322,863 research outputs found
Health, human rights, and the policy process
No full text[Extract] The health care systems and health status of Aboriginal Australians are shaped by history, and social and political forces that predominantly reflect the values and ideologies of the broader Australian population. Aboriginal peoples and Torres Strait Islanders have by far the worst health status of any identifiable group in Australia, and the poorest access to health systems. Therefore, their potential capacity to benefit from well-targeted interventions is very high. Well-developed health sector policies and strategies can enable these interventions, contribute material resources, support efficiencies, encourage intersectoral collaboration, and stimulate significant innovations that reduce health inequities
Skin infections
No full textIn Aboriginal populations, group A streptococci are still the predominant pathogens in skin infections (pyoderma/impetigo/skin sores). A lack of water and overcrowding contribute to skin sore development, and the resolution of these environmental hazards should have the greatest and most sustainable impact on the burden of skin disease. Single-dose intramuscular (IM) benzathine penicillin remains the treatment of choice for pyoderma. Much of the streptococcal pyoderma is secondary to scabies and the control of scabies infestations, which are also a feature of overcrowding, can significantly reduce skin infections. Coordinated mass treatment with 5%permethrin cream has resulted in significant medium-term reductions in both scabies and pyoderma. Single-dose ivermectin as a scabicide is also effective and safe in children over the age of 5 years. Identifying and treating people with scabies hyperinfestation (crusted/Norwegian scabies) is important to prevent ongoing scabies epidemics. There is little evidence of benefit to human disease in treating community dogs for scabietic mange. The burden of fungal infections in Aboriginal communities in the tropics also contributes to streptococcal pyoderma and oral terbinafine is significantly more efficacious than older therapies
Leprosy
No full textLeprosy (also known as Hansen's disease) has been endemic in tropical Australia for around 100 years, and Aboriginal peoples continue to be affected by this disease. Although numbers are small, new cases of leprosy are reported every year. Early diagnosis of new cases is vital, as is ensuring completion of treatment courses to affect bacteriological cure; monitoring patients on treatment for new nerve function impairment (NFI); and prevention of deterioration in previously treated cases with residual nerve impairment.
Early diagnosis and treatment with World Health Organization (WHO) multi-drug therapy (MDT) rapidly interrupts transmission, and lessens the likelihood of nerve function impairment and disability. MDT has also shortened treatment durations and reduced relapses of disease. At the time a health worker directly observes the monthly dose of MDT, monitoring of NFI using a brief, standardised voluntary muscle and sensory test (VMT-ST) is also periormed. NFI can occur silently or with symptoms of leprosy reactions, but if detected early ;s reversible with anti-inflammatory treatment such as prednisolone. BCG vaccine, which is used extensively for the prevention of tuberculosis, may also induce protective immunity against leprosy. The eradication of leprosy among Aboriginal peoples in Australia may be enhanced by the use of a single dose chemoprophylaxis in close contacts of new cases
Rheumatic fever
No full textAcute rheumatic fever (ARF ) is an autoimmune disease, precipitated by infection with the group A streptococcus (GAS) bacterium. ARF leads to rheumatic heart disease (RHD) and is still a significant cause of cardiovascular morbidity and mortality in northern and central Australia, suffered almost exclusively by Aboriginal people. It is a classical disease of poverty, as overcrowding and difficulties in maintaining high standards of community as well as personal hygiene facilitate streptococcal infection and transmission. Primary prevention of ARF includes interventions to reduce circulating streptococci (including prevention and treatment of skin infections, improved housing, and hygiene infrastructure) and primary prophylaxis (treatment of streptococcal sore throat with penicillin). As yet there is no vaccine available to prevent ARF, and there is insufficient evidence to support the use of mass penicillin prophylaxis in its primary prevention. Secondary prophylaxis of ARF is the single most important prevention strategy. Benzathine penicillin G is the optimal choice of prophylactic agent, given every 4 weeks, although 3-weekly doses have been shown to offer superior rheumatic fever control. A coordinated control program, based around both local and centralised ARF and RHD registers, is the best way to improve benzathine penicillin G adherence rates and to ensure that those with RHD are identified and receive adequate clinical follow-up, including specialist review and echocardiography
Ear health
No full text[Extract] Otitis media in childhood, and its important consequences such as hearing loss, are more common in the Aboriginal population than in the broader Australian population. According to the World Health Organization, the burden of chronic suppurative otitis media (CSOM)in Aboriginal children constitutes a massive public health problem. Hearing loss may well be a major contributor to poor education and to unemployment, which are in themselves risk factors for contact with the justice system. Early bacterial (respiratory pathogens) colonisation of the nasopharynx strongly predicts early otitis media and this in turn predicts the recurrence of otitis media in childhood. Early otitis media has been related to poverty and overcrowding. Bottle-feeding and passive smoking are also recognised risk factors. The key prevention issues involve environmental modifications that address overcrowding and passive smoking, a small role for influenza vaccine, polysaccharide and conjugate pneumococcal vaccine, prolonged antibiotic use in those children with documented recurrences, appropriate treatment of CSOM, surgery for otitis media with effusion (OME) and for CSOM, and the early detection of hearing loss in order to implement treatment and rehabilitative systems. There is some evidence that surgical and rehabilitative needs are not being met for the Aboriginal population, particularly in remote Australia, and these issues need to be addressed
Diabetes
No full textThis publication does not have an abstract. The first paragraph of the summary is displayed as the abstract.
Diabetes is a significant cause of excess morbidity and mortality among Aboriginal peoples and Torres Strait Islanders. The development of diabetes and the progression
to complications can be prevented. The significant proportion of Aboriginal peoples who have undiagnosed diabetes are missing out on the benefits of secondary and tertiary preventive interventions. An integrated approach to prevention is required that promotes the benefits of physical activity (even in the absence of dietary change or weight loss), leanness, and a healthy diet that is high in complex carbohydrates and low in fat (with monounsaturates replacing saturated fats) and extended to all Aboriginal people
Leprosy
No full textLeprosy (also known as Hansen's disease) has been endemic in tropical Australia for around 100 years, and Aboriginal peoples continue to be affected by this disease. Although numbers are small, new cases of leprosy are reported every year. Early diagnosis of new cases is vital, as is ensuring completion of treatment courses to affect bacteriological cure; monitoring patients on treatment for new nerve function impairment (NFI); and prevention of deterioration in previously treated cases with residual nerve impairment.
Early diagnosis and treatment with World Health Organization (WHO) multi-drug therapy (MDT) rapidly interrupts transmission, and lessens the likelihood of nerve function impairment and disability. MDT has also shortened treatment durations and reduced relapses of disease. At the time a health worker directly observes the monthly dose of MDT, monitoring of NFI using a brief, standardised voluntary muscle and sensory test (VMT-ST) is also periormed. NFI can occur silently or with symptoms of leprosy reactions, but if detected early ;s reversible with anti-inflammatory treatment such as prednisolone. BCG vaccine, which is used extensively for the prevention of tuberculosis, may also induce protective immunity against leprosy. The eradication of leprosy among Aboriginal peoples in Australia may be enhanced by the use of a single dose chemoprophylaxis in close contacts of new cases
Chronic kidney disease
No full textDriven as the tragic consequence of poverty, a heavy community burden of diabetes, hypertension and obesity, and inadequate access to health services relative to need, kidney disease rates among Aboriginal populations continue to increase. New cases of end-stage kidney disease (ESKD) occur at 2 to 30 times the rate of non-Indigenous Australians. A 'whole of government' response will be required to address the root causes of this excess chronic disease burden.
There is evidence that kidney disease is often unrecognised and that a lack of preparation (including delayed referral) for the management of chronic kidney disease (CKD) and ESKD may be responsible for the poor outcomes of tertiary level care. Dipstick testing for proteinuria should be undertaken annually to screen Aboriginal adults for early indicators of kidney disease. People with abnormal findings on dipstick testing should undergo further assessment of kidney function, including serum creatinine and calculated glomerular filtration rate (GFR).
In the primary prevention of CKD, social factors such as diet and exercise, combined with minimisation of nicotine and alcohol use, are most important. Environmental factors such as appropriate housing and community measures to reduce skin infections will reduce the risk of acute glomerulonephritis and possibly contribute to a reduction in CKD. Among people with early CKD, hypertension is one of the major factors contributing to a decline in kidney function. Blood pressure should be kept below 130/85, or 125/75 in the presence of proteinuria. The optimal antihypertensive choices are the angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (alone or in combination), to delay the progression of diabetic and non-diabetic-related kidney disease by as much as twofold, and reduce proteinuria by 50%. The key aspects of CKD management are lowering blood pressure, reducing proteinuria, and avoiding nephrotoxic drugs.
CKD is an independent risk factor for cardiovascular disease and there is a very high risk of concurrent generalised vascular disease. People with CKD who have established cardiovascular disease should receive lipid-lowering therapy. Among people with CKD who have not had a prior vascular event, evidence supporting a role for the statin-class of cholesterol-lowering drugs in cardio-renal protection is inconclusive.
All patients with CKD should be monitored at least every 3-6 months with serum creatinine, for hypertension, diabetic control, dyslipidaemia, weight, diet, and level of physical activity. Involvement of Aboriginal Health Workers (AHWs), point-of-care testing, and immediate feedback of results all assist in management. Patients with progressive kidney disease should be referred to a nephrologist at or before reaching a calculated GFR of 30mL/min. Specialist nephrology management will involve correction of anaemia, treatment of renal bone disease and electrolyte disturbances, education regarding ESKD options, and timely preparation for kidney replacement therapy, including creation of vascular access. As much as possible, Aboriginal patients, whether in urban, rural, or remote settings, should be given the same opportunities for ESKD treatment as non-Aboriginal patients.
Following the recommendations of the USA Kidney Disease Quality Initiative, the term 'renal disease' has been replaced by 'kidney disease' throughout this chapter (see box 15.2)
Failure to thrive
No full textFailure to thrive (FTT) is a descriptive term referring to the lack of attainment or maintenance of the growth potential expected for a child, and is generally applied when the child's growth crosses 2 or more Z-scores (or centile lines) on a standard growth chart. Reductions in child mortality over recent decades have not translated into improved growth for all Aboriginal children. Many continue to suffer high rates of wasting, stunting, microcephaly, and iron deficiency. The long-term consequences of malnutrition may be substantial, and there is growing evidence implicating low birth weight and poor infant growth patterns in the development of adult chronic disease such as diabetes, chronic kidney disease, and coronary artery disease.
Causes of failure to thrive include: 1) immediate determinants such as a child's food intake (lack of breastfeeding or early cessation of exclusive breastfeeding, suboptimal complementary feeding practices, and factors influencing appetite); and child's health status (birth weight, prematurity, the infection-nutrition cycle, and environmental enteropathy); and 2) underlying determinants such as household income and food access; caregiver education, knowledge and child care practices; and the health environment and services (including safe water supply, adequate sanitation, and health care availability).
Assessment of the child with failure to thrive involves thorough history and examination. Major organic disease is found in <5% of community cases of FTT and can mostly be diagnosed from signs and symptoms accompanying the growth failure. Investigations including urinalysis, stool examination, and assessment of haemoglobin and iron status are warranted in most cases. Routine hospitalisation with an extensive laboratory work-up to exclude rare causes is considered inappropriate. Anthropometric assessment can differentiate wasting and stunting.
Effective primary preventive measures include optimal maternal care and nutrition, breastfeeding promotion, reduction in overcrowding and improved sanitation, community-driven nutrition programs, education, food supplementation for those at risk where food insecurity exists, and integration with primary health care services. Community-based parasite treatment programs may be effective in reducing rates of anaemia in areas of high parasite prevalence.
Secondary prevention is recommended with growth monitoring using World Health Organization (WHO) International Child Growth Standards, provided monitoring is coupled with appropriate intervention when growth faltering is detected. Resources should be directed to screening infants and children between 0-2 years of age, since this represents the critical period for linear growth. Screening for anaemia in high-risk infants at around 9 months and again at 18 months is recommended.
Hospital admission is rarely needed in the management of children with FTI as community-based therapy is at least as effective and Significantly less disruptive for child and carer. Hospitalisation is reserved for children with severe wasting, dehydration and/or infection, and where community-based therapy is failing.
A national monitoring and surveillance system for child health should include quality indicators of childhood nutritional status, and performance indicators which reflect intervention and outcomes
Trachoma
No full textTrachoma is still endemic in some remote Aboriginal communities of northern and central Australia. Control depends on reducing the reservoir of infection by treating identified cases and their family contacts. In high-prevalence areas this will equate to full community-wide treatment. To determine how widespread trachoma is requires screening of primary school children (aged 5-9 years), using the simplified World Health Organization (WHO) criteria for diagnosis. All members of the families of those children found to have trachoma should be treated with a single dose of azithromycin. Treatment for their family unit, including maternal caregivers, siblings, and other family members, should be provided. If the prevalence of active trachoma in children exceeds 10%, consideration should be given to treating the entire community and repeating treatment at 6-monthly intervals until prevalence falls to below 5%. There should be community awareness of the need for environmental control strategies, such as access to water, facial cleanliness, and fly control. Of these, the most important and the most amenable to immediate change is facial cleanliness. Opportunistic screening for trichiasis is recommended in the older Aboriginal population. This is best implemented as part of the periodic health examination in the integrated assessment of health status or by regular surveys (2-3 years) of the over 40-50 year old population
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