ARF were greatest in the Cape York and the Torres Strait and Northern Peninsula Area Districts. However, the incidence of ARF in north Queensland is considerably lower than that reported from the Top End of the Northern Territory (NT). Furthermore, there appears to be less chorea and less monoarthritis, but more group A streptococci isolated from throat swabs, in ARF cases in north Queensland compared with those from the Top End of the NT. Implications: There is a need for greater awareness of ARF and its complications among both ARF patients and primary health care workers in the region, and for more reliable mechanisms for recalling patients for their prophylaxis and clinical reviews.

There is the potential to identify prospectively women presenting for antenatal care who are heavy drinkers and risk FAS in their infants, using the self-reported information about alcohol intake already being collected by our service; such women may then be offered specific interventions to try to reduce alcohol consumption in pregnancy.