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Ricciardo BM, Kessaris HL, Nannup N, Tilbrook D, Farrant B, Michie C, Hansen L, Douglas R, Walton J, Poore A, Whelan A, Barnett TC, Kumarasinghe PS, Carapetis JR, Bowen AC. Describing skin health and disease in urban-living Aboriginal children: co-design, development and feasibility testing of the Koolungar Moorditj Healthy Skin pilot project. Pilot Feasibility Stud 2024; 10:6. [PMID: 38200545 PMCID: PMC10782716 DOI: 10.1186/s40814-023-01428-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Indigenous children in colonised nations experience high rates of health disparities linked to historical trauma resulting from displacement and dispossession, as well as ongoing systemic racism. Skin infections and their complications are one such health inequity, with the highest global burden described in remote-living Australian Aboriginal and/or Torres Strait Islander (hereafter respectfully referred to as Aboriginal) children. Yet despite increasing urbanisation, little is known about the skin infection burden for urban-living Aboriginal children. More knowledge is needed to inform service provision, treatment guidelines and community-wide healthy skin strategies. In this pilot study, we aimed to test the feasibility and design of larger multi-site observational studies, provide initial descriptions of skin disease frequency and generate preliminary hypotheses of association. METHODS This project has been co-designed with local (Noongar) Elders to provide an Australian-first description of skin health and disease in urban-living Aboriginal children. In collaboration with an urban Aboriginal Community Controlled Health Organisation (Derbarl Yerrigan Health Service), we conducted a week-long cross-sectional observational cohort study of Aboriginal children (0-18 years) recruited from the waiting room. Participants completed a questionnaire, skin examination, clinical photos, and swabs and received appropriate treatment. We assessed the feasibility and impact of the pilot study. RESULTS From 4 to 8 October 2021, we recruited 84 Aboriginal children of whom 80 (95%) were urban-living. With a trusted Aboriginal Health Practitioner leading recruitment, most parents (or caregivers) who were approached consented to participate. Among urban-living children, over half (45/80, 56%) of parents described a current concern with their child's skin, hair and/or nails; and one-third (26/80, 33%) reported current itchy skin. Using a research-service model, 27% (21/79) of examined urban-living participants received opportunistic same-day treatment and 18% (14/79) were referred for later review. CONCLUSIONS This co-designed pilot study to understand skin health in urban-living Aboriginal children was feasible and acceptable, with high study participation and subsequent engagement in clinical care observed. Co-design and the strong involvement of Aboriginal people to lead and deliver the project was crucial. The successful pilot has informed larger, multi-site observational studies to more accurately answer questions of disease burden and inform the development of healthy skin messages for urban-living Aboriginal children.
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Affiliation(s)
- Bernadette M Ricciardo
- University of Western Australia, Crawley, WA, Australia.
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, WA, Australia.
- Fiona Stanley Hospital, Murdoch, WA, Australia.
- Perth Children's Hospital, Nedlands, WA, Australia.
| | - Heather-Lynn Kessaris
- Fiona Stanley Hospital, Murdoch, WA, Australia
- Perth Children's Hospital, Nedlands, WA, Australia
- Telethon Kids Institute, Nedlands, WA, Australia
| | - Noel Nannup
- Telethon Kids Institute, Nedlands, WA, Australia
| | - Dale Tilbrook
- Telethon Kids Institute, Nedlands, WA, Australia
- Maalingup Aboriginal Gallery, Caversham, WA, Australia
| | - Brad Farrant
- University of Western Australia, Crawley, WA, Australia
- Telethon Kids Institute, Nedlands, WA, Australia
| | - Carol Michie
- Telethon Kids Institute, Nedlands, WA, Australia
| | - Lorraine Hansen
- Derbarl Yerrigan Health Services Aboriginal Corporation, East Perth, WA, Australia
| | - Richelle Douglas
- Derbarl Yerrigan Health Services Aboriginal Corporation, East Perth, WA, Australia
| | - Jacinta Walton
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, WA, Australia
- Telethon Kids Institute, Nedlands, WA, Australia
| | - Ainslie Poore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, WA, Australia
- Telethon Kids Institute, Nedlands, WA, Australia
| | - Alexandra Whelan
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, WA, Australia
- Telethon Kids Institute, Nedlands, WA, Australia
| | - Timothy C Barnett
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, WA, Australia
- Marshall Centre for Infectious Diseases Research and Training, School of Biomedical Sciences, University of Western Australia, Nedlands, WA, Australia
| | | | - Jonathan R Carapetis
- University of Western Australia, Crawley, WA, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, WA, Australia
- Perth Children's Hospital, Nedlands, WA, Australia
- Telethon Kids Institute, Nedlands, WA, Australia
| | - Asha C Bowen
- University of Western Australia, Crawley, WA, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, WA, Australia
- Perth Children's Hospital, Nedlands, WA, Australia
- Telethon Kids Institute, Nedlands, WA, Australia
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McRae T, Walker R, Enkel S, Thomas HMM, Jacky J, Sibosado S, Mullane M, Maginnis N, Coffin J, Carapetis JR, Bowen AC. HipHop2SToP a community-led health promotion initiative empowering Aboriginal youth in the Kimberley region of Western Australia: a process evaluation. Front Public Health 2023; 11:1258517. [PMID: 38145075 PMCID: PMC10740280 DOI: 10.3389/fpubh.2023.1258517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/08/2023] [Indexed: 12/26/2023] Open
Abstract
Introduction For millennia, Aboriginal people's ways of knowing, doing and being were shared through art, song, and dance. Colonisation silenced these ways, affecting loss of self-determination for Aboriginal people. Over the past decade in Australia, hip-hop projects have become culturally appropriate approaches for health promotion. When community led, and Aboriginal worldviews centralised, hip-hop workshops are more likely to be effective. In 2020, during the COVID-19 pandemic, a community-led health promotion hip-hop music video, 'HipHop2SToP' was produced involving young people in Dampier Peninsula communities address healthy skin and healthy living practices. Methods We report here a qualitative process evaluation of the HipHop2SToP project. Participants who had been involved in the planning and production of HipHop2SToP were selected using a purposive approach and invited either by email or face-to-face to participate in semi-structured interviews and share their experiences. Semi-structured interviews ranged from 30 to 60 min in duration and were conducted either face-to-face or virtually over MS Teams. Due to personal time constraints, two participants provided written responses to the semi-structured questions. All interviews were audio-recorded with consent and saved as a digital recording in a de-identified format. All audio recordings were transcribed verbatim and uploaded into QSR NVivo v12 along with written responses. Results As a health promotion project, the critical success factors were community-ownership and discovering novel ways to collaborate virtually with remote communities using Microsoft (MS) software. Highlights included observing the young people actively engaged in the project and their catchy lyrics and key messaging for environmental health and skin infections. COVID-19 presented some challenges. Gaps in communication, clarification of stakeholder roles and expectations, and post-production outcomes were also identified as challenges. Conclusion HipHop2SToP validates the need for Aboriginal community led health promotion programs. While creating some challenges COVID-19 also strengthened community ownership and created novel ways of maintaining relationships with remote Aboriginal communities. Future hip-hop projects would benefit from clarity of roles and responsibilities. Strengthening post-production outcomes by including a launch and well-planned, targeted communication and dissemination strategy will ensure the wider translation of important health messages and potential strengthen sustainability.
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Affiliation(s)
- Tracy McRae
- School of Medicine, University of Western Australia, Perth, WA, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, WA, Australia
| | - Roz Walker
- Ngangk Yira Institute For Change, Murdoch University, Perth, WA, Australia
- School of Indigenous Studies, Poche Centre for Indigenous Health Research, University of Western Australia, Perth, WA, Australia
- School of Population and Global Health, University of Western Australia, Perth, WA, Australia
| | - Stephanie Enkel
- School of Medicine, University of Western Australia, Perth, WA, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, WA, Australia
| | - Hannah M. M. Thomas
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, WA, Australia
| | - John Jacky
- Telethon Kids Institute, Nedlands, WA, Australia
| | | | - Marianne Mullane
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, WA, Australia
| | | | - Juli Coffin
- Ngangk Yira Institute For Change, Murdoch University, Perth, WA, Australia
| | - Jonathan R. Carapetis
- School of Medicine, University of Western Australia, Perth, WA, Australia
- Telethon Kids Institute, Nedlands, WA, Australia
- Department of Infectious Diseases, Perth Children’s Hospital, Nedlands, WA, Australia
| | - Asha C. Bowen
- School of Medicine, University of Western Australia, Perth, WA, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, WA, Australia
- Department of Infectious Diseases, Perth Children’s Hospital, Nedlands, WA, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
- University of Notre Dame, Fremantle, WA, Australia
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3
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Wiegele S, McKinnon E, van Schaijik B, Enkel S, Noonan K, Bowen AC, Wyber R. The epidemiology of superficial Streptococcal A (impetigo and pharyngitis) infections in Australia: A systematic review. PLoS One 2023; 18:e0288016. [PMID: 38033025 PMCID: PMC10688633 DOI: 10.1371/journal.pone.0288016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 06/09/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Streptoccocal A (Strep A, GAS) infections in Australia are responsible for significant morbidity and mortality through both invasive (iGAS) and post-streptococcal (postGAS) diseases as well as preceding superficial (sGAS) skin and throat infection. The burden of iGAS and postGAS are addressed in some jurisdictions by mandatory notification systems; in contrast, the burden of preceding sGAS has no reporting structure, and is less well defined. This review provides valuable, contemporaneous evidence on the epidemiology of sGAS presentations in Australia, informing preventative health projects such as a Streptococcal A vaccine and standardisation of primary care notification. METHODS AND FINDINGS MEDLINE, Scopus, EMBASE, Web of Science, Global Health, Cochrane, CINAHL databases and the grey literature were searched for studies from an Australian setting relating to the epidemiology of sGAS infections between 1970 and 2020 inclusive. Extracted data were pooled for relevant population and subgroup analysis. From 5157 titles in the databases combined with 186 grey literature reports and following removal of duplicates, 4889 articles underwent preliminary title screening. The abstract of 519 articles were reviewed with 162 articles identified for full text review, and 38 articles identified for inclusion. The majority of data was collected for impetigo in Aboriginal and Torres Strait Islander populations, remote communities, and in the Northern Territory, Australia. A paucity of data was noted for Aboriginal and Torres Strait Islander people living in urban centres or with pharyngitis. Prevalence estimates have not significantly changed over time. Community estimates of impetigo point prevalence ranged from 5.5-66.1%, with a pooled prevalence of 27.9% [95% CI: 20.0-36.5%]. All studies excepting one included >80% Aboriginal and Torres Strait Islander people and all excepting two were in remote or very remote settings. Observed prevalence of impetigo as diagnosed in healthcare encounters was lower, with a pooled estimate of 10.6% [95% CI: 3.1-21.8%], and a range of 0.1-50.0%. Community prevalence estimates for pharyngitis ranged from 0.2-39.4%, with a pooled estimate of 12.5% [95% CI: 3.5-25.9%], higher than the prevalence of pharyngitis in healthcare encounters; ranging from 1.0-5.0%, and a pooled estimate of 2.0% [95% CI: 1.3-2.8%]. The review was limited by heterogeneity in study design and lack of comparator studies for some populations. CONCLUSIONS Superficial Streptococcal A infections contribute to an inequitable burden of disease in Australia and persists despite public health interventions. The burden in community studies is generally higher than in health-services settings, suggesting under-recognition, possible normalisation and missed opportunities for treatment to prevent postGAS. The available, reported epidemiology is heterogeneous. Standardised nation-wide notification for sGAS disease surveillance must be considered in combination with the development of a Communicable Diseases Network of Australia (CDNA) Series of National Guideline (SoNG), to accurately define and address disease burden across populations in Australia. TRIAL REGISTRATION This review is registered with PROSPERO. Registration number: CRD42019140440.
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Affiliation(s)
- Sophie Wiegele
- Perth Children’s Hospital, Nedlands, Western Australia, Australia
- Telethon Kids Institute, Nedlands, Western Australia, Australia
| | | | - Bede van Schaijik
- University of Western Australia, Perth, Western Australia, Australia
| | - Stephanie Enkel
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- University of Western Australia, Perth, Western Australia, Australia
| | | | - Asha C. Bowen
- Perth Children’s Hospital, Nedlands, Western Australia, Australia
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- University of Western Australia, Perth, Western Australia, Australia
| | - Rosemary Wyber
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- University of Western Australia, Perth, Western Australia, Australia
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia
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4
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McRae T, Leaversuch F, Sibosado S, Coffin J, Carapetis JR, Walker R, Bowen AC. Culturally supported health promotion to See, Treat, Prevent (SToP) skin infections in Aboriginal children living in the Kimberley region of Western Australia: a qualitative analysis. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 35:100757. [PMID: 37424680 PMCID: PMC10326714 DOI: 10.1016/j.lanwpc.2023.100757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 07/11/2023]
Abstract
Background While there are many skin infections, reducing the burden of scabies and impetigo for remote living Aboriginal people, particularly children remains challenging. Aboriginal children living in remote communities have experienced the highest reported rate of impetigo in the world and are 15 times more likely to be admitted to hospital with a skin infection compared to non-Aboriginal children. Untreated impetigo can develop into serious disease and may contribute to the development of acute rheumatic fever (ARF) and rheumatic heart disease (RHD). As the largest organ protecting the body and visible to everyone, skin infections are often unsightly and very painful, therefore maintaining healthy skin and reducing the burden of skin infections is important for overall physical and cultural health and well-being. Biomedical treatments alone will not address these factors; therefore, a holistic, strengths-based approach that aligns with the Aboriginal world view of wellness is required to help reduce the prevalence of skin infections and their downstream consequences. Methods Culturally appropriate yarning sessions with community members were conducted between May 2019 and November 2020. Yarning sessions have been identified as a valid method for story sharing and collecting information. Semi-structured, face-to-face interviews and focus groups with school and clinic staff were conducted. When consent was provided, interviews were audio-recorded and saved as a digital recording in a de-identified format; for those yarning sessions not recorded, handwritten notes were scribed. Audio recordings and handwritten notes were uploaded into NVivo software prior to a thematic analysis being conducted. Findings Overall, there was a strong knowledge of recognition, treatment, and prevention of skin infections. However, this did not extend to the role skin infections play in causing ARF, RHD or kidney failure. Our study has confirmed three main findings: 1. The biomedical model of treatment of skin infections remained strong in interviews with staff living in the communities; 2. Community members have a reliance and belief in traditional remedies for skin infections; and 3. Ongoing education for skin infections using culturally appropriate health promotion resources. Interpretation While this study revealed ongoing challenges with service practices and protocols associated with treating and preventing skin infections in a remote setting, it also provides unique insights requiring further investigation. Bush medicines are not currently practiced in a clinic setting, however, using traditional medicines alongside biomedical treatment procedures facilitates cultural security for Aboriginal people. Further investigation, and advocacy to establish these into practice, procedures and protocols is warranted. Establishing protocols and practice procedures focused on improving collaborations between service providers and community members in remote communities is also recommended. Funding Funding was received from the National Health and Medical Research Council [NHMRC] (GNT1128950), Health Outcomes in the Tropical NORTH [HOT NORTH 113932] (Indigenous Capacity Building Grant), and WA Health Department and Healthway grants contributed to this research. A.C.B. receives a NHMRC investigator Award (GNT1175509). T.M. receives a PhD scholarship from the Australian Centre for Elimination of Neglected Tropical Diseases (ACE-NTD), an NHMRC centre of excellence (APP1153727).
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Affiliation(s)
- Tracy McRae
- University of Western Australia, 35 Stirling Highway, Perth, Western Australia 6009, Australia
- Telethon Kids Institute, 15 Hospital Road, Nedlands, Western Australia 6009, Australia
| | | | - Slade Sibosado
- Telethon Kids Institute, 15 Hospital Road, Nedlands, Western Australia 6009, Australia
| | - Juli Coffin
- University of Western Australia, 35 Stirling Highway, Perth, Western Australia 6009, Australia
- Ngangk Yira Institute for Change, Murdoch University, 90 South St, Murdoch, Western Australia 6150, Australia
| | - Jonathan R. Carapetis
- University of Western Australia, 35 Stirling Highway, Perth, Western Australia 6009, Australia
- Telethon Kids Institute, 15 Hospital Road, Nedlands, Western Australia 6009, Australia
- Perth Children's Hospital, 15 Hospital Road, Nedlands, Western Australia, 6009, Australia
| | - Roz Walker
- Ngangk Yira Institute for Change, Murdoch University, 90 South St, Murdoch, Western Australia 6150, Australia
- School of Indigenous Studies, Poche Centre for Indigenous Health Research, University of Western Australia, 35 Stirling Highway, Perth, Australia
- School of Population and Global Health, University of Western Australia, 35 Stirling Highway, Perth, Australia
| | - Asha C. Bowen
- University of Western Australia, 35 Stirling Highway, Perth, Western Australia 6009, Australia
- Telethon Kids Institute, 15 Hospital Road, Nedlands, Western Australia 6009, Australia
- Perth Children's Hospital, 15 Hospital Road, Nedlands, Western Australia, 6009, Australia
- Menzies School of Health Research, Rocklands Drive, Tiwi, Northern Territory 0810, Australia
- University of Notre Dame, 32 Mouat St, Fremantle, Western Australia 6160, Australia
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5
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Ricciardo BM, Kessaris H, Kumarasinghe P, Carapetis JR, Bowen AC. The burden of atopic dermatitis and bacterial skin infections among urban-living Indigenous children and young people in high-income countries: A systematic review. Pediatr Dermatol 2023; 40:35-43. [PMID: 36349531 PMCID: PMC10946708 DOI: 10.1111/pde.15153] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/20/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND A high burden of bacterial skin infections (BSI) is well documented in remote-living Indigenous children and young people (CYP) in high-income countries (HIC). Atopic dermatitis (AD) is the most common chronic inflammatory skin condition seen in CYP and predisposes to BSI. Despite the rate of urbanization for Indigenous people increasing globally, research is lacking on the burden of AD and BSI for urban-living Indigenous CYP in HIC. Indigenous people in HIC share a history of colonization, displacement and subsequent ongoing negative impacts on health. OBJECTIVE To provide a global background on the burden of AD and BSI in urban-living Indigenous CYP in HIC. METHODS A systematic review of primary observational studies on AD and BSI in English containing epidemiologic data was performed. MEDLINE, EMBASE, EMCARE, Web of Science, and PubMed databases were searched for articles between January 1990 and December 2021. RESULTS From 2278 original manuscripts, 16 were included: seven manuscripts documenting eight studies on AD; and nine manuscripts documenting nine studies on BSI. Current and severe symptoms of AD were more common in urban-living Indigenous CYP in HIC compared with their non-Indigenous peers, with children having a higher prevalence than adolescents. Urban-living Indigenous CYP in HIC had a higher incidence of all measures of BSI compared with their non-Indigenous peers, and were over-represented for all measures of BSI compared with their proportion of the background population. Limitations include incomplete representation of all Indigenous populations in HIC. CONCLUSION A significant burden of AD and BSI exists in urban-living Indigenous CYP in HIC.
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Affiliation(s)
- Bernadette M. Ricciardo
- School of MedicineUniversity of Western AustraliaCrawleyAustralia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids InstituteNedlandsAustralia
- Department of DermatologyFiona Stanley HospitalMurdochAustralia
| | | | | | - Jonathan R. Carapetis
- School of MedicineUniversity of Western AustraliaCrawleyAustralia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids InstituteNedlandsAustralia
- Department of Infectious DiseasesPerth Children's HospitalNedlandsAustralia
| | - Asha C. Bowen
- School of MedicineUniversity of Western AustraliaCrawleyAustralia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids InstituteNedlandsAustralia
- Department of Infectious DiseasesPerth Children's HospitalNedlandsAustralia
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6
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Moore HC, Cannon JW, Kaslow DC, Lamagni T, Bowen AC, Miller KM, Cherian T, Carapetis J, Van Beneden C. A systematic framework for prioritising burden of disease data required for vaccine development and implementation: the case for group A streptococcal diseases. Clin Infect Dis 2022; 75:1245-1254. [PMID: 35438130 PMCID: PMC9525082 DOI: 10.1093/cid/ciac291] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/04/2022] [Indexed: 12/30/2022] Open
Abstract
Vaccine development and implementation decisions need to be guided by accurate and robust burden of disease data. We developed an innovative systematic framework outlining the properties of such data that are needed to advance vaccine development and evaluation, and prioritize research and surveillance activities. We focus on 4 objectives—advocacy, regulatory oversight and licensure, policy and post-licensure evaluation, and post-licensure financing—and identify key stakeholders and specific requirements for burden of disease data aligned with each objective. We apply this framework to group A Streptococcus, a pathogen with an underrecognized global burden, and give specific examples pertinent to 8 clinical endpoints. This dynamic framework can be adapted for any disease with a vaccine in development and can be updated as vaccine candidates progress through clinical trials. This framework will also help with research and innovation priority setting of the Immunization Agenda 2030 (IA2030) and accelerate development of future vaccines.
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Affiliation(s)
- Hannah C Moore
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Jeffrey W Cannon
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | | | - Asha C Bowen
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,Perth Children's Hospital, Perth, Western Australia, Australia
| | - Kate M Miller
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | | | - Jonathan Carapetis
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,Perth Children's Hospital, Perth, Western Australia, Australia
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7
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Cannon JW, Bowen AC. An update on the burden of group A streptococcal diseases in Australia and vaccine development. Med J Aust 2021; 215:27-28. [PMID: 34126654 PMCID: PMC8447201 DOI: 10.5694/mja2.51126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/17/2021] [Accepted: 05/17/2021] [Indexed: 12/24/2022]
Affiliation(s)
- Jeffrey W Cannon
- Wesfarmers Centre of Vaccines and Infectious DiseasesTelethon Kids InstitutePerthWA
- Harvard T. H. Chan School of Public HealthBostonMAUnited States of America
| | - Asha C Bowen
- Wesfarmers Centre of Vaccines and Infectious DiseasesTelethon Kids InstitutePerthWA
- Perth Children’s HospitalPerthWA
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8
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Salleo E, MacKay CI, Cannon J, King B, Bowen AC. Cellulitis in children: a retrospective single centre study from Australia. BMJ Paediatr Open 2021; 5:e001130. [PMID: 34337163 PMCID: PMC8287612 DOI: 10.1136/bmjpo-2021-001130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 06/27/2021] [Indexed: 11/25/2022] Open
Abstract
AIM To characterise the epidemiology, clinical features and treatment of paediatric cellulitis. METHODS A retrospective study of children presenting to a paediatric tertiary hospital in Western Australia, Australia in 2018. All inpatient records from 1 January to 31 December 2018 and emergency department presentations from 1 July to 31 December 2018 were screened for inclusion. RESULTS 302 episodes of cellulitis were included comprising 206 (68.2%) admitted children and 96 (31.8%) non-admitted children. The median age was 5 years (IQR 2-9), 40 (13.2%) were Aboriginal and 180 (59.6%) boys. The extremities were the most commonly affected body site among admitted and non-admitted patients. There was a greater proportion of facial cellulitis in admitted patients (27.2%) compared with non-admitted patients (5.2%, p<0.01). Wound swab was the most frequent microbiological investigation (133/302, 44.0%), yielding positive cultures in the majority of those tested (109/133, 82.0%). The most frequent organisms identified were Staphylococcus aureus (94/109, 86.2%) (methicillin-susceptible S. aureus (60/94, 63.8%), methicillin-resistant S. aureus) and Streptococcus pyogenes (22/109, 20.2%) with 14 identifying both S. aureus and S. pyogenes. Intravenous flucloxacillin was the preferred antibiotic (154/199, 77.4%), with median intravenous duration 2 days (IQR 2-3), oral 6 days (IQR 5-7) and total 8 days (IQR 7-10). CONCLUSIONS Cellulitis is a common reason for presentation to a tertiary paediatric hospital. We confirm a high prevalence of extremity cellulitis and demonstrate that children with facial cellulitis often require admission. Cellulitis disproportionately affected Aboriginal children and children below 5 years. Prevention of cellulitis involves early recognition and treatment of skin infections such as impetigo and scabies.
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Affiliation(s)
- Elise Salleo
- Medical School, The University of Western Australia Faculty of Health and Medical Sciences, Perth, Western Australia, Australia.,Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Conor I MacKay
- Medical School, The University of Western Australia Faculty of Health and Medical Sciences, Perth, Western Australia, Australia.,Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Jeffrey Cannon
- Medical School, The University of Western Australia Faculty of Health and Medical Sciences, Perth, Western Australia, Australia.,Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Barbara King
- Medical Services, Albany Health Campus, Albany, Western Australia, Australia
| | - Asha C Bowen
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia.,Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
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9
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Wyber R, Noonan K, Halkon C, Enkel S, Cannon J, Haynes E, Mitchell AG, Bessarab DC, Katzenellenbogen JM, Bond-Smith D, Seth R, D'Antoine H, Ralph AP, Bowen AC, Brown A, Carapetis JR. Ending rheumatic heart disease in Australia: the evidence for a new approach. Med J Aust 2020; 213 Suppl 10:S3-S31. [PMID: 33190287 DOI: 10.5694/mja2.50853] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
■The RHD Endgame Strategy: the blueprint to eliminate rheumatic heart disease in Australia by 2031 (the Endgame Strategy) is the blueprint to eliminate rheumatic heart disease (RHD) in Australia by 2031. Aboriginal and Torres Strait Islander people live with one of the highest per capita burdens of RHD in the world. ■The Endgame Strategy synthesises information compiled across the 5-year lifespan of the End Rheumatic Heart Disease Centre of Research Excellence (END RHD CRE). Data and results from priority research projects across several disciplines of research complemented literature reviews, systematic reviews and narrative reviews. Further, the experiences of those working in acute rheumatic fever (ARF) and RHD control and those living with RHD to provide the technical evidence for eliminating RHD in Australia were included. ■The lived experience of RHD is a critical factor in health outcomes. All future strategies to address ARF and RHD must prioritise Aboriginal and Torres Strait Islander people's knowledge, perspectives and experiences and develop co-designed approaches to RHD elimination. The environmental, economic, social and political context of RHD in Australia is inexorably linked to ending the disease. ■Statistical modelling undertaken in 2019 looked at the economic and health impacts of implementing an indicative strategy to eliminate RHD by 2031. Beginning in 2019, the strategy would include: reducing household crowding, improving hygiene infrastructure, strengthening primary health care and improving secondary prophylaxis. It was estimated that the strategy would prevent 663 deaths and save the health care system $188 million. ■The Endgame Strategy provides the evidence for a new approach to RHD elimination. It proposes an implementation framework of five priority action areas. These focus on strategies to prevent new cases of ARF and RHD early in the causal pathway from Streptococcus pyogenes exposure to ARF, and strategies that address the critical systems and structural changes needed to support a comprehensive RHD elimination strategy.
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Affiliation(s)
- Rosemary Wyber
- George Institute for Global Health, Sydney, NSW.,Telethon Kids Institute, Perth, WA
| | | | | | | | | | | | | | | | | | | | - Rebecca Seth
- Telethon Kids Institute, Perth, WA.,University of Western Australia, Perth, WA
| | | | | | - Asha C Bowen
- Telethon Kids Institute, Perth, WA.,Perth Children's Hospital, Perth, WA
| | - Alex Brown
- South Australian Health and Medical Research Institute, Adelaide, SA.,University of South Australia, Adelaide, SA
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10
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Haggett MG, Tait CP. Five years of dermatological disease requiring specialist care in the Kimberley region of Western Australia. Australas J Dermatol 2020; 62:157-161. [PMID: 33247840 DOI: 10.1111/ajd.13500] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 09/22/2020] [Accepted: 10/05/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Epidemiological studies that document the burden of skin diseases in rural and remote regions of Australia are vital in ensuring proper health-care planning and management. The purpose of this study was to establish the burden of skin disease requiring specialist dermatology input for both the Aboriginal and non-Aboriginal communities in the Kimberley. METHODS A retrospective audit of all outpatient encounters with the primary Country Health Service visiting dermatology specialist in the Kimberley region between January 2012 and January 2017. RESULTS A total of 2281 encounters were recorded with 1459 unique patients seen. The most common disease categories seen in the general population were premalignant and malignant skin disease (40%), eczema and dermatitis (17%) and benign skin neoplasms (12%). Among Aboriginal patients, the most common conditions were eczema and dermatitis (19%), autoimmune connective tissue disease/rheumatological and autoinflammatory syndromes (17%), adnexal diseases (10%), pigmentary disorders (7%) and benign skin neoplasms (7%). CONCLUSION These findings can be used to enhance, direct and plan dermatological services for both the Aboriginal and non-Aboriginal populations in the Kimberley region.
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Affiliation(s)
| | - Clare P Tait
- Dermatology Specialist Group, Perth, Western Australia, Australia
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11
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Davidson L, Knight J, Bowen AC. Skin infections in Australian Aboriginal children: a narrative review. Med J Aust 2019; 212:231-237. [PMID: 31630410 PMCID: PMC9543154 DOI: 10.5694/mja2.50361] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Impetigo, scabies, cellulitis and abscesses are common in Australian Aboriginal children. These conditions adversely affect wellbeing and are associated with serious long term sequelae, including invasive infection and post‐infectious complications, such as acute post‐streptococcal glomerulonephritis and acute rheumatic fever, which occurs at the highest documented rates in the world in remote Aboriginal communities. Observational research in remote communities in northern Australia has demonstrated a high concurrent burden of scabies and impetigo and their post‐infectious complications. Few data are available for other Australian states, especially for urban Aboriginal children; however, nationwide hospital data indicate that the disparity between Aboriginal and non‐Aboriginal children in skin infection prevalence also exists in urban settings. The Australian National Healthy Skin Guideline summarises evidence‐based treatment of impetigo, scabies and fungal infections in high burden settings such as remote Aboriginal communities. It recommends systemic antibiotics for children with impetigo, and either topical permethrin or oral ivermectin (second line) for the individual and their contacts as equally efficacious treatments for scabies. β‐Lactams are the treatment of choice and trimethoprim–sulfamethoxazole and clindamycin are effective alternatives for treatment of paediatric cellulitis. Abscesses require incision and drainage and a 5‐day course of trimethoprim–sulfamethoxazole or clindamycin. Addressing normalisation of skin infections and the social determinants of skin health are key challenges for the clinician. Research is underway on community‐wide skin health programs and the role for mass drug administration which will guide future management of these common, treatable diseases.
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Affiliation(s)
| | - Jessica Knight
- University of Western Australia, Perth, WA.,Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA
| | - Asha C Bowen
- University of Western Australia, Perth, WA.,Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA.,Perth Children's Hospital, Perth, WA
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12
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Mullane MJ, Barnett TC, Cannon JW, Carapetis JR, Christophers R, Coffin J, Jones MA, Marsh JA, Mc Loughlin F, O'Donnell V, Pavlos R, Smith B, Steer AC, Tong SYC, Walker R, Bowen AC. SToP (See, Treat, Prevent) skin sores and scabies trial: study protocol for a cluster randomised, stepped-wedge trial for skin disease control in remote Western Australia. BMJ Open 2019; 9:e030635. [PMID: 31551385 PMCID: PMC6773324 DOI: 10.1136/bmjopen-2019-030635] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Skin is important in Australian Aboriginal culture informing kinship and identity. In many remote Aboriginal communities, scabies and impetigo are very common. Untreated skin infections are painful, itchy and frequently go untreated due to under-recognition and lack of awareness of their potential serious complications. We hypothesise that the skin infection burden in remote Aboriginal communities can be reduced by implementing streamlined training and treatment pathways integrated with environmental health and health promotion activities, tested in the See, Treat, Prevent (SToP skin sores and scabies) trial. METHODS AND ANALYSIS SToP will evaluate a skin control programme using a stepped-wedge, cluster randomised trial design with three intervention components (the 'SToP activities'): (1) seeing skin infections (development of training resources implemented within a community dermatology model); (2) treating skin infections (employing the latest evidence for impetigo, and scabies treatment); and (3) preventing skin infections (embedded, culturally informed health promotion and environmental health activities). Four community clusters in the remote Kimberley region of Western Australia will participate. Following baseline data collection, two clusters will be randomly allocated to the SToP activities. At 12 months, the remaining two clusters will transition to the SToP activities. The primary outcome is the diagnosis of impetigo in children (5-9 years) at school-based surveillance. Secondary outcome measures include scabies diagnosis, other child health indicators, resistance to cotrimoxazole in circulating pathogenic bacteria, determining the economic burden of skin disease and evaluating the cost effectiveness of SToP activities. ETHICS AND DISSEMINATION This study protocol was approved by the health ethics review committees at the Child and Adolescent Health Service (Approval number RGS0000000584), the Western Australian Aboriginal Health Ethics Committee (Reference number: 819) and the University of Western Australia (Reference RA/4/20/4123). Study findings will be shared with community members, academic and medical communities via publications and presentations, and in reports to funders. Authorship for all publications based on this study will be determined in line with the Uniform Requirements for Manuscripts Submitted to Biomedical Journals published by the International Committee of Medical Journal Editors. Sharing results with organisations and communities who contributed to the study is paramount. The results of the SToP trial will be shared with participants in a suitable format, such as a single summary page provided to participants or presentations to communities, the Kimberly Aboriginal Health Planning Forum Research Subcommittee and other stakeholders as appropriate and as requested. Communication and dissemination will require ongoing consultation with Aboriginal communities to determine appropriate formats. TRIAL REGISTRATION NUMBER ACTRN12618000520235.
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Affiliation(s)
- Marianne J Mullane
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Timothy C Barnett
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Jeffrey W Cannon
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Jonathan R Carapetis
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
- Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia, Australia
- Department of Paediatric Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Ray Christophers
- Nirrumbuk Environmental Health & Services, Nirrumbuk Aboriginal Corporation, Broome, Western Australia, Australia
| | - Juli Coffin
- Aboriginal Health, Telethon Kids Kimberley, Telethon Kids Institute, University of Western Australia, Broome, Western Australia, Australia
- Nulungu Research Institute, University of Notre Dame, Broome, Western Australia, Australia
| | - Mark A Jones
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Julie A Marsh
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Frieda Mc Loughlin
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Vicki O'Donnell
- Kimberley Aboriginal Medical Services, Broome, Western Australia, Australia
| | - Rebecca Pavlos
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Bec Smith
- Western Australian Country Health Services-Kimberley, Broome, Western Australia, Australia
| | - Andrew C Steer
- Tropical Diseases Research Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Department of General Paediatrics, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Steven Y C Tong
- Peter Doherty Institute for Infection and Immunity, Royal Melbourne Hospital and The University of Melbourne, Melbourne, Victoria, Australia
- Menzies School of Health Research, Casuarina, Northern Territory, Australia
| | - Roz Walker
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Asha C Bowen
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
- Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia, Australia
- Department of Paediatric Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia
- Menzies School of Health Research, Casuarina, Northern Territory, Australia
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13
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Barnes R, Bowen AC, Walker R, Tong SYC, McVernon J, Campbell PT, Fathima P, de Klerk NH, Wu Y, Blyth CC, Carapetis JR, Moore HC. Perinatal risk factors associated with skin infection hospitalisation in Western Australian Aboriginal and Non-Aboriginal children. Paediatr Perinat Epidemiol 2019; 33:374-383. [PMID: 31513286 DOI: 10.1111/ppe.12573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 04/30/2019] [Accepted: 05/21/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hospitalisation with skin infection in Western Australian (WA) Aboriginal children is common, with the highest rates in infants and children from remote WA. OBJECTIVE We aimed to quantify infant, maternal, and sociodemographic risk factors for skin infection hospitalisation in WA children, focussing on Aboriginal children aged <17 years. METHODS We conducted a retrospective population-based cohort study with linked perinatal and hospitalisation data on WA-born children (1996-2012), of whom 31 348 (6.7%) were Aboriginal. We used Cox regression to calculate adjusted hazard ratios and associated population attributable fractions (PAFs) for perinatal factors attributed to first hospitalisation with skin infection. To identify specific risk factors for early-onset infection, we further restricted the cohort to infants aged <1 year. RESULTS Overall, 5439 (17.4%) Aboriginal and 6750 (1.5%) non-Aboriginal children were hospitalised at least once with a skin infection. Aboriginal infants aged <1 year had the highest skin infection hospitalisation rate (63.2 per 1000 child-years). The strongest risk factors in Aboriginal children aged <17 years were socio-economic disadvantage, very remote location at birth, and multi-parity (≥3 previous pregnancies) accounting for 24%, 23%, and 15% of skin infection hospitalisations, respectively. Other risk factors included maternal age <20 years, maternal smoking during pregnancy, and low birthweight. CONCLUSIONS We have quantified the relative influence of perinatal risk factors associated with skin infection hospitalisations in WA children, providing measures indicating which factors have the potential to reduce the most hospitalisations. Our evidence not only supports existing calls for substantial government investment in addressing underlying social and environmental barriers to healthy skin in WA Aboriginal children but also identifies potential areas to target health promotion messaging at individuals/families on maternal smoking during pregnancy and skin hygiene for families.
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Affiliation(s)
- Rosanne Barnes
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia
| | - Asha C Bowen
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia.,School of Medicine, The University of Western Australia, Perth, WA, Australia.,Department of Infectious Diseases, Perth Children's Hospital, Nedlands, WA, Australia.,Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia
| | - Roz Walker
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia.,Centre for Child Health Research, The University of Western Australia, Nedlands, WA, Australia
| | - Steven Y C Tong
- Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia.,Victorian Infectious Disease Service, The Royal Melbourne Hospital, Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia.,Doherty Department, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Vic, Australia
| | - Jodie McVernon
- Doherty Department, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Vic, Australia.,Victorian Infectious Diseases Reference Laboratory Epidemiology Unit, The Royal Melbourne Hospital, Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Vic, Australia.,Infection and Immunity Theme, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Vic, Australia
| | - Patricia T Campbell
- Doherty Department, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Vic, Australia.,Victorian Infectious Diseases Reference Laboratory Epidemiology Unit, The Royal Melbourne Hospital, Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia
| | - Parveen Fathima
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia
| | - Nicholas H de Klerk
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia
| | - Yue Wu
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia
| | - Christopher C Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia.,School of Medicine, The University of Western Australia, Perth, WA, Australia.,Department of Infectious Diseases, Perth Children's Hospital, Nedlands, WA, Australia
| | - Jonathan R Carapetis
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia.,School of Medicine, The University of Western Australia, Perth, WA, Australia.,Department of Infectious Diseases, Perth Children's Hospital, Nedlands, WA, Australia
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia
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14
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Mohan JV, Atkinson DN, Rosman JB, Griffiths EK. Acute kidney injury in Indigenous Australians in the Kimberley: age distribution and associated diagnoses. Med J Aust 2019; 211:19-23. [PMID: 30860606 DOI: 10.5694/mja2.50061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 10/30/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To describe the frequencies of acute kidney injury (AKI) and of associated diagnoses in Indigenous people in a remote Western Australian region. DESIGN Retrospective population-based study of AKI events confirmed by changes in serum creatinine levels. SETTING, PARTICIPANTS Aboriginal and Torres Strait Islander residents of the Kimberley region of Western Australia, aged 15 years or more and without end-stage kidney disease, for whom AKI between 1 June 2009 and 30 May 2016 was confirmed by an acute rise in serum creatinine levels. MAIN OUTCOME MEASURES Age-specific AKI rates; principal and other diagnoses. RESULTS 324 AKI events in 260 individuals were recorded; the median age of patients was 51.8 years (IQR, 43.9-61.0 years), and 176 events (54%) were in men. The overall AKI rate was 323 events (95% CI, 281-367) per 100 000 population; 92 events (28%) were in people aged 15-44 years. 52% of principal diagnoses were infectious in nature, including pneumonia (12% of events), infections of the skin and subcutaneous tissue (10%), and urinary tract infections (7.7%). 80 events (34%) were detected on or before the date of admission; fewer than one-third of discharge summaries (61 events, 28%) listed AKI as a primary or other diagnosis. CONCLUSION The age distribution of AKI events among Indigenous Australians in the Kimberley was skewed to younger groups than in the national data on AKI. Infectious conditions were common in patients, underscoring the significance of environmental determinants of health. Primary care services can play an important role in preventing community-acquired AKI; applying pathology-based criteria could improve the detection of AKI.
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Affiliation(s)
- Joseph V Mohan
- The University of Western Australia, Perth, WA.,Rural Clinical School of Western Australia, University of Western Australia, Broome, WA
| | - David N Atkinson
- Rural Clinical School of Western Australia, University of Western Australia, Broome, WA
| | | | - Emma K Griffiths
- Rural Clinical School of Western Australia, University of Western Australia, Broome, WA.,Kimberley Aboriginal Medical Services, Broome, WA
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15
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Hendrickx D, Bowen AC, Marsh JA, Carapetis JR, Walker R. Ascertaining infectious disease burden through primary care clinic attendance among young Aboriginal children living in four remote communities in Western Australia. PLoS One 2018; 13:e0203684. [PMID: 30222765 PMCID: PMC6141079 DOI: 10.1371/journal.pone.0203684] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 08/24/2018] [Indexed: 11/18/2022] Open
Abstract
Infectious diseases contribute a substantial burden of ill-health in Australia’s Aboriginal children. Skin infections have been shown to be common in remote Aboriginal communities, particularly in the Northern Territory, Australia. However, primary care data on skin and other infectious diseases among Aboriginal children living in remote areas of Western Australia are limited. We conducted a retrospective review of clinic presentations of all children aged 0 to 5 years presenting to four clinics located in the Western Desert region of Western Australia between 2007 and 2012 to determine this burden at a local level. Infectious diseases accounted for almost 50% of all clinic presentations. Skin infections (sores, scabies and fungal infections) were the largest proportion (16%), with ear infections (15%) and upper respiratory infections (13%) also high. Skin infections remained high in all age groups; 72% of children presented at least once with skin infections. Scabies accounted for only 2% of all presentations, although one-quarter of children presented during the study for management of scabies. Skin sores accounted for 75% of the overall burden of skin infections. Improved public health measures targeting bacterial skin infections are needed to reduce this high burden of skin infections in Western Australia.
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Affiliation(s)
- David Hendrickx
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia
- NHMRC Centre for Research Excellence in Aboriginal Health and Wellbeing, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- * E-mail:
| | - Asha C. Bowen
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Julie A. Marsh
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia
| | - Jonathan R. Carapetis
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Roz Walker
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia
- NHMRC Centre for Research Excellence in Aboriginal Health and Wellbeing, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
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