Professor Anna Ralph is a practicing medical specialist and leads the Global and Tropical Health division at Menzies School of Health Research in Darwin.
'I am motivated by a desire for better equity in health, by unsolved questions and by inspirational mentors. I wanted to work in Indigenous health since I was a teenager,' said Professor Ralph.
This story is part of our 10 of the Best - thirteenth edition. 10 of the Best is an annual NHMRC publication, showcasing 10 NHMRC-funded health and medical research projects. See more 10 of the Best.
Acute rheumatic fever (ARF) is an autoimmune response to streptococcal infection, which can cause permanent heart damage called rheumatic heart disease (RHD). It is a serious preventable disease, causing premature illness and death. However, high rates continue to occur in Australian Indigenous communities. Prevention can be achieved with regular penicillin injections, but there are many barriers to accessing treatment, and those needing the injections frequently miss doses.
If no further action is taken to address RHD, over 10,000 Aboriginal and Torres Strait Islander people are likely to develop RHD or ARF by 2031. Of these, about 1,300 will need heart surgery and over 500 will die. The total cost to the community for the associated medical care could exceed $300 million. Professor Ralph
If ARF can be detected earlier, 'secondary prevention' treatment can be appropriately commenced, and RHD can be avoided, or at least mitigated. RHD shares its origins with many other transmissible diseases of disadvantage. Thus, steps to reduce RHD rates will not only reduce suffering and healthcare costs but will also have wider ramifications in general disease treatment.
Supported by an NHMRC Translating Research into Practice (TRIP) Fellowship, my research program has helped to close the evidence-practice gap by forming partnerships to effectively roll out rheumatic fever prevention strategies in clinics across the Northern Territory.
Findings from an RHD trial I co-led have been incorporated into the draft "Endgame Strategy" for RHD elimination, and new diagnostic categories for ARF that I have developed are now being appropriately applied, contributing to improved detection of ARF and earlier commencement of protective treatment. Professor Ralph
The ARF Diagnosis App developed by Professor Ralph and her team has been shown to help clinicians who are often unfamiliar with ARF. Moreover, the National ARF and RHD Clinical Practice Guidelines that she co-edited have been downloaded more than 25,000 times and provide a definitive resource to support clinicians managing this condition. 'Collectively, this work brings us closer to being able to recognise ARF better, get people onto treatment sooner, and protect children and young adults from the development of permanent heart disease'.
Next steps
Professor Ralph sees research as a great privilege in building networks and collaborations, understanding community priorities, learning what community-driven research really means and learning from Aboriginal communities about how they want projects to be implemented.
Professor Ralph wants to see a paradigm shift within our health systems in order to provide the care that Aboriginal people require and believes this needs to come from health systems research with First Nations leadership.
Chief Investigator (CIA)
Professor Anna Ralph
Institution
Menzies School of Health Research
Title
Translating rheumatic fever prevention strategies into practice in Australia's high burden settings
Team members
Ms Vicki Wade
Ms Vicki Kerrigan
Dr Joshua Francis
Dr Marita Hefler
Dr Tina Noutsos
Professor Bart Currie
Professor Alan Cass
Professor Jonathan Carapetis
Dr James Marangou
Dr Bianca Middleton
Dr Trisasi Lestari
Dr Chris Lowbridge
Dr Teresa Wozniak
Grant information
$178,158
2016-2017
Translating Research into Practice (TRIP) Fellowship