The role of social determinants of health in the risk and prevention of group A streptococcal infection, acute rheumatic fever and rheumatic heart disease: A systematic review

Abstract

BackgroundRheumatic heart disease (RHD) poses a major disease burden among disadvantaged populations globally. It results from acute rheumatic fever (ARF), a complication of Group A Streptococcal (GAS) infection. These conditions are acknowledged as diseases of poverty, however the role of specific social and environmental factors in GAS infection and progression to ARF/RHD is not well understood. The aim of this systematic review was to determine the association between social determinants of health and GAS infection, ARF and RHD, and the effect of interventions targeting these.MethodologyWe conducted a systematic literature review using PubMed, the Cochrane Library and Embase. Observational and experimental studies that measured: crowding, dwelling characteristics, education, employment, income, nutrition, or socioeconomic status and the relationship with GAS infection, ARF or RHD were included. Findings for each factor were assessed against the Bradford Hill criteria for evidence of causation. Study quality was assessed using a standardised tool.Principle findings1,164 publications were identified. 90 met inclusion criteria, comprising 91 individual studies. 49 (50.5%) were poor quality in relation to the specific study question. The proportion of studies reporting significant associations between socioeconomic determinants and risk of GAS infection was 57.1%, and with ARF/RHD was 50%. Crowding was the most assessed factor (14 studies with GAS infection, 36 studies with ARF/RHD) followed by socioeconomic status (6 and 36 respectively). The majority of studies assessing crowding, dwelling characteristics, education and employment status of parents or cases, and nutrition, reported a positive association with risk of GAS infection, ARF or RHD. Crowding and socioeconomic status satisfactorily met the criteria of a causal association. There was substantial heterogeneity across all key study aspects.ConclusionThe extensive literature examining the role of social determinants in GAS infection, ARF and RHD risk lacks quality. Most were observational, not interventional. Crowding as a cause of GAS infection and ARF/RHD presents a practical target for prevention actions.

Alterations in the Nervous System and Gut Microbiota after β-Hemolytic Streptococcus Group A Infection—Characteristics and Diagnostic Criteria of PANDAS Recognition

“…Rheumatic fever is an acute autoimmune disease constituting a relatively late complication of GAS infection [12,13]. The Jones criteria for rheumatic fever include major criteria (carditis, arthritis, chorea, erythema marginatum, subcutaneous nodules) and minor criteria (polyarthralgia, fever, prolonged PR interval, erythrocyte sedimentation rate (ESR) ≥60 mm, C-reactive protein (CRP) ≥3.0 mg/dL) [14].…”

Skin infections in Australian Aboriginal children: a narrative review

“…Addressing the social determinants of health is ultimately needed for skin infections in Aboriginal children to reduce to parity with their non-Aboriginal peers. 75 Interventional research highlights that in high burden settings, individual treatment strategies without community-level impacts are ineffective in reducing disease burden. 29,63 This is due in part to extensive community-level transmission of impetigo, which sustains a high environmental load of microbial pathogens.…”

How do we improve health care? The example of missed opportunities to address chronic wet cough in children in remote Australia

“…It is considered a disease of poverty, being related to factors such as undernutrition, crowded housing and housing quality, education, income and employment and access to health care. Rheumatic heart disease, highly prevalent in this same population, is similarly socially determined …”

“…Rheumatic heart disease, highly prevalent in this same population, is similarly socially determined. 1 A recent study by Laird et al published in Respirology recognizes a need to explain why PBB may be underrecognized and under-treated. 2 In remote Western Australia, it seeks to find the barriers to and enablers of good care from the health provider and system perspectives in an ambulatory Aboriginal Medical Service and regional hospital.…”