Health authorities in NSW must do more to protect Aboriginal children in remote communities from "diseases of poverty", a coroner has warned.
Kia Shillingsworth was four when she was rushed to Brewarrina Hospital in the NSW far northwest on October 29, 2012.
Kia had been active that morning but by the afternoon was coughing, wheezing, lethargic and running a temperature.
By 9pm, Kia was coughing blood and specialist crews were rushed to her hospital bedside by midnight.
She was pronounced dead around 2am.
Kia's official cause of death was recorded as undiagnosed acute rheumatic heart fever.
The disease is 25 times more common among indigenous Australians.
"Like too many others in remote Aboriginal communities Kia died of a disease of poverty at an early age," deputy state coroner Hugh Dillon said on Monday.
"How this occurred in contemporary Australia has been the underlying problem this inquiry has explored."
Kia had been treated for a string of skin and throat infections in the months before her death.
Mr Dillon said there was evidence to suggest these infections may cause - or at least contribute to causing - the disease which took Kia's life.
He said better medical treatment on the night Kia died may have made a difference but wouldn't have definitely increased her chance of survival.
The coroner said by that point, Kia was almost certainly past the point of no return.
"Her life, although tragically ended now, has not been wasted," he said.
"Encouraging people to seek early treatment for these relatively minor ailments and adhere to courses of antibiotics they're prescribed may also assist in the prevention of rheumatic disease."
Mr Dillon recommended a treatment manual be adopted in remote hospitals, especially those in areas with large Aboriginal communities.
He also recommended all locals and new staff be given information about specific health and social issues facing indigenous communities.
