A Community-Directed Integrated Strongyloides Control Program in Queensland, Australia.

Adrian Miller,Michelle Smith,Robert Cody,Valarie Tye,Vicki Saunders,Rick Speare,Jenni Judd,Elizebeth Young,Melody Muscat

doi:10.3390/tropicalmed3020048

Abstract

This paper describes two phases of a community-directed intervention to address strongyloidiasis in the remote Aboriginal community of Woorabinda in central Queensland, Australia. The first phase provides the narrative of a community-driven ‘treat-and-test’ mass drug administration (MDA) intervention that was co-designed by the Community Health Service and the community. The second phase is a description of the re-engagement of the community in order to disseminate the key factors for success in the previous MDA for Strongyloides stercoralis, as this information was not shared or captured in the first phase. During the first phase in 2004, there was a high prevalence of strongyloidiasis (12% faecal examination, 30% serology; n = 944 community members tested) that resulted in increased morbidity and at least one death in the community. Between 2004–2005, the community worked in partnership with the Community Health Service to implement a S. stercoralis control program, where all of the residents were treated with oral ivermectin, and repeat doses were given for those with positive S. stercoralis serology. The community also developed their own health promotion campaign using locally-made resources targeting relevant environmental health problems and concerns. Ninety-two percent of the community residents participated in the program, and the prevalence of strongyloidiasis at the time of the ‘treat-and-test’ intervention was 16.6% [95% confidence interval 14.2–19.3]. The cure rate after two doses of ivermectin was 79.8%, based on pre-serology and post-serology tests. The purpose of this paper is to highlight the importance of local Aboriginal leadership and governance and a high level of community involvement in this successful mass drug administration program to address S. stercoralis. The commitment required of these leaders was demanding, and involved intense work over a period of several months. Apart from controlling strongyloidiasis, the community also takes pride in having developed and implemented this program. This appears to be the first community-directed S. stercoralis control program in Australia, and is an important part of the national story of controlling infectious diseases in Indigenous communities.

Highlights

Strongyloidiasis is considered one of the most neglected tropical diseases and is estimated to affect over 100 million people worldwide including Indigenous Australians [2,3]
The first phase reports on a community-directed S. stercoralis control program in the Indigenous community of Woorabinda, central Queensland Australia
Cultural humility cannot be collapsed into a single workshop; it is commitment and active engagement in a lifelong process ‘that individuals enter on an ongoing basis with patients, communities, colleagues, and with themselves’ [1] (p. 118)

Summary

Introduction

Strongyloidiasis is considered one of the most neglected tropical diseases and is estimated to affect over 100 million people worldwide including Indigenous Australians [2,3]. Chronic strongyloidiasis increases the risk of unpredictable fatal hyperinfection when patients become immunocompromised, malnourished, or immunosuppressed. Hyperinfection can be caused by the administration of corticosteroids to patients with strongyloidiasis [4,5]. This paper documents two historical phases of a community-directed Strongyloides stercoralis control program. The first phase reports on a community-directed S. stercoralis control program in the Indigenous community of Woorabinda, central Queensland Australia. The second phase documents the need to have local Indigenous leadership and direction for community-wide health interventions, and the importance of the researchers having cultural humility. Cultural humility cannot be collapsed into a single workshop; it is commitment and active engagement in a lifelong process ‘that individuals enter on an ongoing basis with patients, communities, colleagues, and with themselves’ [1] This paper is a testament to Rick Speare’s cultural humility across his research career

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