24 January 2023

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'.

Photo of Professor Anna Ralph standing in front of plants
Professor Anna Ralph

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


Menzies School of Health Research


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



Translating Research into Practice (TRIP) Fellowship


Featured image Credit
Photo supplied by: Menzies School of Health Research